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Grant A, Henegan J, Jones A, Ahmadi N, Thomas R, Stanton R, Sowter S. Patterns of infection following transrectal ultrasound-guided biopsy of the prostate in a regional New South Wales Centre. Aust J Rural Health 2020; 28:301-306. [PMID: 32478441 DOI: 10.1111/ajr.12600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 08/13/2019] [Accepted: 12/16/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To determine the rates, severity and patterns of resistance in patients presenting with post-transrectal ultrasound infection in a regional centre in New South Wales, Australia. DESIGN A single-centre retrospective review from August 2013 until August 2017. SETTING Murrumbidgee Local Health District, New South Wales. PARTICIPANTS All patients who underwent transrectal ultrasonography biopsy of the prostate in the public health system. MAIN OUTCOME MEASURES Rate of infection and sepsis following biopsy of the prostate requiring readmission to hospital within 30 days from the procedure. RESULTS A total of 317 men underwent transrectal ultrasound-guided biopsy of the prostate over the study period. Nineteen (6%) patients presented with clinical signs of post-transrectal ultrasound infection, of which 18 (5.7%) required readmission for intravenous antibiotics. Median time to readmission was 2 days (0-7), and the average length of hospital stay was 5 days (1-15). Three (0.3%) patients required admission to intensive care for inotropic support. Thirteen patients (68%) had positive blood cultures, and all were positive for Escherichia coli. Four of these patients (21%) had extended spectrum beta-lactamase producing isolates resistant to their preoperative antibiotics. CONCLUSION Prostate cancer is common in the elderly community with worse outcomes in regional settings. Infective complications from transrectal ultrasound biopsy were 6% in this regional setting with high rates of multi-resistant organisms. Awareness of this is important for rural health practitioners who are likely to be exposed to this patient population.
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Yu CW, Rau PLP, Liu X. Development and Preliminary Usability Evaluation of a Somatosensory Square Dance System for Older Chinese Persons: Mixed Methods Study. JMIR Serious Games 2020; 8:e16000. [PMID: 32463376 PMCID: PMC7290448 DOI: 10.2196/16000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/15/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background Chinese square dancing, known as guangchang wu in Chinese, is a well-known public fitness activity that provides an entertaining way for older Chinese women to improve their flexibility, lower extremity strength, overall coordination, and balance. However, injuries, noise conflicts, and lack of space are challenging aspects of this activity. Somatosensory games (SG) are an increasingly popular physical fitness approach to enhance the selective attention of older persons with indoor engagement and exercises. Objective The objectives of this study were to develop a newly designed somatosensory square dance system for older Chinese people and to evaluate its usability. Methods This is a mixed methods study. The newly designed somatosensory square dance system is a somatic training tool that provides adequate Chinese square dance fitness training based on Laban Movement Analysis (LMA) and design guidelines established in a previous stage. The usability evaluation involved a questionnaire and interviews. Twelve participants were interviewed before and after experiencing the 15-minute dancing and learning process within the program. In addition, participants scored their experience satisfaction in psychological, physiological, and relaxation sections on a scale of 1 to 5 using a questionnaire. Qualitative content analysis and quantitative analysis of the satisfaction scores supported understanding of usability problems. Results Based on the interview results, 6/12 (50%) of the participants thought the system could help them correct their dancing movements indoors without being affected by poor outdoor weather. Among the participants, 3/12 (25%) indicated that this indoor system could enable them to enjoy fitness activities in a private space. Moreover, 3/12 participants (25%) stated that this system could promote family relationships by providing easy dancing movements. All participants were highly satisfied with the relaxation aspect of the system (4.45/5). The participants were all psychologically satisfied and interested in the novel features of the system, with an average score of 4.16/5. Physiologically, participants affirmed that the system could help them maintain good health (4.91/5). Conclusions The results of this study suggest that the somatosensory square dance system can be used as an indoor fitness tool to improve older Chinese square dancers’ health conditions with reasonable dance training. Noise and space conflicts can be addressed. The Laban Elated Square Dance system, which was modified by therapists based on LMA and square dance design guidelines, was highly approved by dancers because it decreased the possibility of injuries, falls, and joint damage by considering the physical and psychological difficulties of older persons. Different features will be considered in the next stage, such as greater selection of exercises and difficulty level settings. Users’ social needs will also be explored in subsequent stages.
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Martani A, Brunner A, Wangmo T. Intergenerational familial care: Shaping future care policies for older adults. Nurs Ethics 2020; 28:864-877. [PMID: 32406294 DOI: 10.1177/0969733020916748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An increasingly ageing society together with concerns about sustainability of old-age benefits call for reforming the care structure of many western welfare states. However, finding an acceptable balance between the formal care provided by institutions and informal care provided by family members is a delicate policy choice with profound ethical implications. In this respect, literature on intergenerational familial relationships can offer insights to inform policymaking in this field and help resolve the ethical concerns that excessive reliance on informal caregiving might entail. In this contribution, we start by presenting - with Switzerland as a case study - the challenges of the current care structure and illustrate some of the ethical issues that reshaping the balance between formal and informal care raises. We then review and analyse available theoretical literature on intergenerational familial relationships and present three dimensions that underpin such relationships: ethical, theoretical and practical. Based on our analysis, we provide two recommendations to inform policymaking on how to support care needs of the elderly and set an ethically acceptable balance between formal and informal care when familial generations are involved.
