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de Siqueira Silva Í, de Araújo AJ, Lopes RH, Silva CRDV, Xavier PB, de Figueirêdo RC, Brito EWG, Lapão LV, Martiniano CS, de Araújo Nunes VM, da Costa Uchôa SA. Digital home care interventions and quality of primary care for older adults: a scoping review. BMC Geriatr 2024; 24:507. [PMID: 38858634 PMCID: PMC11163791 DOI: 10.1186/s12877-024-05120-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Population aging is forcing the transformation of health care. Long-term care in the home is complex and involves complex communication with primary care services. In this scenario, the expansion of digital health has the potential to improve access to home-based primary care; however, the use of technologies can increase inequalities in access to health for an important part of the population. The aim of this study was to identify and map the uses and types of digital health interventions and their impacts on the quality of home-based primary care for older adults. METHODS This is a broad and systematized scoping review with rigorous synthesis of knowledge directed by the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The quantitative data were analyzed through descriptive statistics, and the qualitative data were analyzed through basic qualitative content analysis, considering the organizational, relational, interpersonal and technical dimensions of care. The preliminary results were subjected to consultation with stakeholders to identify strengths and limitations, as well as potential forms of socialization. RESULTS The mapping showed the distribution of publications in 18 countries and in the Sub-Saharan Africa region. Older adults have benefited from the use of different digital health strategies; however, this review also addresses limitations and challenges, such as the need for digital literacy and technological infrastructure. In addition to the impacts of technologies on the quality of health care. CONCLUSIONS The review gathered priority themes for the equitable implementation of digital health, such as access to home caregivers and digital tools, importance of digital literacy and involvement of patients and their caregivers in health decisions and design of technologies, which must be prioritized to overcome limitations and challenges, focusing on improving quality of life, shorter hospitalization time and autonomy of older adults.
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Affiliation(s)
- Ísis de Siqueira Silva
- Postgraduate in Collective Health, Federal University of Rio Grande Do Norte, Natal, Brazil.
| | | | | | | | - Pedro Bezerra Xavier
- Postgraduate in Health Sciences, Federal University of Rio Grande Do Norte, Natal, Brazil
| | | | | | - Luís Velez Lapão
- Institute of Hygiene and Tropical Medicine, Global Health and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
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Greeley B, Chung SS, Graves L, Song X. Combating Barriers to the Development of a Patient-Oriented Frailty Website. JMIR Aging 2024; 7:e53098. [PMID: 38807317 DOI: 10.2196/53098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/02/2024] [Accepted: 03/07/2024] [Indexed: 05/30/2024] Open
Abstract
Unlabelled This viewpoint article, which represents the opinions of the authors, discusses the barriers to developing a patient-oriented frailty website and potential solutions. A patient-oriented frailty website is a health resource where community-dwelling older adults can navigate to and answer a series of health-related questions to receive a frailty score and health summary. This information could then be shared with health care professionals to help with the understanding of health status prior to acute illness, as well as to screen and identify older adult individuals for frailty. Our viewpoints were drawn from 2 discussion sessions that included caregivers and care providers, as well as community-dwelling older adults. We found that barriers to a patient-oriented frailty website include, but are not limited to, its inherent restrictiveness to frail persons, concerns over data privacy, time commitment worries, and the need for health and lifestyle resources in addition to an assessment summary. For each barrier, we discuss potential solutions and caveats to those solutions, including assistance from caregivers, hosting the website on a trusted source, reducing the number of health questions that need to be answered, and providing resources tailored to each users' responses, respectively. In addition to screening and identifying frail older adults, a patient-oriented frailty website will help promote healthy aging in nonfrail adults, encourage aging in place, support real-time monitoring, and enable personalized and preventative care.
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Tavemark S, Kihlgren A, Norell Pejner M, James I. Individual goal-setting in municipal homecare: A participatory appreciative action and reflection study. J Public Health Res 2023; 12:22799036231181198. [PMID: 37361239 PMCID: PMC10285594 DOI: 10.1177/22799036231181198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/28/2023] [Indexed: 06/28/2023] Open
Abstract
Background There is a need for structural change in municipal homecare to shift power to older persons and to center the individuals in need. To make this change, the individual older persons should have enough self-determination to formulate their own individual homecare goals. Our aim was to explore how stakeholders reason about individual goal-setting in homecare. Design and methods We theoretically and methodologically used a participatory appreciative action and reflection (PAAR) design. The stakeholders, that is, the older persons, the older persons' relatives, and the multi-professional team, were seen as co-researchers. Data were collected between 2019 and 2020 through in depth-interviews, focus group discussions, and reference groups. The data were analyzed using thematic analysis. Results We learned from the stakeholders that it was a struggle to sustain the individual's goal to continue life as usual, that is, being an ordinary human being with an ordinary everyday life and maintaining individual roles. The individual wants to improve health, be active, and enjoying life. The individuals were struggling against the homecare organization, which tended to overshadow the individual's goals. The individual's goals fall under several legal jurisdictions and come to be overshadowed by the professionals' dominant goal. The organization is rigid, with finances and resources creating the framework. Conclusion We learned that older persons receiving homecare must have the same rights as other citizens in society, which is in line with public health goals.
