Hearing the voices of people with high support needs

What are the priorities for research of older people living in their own home, including those living with frailty? A systematic review and content analysis of studies reporting older people's priorities and unmet needs

BACKGROUND

There is limited evidence regarding the needs of older people, including those living with frailty, to inform research priority setting.

OBJECTIVES

This systematic review aimed to identify the range of research priorities of community-dwelling older people living in their own home, including those living with frailty.

METHODS

Included studies were from economically developed countries and designed to identify the priorities for research or unmet needs of community-dwelling older people. Studies were excluded if they described priorities relating to specific health conditions. Medline, Embase, PsycInfo and CINAHL were searched (January 2010-June 2022), alongside grey literature. Study quality was assessed, but studies were not excluded on the basis of quality. A bespoke data extraction form was used and content analysis undertaken to synthesise findings.

RESULTS

Seventy-five reports were included. Seven explicitly aimed to identify the priorities or unmet needs of frail older people; 68 did not specify frailty as a characteristic. