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Chen T, Dredze M, Weiner JP, Kharrazi H. Identifying vulnerable older adult populations by contextualizing geriatric syndrome information in clinical notes of electronic health records. J Am Med Inform Assoc 2021; 26:787-795. [PMID: 31265063 DOI: 10.1093/jamia/ocz093] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/12/2019] [Accepted: 05/17/2019] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Geriatric syndromes such as functional disability and lack of social support are often not encoded in electronic health records (EHRs), thus obscuring the identification of vulnerable older adults in need of additional medical and social services. In this study, we automatically identify vulnerable older adult patients with geriatric syndrome based on clinical notes extracted from an EHR system, and demonstrate how contextual information can improve the process. MATERIALS AND METHODS We propose a novel end-to-end neural architecture to identify sentences that contain geriatric syndromes. Our model learns a representation of the sentence and augments it with contextual information: surrounding sentences, the entire clinical document, and the diagnosis codes associated with the document. We trained our system on annotated notes from 85 patients, tuned the model on another 50 patients, and evaluated its performance on the rest, 50 patients. RESULTS Contextual information improved classification, with the most effective context coming from the surrounding sentences. At sentence level, our best performing model achieved a micro-F1 of 0.605, significantly outperforming context-free baselines. At patient level, our best model achieved a micro-F1 of 0.843. DISCUSSION Our solution can be used to expand the identification of vulnerable older adults with geriatric syndromes. Since functional and social factors are often not captured by diagnosis codes in EHRs, the automatic identification of the geriatric syndrome can reduce disparities by ensuring consistent care across the older adult population. CONCLUSION EHR free-text can be used to identify vulnerable older adults with a range of geriatric syndromes.
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Affiliation(s)
- Tao Chen
- Center for Language and Speech Processing, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | - Jonathan P Weiner
- Center for Population Health IT, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hadi Kharrazi
- Center for Population Health IT, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Effective implementation approaches for healthy ageing interventions for older people: A rapid review. Arch Gerontol Geriatr 2020; 92:104263. [PMID: 33010790 DOI: 10.1016/j.archger.2020.104263] [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] [Received: 06/01/2020] [Revised: 09/16/2020] [Accepted: 09/19/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Systematic reviews on healthy ageing interventions have primarily focused on assessing their effectiveness, not the implementation processes underpinning them, and the factors influencing program effectiveness. This has created a knowledge gap about what are effective implementation approaches, and how to scale up such interventions at the population level. Our aim in this rapid review was to synthesise the evidence on implementation of effective healthy ageing interventions, and to identify the factors that influence population-level implementation of these interventions. DESIGN AND METHODS Following the PRISMA checklist, we searched for papers in six databases: Ovid Medline, Ovid Embase, CENTRAL, CINAHL, PsycArticles and PsycINFO. A narrative synthesis was used to summarise the results. RESULTS Twenty-nine articles reporting on 21 healthy ageing interventions (studies) were included in the review. The findings show that a wide range of approaches to implementation were used including collaborative partnership, co-design, use of volunteers, person centred-care, and self-directed/professional-led approaches. The key implementation drivers were the use of behavioural change techniques, social interaction, tailoring of interventions, booster sessions, and multi-component and multi-professional team approach to intervention design and delivery. CONCLUSION The effectiveness of healthy ageing interventions is contingent on a number of factors including the type of implementation approaches used, the context in which programs are implemented, and the specific mechanisms that may be at play at the individual older adult level.
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Social inequalities over the lifecourse and healthy ageing in Aotearoa/New Zealand: differences by Māori ethnicity and gender. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Lifecourse approaches to healthy ageing recognise that health in older age is affected by long-term cumulative inequalities between socio-economic status (SES), gender and ethnicity groups, which begin in childhood. Combining longitudinal survey data with lifecourse history interviews from 729 older New Zealanders aged 61–81 (mean = 72, standard deviation = 4.5), we tested a lifecourse model of predictors of physical, mental and social health in older age. Latent growth curve and mediation analysis showed that the link between childhood SES and late-life health (over 10 years) was mediated by education, occupation and adult wealth. To account for the moderating effects of gender and ethnicity, we modelled the effects for sub-groups separately (225 non-Māori women, 158 Māori women, 219 non-Māori men and 127 Māori men). Childhood SES was an important predictor of later-life health, mediated by education and adult SES for all participants and for non-Māori men. However, there were significantly different pathways for Māori men and for women. Māori men and women and non-Māori women did not attain the same health benefits from higher childhood SES and education as non-Māori men. Findings point to the importance of considering the mediators of lifelong impacts on health in older age, and recognition of how membership of different socially structured groups produces different pathways to late-life health.
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Holman D, Salway S, Bell A. Mapping intersectional inequalities in biomarkers of healthy ageing and chronic disease in older English adults. Sci Rep 2020; 10:13522. [PMID: 32782305 PMCID: PMC7419497 DOI: 10.1038/s41598-020-69934-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/05/2020] [Indexed: 11/29/2022] Open
Abstract
Chronic diseases and their inequalities amongst older adults are a significant public health challenge. Prevention and treatment of chronic diseases will benefit from insight into which population groups show greatest risk. Biomarkers are indicators of the biological mechanisms underlying health and disease. We analysed disparities in a common set of biomarkers at the population level using English national data (n = 16,437). Blood-based biomarkers were HbA1c, total cholesterol and C-reactive protein. Non-blood biomarkers were systolic blood pressure, resting heart rate and body mass index. We employed an intersectionality perspective which is concerned with how socioeconomic, gender and ethnic disparities combine to lead to varied health outcomes. We find granular intersectional disparities, which vary by biomarker, with total cholesterol and HbA1c showing the greatest intersectional variation. These disparities were additive rather than multiplicative. Each intersectional subgroup has its own profile of biomarkers. Whilst the majority of variation in biomarkers is at the individual rather than intersectional level (i.e. intersections exhibit high heterogeneity), the average differences are potentially associated with important clinical outcomes. An intersectional perspective helps to shed light on how socio-demographic factors combine to result in differential risk for disease or potential for healthy ageing.
