Influence of gustatory and olfactory functions on appetite and nutritional status in older persons

This study investigated olfactory/taste functions in older persons requiring nursing care to clarify whether these functions are associated with appetite or nutritional status. Seventy-two older persons requiring nursing care and 37 unassisted persons were surveyed for olfactory function, taste function, appetite, and nutritional status. Age-adjusted covariance analysis was conducted between the two groups. Both groups showed reduced olfactory and taste functions; these functions were more markedly reduced in participants requiring nursing care compared to those who did not. Both groups had similar appetite and nutritional status findings, suggesting that these factors are not associated with olfactory and taste functions.

Exploring the Motivations of Family Caregivers Caring for Older Persons in Urban Poor Accra, Ghana

There is a general paucity of studies on family caregivers' motivations for providing care to older persons in the urban poor context in Ghana. This study seeks to explore family caregivers' motivations for providing care to older persons in urban poor Accra, Ghana. A qualitative descriptive design was used and in-depth interviews were conducted with thirty-one family caregivers. The QSR NVivo 10 software was used to analyze the data thematically. We found that autonomous motivation inspired family caregivers to provide care. Empathy and affection intrinsically motivated some caregivers to provide care to their care recipients, while others were extrinsically motivated by filial responsibility, reciprocity, and obligation to provide care. These findings showed that family caregivers were autonomously motivated to provide care to older persons. We recommend the need for future studies to explore changes in family caregivers' motivations to provide care over time.

Falling into an identity crisis: Integrating identity into the assessment and management of falls in older adults

OBJECTIVES

This article examines the psychological effects of falls for older adults through the lens of identity and suggests these may be integrated in the assessment and management of older patients within acute care and rehabilitation settings post-fall. An illustrative vignette is described to demonstrate this approach.

CONCLUSION

Falls in older adults are complex phenomena which can lead to an identity threat, sometimes manifest as psychological symptoms and poor engagement in post-fall rehabilitation. A psychiatric formulation which incorporates an older person's self-identity and agency may inform interventions to address psychological and behavioural sequelae of falls.

HMM-Based Action Recognition System for Elderly Healthcare by Colorizing Depth Map

Addressing the problems facing the elderly, whether living independently or in managed care facilities, is considered one of the most important applications for action recognition research. However, existing systems are not ready for automation, or for effective use in continuous operation. Therefore, we have developed theoretical and practical foundations for a new real-time action recognition system. This system is based on Hidden Markov Model (HMM) along with colorizing depth maps. The use of depth cameras provides privacy protection. Colorizing depth images in the hue color space enables compressing and visualizing depth data, and detecting persons. The specific detector used for person detection is You Look Only Once (YOLOv5). Appearance and motion features are extracted from depth map sequences and are represented with a Histogram of Oriented Gradients (HOG). These HOG feature vectors are transformed as the observation sequences and then fed into the HMM. Finally, the Viterbi Algorithm is applied to recognize the sequential actions. This system has been tested on real-world data featuring three participants in a care center. We tried out three combinations of HMM with classification algorithms and found that a fusion with Support Vector Machine (SVM) had the best average results, achieving an accuracy rate (84.04%).

Validating the interpersonal theory of suicide among older adultspre- and peri-COVID-19 pandemic

OBJECTIVES

Global suicide rates are highest among older adults, and especially older men, yet proximal predictors of suicidal ideation in older age remain poorly understood. This study tested the Interpersonal Theory of Suicide in older men and women by investigating whether perceived burdensomeness and thwarted belongingness and/or their interaction are proximal predictors of suicidal ideation before versus during the global COVID-19 pandemic.

METHODS

The sample (N = 208) included healthy community-dwelling older Australian persons surveyed face-to-face pre-pandemic (n = 102), or online peri-pandemic (n = 106). Depression, social interaction, social satisfaction, thwarted belongingness, and perceived burdensomeness were assessed as predictors of suicidal ideation.

RESULTS

Perceived burdensomeness was a more proximal predictor of suicidal ideation among older adults than depression or thwarted belongingness. Suicidal ideation and perceived burdensomeness were higher in men than women, but sex did not moderate the influence of perceived burdensomeness, thwarted belongingness or social satisfaction on suicidal desire. The interaction between perceived burdensomeness and thwarted belongingness predicted more additional variance in suicidal ideation in the older persons surveyed during the COVID-19 pandemic relative to those surveyed before the pandemic.