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Kikushima R, Takahashi K. [Access to grocery stores and nutrition/food intake observed in the National Health and Nutrition Survey: Focusing on the substitution-complementary relation]. [NIHON KOSHU EISEI ZASSHI] JAPANESE JOURNAL OF PUBLIC HEALTH 2020; 67:261-271. [PMID: 32389925 DOI: 10.11236/jph.67.4_261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective This study aimed to identify the characteristics of nutrition and food intake among people who have limited access to grocery stores (hereinafter, "people with limited access").Method Data from the 2011 National Health and Nutrition Survey and 2011 Comprehensive Survey of Living Conditions were compiled using a data-linkage method. These are the only surveys that contain data regarding people's access to grocery stores. Nutrition and food intake among people with limited access were examined using an econometric method targeting 1,051 women aged 65 years and older. The objective variables for the analysis were caloric intake (kcal) from energy-providing nutrients, namely, proteins, fats, and carbohydrates, and 17 items in different food groups (g/1,000 kcal). The analysis used the seemingly unrelated regressions model, a simultaneous equations model designed to address endogeneity through simultaneous determinations of objective variables. This model indicated, by way of coefficients, the influence of the factors (variables) that define caloric intake from each nutrient and food group. The substitution-complementary relation among the nutrients and among the food groups was expressed as a correlation matrix between error terms.Results The characteristics of people with limited access were examined targeting women aged 65 years and older with respect to their access to grocery stores and intake of energy-providing nutrients. The results indicated that their caloric intake (kcal) of carbohydrates was significantly high, whereas their caloric intake (kcal) of fats was significantly low. Their caloric intake by food group (g/1,000 kcal) also confirmed similar results: their intake of grains was high, but that of fats was low. Thus, the results indicated a strong likelihood that people with limited access, even after accounting for the substitution-complementary relation, had a diet that was too high in carbohydrates.Conclusion People with limited access tended to have a diet that was too high in carbohydrates. This tendency had a strong likelihood to be because of not simply the prices or their preferences but their food environment-that is, their limited access to grocery stores. The food environment prescribes people's diet, even when individuals' financial situations are taken into account. Therefore, the study indicated the necessity for chain store operators to cooperate with one another and with the government to create an environment that facilitates shopping-support services.
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Lipardo DS, Tsang WW. Effects of combined physical and cognitive training on fall prevention and risk reduction in older persons with mild cognitive impairment: a randomized controlled study. Clin Rehabil 2020; 34:773-782. [PMID: 32380917 DOI: 10.1177/0269215520918352] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the effects of combined physical and cognitive training on fall rate and risks of falling in older adults with mild cognitive impairment. DESIGN The design of this study was an assessor-blinded, randomized controlled trial. SETTING The setting for this study is the community from Manila, Philippines. SUBJECTS In total, 92 community-dwelling older persons with mild cognitive impairment (aged 60-83) were randomly allocated to three intervention groups and one waitlist control group. INTERVENTIONS The physical training, cognitive training, and combined physical and cognitive training intervention programs were delivered for 60 to 90 minutes, one to three times per week for 12 weeks with six-month follow-up. MAIN MEASURES Participants were assessed at baseline, 12 weeks after baseline, and 36 weeks after baseline for fall incidence, overall fall risk, dynamic balance, walking speed, and lower limb strength. RESULTS No significant difference was observed across time and groups on fall incidence rate at 12 weeks (P = 0.152) and at 36 weeks (P = 0.954). The groups did not statistically differ in other measures except for a significant improvement in dynamic balance based on Timed Up and Go Test in the combined physical and cognitive training group (9.0 seconds with P = 0.001) and in the cognitive training alone group (8.6 seconds with P = 0.012) compared to waitlist group (11.1 seconds) at 36 weeks. CONCLUSION There was no significant difference among groups on fall rate and risks of falling post-intervention. Dynamic balance was improved with combined physical and cognitive training and cognitive training alone. Further research with a larger sample size is needed to establish whether or not the interventions are effective.
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Rades D, Nguyen T, Janssen S, Khoa MT, Schild SE. Individualisation of Radiation Therapy for Older Persons With Secondary Brain Lesions from Carcinoma of the Breast. Anticancer Res 2020; 40:2271-2274. [PMID: 32234925 DOI: 10.21873/anticanres.14191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Outcomes of older persons with secondary brain lesions from carcinoma of the breast may be improved by individualized therapy. This process will likely be easier with survival scores. PATIENTS AND METHODS A retrospective study was performed in 111 older patients with carcinoma of the breast irradiated for secondary brain lesions. Dose-fractionation, age, general condition, number of brain lesions, other visceral metastases and time period from breast cancer detection until radiation therapy were investigated. RESULTS Post-radiation survival was significantly related to general condition (p<0.0001) and other visceral metastases (p=0.041). When using these characteristics, sum-scores of 0 (n=46), 1 (n=50) or 2 (n=15) points were gained. Six- and 12-month survival was 7% and 3% for 0 points, 43% and 19% for 1 point, and 73% and 52% for 2 points (p<0.0001). CONCLUSION This survival score contributes to treatment individualisation of older patients with secondary brain lesions from carcinoma of the breast.
