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Cheng C, Christensen M. Interventions Addressing Symptoms in Older Adults with Multimorbidity: An Umbrella Review. J Multidiscip Healthc 2024; 17:3181-3192. [PMID: 39006878 PMCID: PMC11246035 DOI: 10.2147/jmdh.s452426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/07/2024] [Indexed: 07/16/2024] Open
Abstract
This umbrella review was to synthesize the summarized evidence-based research regarding interventions addressing symptoms in older populations with multimorbidity. Three databases including PsycINFO, MEDLINE, and CINAHL were searched systematically. The JBI Methodology for Umbrella Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements were used to report this review. Six reviews published between 2016 and 2010 were included for analysis. Interventions were mixed and included components on health-related behaviors, body systems or functions, activities and participation domains, and the environment. Outcomes concerning physiological/clinical functioning were most reported. The evidence regarding the symptoms-related interventions was mixed, but all showed promising outcomes compared with usual care or not. To sum up, this umbrella review reveals the lack of strong empirical evidence for the effectiveness of intervention addressing symptoms in older adults with multimorbidity. It highlights the need to evaluate the established approach of interventions further to support this population.
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Affiliation(s)
- Cheng Cheng
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, People’s Republic of China
- School of Nursing, Fudan University, Xuhui, Shanghai, People’s Republic of China
| | - Martin Christensen
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, People’s Republic of China
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Reji ES, Fredi F, Ismail RM, Bindu VM, Pereira P, Ramesh M, Syed J, Chalasani SH. Assessment of drug therapy satisfaction amongst the elderly: A patient reported outcomes measures approach. Geriatr Nurs 2024; 59:33-39. [PMID: 38981206 DOI: 10.1016/j.gerinurse.2024.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/20/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Understanding elderly experiences enhance healthcare outcomes and patient satisfaction. Recognizing caregivers' role and implementing supportive measures enhance care. OBJECTIVES Quantify drug satisfaction using patient-reported outcomes measures approach. Assess caregiver burden using short version of Burden Scale for Family Caregivers. METHODS Six-month cross-sectional study in Department of Geriatrics. Elderly (≥60), minimum one comorbidity, admitted for >48 h, and consenting to participate were enrolled. Patient satisfaction assessed using Treatment Satisfaction with Medicines Questionnaire (SATMED-Q). SPSS version 27 used to calculate odds ratio. RESULTS 282 participants enrolled. SATMED-Q score 47.41 ± 10.34, indicating overall satisfaction. Treatment satisfaction range 47.07 % to 100 %. Age [OR 0.964, 95 % CI 0.932-0.996 (p = 0.029)] and education [OR 1.500, 95 % CI 1.129-1.992 (p = 0.005)] influenced satisfaction. 268 [95.03 %] had caregivers, 14 [4.96 %] did not. Caregiver burden score 9.25 ± 9.11. CONCLUSION Insights obtained from assessing satisfaction and caregiver burden enables physicians to improve welfare of elderly and caregivers.
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Affiliation(s)
- Eileen Susa Reji
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - Feba Fredi
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - R Muhammad Ismail
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - V M Bindu
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - Pratibha Pereira
- Department of Geriatrics, JSS Medical College & Hospital, JSS Academy of Higher Education & Research, Mysuru - 15 Karnataka, India
| | - M Ramesh
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - Jehath Syed
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India
| | - Sri Harsha Chalasani
- Department of Pharmacy Practice JSS College of Pharmacy JSS Academy of Higher Education & Research, Mysuru -15, Karnataka, India.