CONCLUSION

Suicidal ideation among older persons peri-pandemic is discussed, and recommendations are made for age-specific suicide prevention strategies.

Well-being among older persons with disabilities in Trinidad

Given the expected increase in the proportion of older persons and evidence of poverty among persons with disabilities in general, well-being among older persons with disabilities is an important issue. Using Sen's capability approach, this article examines well-being among older persons with disabilities in Trinidad. A multiphase mixed-methods design with three phases was employed. In the initial exploratory phase, functionings which are things people value doing or being were identified via 11 interviews. These functionings were used in the subsequent phase to develop an instrument with both closed- and open-ended questions. The instrument was then administered in the third phase to measure well-being and to identify its hindering factors. Responses from 31 participants revealed moderate-to-severe deprivations among older persons with disabilities in Trinidad including for functionings related to food, healthcare, information and transportation. The integrated findings suggested changes to social care and healthcare systems to promote well-being among older persons with disabilities in Trinidad, as well as the need to develop community interactions and public services regarding transportation, supportive devices, and therapy.

Dialysis modality utilization patterns and mortality in older persons initiating dialysis in Australia and New Zealand

AIM

The benefits of dialysis in the older population remain highly debated, particularly for certain dialysis modalities. This study aimed to explore the dialysis modality utilization patterns between in-centre haemodialysis (ICHD), peritoneal dialysis (PD) and home haemodialysis (HHD) and their association with outcomes in older persons.

METHODS

Older persons (≥75 years) initiating dialysis in Australia and New Zealand from 1999 to 2018 reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry were included. The main aim of the study was to characterize dialysis modality utilization patterns and describe individual characteristics of each pattern. Relationships between identified patterns and survival, causes of death and withdrawal were examined as secondary analyses, where the pattern was considered as the exposure.

RESULTS

A total of 10 306 older persons initiated dialysis over the study period. Of these, 6776 (66%) and 1535 (15%) were exclusively treated by ICHD and PD, respectively, while 136 (1%) ever received HHD during their dialysis treatment course. The remainder received both ICHD and PD: 906 (9%) started dialysis on ICHD and 953 (9%) on PD. Different individual characteristics were seen across dialysis modality utilization patterns. Median survival time was 3.0 (95%CI 2.9-3.1) years. Differences in survival were seen across groups and varied depending on the time period following dialysis initiation. Dialysis withdrawal was an important cause of death and varied according to individual characteristics and utilization patterns.

CONCLUSION

This study showed that dialysis modality utilization patterns in older persons are associated with mortality, independent of individual characteristics.

Older persons with multiple chronic conditions' experiences of unplanned readmission: An integrative review

BACKGROUND

As persons, 60 years of age and older live longer, they are more likely to develop one or more chronic conditions. Rising numbers of older persons with multiple chronic conditions (MCCs) will increase the need for home healthcare services and hospital services and unplanned readmissions will increase globally.

AIM

The aim of this integrative review was to explore the experiences of older persons with MCCs' unplanned readmission from home to hospital within 30 days of discharge using an integrative review.

METHOD

Whittemore and Knafl's method was followed to address the research aim. Four databases (Ovid MEDLINE, Scopus, CINAHL and Embase) were searched between 2005 and 2020, suitability for inclusion was assessed, and data were extracted and analysed using content analysis.

RESULTS

Thirteen articles (10 qualitative, one quantitative, and two mixed methods) were included in this review. Three themes emerged from the data that reflected older persons with MCCs' unplanned readmission experiences. These themes included (a) feelings of security, support and relief; (b) undesirable challenges at home (struggling to manage care and balancing support needs); and (c) unpleasant feelings and emotions (feelings of fear and mistrust, feelings of disappointment and loss, feelings of anxiousness and pressure).

CONCLUSION

Research about unplanned readmission to the hospital does not provide sufficient detail or understanding about older persons with MCCs' experiences or their psychosocial experiences. Addressing research gaps related to the psychosocial processes and factors associated with unplanned readmission is needed to expand the current understanding of the process and concept of unplanned readmission.