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Affiliation(s)
- Daniel Holman
- Department of Sociological Studies, University of Sheffield, Sheffield, UK.
| | - Sarah Salway
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Andrew Bell
- Sheffield Methods Institute, University of Sheffield, Sheffield, UK
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Schluter PJ, Askew DA, McKelvey VA, Jamieson HA, Lee M. Oral Health Among Older Adults With Complex Needs Living in the Community and in Aged Residential Care Facilities within New Zealand. J Am Med Dir Assoc 2020; 22:1177-1183.e1. [PMID: 32736993 DOI: 10.1016/j.jamda.2020.06.041] [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] [Received: 03/22/2020] [Revised: 06/10/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the oral health status and dental service use of older adults with complex needs living within the community and aged residential care (ARC) facility settings, and to determine associations between dental service utilization and sociodemographic variables. DESIGN Secondary analysis of 2 continuously recruited national cohorts. SETTING AND PARTICIPANTS Adults aged ≥65 years having standardized assessments between July 1, 2012, and May 31, 2018, within New Zealand and who provided consent. METHODS All community-living older people with complex needs undergo a standardized assessment, using the Home Care International Residential Assessment Instrument (interRAI-HC), whereas all ARC facility residents undergo Long Term Care Facilities assessments (interRAI-LTCF). Anonymized data from consenting participants were extracted. Cross-sectional analyses of oral health status and dental service use variables employed logistic regression models, whereas longitudinal analysis of factors influencing dental service utilization employed binary generalized estimating equation models. RESULTS Overall, 144,380 interRAI-HC assessments from 97,229 participants, and 195,549 interRAI-LTCF assessments from 62,798 participants were eligible. At first assessment, their average age was 81.9 years (range: 65-109 years) and 84.4 years (range: 65-110 years), respectively. Approximately 65% of the participants wore dentures; 9% had broken, fragmented, loose, or otherwise nonintact natural teeth; and 10% reported difficulties chewing. Overall, only 25.3% of community-dwelling older adults and 17.5% of ARC residents had a dental examination within the previous year. Stark inequalities were observed with, for example, Māori participants having adjusted odds 3.14 [95% confidence interval (CI): 2.88, 3.42] and 2.08 (95% CI: 1.81, 2.39) of not having a dental examination in community and ARC facility settings compared with their New Zealand European counterparts. CONCLUSIONS AND IMPLICATIONS Heavy and unequal oral health burdens were observed among older adults with complex needs, together with low dental service uptake. New Zealand needs an oral health policy for older adults.
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Affiliation(s)
- Philip J Schluter
- School of Health Sciences, University of Canterbury-Te Whare Wānanga o Waitaha, Christchurch, New Zealand; School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia.
| | - Deborah A Askew
- School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia; Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Inala, Queensland, Australia
| | - Victoria A McKelvey
- Hospital Dental Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand; Older Person's Health, Canterbury District Health Board, Christchurch, New Zealand
| | - Martin Lee
- Community Dental Service, Canterbury District Health Board, Christchurch, New Zealand
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Markle-Reid M, McAiney C, Ganann R, Fisher K, Gafni A, Gauthier AP, Heald-Taylor G, McElhaney J, Ploeg J, Urajnik DJ, Valaitis R, Whitmore C. Study protocol for a hospital-to-home transitional care intervention for older adults with multiple chronic conditions and depressive symptoms: a pragmatic effectiveness-implementation trial. BMC Geriatr 2020; 20:240. [PMID: 32650732 PMCID: PMC7350576 DOI: 10.1186/s12877-020-01638-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Older adults (> 65 years) with multiple chronic conditions (MCC) and depressive symptoms experience frequent transitions between hospital and home. Care transitions for this population are often poorly coordinated and fragmented, resulting in increased readmission rates, adverse medical events, decreased patient satisfaction and safety, and increased caregiver burden. There is a dearth of evidence on best practices in the provision of transitional care for older adults with MCC and depressive symptoms transitioning from hospital-to-home. This paper presents a protocol for a two-armed, multi-site pragmatic effectiveness-implementation trial of Community Assets Supporting Transitions (CAST), an evidence-informed nurse-led six-month intervention that supports older adults with MCC and depressive symptoms transitioning from hospital-to-home. The Collaborative Intervention Planning Framework is being used to engage patients and other key stakeholders in the implementation and evaluation of the intervention and planning for intervention scale-up to other communities. METHODS Participants will be considered eligible if they are > 65 years, planned for discharged from hospital to the community in three Ontario locations, self-report at least two chronic conditions, and screen positive for depressive symptoms. A total of 216 eligible and consenting participants will be randomly assigned to the control (usual care) or intervention (CAST) arm. The intervention consists of tailored care delivery comprising in-home visits, telephone follow-up and system navigation support. The primary measure of effectiveness is mental health functioning of the older adult participant. Secondary outcomes include changes in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health and social service use and cost, from baseline to 6- and 12-months. Caregivers will be assessed for caregiver strain, depressive symptoms, anxiety, health-related quality of life, and health and social service use and costs. Descriptive and qualitative data from older adult and caregiver participants, and the nurse interventionists will be used to examine implementation of the intervention, how the intervention is adapted within each study region, and its potential for sustainability and scalability to other jurisdictions. DISCUSSION A nurse-led transitional care strategy may provide a feasible and effective means for improving health outcomes and patient/caregiver experience and reduce service use and costs in this vulnerable population. TRIAL REGISTRATION # NCT03157999 . Registration Date: April 4, 2017.
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Affiliation(s)
- Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada. .,Murray Alzheimer Research & Education Program (MAREP), School of Public Health and Health Systems, University of Waterloo,University of Waterloo Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Carrie McAiney
- Murray Alzheimer Research & Education Program (MAREP), School of Public Health and Health Systems, University of Waterloo,University of Waterloo Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Rebecca Ganann
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Kathryn Fisher
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Amiram Gafni
- Department of Health Research Methods, Evidence, and Impact; and Centre for Health Economics and Policy Analysis, McMaster University, 1200 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Alain P Gauthier
- School of Human Kinetics, Laurentian University, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada
| | | | - Janet McElhaney
- Medical Sciences Division, Northern Ontario School of Medicine, Health Sciences North Research Institute, 41 Ramsey Lake Road, Sudbury, ON, P3E 5J1, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Diana J Urajnik
- Centre for Rural and Northern Health Research, Laurentian University, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada
| | - Ruta Valaitis
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Carly Whitmore
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
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Naah FL, Njong AM, Kimengsi JN. Determinants of Active and Healthy Ageing in Sub-Saharan Africa: Evidence from Cameroon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3038. [PMID: 32349334 PMCID: PMC7246554 DOI: 10.3390/ijerph17093038] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/03/2023]
Abstract
This paper examines the determinants and policy implications of active and healthy ageing in Sub-Saharan Africa, taking the case of Bamenda, in Cameroon. Specifically, the study sought to identify and explore the determinants of active and healthy ageing using a mixed-methods approach involving qualitative and quantitative data collection and analysis. Focus group discussions were conducted complemented by a survey (random and snowball sampling) using a structured questionnaire. Narratives and thematic analysis were used to analyze the data generated from the focus group discussion and Tobit regression was employed to analyze the multiple determinants of active ageing by dimensions and on a global scale in Cameroon. Results identified three key dimensions of active and healthy ageing: employment/livelihood options (EL), community support and health (CH) and housing and living in Bamenda (HL). The regression results reveal gender bias in active ageing, a non-effect of education and health on active ageing, and a positive effect of income on active and healthy ageing. This study contributes, among others, to the competence-environmental press theory on active ageing with regards to unbundling context specific determinants of active and healthy ageing. It equally derives policy considerations with regards to gender mainstreaming and the identification of age friendly income earning options to enhance the active and healthy ageing process.
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Affiliation(s)
- Fomba Louisette Naah
- Faculty of Business and Management Sciences, Department of Health Economics, Policy and Management, Catholic University of Cameroon (CATUC), P. O. Box 782 Bamenda, Cameroon;
| | - Aloysius Mom Njong
- Faculty of Economics and Management Sciences, The University of Bamenda, P. O. Box 39, Bambili, Cameroon;
| | - Jude Ndzifon Kimengsi
- Faculty of Environmental Science, Technische Universität Dresden, 01737 Tharandt, Germany
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Getting Old Well in Sub Saharan Africa: Exploring the Social and Structural Drivers of Subjective Wellbeing among Elderly Men and Women in Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072347. [PMID: 32244270 PMCID: PMC7177324 DOI: 10.3390/ijerph17072347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 01/08/2023]
Abstract
While literature attempts to explain why self-reported subjective wellbeing (SWB) generally increases with age in most high-income countries based on a social determinants of a health framework, little work attempts to explain the low levels of self-report SWB among older persons in sub-Saharan Africa. Using the 2013 Uganda Study on Global Aging and Health with 470 individuals, this research examines (i) direct and indirect effects of age on SWB through social and structural determinants, and (ii) how direct and indirect effects vary by gender. Results show a significant direct and negative effect of age on SWB (β = 0.42, p = 0.01). Six indirect paths were statistically significant and their indirect effects on wellbeing varied by gender. Providing support, education, working status, asset level, financial status and financial improvement were significantly positively associated with men’s SWB, whereas younger age, providing community support, participating in group activities, number of close friends/relatives, government assistance and all socio-economic variables were significantly positively associated with women’s SWB. Strategies to address gendered economic, social and political inequalities among and between elderly populations are urgently needed.
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Walker RJ, Garacci E, Campbell JA, Harris M, Mosley-Johnson E, Egede LE. Relationship Between Multiple Measures of Financial Hardship and Glycemic Control in Older Adults With Diabetes. J Appl Gerontol 2020; 40:162-169. [PMID: 32167406 DOI: 10.1177/0733464820911545] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: To examine the relationship between multiple measures of financial hardship and glycemic control in older adults with diabetes. Methods: Using data from Health and Retirement Study (HRS), we investigated four measures of financial hardship: difficulty paying bills, ongoing financial strain, decreasing food intake due to money, and taking less medication due to cost. Using linear regression models, we investigated the relationship between each measure, and a cumulative score of hardships per person, on glycemic control (HbA1c). Results: After adjustment, a significant relationship existed with each increasing number of hardships associated with increasing HbA1c (0.09, [95%CI 0.04, 0.14]). Difficulty paying bills (0.25, [95%CI 0.14, 0.35]) and decreased medication usage due to cost (0.17, [95%CI 0.03, 0.31]) remained significantly associated with HbA1c. Conclusion: In older adults, difficulty paying bills and cost-related medication nonadherence is associated with glycemic control, and every additional financial hardship was associated with an increased HbA1c by nearly 0.1%.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Melissa Harris
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Elise Mosley-Johnson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
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The healthy aging phenotype in older people in Manizales. ACTA ACUST UNITED AC 2020; 40:102-116. [PMID: 32220167 PMCID: PMC7357375 DOI: 10.7705/biomedica.4799] [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: 10/22/2018] [Indexed: 11/27/2022]
Abstract
Introducción. El fenotipo de envejecimiento saludable está presente en aquellos individuos que envejecen con poca morbilidad, sin deterioro funcional ni cognitivo, y con un nivel aceptable de bienestar y de participación social. Objetivo. Establecer la frecuencia del fenotipo de envejecimiento saludable según un modelo multidimensional, uno biomédico y uno psicosocial, y determinar los factores de predicción en cada uno de ellos. Materiales y métodos. Se hizo un estudio de diseño transversal, observacional y descriptivo, que incluyó a 402 personas (50,1 % mujeres) de 65 años y más (promedio de edad, 69,2) en el área urbana de Manizales. El fenotipo de envejecimiento saludable se caracterizó en cinco dimensiones: salud metabólica y fisiológica, función física, función cognitiva, bienestar psicológico y bienestar social. Los factores asociados incluyeron aspectos sociodemográficos y de salud. Resultados. La prevalencia de envejecimiento saludable fue de 15,5 % en el modelo multidimensional, de 12,3 % en el biomédico y de 63,3 % en el psicosocial. El tener autopercepción de buena salud fue un factor de predicción independiente de envejecimiento saludable en los tres modelos, así como la satisfacción con los ingresos económicos en el modelo biomédico y en el psicosocial. Un tercer factor de predicción fue el estar casado, aunque fue significativo solamente en el modelo psicosocial. Conclusiones. La prevalencia del fenotipo de envejecimiento saludable fue baja en el modelo biológico y en el multidimensional (1 de cada 10 personas), y mayor en el modelo psicosocial (6 de cada 10). A pesar de ello, los factores predictores independientes fueron los mismos: la autopercepción de buena o muy buena salud, la satisfacción con los ingresos económicos y el estar casado.
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Stephens C, Szabó Á, Allen J, Alpass F. Livable Environments and the Quality of Life of Older People: An Ecological Perspective. THE GERONTOLOGIST 2020; 59:675-685. [PMID: 29982561 DOI: 10.1093/geront/gny043] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The WHO "Framework for Policy for Healthy Ageing' (2015) focuses on the broader environment and the support it provides for everyday functioning of older people. The concept of "livability" supports this framework by providing a conceptualization of environments that support good quality of life. RESEARCH DESIGN AND METHODS This observational study used an ecological framework of livability to assess cross-sectional relationships between living environments and perceived quality of life among 4,028 respondents, aged 50-89 years who were surveyed in 2016. A 4-step hierarchical model regressed quality of life on individual resources (health, chronic conditions, SES), contextual variables (distance to health care; rural/urban setting), perceptions of housing and neighborhood environments (housing satisfaction, neighborhood quality, neighborhood social cohesion), and interactions between these levels of the ecological model. RESULTS As predicted, housing and neighborhood perceptions contributed an additional 5% variance to the model which explained 49% of quality of life. There were significant interactions between the contextual variables and qualities of housing and neighborhood. DISCUSSION AND IMPLICATIONS These findings support the importance of material and social provisions of housing and neighborhoods to quality of life among older people. The ecological model highlights critical information provided by taking different levels of the environment and personal circumstances into account. The concept of "livability," focusing on perceptions of the environment, can assist a shift from seeking the universal ideal neighborhood toward understanding the ways in which different communities may achieve quality of housing and neighborhood facilities that meet community members' needs.