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Lauretani F, Bellelli G, Pelà G, Morganti S, Tagliaferri S, Maggio M. Treatment of Delirium in Older Persons: What We Should Not Do! Int J Mol Sci 2020; 21:ijms21072397. [PMID: 32244301 PMCID: PMC7177924 DOI: 10.3390/ijms21072397] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 12/13/2022] Open
Abstract
The presentation of common acute diseases in older age is often referred to as “atypical”. Frequently, the symptoms are neither single nor tissue related. In most cases, the onset of symptoms and diseases is the expression of a diminished reserve with a failure of the body system and imbalance of brain function. Delirium is one of the main devastating and prevalent atypical symptoms and could be considered as a geriatric syndrome. It encompasses an array of neuropsychiatric symptoms and represents a disarrangement of the cerebral function in response to one or more stressors. The most recent definition, reported in the DSM-V, depicts delirium as a clear disturbance in attention and awareness. The deficit is to be developed in a relatively short time period (usually hours or days). The attention disorder must be associated with another cognitive impairment in memory, orientation, language, visual-spatial or perception abilities. For the treatment, it is imperative to remove the potential causes of delirium before prescribing drugs. Even a non-pharmacological approach to reducing the precipitating causes should be identified and planned. When we are forced to approach the pharmacological treatment of hyperactive delirium in older persons, we should select highly cost-effective drugs. High attention should be devoted to the correct balance between improvement of psychiatric symptoms and occurrence of side effects. Clinicians should be guided in the correct choice of drugs following cluster symptoms presentation, excluding drugs that could potentially produce complications rather than advantages. In this brief point-of-view, we propose a novel pharmacological flow-chart of treatment in relation to the basic clusters of diseases of an older patient acutely admitted to the hospital and, in particular, we emphasize “What We Should Not Do!”, with the intention of avoiding possible side effects of drugs used.
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Conn DK, Hogan DB, Amdam L, Cassidy KL, Cordell P, Frank C, Gardner D, Goldhar M, Ho JMW, Kitamura C, Vasil N. Canadian Guidelines on Benzodiazepine Receptor Agonist Use Disorder Among Older Adults Title. Can Geriatr J 2020; 23:116-122. [PMID: 32226570 PMCID: PMC7067147 DOI: 10.5770/cgj.23.419] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Benzodiazepine receptor agonist (BZRA) use disorder among older adults is a relatively common and challenging clinical condition. Method The Canadian Coalition for Seniors’ Mental Health, with financial support from Health Canada, has produced evidence-based guidelines on the prevention, identification, assessment, and management of this form of substance use disorder. Results Inappropriate use of BZRAs should be avoided by considering non-pharmacological approaches to the management of late life insomnia, anxiety, and other common indications for the use of BZRA. Older persons should only be prescribed BZRAs after they are fully informed of alternatives, benefits, and risks associated with their use. Clinicians should have a high index of suspicion for the presence of BZRA use disorders. The full version of these guidelines can be accessed at www.ccsmh.ca Conclusions A person-centred, stepped care approach utilizing gradual dose reductions should be used in the management of BZRA use disorder.
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Rades D, Nguyen T, Janssen S, Schild SE. An Easy-To-Use Survival Score Compared to Existing Tools for Older Patients with Cerebral Metastases from Colorectal Cancer. Cancers (Basel) 2020; 12:cancers12040833. [PMID: 32235637 PMCID: PMC7226154 DOI: 10.3390/cancers12040833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 12/25/2022] Open
Abstract
An easy-to-use survival score was developed specifically for older patients with cerebral metastases from colorectal cancer, and was compared to existing tools regarding the accuracy of identifying patients who die in ≤6 months and those who survive for ≥6 months. The new score was built from 57 patients receiving whole-brain irradiation. It included three groups identified from 6-month survival rates based on two independent predictors (performance status and absence/presence of non-cerebral metastases), with 6-month survival rates of 0% (0 points), 26% (1 point), and 75% (2 points), respectively. This score was compared to diagnosis-specific scores, namely the diagnosis-specific graded prognostic assessment (DS-GPA), the Dziggel-Score and the WBRT-30-CRC (whole-brain radiotherapy with 30 Gy in 10 fractions for cerebral metastases from colorectal cancer) score and to a non-diagnosis-specific score for older persons (Evers-Score). Positive predictive values were 100% (new score), 87% (DS-GPA), 86% (Dziggel-Score), 91% (WBRT-30-CRC), and 100% (Evers-Score), respectively, for patients dying ≤6 months, and 75%, 33%, 75%, 60%, and 45%, respectively, for survivors ≥6 months. Of the five tools, the new score and the Evers-Score were most precise in identifying patients dying ≤6 months. The new score and the Dziggel-Scores were best at identifying patients surviving ≥6 months. When combining the results, the new score appeared preferable to the existing tools. The score appears not necessary for patients with additional liver metastases, since their 6-month survival rate was 0%.