Factors Associated with the Participation of Older Adults in Cultural and Sports Activities

In the context of population aging, we have witnessed an increased interest in studying the participation of older persons in cultural and sport activities. The aim of this paper is to identify the participation rate in cultural and sports activities among Romanian older adults and the sociodemographics/behavioral variables that correlate with the participation rate in cultural and sports activities. In order to answer our research questions, we employed a questionnaire-based survey, and we used a nationally representative sample. Results point to low participation in both cultural and sports activities. Gender, residence, education, income, degree of mobility, internet connection, and availability of financial resources are significant variables that correlate with the engagement of older people in cultural and sports activities. Our study could serve as a base for concrete policy measures in the field of health and social inclusion of older persons.

Friendship in Later Life: How Friends Are Significant Resources in Older Persons' Communication about Chronic Pain

BACKGROUND

This article focuses on how older persons perceive their friends' role in their daily experience of chronic pain. It reports part of the results of a study in which we interviewed 49 participants, aged 75 and older, about the way they communicate about chronic pain within their social network.

METHODOLOGY

Using discourse and content analysis, we first examine older persons' definition of friendship, and then identify the various dimensions of friendship that are engaged in the communication about chronic pain.

RESULTS

Participants define close friends as people with whom they share intimacy and social proximity (same gender, age and experience of pain). These dimensions allow older persons to talk freely about their pain without the fear of being judged or rejected, particularly when it is related to a dynamic of reciprocity.

CONCLUSIONS

This article shows that the contribution of friends to the everyday life of older persons with chronic pain is mainly that of providing emotional support.

Older Persons' Views on Important Values in Swedish Home Care Service: A Semi-Structured Interview Study

Introduction

Knowledge of older person's experiences of important values in home care service can facilitate the development and delivery of high-quality services supporting their well-being, dignity and participation in the care provided. To date, few studies have explored older person's values and experiences of home care services.

Purpose

This study aimed to explore values that older person holds regarding home care services and their experiences of how these values manifest in home care service delivery.

Participants and Methods

The study has a qualitative exploratory design. Semi-structured interviews were conducted with 16 older persons aged 74-90 who received home care service. Data were analysed using qualitative content analysis.

Results

Two themes (each with sub-themes) of values relating to the experience of home care service from the perspective of the 16 older persons were identified: to be supported as an autonomous person and to be supported as a relational being. The participants experience that these two values were only partly manifested in the home care services they received. They also noted that their well-being was negatively affected when staff failed to implement these values. The fundamental values identified in study related to the older person feeling safe, being autonomous, maintaining control and independence, and having relationships. The values constitute help to guide practice from the perspective of older persons who receive home care services.

Conclusion

The identified values are primarily interpersonal-level values. However, such values are also of importance for home care service organisations when promoting delivery of person-centred care. Taking such a position implies adopting a relation-oriented rather than a task-oriented approach in providing home care services for older persons.

Does Late-Life Depression Counteract the Beneficial Effect of Physical Activity on Cognitive Decline? Results From the NESDO Study

OBJECTIVES

Depression both affects physical activity (PA) and cognition in older persons, yet its impact on the association between PA and cognitive decline is to be determined. We aimed to investigate the association between baseline PA and cognitive functioning over time, stratified for depression.

METHODS

We used data of the Netherlands Study of Depression in Older persons (NESDO), a multi-site cohort study with 6-years follow-up. Patients with complete data on PA and cognitive functioning at baseline were included, yielding 394 participants for the analyses of whom 297 were depressed and 97 non-depressed. PA (continuous) was measured with the International Physical Activity Questionnaire. Linear mixed models were used to determine differential effects of baseline PA on the rate of decline of 5 standardized outcomes of cognitive functioning over 6-year follow-up. For this purpose, we examined the significance of the interaction-term (PA*time) in both basic and adjusted models. We also assessed the association between time and cognitive functioning. All analyses were stratified for depression.

RESULTS

In both groups, no robust significant interactions of PA with time were found. Furthermore, only decline in working memory was significantly worse in the depressed compared to the non-depressed.

CONCLUSION

At older age, the impact of a more inactive lifestyle on cognitive decline was shown to be limited, irrespective of depression that appeared to worsen age-related decline of working memory only. As a higher PA-level at older age has a positive effect on a multitude of other health outcomes, PA should still be encouraged in this population.