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Affiliation(s)
- Sofia Tavemark
- School of Health Sciences, Örebro University, Örebro, Sweden
- Örebro Municipality Healthcare and Social Services, Örebro, Sweden
- Research Environment: Older People’s Health and Living Condition, Örebro University, Örebro, Sweden
| | - Annica Kihlgren
- School of Health Sciences, Örebro University, Örebro, Sweden
- Research Environment: Older People’s Health and Living Condition, Örebro University, Örebro, Sweden
| | - Margaretha Norell Pejner
- School of Health Sciences, Örebro University, Örebro, Sweden
- Research Environment: Older People’s Health and Living Condition, Örebro University, Örebro, Sweden
- Department of Home Care, Halmstad Municipality, Halmstad, Sweden
| | - Inger James
- Research Environment: Older People’s Health and Living Condition, Örebro University, Örebro, Sweden
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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Dang S, Desir M, Lamba S, Muralidhar K, Tang F, Valencia WM. Recognizing the Needs of High-Need High-Risk Veterans. Clin Interv Aging 2022; 17:1907-1918. [PMID: 36601358 PMCID: PMC9807015 DOI: 10.2147/cia.s280437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/22/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction Understanding the needs of higher-risk older adult patients can support the delivery of high quality and patient-centered healthcare. We sought to characterize the physical, functional, social and psychological needs of High-Need High-Risk (HNHR) Veterans. We hypothesized that the concept of frailty could be useful in identifying the highest-risk HNHR patients and characterizing their needs. Methods We conducted a cross-sectional study of Veterans in the Miami Veterans Affairs Healthcare System who were identified as High-Need High-Risk by the Department of Veterans Affairs (VA) using data analytic techniques. We analyzed data of 634 Veterans who completed questionnaires by mail, telephone or in person. We assessed the Veterans' frailty status and needs in the physical, functional, psychological and social domains. Beyond descriptive statistics, we used Chi-square (χ 2) test, one-way ANOVA and Kruskal-Wallis to analyze whether there were differences in Veterans' needs in relation to frailty status. Results The HNHR Veterans who participated in the questionnaire had complex needs that spanned the physical, functional, psychological, and social domains. We observed a potential mismatch between functional needs and social support; over two-thirds of respondents endorsed having dependence in at least one ADL but only about a third of respondents reported having a caregiver. Patients with frailty had higher levels of functional dependence and were more likely than the other HNHR respondents to report recent falls, recent hospitalizations, depression, and transportation issues. Conclusion High-Need High-Risk Veterans have complex needs related to the physical, functional, psychological and social domains. Within the HNHR population, HNHR Veterans with frailty appear to have particularly high levels of risk and multidomain needs. Increased attention to identifying members of these groups and aligning them with biopsychosocial interventions that are targeted to their specific needs may support development of appropriate strategies and care-models to support HNHR Veterans.
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Affiliation(s)
- Stuti Dang
- Miller School of Medicine, University of Miami, Miami, FL, USA,Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, FL, USA,Department of Veterans Affairs Elizabeth Dole Center of Excellence in Veteran and Caregiver Research, Miami, FL, USA,Correspondence: Stuti Dang, Email
| | - Marianne Desir
- Miller School of Medicine, University of Miami, Miami, FL, USA,Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, FL, USA,Department of Veterans Affairs Elizabeth Dole Center of Excellence in Veteran and Caregiver Research, Miami, FL, USA
| | - Shiv Lamba
- Washington University, St. Louis, MO, USA
| | | | - Fei Tang
- Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, FL, USA
| | - Willy Marcos Valencia
- Division of Endocrinology, Diabetes and Metabolic Diseases, Medical University of South Carolina, Charleston, SC, USA
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Giosa JL, Byrne K, Stolee P. Person- and family-centred goal-setting for older adults in Canadian home care: A solution-focused approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2445-e2456. [PMID: 34931382 PMCID: PMC9543740 DOI: 10.1111/hsc.13685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 05/13/2023]
Abstract
Goal-setting with older adults in home care is often inhibited by a lack of structure to support person- and family-centred care planning, paternalistic decision-making and task-oriented delivery models. The objective of this research study was to determine how goal-setting practices for older adults could be re-oriented around individuals' self-perceived goals, needs and preferences. Solution-focused semi-structured key informant interviews were conducted with older adult home care clients aged 65 years and older (n = 13) and their family/friend caregivers (n = 12) to explore changes, solutions and strategies for person- and family-centred goal-setting. Participants were recruited through community advertisement in a single region of Ontario, Canada between July and October of 2017. Interviews were conducted in-person and were audio-recorded and transcribed verbatim. Thematic analysis was guided by a multi-step framework method. Four themes emerged from the data: (1) seeing beyond age enables respect and dignity; (2) relational communication involves two-way information sharing; (3) doing 'with' instead of doing 'for' promotes participation and (4) collaboration is easier when older adults and caregivers lead the way. Older adults and caregivers want to be actively engaged in dialogue during care planning to ensure their preferences are included. The findings from this study add the direct perspectives of older adults and their caregivers to literature on solutions to address ageism, improve communication, enhance information sharing and promote collaboration in geriatric care. Next steps for this work could involve testing the changes, solutions and strategies that emerged to determine the effect on person- and family-centred home care delivery.