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de Medeiros K, Ermoshkina P. Vulnerability and narrative in later life. Z Gerontol Geriatr 2024; 57:266-271. [PMID: 38761242 DOI: 10.1007/s00391-024-02310-7] [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: 02/06/2024] [Accepted: 04/11/2024] [Indexed: 05/20/2024]
Abstract
Narrative gerontology considers how people age biographically as well as socially and biologically. Vulnerability as a process category and state of being remains undertheorized in the context of narratives of later life. It is argued that the narrative space for stories from old age privilege backward-looking stories that focus on positive milestones and support cultural narratives of a "life well lived." Sad, emotionally laden or uncertain/unfinished stories that reveal vulnerabilities are rejected and potentially viewed as problematic. Using an illustrative case example of a study of resilience narratives and aging, this paper considers how the study authors position and identify resilience. Some interpretative judgements used in the research regarding who is resilient based on expressions of vulnerability are highlighted. Overall, the tensions between cultural and personal narratives that position older people as vulnerable subjects are considered and it is argued that vulnerability can be a great source of strength and meaning in later life.
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Affiliation(s)
- Kate de Medeiros
- Department of Sociology and Anthropology, Concordia University, Room H-1125.44, 1455 de Maisonneuve Blvd. W., QC H3G 1 Mb, Montreal, QC, Canada.
| | - Polina Ermoshkina
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
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Kainradl AC. Perspectives on vulnerability from the narratives of older migrants. Z Gerontol Geriatr 2024; 57:272-277. [PMID: 38904845 PMCID: PMC11208271 DOI: 10.1007/s00391-024-02328-x] [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: 02/12/2024] [Accepted: 05/06/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Older migrants are considered a vulnerable population group in many ways. Marginalization and social exclusion lead to unequal opportunities for social participation. AIM In order to break down barriers for older migrants, the perspectives of people with migration biographies should be given greater consideration. MATERIAL AND METHODS To this end, the results of an explorative intersectional ethical analysis of care narratives of older migrants are discussed in the light of aging studies research. The focus is on the ethical analysis of five guided interviews with older migrants between 65 and 80 years old, who have migrated from different countries in southeastern Europe. RESULTS AND DISCUSSION In contrast to the prevalent expert perspective, the narratives of the older migrants interviewed revealed not only resistance to vulnerabilization but also multiple negotiations of autonomy and dependency. By making ambivalent narrative and action strategies visible and linking them to narratives of intergenerational care relationships, the significance of care-ethical interpretations of vulnerability and characterization of vulnerability as "a universal, inevitable, and anthropological feature of humanity resulting from the embodied, finite, and socially contingent structure of human existence" [4] can be demonstrated.
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Affiliation(s)
- Anna-Christina Kainradl
- Center for Interdisciplinary Research on Aging and Care (CIRAC), University of Graz, Schubertstraße 23/1, 8010, Graz, Austria.
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Man GM, Popa RI, Man M. Blaming the young is always more accessible rather than accusing the older employees: an experimental view over age and health in organizations. Front Psychol 2024; 15:1340711. [PMID: 38993333 PMCID: PMC11238820 DOI: 10.3389/fpsyg.2024.1340711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/29/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction The stereotype content model postulates that different groups evoke different emotions and reactions based on two dimensions: intention toward others (warmth) and competence. Methods In this study, we used an experimental design and a qualitative approach to investigate how managerial strategies are selected and motivated when a subordinate makes a work task related error but belongs to a group that is stereotypical perceived differently in terms of warmth and competence (age groups with or without a medical condition). Thus 75 employees analyzed one of the five hypothetical cases and described the managerial strategy and motivation for usage. Results Data revealed that managerial strategies incorporate more active harm elements for younger employees in contrast with vulnerable groups (older employees with unspecified medical conditions, younger or older employees with a medical condition), who benefit from more active facilitation strategies. The strategy usage motivation is also different in the case of younger employees, the control group and the vulnerable groups. Discussion The study outcomes bring additional evidence to support the stereotype content model theory and the socioemotional selectivity theory, enriching applicability on organizational practice and human resources management.