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Affiliation(s)
| | - Ágnes Szabó
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Joanne Allen
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Fiona Alpass
- School of Psychology, Massey University, Palmerston North, New Zealand
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Kietzman KG, Toy P, Bravo RL, Duru OK, Wallace SP. Multisectoral Collaborations to Increase the Use of Recommended Cancer Screening and Other Clinical Preventive Services by Older Adults. THE GERONTOLOGIST 2020; 59:S57-S66. [PMID: 31100143 DOI: 10.1093/geront/gnz004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Indexed: 01/29/2023] Open
Abstract
The Healthy Aging Partnerships in Prevention Initiative (HAPPI) is a multisectoral collaboration that aims to increase use of recommended cancer screening and other clinical preventive services (CPS) among underserved African American and Latino adults aged 50 and older in South Los Angeles. HAPPI uses the principles of the evidence-based model Sickness Prevention Achieved through Regional Collaboration to increase capacity for the delivery of breast, cervical, and colorectal cancer screening, as well as influenza and pneumococcal immunizations, and cholesterol screening. This article describes HAPPI's collaborative efforts to enhance local capacity by training personnel from community health centers (CHCs) and community-based organizations (CBOs), implementing a small grants program, and forming a community advisory council. HAPPI demonstrates that existing resources in the region can be successfully linked and leveraged to increase awareness and receipt of CPS. Five CHCs expanded quality improvement efforts and eight CBOs reached 2,730 older African Americans and Latinos through locally tailored educational programs that encouraged community-clinic linkages. A community council assumed leadership roles to ensure HAPPI sustainability. The lessons learned from these collective efforts hold promise for increasing awareness and fostering the use of CPS by older adults in underserved communities.
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Affiliation(s)
- Kathryn G Kietzman
- UCLA Center for Health Policy Research, Los Angeles, California.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California
| | - Peggy Toy
- Health DATA Program, UCLA Center for Health Policy Research, Los Angeles, California
| | - Rosana L Bravo
- Department of Health Sciences Education, College of Health Sciences, Western University of Health Sciences, Pomona, California
| | - O Kenrik Duru
- Division of General Internal Medicine and Health Services Research, UCLA Geffen School of Medicine, Los Angeles, California
| | - Steven P Wallace
- UCLA Center for Health Policy Research, Los Angeles, California.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California
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Lima ALBD, Espelt A, Bosque-Prous M, Lima KC. Gender differences in disability among older adults in the context of social gender and income inequalities: 2013 Brazilian Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200002. [DOI: 10.1590/1980-549720200002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/10/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT: Objectives: To estimate the magnitude of gender differences in disability among adults aged 60 and older and to evaluate whether they can be associated with social gender inequality and socioeconomic contextual factors at the level of Brazilian federative units. Methods: This is a multilevel study that used data from 23,575 older adults of 27 federative units who participated in the 2013 Brazilian Health Survey. The activity limitation index was developed from the item response theory, using activities of daily living and instrumental activities of daily living variables. The association of individual and contextual variables with disability was estimated by assessing the magnitude of differences between genders, using cross-level interaction effects in multilevel generalized linear models, including only the variables that were statistically significant in the final model. Results: The prevalence of disability was higher among women (37.6%) than among men (26.5%), totaling 32.7% of the older adults. In the adjusted multilevel analysis, disability was influenced by income inequality (γgini = 0.022, p < 0.001) among federative units. In addition, gender differences in disability were associated with social gender inequalities (γmgiiXsex = 0.020, p = 0.004). Conclusion: Women had higher disability disadvantages compared to men, and those differences were associated with social gender inequalities among the Brazilian federative units influenced by income inequality.
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Affiliation(s)
| | - Albert Espelt
- Universitat de Vic Universitat Central de Catalunya, Spain; Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Spain
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Hebert CA, Trudeau SA, Sprinkle W, Moo LR, McConnell ES. Directed content analysis of Veterans Affairs policy documents: A strategy to guide implementation of a dementia home safety toolkit for Veterans to promote ageing in place. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:182-194. [PMID: 31523881 DOI: 10.1111/hsc.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/17/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
Older adults' preference to age in place, coupled with an increasing prevalence of dementia, creates an imperative to address home safety risks that occur due to cognitive impairment. Providing caregivers with home safety items and education can facilitate ageing in place for older adults living with dementia. In 2015-2017, we examined barriers and facilitators within 17 policy documents and dementia guidelines of the United States (US) Veterans Health Administration pertinent to implementation of a home safety toolkit (HST) for Veterans living with dementia. The documents were issued from 2000 to 2015. Directed qualitative content analysis of these documents guided by themes from stakeholder interviews revealed two key implementation barriers: a focus on physical rather than cognitive risks when determining medical necessity for home equipment, and a focus on rehabilitation and treatment rather than prevention. Mandates for person-centred care planning, including comprehensive assessment, interdisciplinary collaboration, staff education and a focus on population health in primary care facilitate HST implementation. Content analysis can identify policy-level barriers that slow innovation and facilitators that can increase access to care that support ageing in place.
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Affiliation(s)
| | - Scott A Trudeau
- American Occupational Therapy Association, Inc., Bethesda, Maryland
- NE Geriatric Research Education and Clinical Center, Bedford, Massachusetts
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts
| | | | - Lauren R Moo
- New England GRECC, ENRM VAMC, Bedford, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Eleanor S McConnell
- Durham VA Geriatric Research, Education and Clinical Center (GRECC), Durham, North Carolina
- Duke University School of Nursing, Durham, North Carolina
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Welch V, Howe TE, Marcus S, Mathew CM, Sadana R, Rogers M, Sheehy L, Borg J, Pottie K, Thompson‐Coon J, Lyddiatt A, Kristjansson E, Nickerson JW, Walker P, Tanuseputro P, Shea B, Sveistrup H, Babelmorad P, Zhang W. PROTOCOL: Health, social care and technological interventions to improve functional ability of older adults: Evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1054. [PMID: 37131851 PMCID: PMC8356486 DOI: 10.1002/cl2.1054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This is a protocol for a Campbell Evidence and Gap Map. The objectives are to identify and assess the available evidence on health, social care and technological interventions to improve functional ability among older adults.