The Prevalence of Anemia and Its Associated Factors among Older Persons: Findings from the National Health and Morbidity Survey (NHMS) 2015

Background: There is limited evidence on the association of anemia with chronic diseases and disabilities among older persons in Malaysia. We assessed the prevalence of anemia and its associated factors among community-dwelling older persons. Methods: This was a cross-sectional study using data from the nationwide National Health and Morbidity Survey 2015 (NHMS 2015) on the health of older adults conducted by the Institute for Public Health, National Institutes of Health, Malaysia. A two-stage stratified random-cluster sampling design was utilized. Data were collected on the sociodemographic profiles, non-communicable disease (NCD) comorbidities (hypertension, diabetes and hypercholesterolemia status) and disabilities among the older persons. Anemia was defined based on the World Health Organization’s standards. A multivariable logistic regression analysis was used to assess the association of anemia with chronic diseases and disabilities. Results: The prevalence of anemia was 35.3% (95% CI: 33.1, 37.4) in the older persons. Chronic disease profiling showed that the prevalence rates of anemia among the older persons with diabetes, hypertension and hypercholesterolemia were 38.6%, 35.3% and 34.1%, respectively. In the multivariable analysis, persons aged 80 years and above (adjusted OR (aOR): 2.64; 95% CI: 2.00, 3.47), 70–79 years (aOR: 1.42; 95% CI: 1.21, 1.66), with diabetes (aOR: 1.30; 95% CI: 1.13, 1.51) and with disabilities in walking (aOR: 1.31; 95% CI: 1.11, 1.54) and self-care (aOR: 1.58; 95% CI: 1.22, 2.05) had higher odds of anemia compared to their respective reference categories. Among the persons with diabetes, the respondents aged 80 years and above (aOR: 2.48; 95% CI: 1.56, 3.94), 70–79 years old (aOR: 1.38; 95% CI: 1.08, 1.76) and with disabilities in vision (aOR: 1.29; 95% CI: 1.02, 1.63) and walking (aOR: 1.50; 95% CI: 1.18, 1.91) were more likely to be anemic. Furthermore, among the older persons without diabetes, persons aged 80 years and above (aOR: 2.89; 95% CI: 2.05, 4.07), 70–79 years old (aOR: 1.46; 95% CI: 1.19, 1.80) and with difficulty in self-care (aOR: 1.87; 95% CI: 1.30, 2.69) were more likely to be anemic. Conclusions: The resilient predictors of developing anemia were advancing age and diabetes, based on our study. Anemia is significantly associated with walking and vision disabilities among older persons with diabetes and with self-care difficulties in those without diabetes. There is a need for future studies to evaluate strategies to prevent anemia among older adults in order to promote healthy aging.

Development of a multi-component intervention to promote sleep in older persons with dementia transitioning from hospital to home

BACKGROUND

Hospitalised older persons with dementia are commonly discharged with intensified sleep disturbances. These disturbances can impede the recovery process. Nurses are well-positioned to assist persons with dementia and their family caregivers in managing sleep disturbances during the transition from hospital to home.

OBJECTIVES

To describe the development of a multi-component intervention to promote sleep.

METHODS

We applied three stages of the intervention mapping method to develop a non-pharmacological, multi-component sleep intervention. The first stage involved a review of the literature to generate an understanding of the determinants of sleep disturbances experienced by persons with dementia in hospital and home settings. The second stage consisted of a literature review to identify therapies for managing commonly reported determinants of sleep disturbances. The third stage entailed delineation of the intervention components.

RESULTS

The most common determinants of sleep disturbances experienced by persons with dementia in hospital and home settings were: physiological changes associated with ageing, sleep environments non-conducive to sleep, limited exposure to light and engagement in physical activity, stress and sleep-related beliefs and behaviours. Therapies found effective included: light therapy, physical activity therapy, sleep hygiene, and stimulus control therapy. These therapies were integrated into a multi-component sleep intervention to be provided using the teach-back technique, during and following hospitalisation.

DISCUSSION

Consistent with the principles of patient engagement, the multi-component sleep intervention will be evaluated for its acceptability and feasibility.

IMPLICATIONS FOR PRACTICE

The intervention has potentials to improve sleep during the transition from hospital to home.