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Gill TM, McGloin JM, Shelton A, Bianco LM, Skokos EA, Latham NK, Ganz DA, Nyquist LV, Wallace RB, Carnie MB, Dykes PC, Goehring LA, Doyle M, Charpentier PA, Greene EJ, Araujo KL. Optimizing Retention in a Pragmatic Trial of Community-Living Older Persons: The STRIDE Study. J Am Geriatr Soc 2020; 68:1242-1249. [PMID: 32212395 DOI: 10.1111/jgs.16356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study is testing the effectiveness of a multifactorial intervention to prevent serious fall injuries. Our aim was to describe procedures that were implemented to optimize participant retention; report retention yields by age, sex, clinical site, and follow-up time; provide reasons for study withdrawals; and highlight the successes and lessons learned from the STRIDE retention efforts. DESIGN Pragmatic cluster randomized trial. SETTING A total of 86 primary care practices within 10 US healthcare systems. PARTICIPANTS A total of 5451 community-living persons, 70 years of age or older, at high risk for serious fall injuries. MEASUREMENTS Study outcomes were collected every 4 months by a central call center. Reconsent was required to extend follow-up beyond the originally planned 36 months. RESULTS Over a median follow-up of 3.2 years (interquartile range = 2.8-3.7 y), 439 (8.1%) participants died and 600 (11.0%) withdrew their consent or did not reconsent to extend follow-up beyond 36 months, yielding rates (per 100 person-years) of deaths and withdrawals of 2.6 and 3.6, respectively. The withdrawal rate increased with advancing age, was comparable for men and women, and did not differ much by clinical site. The most common reasons for withdrawal were illness and unable to contact for reconsent at 36 months. Completion of the follow-up interviews was greater than 93% at each time point. Most participants completed all (71.8%) or all but one (9.2%) of the follow-up interviews. The most common reason for not completing a follow-up interview was unable to contact, with rates ranging from 2.8% at 40 months to 4.6% at 20 months. CONCLUSION Completion of the thrice-yearly follow-up interviews in STRIDE was high, and retention of participants over 44 months exceeded the original projections. The procedures used in STRIDE, together with lessons learned, should assist other investigators who are planning or conducting large pragmatic trials of vulnerable older persons. J Am Geriatr Soc 68:1242-1249, 2020.
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Ivanov VI, Dorofeykov VV, Kaystrya IV, Emanuel VL. [Vitamin D and laboratory indicators of cardiovascular risk in the elderly.]. Klin Lab Diagn 2020; 65:11-15. [PMID: 32155001 DOI: 10.18821/0869-2084-2020-65-1-11-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022]
Abstract
The aim of this work was to study the availability of vitamin D in the population of free living elderly people in St. Petersburg and its relationship with laboratory indicators of the risk of cardiovascular complications. In winter were surveyed 209 volunteers who did not take vitamin D during the previous 6 months, with 152 women and 57 men aged 71 to 91 years. In all the examined patients the concentration of D(OH) in serum was below 30 ng/ml (analyzer and reagents «Architect i1000SR, Abbott»). No significant mutual effects were found between level 25(OH)D and lipid spectrum, hemoglobin A1C, testosterone, ultra-sensitive C-reactive protein. The close relationship between vitamin D(OH) concentration and brain natriuretic peptide (BNP) levels was characterized by rs=0.187 (p=0.007). In older people with severe vitamin deficiency (less than 10 ng/ml), the risk of elevated BNP levels was 2.6 times higher than in those with reduced vitamin levels (20-30 ng/ml).
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Tap L, Dommershuijsen LJ, Corsonello A, Lattanzio F, Bustacchini S, Ziere G, van Saase JL, Mattace-Raso FU. The Possible Impact of Aortic Stiffness on Quality of Late Life: An Exploratory Study. Clin Interv Aging 2020; 15:133-140. [PMID: 32099342 PMCID: PMC7007799 DOI: 10.2147/cia.s239186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Aortic stiffness (AS) is associated with cardiovascular events and all-cause mortality in the older population. AS might also influence the health-related quality of life (HRQOL) as a result of the negative effects of AS on cognitive and physical morbidity. We aimed to investigate the possible association between AS and HRQOL in people aged 75 years and over. Patients and Methods This cross-sectional study was part of the SCOPE study, an international multicenter cohort observational study. The indicators for AS were aortic pulse wave velocity (aPWV) and central pulse pressure (cPP). HRQOL was assessed using the EQ-5D index and the EQ-5D visual analog scale (VAS). ANCOVA and multivariate regression models were used to investigate possible associations. Results We included 280 Dutch participants of the SCOPE study. Median age was 79 years (IQR 76–83) and 42.1% were women. Participants reporting any problem on the EQ-5D index (n=214) had higher values of aPWV (12.6 vs 12.2 m/s, p = 0.024) than participants not experiencing any problem (n=66) and comparable values of cPP (44.4 vs 42.0 mmHg, p = 0.119). Estimates only slightly changed after adjustments. No association was found between indicators of AS and EQ-5D VAS. Conclusion Aortic stiffness was associated with impaired quality of late life. This association could be mediated by subclinical vascular pathology affecting mental and physical health.