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Affiliation(s)
- Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | - Tracey E. Howe
- School of Health & Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Sue Marcus
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | | | - Ritu Sadana
- Ageing and Life‐courseWorld Health OrganizationGenevaSwitzerland
| | - Morwenna Rogers
- NIHR PenCLAHRC, Institute of Health ResearchUniversity of Exeter Medical SchoolExeterUK
| | | | - Johan Borg
- Division of Social Medicine and Global HealthLund UniversityMalmoSweden
| | - Kevin Pottie
- Bruyère Research InstituteOttawaONCanada
- Department of Family MedicineUniversity of OttawaOttawaONCanada
| | - Joanna Thompson‐Coon
- NIHR CLAHRC South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolExeterUK
| | | | | | | | - Peter Walker
- Department of MedicineThe Ottawa HospitalOttawaONCanada
| | - Peter Tanuseputro
- Bruyère Research InstituteOttawaONCanada
- Ottawa Hospital Research InstituteOttawaONCanada
| | | | - Heidi Sveistrup
- Bruyère Research InstituteOttawaONCanada
- School of Rehabilitation Sciences, Faculty of Health SciencesUniversity of OttawaOttawaONCanada
| | | | - Wei Zhang
- Vaccines and Health ProductsWorld Health OrganizationGenevaSwitzerland
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Social position and geriatric syndromes among Swedish older people: a population-based study. BMC Geriatr 2019; 19:267. [PMID: 31615441 PMCID: PMC6792184 DOI: 10.1186/s12877-019-1295-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/26/2019] [Indexed: 01/12/2023] Open
Abstract
Background Older people with a low social position are at higher risk of poor health outcomes compared to those with a higher social position. Whether lower social position also increases the risk of geriatric syndromes (GSs) remains to be determined. This study investigates the association of social position with GSs among older community-dwellers. Methods Three consecutive population-based health surveys in 2006, 2010 and 2014 among older community-dwellers (age 65–84 years) in Stockholm County were combined (n = 17,612) and linked with Swedish administrative registry information. Social position was assessed using registry information (i.e. education, country of origin and civil status) and by self-reports (i.e. type of housing and financial stress). GSs were assessed by self-reports of the following conditions: insomnia, urinary incontinence, functional decline, falls, depressive disorder, hearing or vision problems. Binomial logistic regression analyses were used to estimate the association between social position and GSs after adjusting for age, sex, health status, health behavior and social stress. Results The prevalence of GSs was 70.0%, but varied across GSs and ranged from 1.9% for depression to 39.1% for insomnia. Living in rented accommodation, being born outside the Nordic countries, being widowed or divorced were associated with GS presence. Financial stress was most strongly associated with GSs (adjusted odds ratio, 2.59; 95% CI, 2.13–3.15). Conclusion GSs are highly prevalent among older Swedish community-dwellers with wide variations across syndromes and strong association with all measures of social position, most strikingly that of experiencing financial stress.
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Gebremariam KM, Sadana R. On the ethics of healthy ageing: setting impermissible trade-offs relating to the health and well-being of older adults on the path to universal health coverage. Int J Equity Health 2019; 18:140. [PMID: 31488220 PMCID: PMC6727389 DOI: 10.1186/s12939-019-0997-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022] Open
Abstract
This article aims to clarify the moral underpinning of the policy framework of Healthy Ageing. It is a policy adopted by the World Health Organization designed to operate in alignment with the United Nations (UN) framework of the Sustainable Development Goals (SDGs) and the urgency given for the achievement of Universal Health Coverage (UHC). It particularly reflects on what, if anything, justifies protecting the most basic rights to health and well-being of older adults from possible policy trade-offs on the path to UHC.It argues that the dignity of older adults-under which are nested more specific ideas of self-respect, respect for autonomy, as well as the ethical priority for living well-underpins a categorical moral injunction against imposing the familiar utilitarian calculus as the default criterion for policy trade-offs across age groups. Respect for the dignity of older persons marks the moral threshold that every society ought to uphold even under conditions of relative resource scarcity.The moral constraint on permissible policy trade-offs relating to the health of older adults must reflect an understanding of older persons as active agents in the social structure of (their) well-being, not merely as passive vessels through which a good healthy life may or may not occur. We argue that there are three main domains where trade-offs are unacceptable from the moral point of view: it is impermissible (1) to prioritise key service(s) across different (vulnerable) age groups on the basis of actual or future contribution to society, (2) to prioritise across different age groups when co-prioritisation is warranted by the ethical theory, and (3), to always prioritise (by default) services that improve well-being over those that foster respect for dignity and autonomy.
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Affiliation(s)
| | - Ritu Sadana
- Ageing and Life Course, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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Navas P, Llorente S, García L, Tassé MJ, Havercamp SM. Improving healthcare access for older adults with intellectual disability: What are the needs? JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1453-1464. [PMID: 31192529 DOI: 10.1111/jar.12639] [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: 09/13/2018] [Revised: 04/29/2019] [Accepted: 05/28/2019] [Indexed: 02/02/2023]
Abstract
This qualitative study was carried out in Spain with the aim of identifying the changes that the health system should make to improve healthcare access for older adults with intellectual disability. Three hundred and sixty-nine family members and professionals expressed their opinion on how healthcare access could be improved. Participants responded to two open-ended questions included in a general survey about the health status of older individuals with intellectual disability. Most informants were women and professionals who had known the person with intellectual disability for more than 12 months. A system of categories, which showed good inter-rater agreement, was developed to analyse participants' written responses. Both family members and professionals emphasized the need to improve disability training for healthcare practitioners and highlighted the urgent need for flexibility in the structure of a healthcare system that currently overlooks the specific needs of this vulnerable population.
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Affiliation(s)
- Patricia Navas
- Department of Personality, Assessment and Psychological Treatment, University of Salamanca, Salamanca, Spain.,Institute on Community Integration (INICO), University of Salamanca, Salamanca, Spain
| | - Sandra Llorente
- Institute on Community Integration (INICO), University of Salamanca, Salamanca, Spain
| | - Laura García
- Institute on Community Integration (INICO), University of Salamanca, Salamanca, Spain
| | - Marc J Tassé
- Departments of Psychology and Psychiatry, The Ohio State University, Columbus, Ohio.,Nisonger Center - UCEDD, The Ohio State University, Columbus, Ohio
| | - Susan M Havercamp
- Departments of Psychology and Psychiatry, The Ohio State University, Columbus, Ohio.,Nisonger Center - UCEDD, The Ohio State University, Columbus, Ohio
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López MJ, Lapena C, Sánchez A, Continente X, Fernández A. Community intervention to reduce social isolation in older adults in disadvantaged urban areas: study protocol for a mixed methods multi-approach evaluation. BMC Geriatr 2019; 19:44. [PMID: 30777022 PMCID: PMC6380012 DOI: 10.1186/s12877-019-1055-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/31/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The proportion of older people has dramatically increased in recent decades. Moreover, social and demographic trends show a global increase of older people at risk of loneliness and lack of social relationships. The objective of this study was to evaluate the process, the effectiveness and the cost-effectiveness of a planned 22 weekly group sessions called School of Health for Older People to reduce social isolation. METHODS This is a mixed methods multi-approach evaluation that includes: 1) A qualitative evaluation among coordinators and participants taking part in the intervention, through in depth-interviews and focus groups, respectively. The main topics covered will be positive and negative aspects of the intervention, suggestions for its improvement, opinions on different aspects of the intervention, and perceived benefits; 2) A quantitative quasi-experimental design, comparing a group of individuals taking part in the intervention with another group with similar characteristics not receiving the intervention. Data will be collected at the beginning and at the end of the intervention. Social support will be measured through questions drawn from the Medical Outcomes Study and the National Social Life, Health, and Aging Project questionnaires. Psychological morbidity will be measured through Goldberg's General Health Questionnaire, and Health-related Quality of Life will be measured through the EuroQoL questionnaire. Information on visits to the primary care center in the years before and after the intervention will be obtained from the electronic records of the primary care centers; 3) A cost-utility analysis, which will be conducted from a health system (primary care) perspective, including direct costs of the program and the primary care health services used. The effects of the intervention will be measured on quality-adjusted life years. DISCUSSION There is an urgent need for studies assessing the effectiveness and the efficiency of potential interventions to reduce social isolation among older persons. The results of this study will help to fill the knowledge gap in this area and might be especially useful for the development of social and public health policies and programs for older people in disadvantaged neighborhoods in urban areas. TRIAL REGISTRATION NCT03142048 retrospectively registered (April 11, 2017).