Does Inflammation Contribute to Cancer Incidence and Mortality during Aging? A Conceptual Review

Aging is associated with chronic low-grade inflammation, cancer incidence and mortality. As inflammation contributes to cancer initiation and progression, one could hypothesize that age-associated chronic low-grade inflammation contributes to the increase in cancer incidence and/or mortality observed during aging. Here, we review the evidence supporting this hypothesis: (1) epidemiological associations between biomarkers of systemic inflammation and cancer incidence and mortality in older people, (2) therapeutic clues suggesting that targeting inflammation could reduce cancer incidence and mortality and (3) experimental evidence from animal models highlighting inflammation as a link between various mechanisms of aging and cancer initiation and progression. Despite a large body of literature linking aging, inflammation and cancer, convincing evidence for the clear implication of specific inflammatory pathways explaining cancer incidence or mortality during aging is still lacking. Further dedicated research is needed to fill these gaps in evidence and pave the way for the development of applications in clinical care.

Frailty among Older People during the First Wave of the COVID-19 Pandemic in The Netherlands

Restrictive measures due to the COVID-19 pandemic may cause problems in the physical, social, and psychological functioning of older people, resulting in increased frailty. In this cross-sectional study, we aimed to assess the prevalence and characteristics of frailty, to examine differences in perceived COVID-19-related concerns and threats between frail and non-frail people and to identify variables associated with frailty in the first wave of the COVID-19 pandemic, in Dutch older people aged ≥ 65 years. We used data from the Lifelines COVID-19 Cohort Study. The Groningen Frailty Indicator (GFI) was used, with a score ≥ 4 indicating frailty. Frailty was described per domain (i.e., physical, cognitive, social, and psychological). The association between demographic, health and lifestyle variables and frailty was determined with logistic regression analyses. Frailty was present in 13% of the 11,145 participants that completed the GFI. Most items contributing to a positive frailty score were found within the social domain, in the frail (51%) and the non-frail (59%) persons. For items related to concerns and threats, a significantly higher proportion of frail people reported being worried or feeling threatened. In conclusion, during Corona restrictions, prevalence of frailty was considerable in older people from the Northern Netherlands, with one in eight being frail. Frailty was characterized by social problems and frail people were more often worried and felt threatened by the COVID-19 pandemic.

Hospital-associated deconditioning: Not only physical, but also cognitive

INTRODUCTION

Hospital-associated deconditioning (HAD) or post-hospital syndrome is well recognized as reduced functional performance after an acute hospitalization. Recommendations for the management of HAD are still lacking, partly due to a poor understanding of the underlying processes. We aimed to review existing data on risk factors, pathophysiology, measurement tools, and potential interventions.

MATERIALS AND METHODS

We conducted a systematic review from bibliographical databases in English, Spanish and French with keywords such as 'post-hospitalization syndrome' or 'deconditioning'. We selected studies that included people aged 60 years or older. Three researchers independently selected articles and assessed their quality.

RESULTS

From 4421 articles initially retrieved, we included 94 studies. Most were related to risk factors, trajectories and measures, and focused on the physical aspects of deconditioning. Risk factors for HAD included age, nutritional status, mobility, and pre-admission functional status, but also cognitive impairment and depression. Regarding interventions, almost all studies were devoted to physical rehabilitation and environmental modifications. Only one study focused on cognitive stimulation.

DISCUSSION

In the last decade, studies on HAD have mostly focused on the physical domain. However, neurological changes may also play a role in the pathophysiology of HAD. Beyond physical interventions, cognitive rehabilitation and neurological interventions should also be evaluated to improve deconditioning prevention and treatment in the hospital setting.

Routinization: risk factor or marker of adjustment to negative health issues?

OBJECTIVES

Routinization reflects how older people cope with the health problems. It remains to be seen whether it should be considered as a risk factor of negative health outcomes, or rather, a mechanism of adjustment to health issues: mortality, institutionalization, dementia, disability, cognitive decline, depression and subjective health.

METHODS

From longitudinal data of two large-scale French epidemiological studies, the study sample consists of 961 participants aged 77 years on average, living at home and with no neurocognitive disorder. The relationship between the level of routines measured by the Preferences for Routines Scale-Short form and the adverse health outcomes are studied considering the level of routines at baseline and in time-dependent using Cox proportional hazards models and Latent process mixed models.