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James K, Thompson C, Holder-Nevins D, Willie-Tyndale D, McKoy-Davis J, Eldemire-Shearer D. Caregivers of Older Persons in Jamaica: Characteristics, Burden, and Associated Factors. J Appl Gerontol 2020; 40:713-721. [PMID: 31920135 DOI: 10.1177/0733464819898315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine and characterize caregiver burden among caregivers of community-dwelling older persons in Jamaica. METHOD A nationally representative cross-sectional study was done among persons providing noninstitutional care for a single person (≥60 years). The Zarit Burden Interview (ZBI) and a structured questionnaire were administered to 180 caregivers from four geographic health regions. RESULTS The ZBI scores ranged from 0 to 56 (median = 15). Independently associated factors were relationship to care recipient and age. Children/grandchildren had higher caregiver burden scores than formally employed caregivers (odds ratio = 2.9: 95% confidence interval: [1.02, 8.34]). Compared with caregivers 35 to 44 years, those aged 45 to 65 were almost 5 times more likely to report higher caregiver burden scores. CONCLUSION Caregiver burden as identified by the ZBI was low. Age (45-65 years) and being the child/grandchild of the care recipient were independently associated with greater caregiver burden. Interventions to address caregiver burden must embrace strategies that recognize that these factors.
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Gill TM, Han L, Gahbauer EA, Leo-Summers L, Murphy TE. Cohort Profile: The Precipitating Events Project (PEP Study). J Nutr Health Aging 2020; 24:438-444. [PMID: 32242212 PMCID: PMC7322244 DOI: 10.1007/s12603-020-1341-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Precipitating Events Project (PEP Study) is an ongoing longitudinal study of 754 nondisabled community-living persons age 70 years or older who were members of a large health plan in greater New Haven, Connecticut, USA. The study was established to rigorously evaluate the epidemiology of disability in older persons and to elucidate the role of intervening illnesses and injuries on the disabling process. Of the eligible members, 75.2% agreed to participate and were enrolled between March 1998 and October 1999. Participants have completed comprehensive home-based assessments at 18-month intervals and have been interviewed monthly over the phone with a completion rate of 99%. Detailed participant-level data on health care utilization are obtained annually through linkages with Medicare claims. Through June 2019, 702 (93.1%) participants have died after a median of 109 months, while 43 (5.7%) have dropped out of the study after a median of 27 months. Death certificates are available for all decedents. To date, 117 original reports have been published using data from the PEP Study, including many focusing on other high priority areas such as end of life, frailty, depressive symptoms, aging stereotypes, pain, sleep, and methodologic research. The PEP Study welcomes proposals to access data for meritorious analyses from qualified investigators.
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Odencrants S, Blomberg K, Wallin A. "The meal is an activity involving at least two people"-Experiences of meals by older persons in need of elderly care. Nurs Open 2020; 7:265-273. [PMID: 31871710 PMCID: PMC6917934 DOI: 10.1002/nop2.387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 07/16/2019] [Accepted: 09/08/2019] [Indexed: 11/19/2022] Open
Abstract
Aim A shift of focus on older persons' nutrition has occurred, from focusing on nutrition status to focusing on the whole meal. There is lack of studies on how older persons experience meals. Knowledge is needed to enhance a meal with dignity and pleasure, but also to prevent deterioration in nutrition. The aim was to describe meals from the perspective of older persons in need of elderly care. Design A descriptive qualitative study. Method Semi-structured interviews (N = 18) were conducted and analysed using thematic analyses. Result Three themes were identified: The meal is an activity which involves at least two persons, The meal relates to habits and traditions and The meal seldom gives possibilities to make individual choices. It was obvious that older persons who live in nursing homes miss the opportunity to decide what to eat, when to eat and with whom to eat. Attention must be paid to listening to older persons to enhance mealtime with dignity and autonomy.
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Ganorkar S, Kabir ZN, Rustomfram N, Thakur H. Experiences of Older Persons in Seeking Care at a Private Hospital in Urban India. Gerontol Geriatr Med 2020; 6:2333721420910639. [PMID: 32284954 PMCID: PMC7139167 DOI: 10.1177/2333721420910639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 10/27/2022] Open
Abstract
Objective: The study aims to describe the experiences of older persons in seeking health care in a private hospital in urban India. Methods: Semi-structured interviews were conducted with 50 older persons admitted in or visiting a private hospital in Hyderabad city in India between the period November 2017 and April 2018. The data were analyzed using Content Analysis. Results: Dimensions related to payment mechanisms, quality of health care staff, and hospital quality were reported to be important for the older persons. Payment mechanisms were related to discounts, insurance support, and reducing out-of-pocket expenditure. Quality of care was related to optimizing hospital operational processes like discharge time, standard of treatment, and trustworthiness of the medical staff. Discussion: Payment mechanism can be made friendly for the older persons. Quality of hospital including its staff can be enhanced by developing geriatric-specific competencies which can help them to understand and treat complex health problems specific for the older population.