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Affiliation(s)
- Gabriela-Maria Man
- Department of Psychology, Faculty of Social Sciences and Humanities, "Lucian Blaga" University of Sibiu, Sibiu, Romania
| | - Radu-Ioan Popa
- Department of Social Work, Journalism, Public Relations and Sociology, Faculty of Social Sciences and Humanities, "Lucian Blaga" University of Sibiu, Sibiu, Romania
| | - Mihaela Man
- Department of Psychology, Faculty of Social Sciences and Humanities, "Lucian Blaga" University of Sibiu, Sibiu, Romania
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Albarqi MN. Assessing the Impact of Multidisciplinary Collaboration on Quality of Life in Older Patients Receiving Primary Care: Cross Sectional Study. Healthcare (Basel) 2024; 12:1258. [PMID: 38998793 PMCID: PMC11240966 DOI: 10.3390/healthcare12131258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
The growing aging population presents unique challenges in maintaining their quality of life (QoL), which encompasses physical, psychological, and social wellbeing. This study aimed to assess the impact of multidisciplinary collaboration on QoL among older patients receiving primary care. A cross-sectional study was conducted involving a purposive sampling of 200 participants aged 60 years and above from Primary Healthcare Centers in Al-Ahsa, Saudi Arabia, between March and May 2024. Data were collected using standardized tools: SF-36 for health-related QoL, Multidisciplinary Collaboration Evaluation Tool (MCET), and Lubben Social Network Scale (LSNS). Multivariate regression analyses were performed to examine the associations between multidisciplinary collaboration, social support, and QoL outcomes. Multidisciplinary collaboration exhibited a significant positive association with improvements in physical functioning (β = 2.35, p < 0.001), mental health (β = 3.01, p < 0.001), and general health perceptions (β = 2.12, p < 0.001). Key drivers of effective collaboration included effective communication (β = 0.48, p < 0.001), coordination (β = 0.42, p < 0.001), and patient involvement (β = 0.40, p < 0.001). Social support, particularly from friends (β = 0.33, p < 0.001) and family (β = 0.28, p < 0.001), was also a robust predictor of better QoL. Younger age, female gender, married status, and absence of chronic conditions were associated with greater QoL improvements from multidisciplinary care. Multidisciplinary collaboration and social support networks significantly enhance QoL among older primary care patients. Healthcare systems should prioritize developing collaborative care models, fostering interdisciplinary teamwork, and integrating strategies to promote social connectedness for the aging population.
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Ribera-Casado JM. Ageism revisited. Eur Geriatr Med 2024; 15:291-294. [PMID: 38467914 DOI: 10.1007/s41999-024-00963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
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Kamau M, Nyanja N, Lusambili AM, Shabani J, Mohamoud G. Knowledge, attitudes and beliefs toward polypharmacy among older people attending Family Medicine Clinic, Nairobi, Kenya. BMC Geriatr 2024; 24:132. [PMID: 38317102 PMCID: PMC10845745 DOI: 10.1186/s12877-024-04697-9] [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: 07/22/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Life expectancy has increased over the last century among older people, particularly those aged over 60 years. Aging is associated with increased disability, multiple chronic conditions, and increased use of health services managed with polypharmacy. There are few studies on polypharmacy and aging in sub-Saharan Africa, and it is unclear what older people know and their attitudes toward polypharmacy. This paper presents findings from a study that aimed to understand older people's knowledge, attitudes and beliefs about polypharmacy. METHODS A qualitative study using in-depth interviews of 15 patients aged 60 years and older who were taking more than five medications per day. The study was conducted at the Family Medicine Clinic (FMC), Aga Khan University Hospital, Nairobi. Data were analyzed using NVivo 12 software. RESULT Majority of participants had a good understanding of their underlying health conditions, but they did not know the specific names of the medications they were taking. Participants had diverse attitudes toward polypharmacy, with both positive and negative perceptions. Although adverse side effects were reported, participants remained positive because they believed these medicines were beneficial. Religion, faith and living healthy lifestyles were perceived to contribute to their positive attitude toward polypharmacy. Stigma and the cost of medication were reported as barriers. CONCLUSION This study provides valuable insights into the complexities of polypharmacy in older people. It highlights the importance of patient education, fostering strong patient-provider relationships, de-stigmatization, and improving medication affordability and accessibility. Further research could explore the polypharmacy of older people attending public institutions in rural Kenya.