RESULTS

After adjustment for sociodemographic variables, the routinization score at baseline is not associated with any health outcomes while the routinization score as a time-dependent variable is significantly associated with an increased risk of dementia (hazard ratios (HR) = 1.08, 95% confidence intervals (CI) = 1.02-1.15, p = 0.016) and institutionalization (HR = 1.18, 95% CI = 1.03-1.36, p = 0.019), greater global cognitive decline (β = -0.02, p = 0.001) and depressive symptoms (β = 0.02, p = 0.023) and a decrease in subjective health (β = 0.02, p = 0.008).

CONCLUSIONS

The level of routines measured at a given time is not associated with long-term prediction of negative health outcomes, while in time-dependent, it reveals to be a significant predictor. It should be seen as a marker of adjustment process.

Health Behaviors and Health Literacy: Questing the Role of Weak Social Ties Among Older Persons in Rural and Urban Ghana

Background

Older persons are one of the most vulnerable groups as regards low health literacy. However, little is known about the extent of limitations and multi-faceted nature of their health literacy, such as its characteristics and social and geographical dimensions. Additionally, most existing studies have predominantly treated health literacy as a risk factor of health and wellbeing of older persons as opposed to an outcome that must be pursued.

Objectives

This study investigated the moderating role of weak social ties (bridging social capital) in the relationship between health behaviors, such as smoking, alcohol intake, voluntary body check-up and physical exercise, and health literacy among older persons in rural and urban Ghana.

Methods

Data was drawn from a cross-sectional survey comprising 522 respondents across five administrative regions in Ghana. Ordinary Least Squares regression technique was used to analyse the data.

Results

Older persons in urban areas had higher health literacy [Mean/Standard deviation (SD) = 9.1/4.1 vs. 10.1/4.2] as well as higher bridging social capital (Mean/SD = 2.0/1.2 vs. 1.6/0.9) than their rural counterparts. Bridging social capital was negatively associated with the health literacy of urban residents (B = -0.997, p < 0.01). We found evidence that smoking (B = -0.787, p < 0.05) and undertaking physical activities (B = 0.812, p < 0.01) were associated with health literacy of older persons in rural areas. Having voluntary body check-ups (B = 0.155, p < 0.01) was associated with health literacy in urban areas. Bridging social capital negatively moderated the association of smoking with health literacy in rural areas (B = -5.032, p < 0.01), but it instead positively modified the relationship between alcohol intake and health literacy in urban areas (B = 0.185, p < 0.05).

Conclusion

For policymakers and practitioners aiming to promote older persons' health literacy as a public health asset at individual and community levels, an important starting point to achieving such goals is to understand the fundamental indicators (e.g., health behaviors) and the role that social and geographical factors play in shaping their health literacy.

"Time Does Not Heal All Wounds": Sexual Victimisation Is Associated with Depression, Anxiety, and PTSD in Old Age

Sexual violence (SV) has an important impact on mental health. Childhood sexual abuse is linked to internalising disorders in later life. In older adults, SV occurs more often than previously believed. Moreover, health care workers lack the skills to address SV in later life. Studies researching the mental health impact of lifetime SV, i.e., SV during childhood, adulthood, and old age, are lacking. Between July 2019 and March 2020, 513 older adults living in Belgium participated in structured face-to-face-interviews. Selection occurred via a cluster random probability sampling with a random walk finding approach. Depression, anxiety, and posttraumatic stress syndrome (PTSD) were measured using validated scales. Participants were asked about suicide attempts and self-harm during their lifetime and in the past 12 months. SV was measured using behaviourally specific questions based on a broad SV definition. We found rates for depression, anxiety, and PTSD of 27%, 26%, and 6% respectively, while 2% had attempted suicide, and 1% reported self-harm in the past 12 months. Over 44% experienced lifetime SV and 8% in the past 12 months. Lifetime SV was linked to depression (p = 0.001), anxiety (p = 0.001), and PTSD in participants with a chronic illness/disability (p = 0.002) or no/lower education (p < 0.001). We found no link between lifetime SV and suicide attempts or self-harm in the past 12 months. In conclusion, lifetime SV is linked to mental health problems in late life. Tailored mental health care for older SV victims is necessary. Therefore, capacity building of professionals and development of clinical guidelines and care procedures are important.