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Affiliation(s)
- Justine L. Giosa
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
- SE Research CentreSE HealthMarkhamOntarioCanada
| | - Kerry Byrne
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Paul Stolee
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
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Shin JW, Kim EY, Son YJ. Home-dwelling older adults' experiences of living with both frailty and multimorbidity: A meta-ethnography. Geriatr Nurs 2022; 47:191-200. [PMID: 35940037 DOI: 10.1016/j.gerinurse.2022.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To systematically review qualitative studies about home-dwelling older adults' experiences of living with both frailty and multimorbidity. METHODS This study adopted a meta-ethnography; the databases included PubMed, Embase, CINAHL, Web of Science, PsycINFO, SCOPUS, and Google Scholar. Qualitative peer-reviewed articles in English were searched up to December 31, 2021. Themes and concepts were extracted through constant comparison across the included studies by three reviewers. RESULTS Of the 147 articles screened, nine qualitative articles, encompassing a total sample of 173 participants, were included. The four final synthesised themes were 'Being isolated in a closed life,' 'Being dependent on help from others,' 'Rebuilding to maximise quality of life,' and 'Struggling to live a meaningful life.' CONCLUSION Home-dwelling older adults with both frailty and multimorbidity are more likely to be socially isolated due to their physical limitations and lack of integration between hospital-based care and community healthcare services.
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Affiliation(s)
| | | | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok ro, Dongjak-gu, Seoul 06974, South Korea.
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Chang R, Low H, McDonald A, Park G, Song X. Web-based software applications for frailty assessment in older adults: a scoping review of current status with insights into future development. BMC Geriatr 2021; 21:723. [PMID: 34922466 PMCID: PMC8683817 DOI: 10.1186/s12877-021-02660-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background A crucial aspect of continued senior care is the early detection and management of frailty. Developing reliable and secure electronic frailty assessment tools can benefit virtual appointments, a need especially relevant in the context of the COVID-19 pandemic. An emerging effort has targeted web-based software applications to improve accessibility and usage. The objectives of this scoping review are to identify and evaluate web-based frailty assessment tools currently available and to identify challenges and opportunities for future development. Methods We conducted a review with literature (e.g., using MEDLINE databases) and Google searches (last updated on October 10, 2021). Each of the identified web applications were assessed based on eight featured categories and assigned a rating score accordingly. Results Twelve web-based frailty assessment applications were found, chiefly provided by the USA (50%) or European countries (41%) and focused on frailty grading and outcome prediction for specific patient groups (59%). Categories that scored well among the applications included the User Interface (2.8/3) and the Cost (2.7/3). Other categories had a mean score of 1.6/3 or lower. The least developed feature was Data Saving. Conclusions Web-based applications represent a viable option for remote frailty assessments and multidisciplinary integrated care of older adults. Despite the available web-based frailty assessments on the Internet, many missed certain needed features for professional use in healthcare settings. This situation calls for fully comprehensive web-based applications, taking into consideration a number of key functions linking graphical user interface and functionalities, and paying special attention to secure data management. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02660-6.
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Affiliation(s)
- Riley Chang
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Critical Care Tower T2-820, 13750 96th Avenue, Surrey, BC, V3V 1Z2, Canada
| | - Hilary Low
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Critical Care Tower T2-820, 13750 96th Avenue, Surrey, BC, V3V 1Z2, Canada.,Department of Evaluation and Research Services, Fraser Health, Surrey, BC, Canada
| | - Andrew McDonald
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Critical Care Tower T2-820, 13750 96th Avenue, Surrey, BC, V3V 1Z2, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Grace Park
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Primary Care and Home Health, Fraser Health, Surrey, BC, Canada
| | - Xiaowei Song
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Critical Care Tower T2-820, 13750 96th Avenue, Surrey, BC, V3V 1Z2, Canada. .,Department of Evaluation and Research Services, Fraser Health, Surrey, BC, Canada. .,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
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