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Affiliation(s)
- María José López
- Public Health Agency of Barcelona, Lesseps, 1, 08023 Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Carolina Lapena
- Centre d’Atenció Primària Sanllehy, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès Spain
| | - Alba Sánchez
- Preventive Medicine Department, University Hospital of Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Continente
- Public Health Agency of Barcelona, Lesseps, 1, 08023 Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Ana Fernández
- Public Health Agency of Barcelona, Lesseps, 1, 08023 Barcelona, Spain
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Sadana R, Soucat A, Beard J. Universal health coverage must include older people. Bull World Health Organ 2019; 96:2-2A. [PMID: 29403091 PMCID: PMC5791875 DOI: 10.2471/blt.17.204214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ritu Sadana
- Department of Ageing and Life Course, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Agnes Soucat
- Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - John Beard
- Department of Ageing and Life Course, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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Leroux J, Morrison K, Rosenberg M. Prevalence and Predictors of Food Insecurity among Older People in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2511. [PMID: 30423975 PMCID: PMC6267450 DOI: 10.3390/ijerph15112511] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 11/17/2022]
Abstract
Background: Food insecurity research has been mainly examined among young people. The root causes of food insecurity are closely linked to poverty, and social policies and income supplements, including public and private pensions, have been shown to sharply curb food insecurity into later life. However, social, economic, and political trends that are closely connected to social and health inequalities threaten to undermine the conditions that have limited food insecurity among older people until now. Exploring the prevalence and predictors of food insecurity among older people across Canada has important implications for domestic policies concerning health, healthcare, and social welfare. Methods: Data come from the Canadian Community Health Survey 2012 Annual Component (n = 14,890). Descriptive statistics and a generalized linear model approach were used to determine prevalence and estimate the associations between food insecurity-as measured by the Household Food Security Survey Module-and social, demographic, geographic, and economic factors. Results: Approximately 2.4% of older Canadians are estimated to be moderately or severely food insecure. Income was by far the strongest predictor of food insecurity (total household income <$20,000 compared to >$60,000, OR: 46.146, 95% CI: 12.523⁻170.041, p < 0.001). Younger older people, and those with a non-white racial background also had significantly greater odds of food insecurity (ages 75+ compared to 65⁻74, OR: 0.322, 95% CI: 0.212⁻0.419, p < 0.001; and OR: 2.429, 95% CI: 1.438⁻4.102, p < 0.001, respectively). Sex, home ownership, marital status, and living arrangement were all found to confound the relationship between household income and food insecurity. Prevalence of food insecurity varied between provinces and territories, and odds of food insecurity were approximately five times greater for older people living in northern Canada as compared to central Canada (OR: 5.189, 95% CI: 2.329⁻11.562, p < 0.001). Conclusion: Disaggregating overall prevalence of food insecurity among older people demonstrates how disparities exist among sub-groups of older people. The seemingly negligible existence of food insecurity among older people has obscured the importance, practicality, and timeliness of including this age group in research on food insecurity. The current research underscores the critical importance of an income floor in preventing food insecurity among older people, and contributes a Canadian profile of the prevalence and predictors of food insecurity among older people to the broader international literature.
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Affiliation(s)
- Janette Leroux
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Kathryn Morrison
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 0B9, Canada.
- Department of Geography and Planning, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Mark Rosenberg
- Department of Geography and Planning, Queen's University, Kingston, ON K7L 3N6, Canada.
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Healthy Ageing and Health Equity: Broader Determinants of Health with a Spotlight on Climate Change. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/978-3-319-96529-1_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Rotarou ES, Sakellariou D. Structural disadvantage and (un)successful ageing: gender differences in activities of daily living for older people in Chile. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1492092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet 2018; 391:2236-2271. [PMID: 29893224 PMCID: PMC5986687 DOI: 10.1016/s0140-6736(18)30994-2] [Citation(s) in RCA: 512] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/23/2018] [Accepted: 04/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. FINDINGS In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. INTERPRETATION GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations. FUNDING Bill & Melinda Gates Foundation.
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Marsman D, Belsky DW, Gregori D, Johnson MA, Low Dog T, Meydani S, Pigat S, Sadana R, Shao A, Griffiths JC. Healthy ageing: the natural consequences of good nutrition-a conference report. Eur J Nutr 2018; 57:15-34. [PMID: 29799073 PMCID: PMC5984649 DOI: 10.1007/s00394-018-1723-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many countries are witnessing a marked increase in longevity and with this increased lifespan and the desire for healthy ageing, many, however, suffer from the opposite including mental and physical deterioration, lost productivity and quality of life, and increased medical costs. While adequate nutrition is fundamental for good health, it remains unclear what impact various dietary interventions may have on prolonging good quality of life. Studies which span age, geography and income all suggest that access to quality foods, host immunity and response to inflammation/infections, impaired senses (i.e., sight, taste, smell) or mobility are all factors which can limit intake or increase the body's need for specific micronutrients. New clinical studies of healthy ageing are needed and quantitative biomarkers are an essential component, particularly tools which can measure improvements in physiological integrity throughout life, thought to be a primary contributor to a long and productive life (a healthy "lifespan"). A framework for progress has recently been proposed in a WHO report which takes a broad, person-centered focus on healthy ageing, emphasizing the need to better understand an individual's intrinsic capacity, their functional abilities at various life stages, and the impact by mental, and physical health, and the environments they inhabit.