Geriatric vulnerability and the burden of disability after major surgery

BACKGROUND

Strong epidemiologic evidence linking indicators of geriatric vulnerability to long-term functional outcomes after major surgery is lacking. The objective of this study was to evaluate the association between geriatric vulnerability and the burden of disability after hospital discharge for major surgery.

METHODS

From a prospective longitudinal study of 754 nondisabled community-living persons, aged 70 years or older, 327 admissions for major surgery were identified from 247 participants who were discharged from the hospital from March 1997 to December 2017. The indicators of geriatric vulnerability were ascertained immediately prior to the major surgery or during the prior comprehensive assessment, which was completed every 18 months. Disability in 13 essential, instrumental and mobility activities was assessed each month.

RESULTS

The burden of disability over the 6 months after major surgery was considerably greater for non-elective than elective surgery. In multivariable analysis, 10 factors were independently associated with disability burden: age 85 years or older, female sex, Black race or Hispanic ethnicity, neighborhood disadvantage, multimorbidity, frailty, one or more disabilities, low functional self-efficacy, smoking, and obesity. The burden of disability increased with each additional vulnerability factor, with mean values (credible intervals) increasing from 1.6 (1.4-1.9) disabilities for 0-1 vulnerability factors to 6.6 (6.0-7.2) disabilities for 7 or more vulnerability factors. The corresponding values were 1.2 (0.9-1.5) and 5.9 (5.0-6.7) disabilities for elective surgery and 2.6 (2.1-3.1) and 8.2 (7.3-9.2) disabilities for non-elective surgery.

CONCLUSIONS

The burden of disability after hospital discharge for major surgery increases progressively as the number of geriatric vulnerability factors increases. These factors can be used to identify older persons who are particularly susceptible to poor functional outcomes after major surgery, and a subset may be amenable to intervention, including frailty, low functional self-efficacy, smoking, and obesity.

Ask us! Adjusting experience-based codesign to be responsive to people with intellectual disabilities, serious mental illness or older persons receiving support with independent living

Introduction

Experience‐based codesign (EBCD) is a valuable tool for participatory quality improvement. However, the EBCD process needs to be adjusted to make it suitable for long‐term care. The focus of the improvement process needs to shift to the care relationship, as this is an important part of the quality of care in these settings. Furthermore, the EBCD process needs to be made more accessible to vulnerable populations.

Methods

Through a participatory research approach, EBCD was adjusted to long‐term care. The research was conducted in two care organisations: one supporting people with serious mental illness and intellectual disabilities in independent living and one providing homecare services for older persons.

Results

The participatory research resulted in the development of ‘Ask us!’—a method for critical reflective codesign. The research furthermore provided valuable lessons for participatory projects with vulnerable clients. A common problem with participatory research in long‐term care is ensuring the involvement of clients and informal carers. We report on various strategies developed to include experiences of a diverse set of services users, such as combining interviews with participant observation, photo‐voice and involving experts‐by‐experiences as co‐ethnographers. In close collaboration with an inclusive theatre company, these experiences were translated into 42 short videos on complex situations in the care relationship from the perspective of clients, professionals or informal carers. These videos instigate critical reflection and accelerate the participatory quality improvement process. Moreover, practical tools were developed to overcome barriers regarding the involvement of people with disabilities. These include the use of photo‐elicitation to enable participation of clients with disabilities in heterogeneous group discussions and involving experts‐by‐experience as proxies to share experiences of clients for whom participation in the ‘Ask us’ method remains inaccessible.

Conclusion

The result of a robust participatory process, ‘Ask us!’ is a promising method for participatory quality improvement in long‐term care. The research furthermore generated lessons for involving vulnerable populations in participatory research and codesign.

Patient or Public Contribution

Clients were involved as informants, sharing their experiences with the care relationship in interviews, photovoice and observations. They were also involved as consultants, helping to analyse input for the film scripts during data validation sessions.