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Anderson K, Freeman C, Foster M, Scott I. GP-Led Deprescribing in Community-Living Older Australians: An Exploratory Controlled Trial. J Am Geriatr Soc 2019; 68:403-410. [PMID: 31792947 DOI: 10.1111/jgs.16273] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/05/2019] [Accepted: 10/30/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess feasibility, effectiveness, and safety of a multifaceted general practitioner (GP) led intervention to reduce potentially inappropriate polypharmacy in community-living older people. DESIGN Pragmatic, controlled, pre-post design. SETTING Five general practices in southeast Queensland, Australia. PARTICIPANTS Ten GPs from three practices, two pharmacists, and 78 patients comprised the intervention group, and 10 GPs from two practices and 67 patients comprised the usual care group. Patients were aged 65 years or older, receiving five or more regularly prescribed medicines, and capable of participating in telephone interviews in English. INTERVENTION A 5-hour interactive deprescribing training workshop for clinicians; an extended deprescribing consultation between GPs and enrolled patients, entailing a comprehensive review of their medicines using a standardized software template codesigned by GPs; and comprehensive medicine review by a pharmacist, at the GP's discretion. OUTCOME MEASURES Primary outcome was mean difference in number of regular medicines deprescribed (ie, ceased or dose reduced) per patient over an 18-week follow-up period. Medicine-specific and patient-reported outcomes, safety, and process measures were also evaluated. RESULTS At study completion, mean (SD) number of regular medicines deprescribed per patient was 0.99 (1.23) in the intervention group vs 0.43 (0.84) in the usual care group, equaling a mean difference of 0.55 (95% confidence interval = -0.90 to -0.21; P = .002). Crude totals showed 77 of 649 (11.9%) vs 29 of 571 (5.1%) regular medicines deprescribed in intervention and usual care groups, respectively (P < .001). Supplements, gastric acid suppressants, statins, oral hypoglycemics, and diuretics were medicine classes more frequently deprescribed. There were no statistically significant between-group differences in numbers of medicines commenced, self-reported unplanned hospitalizations, or worsened health-related quality of life. A subset of intervention patients reported greater certainty in the necessity and appropriateness of their medicines at study end. CONCLUSION The deprescribing intervention appears feasible, was modestly effective, and was not associated with any major safety events. J Am Geriatr Soc 68:403-410, 2020.
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Göransson C, Wengström Y, Ziegert K, Langius-Eklöf A, Blomberg K. Self-care ability and sense of security among older persons when using an app as a tool for support. Scand J Caring Sci 2019; 34:772-781. [PMID: 31769888 DOI: 10.1111/scs.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/02/2019] [Indexed: 01/01/2023]
Abstract
THE STUDY'S RATIONALE The need for home care among older persons is increasing, and mHealth is evolving to help meet the challenge. When developing an app to help maintain their health, it is essential to incorporate older persons' preferences. AIMS AND OBJECTIVES To describe and evaluate the experiences of self-care support and sense of security among older persons using an interactive app to report health concerns. METHODOLOGICAL DESIGN AND JUSTIFICATION The study had a descriptive and evaluative design. Qualitative and quantitative methods were applied to achieve a broader understanding. ETHICAL ISSUES AND APPROVAL Ethical approval was obtained from the Regional Ethical Review Board. The older persons received verbal and oral information about the study and gave written informed consent. RESEARCH METHODS Questionnaires (n = 17 older persons) answered at baseline, end of the intervention and at a 6-month follow-up were analysed with statistical analysis. Interviews (n = 17 older persons) conducted at the end of the intervention were analysed using a qualitative directed approach. MEASUREMENTS AND INTERVENTION The questionnaire included the Appraisal of Self-care Agency Scale and a question concerning sense of security. For 3 months, the older persons used an app for regular reporting of health concerns. The app included self-care advice, graphs and a risk assessment model that generated alerts directly to the nurses. RESULTS The older persons described how self-care and sense of security increased at the end of intervention, but statistically, it was shown to decrease afterwards. STUDY LIMITATIONS The small sample size for statistical analysis. CONCLUSIONS This study shows that an app can be a complementary tool to conventional home care that can increase older persons' sense of security and self-care ability. The results mirror the older persons' awareness that the support they received with the app was only temporary. Larger studies are needed for generalisation.