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Affiliation(s)
- D Marsman
- Procter & Gamble, Cincinnati, OH, USA
| | - D W Belsky
- Duke University, Raleigh-Durham, NC, USA
| | | | | | - T Low Dog
- Integrative Medicine Concepts, Tucson, AZ, USA
| | | | - S Pigat
- Creme Global, Dublin, Ireland
| | - R Sadana
- World Health Organization, Geneva, Switzerland
| | - A Shao
- Amway/Nutrilite, Buena Park, CA, USA
| | - J C Griffiths
- Council for Responsible Nutrition-International, Washington, DC, USA.
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Johnson S, Bacsu J. Understanding complex care for older adults within Canadian home care: a systematic literature review. Home Health Care Serv Q 2018; 37:232-246. [PMID: 29578846 DOI: 10.1080/01621424.2018.1456996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In the context of an aging population, both the need for home care services and its complexity of care have increased in many high-income countries. Yet, the definition of what constitutes complex care is largely elusive. This systematic review examined the conceptual definition of complex care within the home care environment using several social and health science databases for research published from 2000 to 2017. Of the 25 articles and reports identified, only 16 addressed complex care specifically and included older adults, aging, and/or home care. The results showed that complex care for older adults is primarily defined from a biomedical approach focusing on chronic disease and management and less commonly from the perspective of the social determinants of health. Future studies should consider the importance of the continuum of care needs from both the biomedical and the social determinants to adequately plan and provide care for older adults.
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Affiliation(s)
- Shanthi Johnson
- a Faculty of Kinesiology and Health Studies and Saskatchewan Population Health and Evaluation Research Unit , University of Regina , Regina , Canada
| | - Juanita Bacsu
- a Faculty of Kinesiology and Health Studies and Saskatchewan Population Health and Evaluation Research Unit , University of Regina , Regina , Canada
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Damião R, Meneguci J, da Silva Santos Á, Matijasevich A, Rossi Menezes P. Nutritional Risk and Quality of Life in Community-Dwelling Elderly: A Cross-Sectional Study. J Nutr Health Aging 2018; 22:111-116. [PMID: 29300430 DOI: 10.1007/s12603-017-0935-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the association between nutritional risk and quality of life in community-dwelling elderly. METHOD A cross-sectional study of individuals aged 60 years or older living in the Brazilian state of Minas Gerais was conducted. Nutritional status was evaluated using the Mini Nutritional Assessment, and quality of life was determined using the WHOQOL-bref and WHOQOL-old. The absolute and relative frequency distributions for each domain were calculated, and chi-square tests were used to examine the association between nutritional risk and quality of life (dichotomous variables). Poisson regression was used to perform univariate and multivariate analyses. RESULTS 789 (27.9%) of the 2823 elderly patients in the sample were at nutritional risk. The risk of malnutrition was associated with the physical, environment, psychological, sensory abilities, social participation and intimacy domains of quality of life [(PR= 1.42, 95%CI 1.23-1.63); (PR= 1.28, 95%CI 1.12-1.47); (PR= 1.18, 95%CI 1.03-1.36); (PR= 1.36, 95%CI 1.20-1.54); (PR= 1.29, 95%CI 1.13-1.46); (PR= 1.14, 95%CI 1.01-1.29); respectively]. CONCLUSION The present findings contribute to the understanding of nutritional risk, and support the association between quality of life and nutritional status. These factors should be considered in the diagnosis, monitoring and treatment of nutritional disorders, and may contribute to the prevention and reduction of nutritional risk in this especially vulnerable population.
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Affiliation(s)
- R Damião
- Renata Damião, Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Av. Tutunas, 490, CEP: 38061-500, Uberaba, MG, Brazil, Tel.: + 55 34 3700-6603, E-mail addresses:
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Kuruvilla S, Sadana R, Montesinos EV, Beard J, Vasdeki JF, Araujo de Carvalho I, Thomas RB, Drisse MNB, Daelmans B, Goodman T, Koller T, Officer A, Vogel J, Valentine N, Wootton E, Banerjee A, Magar V, Neira M, Bele JMO, Worning AM, Bustreo F. A life-course approach to health: synergy with sustainable development goals. Bull World Health Organ 2017; 96:42-50. [PMID: 29403099 PMCID: PMC5791871 DOI: 10.2471/blt.17.198358] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 12/03/2022] Open
Abstract
A life-course approach to health encompasses strategies across individuals’ lives that optimize their functional ability (taking into account the interdependence of individual, social, environmental, temporal and intergenerational factors), thereby enabling well-being and the realization of rights. The approach is a perfect fit with efforts to achieve universal health coverage and meet the sustainable development goals (SDGs). Properly applied, a life-course approach can increase the effectiveness of the former and help realize the vision of the latter, especially in ensuring health and well-being for all at all ages. Its implementation requires a shared understanding by individuals and societies of how health is shaped by multiple factors throughout life and across generations. Most studies have focused on noncommunicable disease and ageing populations in high-income countries and on epidemiological, theoretical and clinical issues. The aim of this article is to show how the life-course approach to health can be extended to all age groups, health topics and countries by building on a synthesis of existing scientific evidence, experience in different countries and advances in health strategies and programmes. A conceptual framework for the approach is presented along with implications for implementation in the areas of: (i) policy and investment; (ii) health services and systems; (iii) local, multisectoral and multistakeholder action; and (iv) measurement, monitoring and research. The SDGs provide a unique context for applying a holistic, multisectoral approach to achieving transformative outcomes for people, prosperity and the environment. A life-course approach can reinforce these efforts, particularly given its emphasis on rights and equity.
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Affiliation(s)
- Shyama Kuruvilla
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ritu Sadana
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Eugenio Villar Montesinos
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - John Beard
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Jennifer Franz Vasdeki
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Rebekah Bosco Thomas
- Department of Gender, Equity and Human Rights, World Health Organization, Geneva, Switzerland
| | - Marie-Noel Brunne Drisse
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Tracey Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Theadora Koller
- Department of Gender, Equity and Human Rights, World Health Organization, Geneva, Switzerland
| | - Alana Officer
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Joanna Vogel
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Nicole Valentine
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Emily Wootton
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Veronica Magar
- Department of Gender, Equity and Human Rights, World Health Organization, Geneva, Switzerland
| | - Maria Neira
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Jean Marie Okwo Bele
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Anne Marie Worning
- Office of the Director-General, World Health Organization, Geneva, Switzerland
| | - Flavia Bustreo
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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Canedo-García A, García-Sánchez JN, Pacheco-Sanz DI. A Systematic Review of the Effectiveness of Intergenerational Programs. Front Psychol 2017; 8:1882. [PMID: 29163269 PMCID: PMC5663734 DOI: 10.3389/fpsyg.2017.01882] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/11/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose of the study: The objective of the present review study is to identify the determinant elements of the effectiveness of empirically based interventions (EBI) in the field of intergenerational work, contrasting face-to-face and combined (face-to-face and virtual) intervention modalities against variables relating to this field according to EBI indicators. Design and Methods: An extensive literature search returned a total of 553 studies. Of these, just 50 studies met the inclusion criteria of being an empirical investigation of the effectiveness of intergenerational programs that contain appropriate elaboration on theoretical constructs and methods. Results: The descriptive and multivariate analysis conducted demonstrates that programs with a greater number of EBI controls have the greatest effectiveness, regardless of the intervention mode employed, and that this effectiveness is also modulated by other variables such as the participants' disabilities, their literacy level, or their membership of an organization. Conclusions: We examined the implications of these findings, noting the need to increase the number of virtual interventions that could improve the efficiency of the activities undertaken, and at the same time ensuring that EBI indicators are also fulfilled.
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Ilinca S, Rodrigues R, Schmidt AE. Fairness and Eligibility to Long-Term Care: An Analysis of the Factors Driving Inequality and Inequity in the Use of Home Care for Older Europeans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101224. [PMID: 29036885 PMCID: PMC5664725 DOI: 10.3390/ijerph14101224] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/22/2017] [Accepted: 10/02/2017] [Indexed: 11/30/2022]
Abstract
In contrast with the case of health care, distributional fairness of long-term care (LTC) services in Europe has received limited attention. Given the increased relevance of LTC in the social policy agenda it is timely to evaluate the evidence on inequality and horizontal inequity by socio-economic status (SES) in the use of LTC and to identify the socio-economic factors that drive them. We address both aspects and reflect on the sensitivity of inequity estimates to adopting different definitions of legitimate drivers of care need. Using Survey of Health, Ageing and Retirement in Europe (SHARE)data collected in 2013, we analyse differences in home care utilization between community-dwelling Europeans in nine countries. We present concentration indexes and horizontal inequity indexes for each country and results from a decomposition analysis across income, care needs, household structures, education achievement and regional characteristics. We find pro-poor inequality in home care utilization but little evidence of inequity when accounting for differential care needs. Household characteristics are an important contributor to inequality, while education and geographic locations hold less explanatory power. We discuss the findings in light of the normative assumptions surrounding different definitions of need in LTC and the possible regressive implications of policies that make household structures an eligibility criterion to access services.
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Affiliation(s)
- Stefania Ilinca
- European Centre for Social Welfare Policy and Research, 1090 Vienna, Austria.
| | - Ricardo Rodrigues
- European Centre for Social Welfare Policy and Research, 1090 Vienna, Austria.
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81
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Michel JP, Sadana R. "Healthy Aging" Concepts and Measures. J Am Med Dir Assoc 2017; 18:460-464. [PMID: 28479271 DOI: 10.1016/j.jamda.2017.03.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ritu Sadana
- Aging and Life Course, World Health Organization, Geneva, Switzerland
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Beard JR, Officer AM, Cassels AK. The World Report on Ageing and Health. THE GERONTOLOGIST 2017; 56 Suppl 2:S163-6. [PMID: 26994257 DOI: 10.1093/geront/gnw037] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- John R Beard
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Alana M Officer
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Andrew K Cassels
- Global Health Programme, The Graduate Institute of International and Development Studies, Geneva, Switzerland
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Abstract
OBJECTIVES Successful aging continues to be applied in a variety of contexts and is defined using a number of different constructs. Although previous reviews highlight the multidimensionality of successful aging, a few have focused exclusively on non-biomedical factors, as was done here. METHODS This scoping review searched Ovid Medline database for peer-reviewed English-language articles published between 2006 and 2015, offering a model of successful aging and involving research with older adults. RESULTS Seventy-two articles were reviewed. Thirty-five articles met the inclusion criteria. Common non-biomedical constructs associated with successful aging included engagement, optimism and/or positive attitude, resilience, spirituality and/or religiosity, self-efficacy and/or self-esteem, and gerotranscendence. DISCUSSION Successful aging is a complex process best described using a multidimensional model. Given that the majority of elders will experience illness and/or disease during the life course, public health initiatives that promote successful aging need to employ non-biomedical constructs, facilitating the inclusion of elders living with disease and/or disability.
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Affiliation(s)
- Lisa F Carver
- Department of Sociology, Queen's University Kingston, ON, Canada
| | - Diane Buchanan
- School of Nursing, Queen's University Kingston, ON, Canada
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Kristiansen M, Razum O, Tezcan-Güntekin H, Krasnik A. Aging and health among migrants in a European perspective. Public Health Rev 2016; 37:20. [PMID: 29450062 PMCID: PMC5809957 DOI: 10.1186/s40985-016-0036-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/05/2016] [Indexed: 11/10/2022] Open
Abstract
Population aging and the associated changes in demographic structures and healthcare needs is a key challenge across Europe. Healthy aging strategies focus on ensuring the ability to maintain health, quality of life and independent living at old age. Concurrent to the process of population aging, the demographics of Europe are affected by increased migration resulting in substantial ethnic diversity. In this paper, we narratively review the health profile of the growing proportion of aging migrants in Europe, outline key factors shaping health among this diverse group and consider ways of addressing their healthcare needs. Although factors shaping aging processes are largely similar across populations, migrant-specific risk factors exist. These include exposure to health risks before and during migration; a more disadvantaged socioeconomic position; language barriers and low health literacy; cultural factors influencing health-seeking behaviours; and psychosocial vulnerability and discrimination affecting health and quality of life. Overall, migrants experience the same morbidity and mortality causes as the native populations, but with different relative importance, severity and age of onset and with substantial differences within and between migrant groups. Little is known regarding health behaviours among aging migrants, although differences in cancer screening behaviours have been identified. Indications of widening health differentials between migrants and native populations with age and informal barriers to quality healthcare for aging migrants are causes of concern. In conclusion, there is a need for attention to migration alongside other determinants of healthy aging. The diversity in individual characteristics, life course processes and contextual factors shaping aging processes among migrants point to the need for a sensitive and comprehensive approach to policies, practices and research within the field of healthy aging. This is important to accommodate for the needs of the growing number of aging migrants in Europe and counter inequities in health and well-being at old age.
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Affiliation(s)
- Maria Kristiansen
- 1Center for Healthy Aging (CEHA), Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Oliver Razum
- 2Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Hürrem Tezcan-Güntekin
- 2Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Allan Krasnik
- 1Center for Healthy Aging (CEHA), Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,3Danish Research Center for Migration, Ethnicity and Health (MESU), Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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van Riet-Nales DA, Hussain N, Sundberg KA, Eggenschwyler D, Ferris C, Robert JL, Cerreta F. Regulatory incentives to ensure better medicines for older people: From ICH E7 to the EMA reflection paper on quality aspects. Int J Pharm 2016; 512:343-351. [DOI: 10.1016/j.ijpharm.2016.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 04/29/2016] [Accepted: 05/01/2016] [Indexed: 10/21/2022]
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Sadana R. Commentary on “Healthy ageing: Evidence that improvement is possible at every age”. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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