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Affiliation(s)
- Maureen Kamau
- Department of Family Medicine, Aga Khan University Hospital, Nairobi, Kenya.
| | - Njeri Nyanja
- Department of Family Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Jacob Shabani
- Department of Family Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Gulnaz Mohamoud
- Department of Family Medicine, Aga Khan University Hospital, Nairobi, Kenya
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Markham SC, McNab J, O'Loughlin K, Clemson L. International responses addressing the under-representation of older people in clinical research. Australas J Ageing 2023; 42:762-768. [PMID: 37724905 DOI: 10.1111/ajag.13234] [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: 04/04/2023] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023]
Abstract
Older people (aged 65 years +) are under-represented in clinical research across many disease areas. Such exclusions limit the generalisability of trial results and can lead to a gap in critical knowledge regarding the efficacy and safety of interventions in older age groups. International bodies and regulators have addressed this issue to varying degrees. The USA's Food and Drug Administration (FDA) has produced regular non-binding guidance about the inclusion of older trial participants, while the National Institutes of Health's (NIH) binding regulations mean that those seeking research funding must include participants of all ages unless there are scientific or ethical reasons to exclude them. European regulations governing clinical trials of new medications require that participants represent the population groups that are likely to use the product being tested, while Britain highlights the need to improve trial participation of under-served groups, which include older people. Australian clinical trial guidelines point to the potential problem of excluding some groups from research but do not specifically address older participants. While current international approaches may provide some improvements in trial representation, additional strategies are required to promote clinical research that better reflects populations seen in clinical practice. Australia could benefit from clinical trial guidance that highlights the specific issue of the under-representation of older participants and outlines strategies to facilitate greater inclusion. This article provides an overview and critique of the current approaches to the inclusion of older people in clinical research and highlights policy gaps and limitations of current strategies.
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Affiliation(s)
- Susan C Markham
- ARC-Funded Centre of Excellence in Population Ageing Research (CEPAR), Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Justin McNab
- Discipline of Behavioural and Social Sciences in Health, Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Kate O'Loughlin
- ARC-Funded Centre of Excellence in Population Ageing Research (CEPAR), Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Lindy Clemson
- ARC-Funded Centre of Excellence in Population Ageing Research (CEPAR), Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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Langmann E, Weßel M. Leaving no one behind: successful ageing at the intersection of ageism and ableism. Philos Ethics Humanit Med 2023; 18:22. [PMID: 38001533 PMCID: PMC10668457 DOI: 10.1186/s13010-023-00150-8] [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: 03/31/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The concept of 'successful ageing' has been a prominent focus within the field of gerontology for several decades. However, despite the widespread attention paid to this concept, its intersectional implications have not been fully explored yet. This paper aims to address this gap by analyzing the potential ageist and ableist biases in the discourse of successful ageing through an intersectional lens. METHOD A critical feminist perspective is taken to examine the sensitivity of the discourse of successful ageing to diversity in societies. The paper analyzes how ageist and ableist biases can manifest in the ways we conceptualize ageing, drawing on examples in the context of mental health. RESULTS We argue that the conventional approach to successful ageing is limited in its ability to account for the experiences of people who have faced intersectional discrimination throughout their lives. Drawing on examples in the context of mental health, we explore among others the link between depression and disabilities. Furthermore, we shed light on the negative impact of ageist and ableist attitudes concerning the diagnosis and treatment of dementia. DISCUSSION We demonstrate how diversity is often overlooked in discussions of ageing well, and how ageist and ableist biases can manifest in the ways we conceptualize ageing. We argue that focusing solely on the health status as a means of achieving success fails to adequately counter ageism for all people. We further emphasize the role of structural factors, such as ageist attitudes, in shaping the experience of ageing and exacerbating health inequalities. CONCLUSION Overall, our findings emphasize the need for a more nuanced and inclusive understanding of ageing and therefore an intersectional approach to conceptions of ageing well that recognizes and addresses the biases and limitations of current discourses. Thereby, this paper offers valuable insights into the complex intersections between age and disabilities from a bioethical perspective, highlighting the need for a more inclusive and intersectional approach to ageing.
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Affiliation(s)
- Elisabeth Langmann
- Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, Tübingen, 72074, Germany.
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