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Liu WM, Koerner J, Lam L, Johnston N, Samara J, Chapman M, Forbat L. Improved Quality of Death and Dying in Care Homes: A Palliative Care Stepped Wedge Randomized Control Trial in Australia. J Am Geriatr Soc 2019; 68:305-312. [PMID: 31681981 DOI: 10.1111/jgs.16192] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Mortality in care homes is high, but care of dying residents is often suboptimal, and many services do not have easy access to specialist palliative care. This study examined the impact of providing specialist palliative care on residents' quality of death and dying. DESIGN Using a stepped wedge randomized control trial, care homes were randomly assigned to crossover from control to intervention using a random number generator. Analysis used a generalized linear and latent mixed model. The trial was registered with ANZCTR: ACTRN12617000080325. SETTING Twelve Australian care homes in Canberra, Australia. PARTICIPANTS A total of 1700 non-respite residents were reviewed from the 12 participating care homes. Of these residents, 537 died and 471 had complete data for analysis. The trial ran between February 2017 and June 2018. INTERVENTION Palliative Care Needs Rounds (hereafter Needs Rounds) are monthly hour-long staff-only triage meetings to discuss residents at risk of dying without a plan in place. They are chaired by a specialist palliative care clinician and attended by care home staff. A checklist is followed to guide discussions and outcomes, focused on anticipatory planning. MEASUREMENTS This article reports secondary outcomes of staff perceptions of residents' quality of death and dying, care home staff confidence, and completion of advance care planning documentation. We assessed (1) quality of death and dying, and (2) staff capability of adopting a palliative approach, completion of advance care plans, and medical power of attorney. RESULTS Needs Rounds are associated with staff perceptions that residents had a better quality of death and dying (P < .01; 95% confidence interval [CI] = 1.83-12.21), particularly in the 10 facilities that complied with the intervention protocol (P < .01; 95% CI = 6.37-13.32). Staff self-reported perceptions of capability increased (P < .01; 95% CI = 2.73-6.72). CONCLUSION The data offer evidence for monthly triage meetings to transform the lives, deaths, and care of older people residing in care homes. J Am Geriatr Soc 68:305-312, 2020.
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Beaglehole B, Bloomer C, Zhang T, Hamilton G, Boden JM, Mulder RT, Bell C, Frampton C. The impact of the Canterbury earthquakes on dispensing for older person's mental health. Int J Geriatr Psychiatry 2019; 34:1599-1604. [PMID: 31291027 DOI: 10.1002/gps.5171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/08/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the impact of the Canterbury earthquakes on the mental health of older people by examining dispensing patterns of psychotropic medication. METHOD Dispensing data from community pharmacies for antidepressants, antipsychotics, anxiolytics, and sedative/hypnotics are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) (n = 67 760 at study onset) and the rest of New Zealand (n = 469 055 at study onset). We compared older age dispensing data between 2008 and 2018 for Canterbury DHB with older age dispensing data nationally in order to assess the impact of the Canterbury earthquakes on the mental health of older persons. RESULTS Older age residents of Canterbury are dispensed antidepressants, antipsychotics, and anxiolytics at higher rates than national comparators, but this finding predated the onset of the earthquakes. Short-term increases in anxiolytic and sedative/hypnotic dispensing occurred for the month following the February 2011 earthquake. No other short- or longer-term increases in dispensing of psychiatric medication were present. CONCLUSION The February 2011 Canterbury earthquake caused a short-term increase in dispensing of anxiolytics and sedative/hypnotics. No longer-term effects on dispensing were observed. This suggests that older persons sought assistance for insomnia and anxiety in the aftermath of the most devastating earthquake, but longer-term rates of clinically significant anxiety and depression for older persons did not increase as a consequence of the earthquakes sequence.
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Sundler AJ, Hjertberg F, Keri H, Holmström IK. Attributes of person-centred communication: A qualitative exploration of communication with older persons in home health care. Int J Older People Nurs 2019; 15:e12284. [PMID: 31642182 DOI: 10.1111/opn.12284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/18/2019] [Accepted: 09/27/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Previous research points to challenges related to the home healthcare of older persons and to the complexity of communication. Although person-centred care has been advocated widely, there remains a need for in-depth knowledge on how to enable person-centred and supportive communication in the care of older persons. AIM The aim of this study was to explore attributes of person-centred communication between nurses and older persons being cared for in their home. METHODS A descriptive study with a qualitative approach was conducted. A data set from the COMHOME-study consisting of 77 audio-recorded home healthcare visits between registered nurses and older persons was analysed with a method for qualitative thematic analysis. RESULTS The findings indicate that the attributes of person-centred communication comprise recognising, inviting and involving older persons. To facilitate this form of communication, attentiveness and responsiveness on the part of RNs seemed significant. Person-centred communication was facilitated when the RNs used verbal expressions to emphasise and acknowledge the older persons' views and were attentive to their emotions and expressions. CONCLUSION The nurses' attentiveness and responsiveness seems important for person-centred communication with older persons. Communication skills are needed to recognise, invite and involve older persons in their care and to support their health and well-being. Implication for practice The importance of communication which facilitate a person-centred approach by nurses should be acknowledged when caring for older persons and included in education and training.