Application of Walkability Index for Older Adults' Health in the Brazilian Context: The Case of Vitória-ES, Brazil

This study follows up on the article ‘Walkability Index for Elderly Health: A Proposal’, published in 2020, as well its validation in the Historic Center of Porto, published in 2021. The 2020 article presented the theoretical and methodological bases relating qualities of public spaces, the walkability of older adults, and the direct benefits on health. The 2021 article validated the applicability of the index in the Historic Center of Porto, Portugal. Both articles incorporated the factor ‘slope’, solving a criticism evidenced in related literature about the slope being ignored in older adults’ walking conditions studies. The present study, however, aims to validate the conceptual design of the Walkability Index for Elderly Health (WIEH) in the Brazilian context at the historic center of Vitória. The methodology included the analysis and evaluation of public spaces regarding the pedestrian network—urban fabric, urban scene, and safety—and the presence of slopes and/or stairways. Subsequently, these spaces were classified according to the WIEH, ascertaining their level of adequacy for older adults’ walkability. The results show that paths friendly to older adults are rare and that the problems encountered focus primarily on the low quality of the pedestrian network and not on the existence of slopes and stairways.

Art of connectedness: Value-creating care for older persons provided with toileting assistance and containment strategies-A critical interpretive synthesis

AIMS AND OBJECTIVES

The aim was to conduct a synthesis of the literature on value-creating care for older persons with incontinence provided with toileting assistance and containment strategies, from the perspectives of older persons and healthcare professionals.

BACKGROUND

Incontinence is a health problem for many persons worldwide and the problem will increase as the global population ages. It can have a profound impact on a person's wellbeing, and assistance with toileting and containment strategies is common in home care settings and nursing homes.

DESIGN

The design was a literature review with an iterative, reflexive and critical approach.

METHODS

A critical interpretive synthesis was conducted. Ten papers published between 2011 and 2019 were analysed. The PRISMA -ScR Checklist was used in this review.

RESULTS

Based on the findings, the conceptual construct 'The art of connectedness' was developed, built on co-created care, personalised care and reflective care between the older person and healthcare professionals. Co-created care is based on establishing a relationship, building trust and respecting preferences. Personalised care consists of meeting the person's needs, promoting comfort and maintaining self-determination. Reflective care entails showing empathy, upholding the person's dignity and developing professional competence.

CONCLUSIONS

Value-creating care consists conceptually of a connectedness that starts with co-creating the care together with the older person in a close relationship. Assistance is given and received based on the older person's individual needs and is highly valued by the older person as it helps them maintain self-determination. Reflective care is of importance for healthcare professionals.

RELEVANCE FOR PRACTICE

The findings are hoped to enhance healthcare professionals' understanding of how to improve the clinical encounter in nursing when providing assistance. They may also stimulate critical reflection among healthcare professionals on how to improve assistance to meet the older person's values.

Experiences and practices of caregiving for older persons living with dementia in African countries: A qualitative scoping review

BACKGROUND

The increasing awareness and diagnosis of dementia in Africa necessitate documentation of caregiving practices to understand local patterns and improve the quality of care. Caregiving in African communities is rooted in informal-communal social organization. This scoping review analyses caregiver characteristics and experiences, and practices of caregiving for persons living with dementia in Africa.

METHODS

A total of 152 references were retrieved, with 64 references obtained from PubMed, 85 from AJOL, and three from Scopus. Based on the relevance of titles, 83 references were further retained from PubMed (64), AJOL (16), and Scopus (3). A rapid review of abstracts was done in Distiller SR, and finally, six relevant articles were content-analyzed using Atlas ti 8.4 qualitative analysis software.

RESULTS

All six included studies were published between 2003 and 2018. Four themes were identified: article characteristics, caregiver characteristics, caregiver in context, and caregiver potentialities (challenges and opportunities). Studies reported findings from research conducted in four African countries: three from Nigeria, and one each from South Africa, Egypt, and Tanzania. Caregivers of persons living with dementia typically had eight years or less of formal education, were unpaid, and spent a daily average of 13 hours in caregiving. Cultural thresholds and individual caregiver differences underlie the interpretation of stressors across cultures. Caregivers lack the right training and information as well as support systems to improve their role performance and reduce accumulated stress.

CONCLUSION

In African countries, informational and educational platforms are essential for improved individual dementia caregiving, vis-à-vis strengthened roles of governments, and religious/traditional leaders and organizations.