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Guerville F, de Souto Barreto P, Taton B, Bourdel-Marchasson I, Rolland Y, Vellas B. Estimated Glomerular Filtration Rate Decline and Incident Frailty in Older Adults. Clin J Am Soc Nephrol 2019; 14:1597-1604. [PMID: 31628118 PMCID: PMC6832058 DOI: 10.2215/cjn.03750319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/11/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Low eGFR is known to be associated with frailty, but the association between the longitudinal decline of eGFR and incident frailty in older persons remains to be determined. The objective of this study was to investigate whether a fast decline on eGFR would be associated with incident frailty. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Community dwellers, aged ≥70, were included in this secondary analysis of the 5-year Multidomain Alzheimer Preventive Trial (MAPT). eGFR was calculated using CKD-Epidemiology Collaboration equation at baseline and at 6, 12, and 24 months. The lowest quartile of eGFR slope (-4.1 ml/min per 1.73 m2 per yr) defined a fast decline. The frailty phenotype (unintentional weight loss, exhaustion, low physical activity, slow gait, low handgrip strength assessed with a 0-5 score, where higher is worse; a score ≥3 defines frailty) was assessed at baseline, 6, 12, 24, 36, 48, and 60 months. Cox models were used to test the association between fast eGFR decline and incident frailty. RESULTS A total of 833 participants were frail neither at baseline nor at 2 years and had appropriate follow-up data. Median (IQR) baseline eGFR was 73 (61-84) ml/min per 1.73 m2. Frailty occurred in 95 (11%) participants between 24 and 60 months. Among them, 31/207 (15%) had fast eGFR decline between baseline and 24 months, and 64/626 (10%) did not. In a Cox model adjusted for demographic variables, cardiovascular comorbidity, C-reactive protein, and baseline eGFR, a fast eGFR decline was associated with incident frailty (HR 1.67, 95% CI 1.03 to 2.71). Sensitivity analyses provided consistent findings. CONCLUSIONS In community-dwelling older adults with relatively preserved baseline eGFR, a fast eGFR decline is associated with incident frailty.
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Sanerma P, Paavilainen E, Åstedt-Kurki P. Home care services for older persons. The views of older persons and family members: A realistic evaluation. Int J Older People Nurs 2019; 15:e12281. [PMID: 31621204 DOI: 10.1111/opn.12281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 08/24/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim of the present study was to evaluate client-centred care in older persons' home care services from the perspective of older persons and family members. The following research questions were addressed: How do home care older persons and family members perceive client-centered care in their home care services? What kind of social mechanisms are realized when home care services are implemented? BACKGROUND Several older persons are dependent on home care services for their continued living at home. The fundamental value and best practice of home care is the client-centred care in services. METHOD The research method was realistic evaluation. Six families with six older person clients of home care and seven family members were interviewed. In the present study, the interview contained three themes (1) content and services of the home care, (2) activities and practices of the home care and (3) development of client centredness in home care. Research data were analysed with deductive content analysis. RESULTS Home care service should be based on analysis of older person's individual life situation. Social mechanisms such as interaction, participation, trust and adaptation are realised in implementation of home care services. The most significant outcomes of client-centred service were timely availability of services, safe care relationship and continuity of care, ability to influence on own services and appropriate price of services. Significant factors in quality of service were unhurriedness, kindness and competence of professionals. IMPLICATION FOR PRACTICE Social mechanisms, such as participation, trust, adaptation and interaction, should be taken in account in care relationship in home care. Client centredness and methods for evaluating it should be defined in practical work. Client-centeredness competence should also be included in all stages of professional education of home care.
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Franse CB, Zhang X, van Grieken A, Rietjens J, Alhambra-Borrás T, Durá E, Garcés-Ferrer J, van Staveren R, Rentoumis T, Markaki A, Bilajac L, Vasiljev Marchesi V, Rukavina T, Verma A, Williams G, Clough G, Koppelaar E, Martijn R, Mattace Raso F, Voorham AJJ, Raat H. A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components. J Adv Nurs 2019; 75:3689-3701. [PMID: 31441529 DOI: 10.1111/jan.14181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/19/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
Abstract
AIMS To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. DESIGN Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach. METHODS The UHCE approach intervention consisted of a preventive assessment, shared decision-making on a care plan and enrolment in one or more of four coordinated care-pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis. RESULTS Having limited function was associated with non-enrolment in falls and loneliness care-pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care. CONCLUSIONS Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care. IMPACT Coordinated preventive care approaches for older community-dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care. TRIAL REGISTRATION ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.
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Amoah PA. The Relationship among Functional Health Literacy, Self-Rated Health, and Social Support among Younger and Older Adults in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173188. [PMID: 31480487 PMCID: PMC6747074 DOI: 10.3390/ijerph16173188] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/16/2022]
Abstract
It is well established that health literacy positively affects health outcomes, and social support influences this association. What remains unclear is which aspect of social support (instrumental, informational, and emotional support) is responsible for this effect and whether the influence differs from one population group to another. This study addresses these lacunae. It examines the impact each type of support makes on the relation between functional health literacy (FHL) and self-rated health status among younger and older adults in Ghana. Data were pooled from two cross-sectional surveys, together comprising 521 participants in the Ashanti Region. The results indicated that young adults were more likely to possess sufficient FHL and perceive their health more positively than older adults. While FHL was positively associated with health status, the relation was stronger when young adults received a high level of emotional support. Among older persons, informational support substantially moderated the association between FHL and health status. Thus, social support modifies the relations between FHL and health status among younger and older adults in different ways and to different degrees. Therefore, interventions to improve FHL and health amongst younger and older adults should pay due regard to relevant aspects of social support.
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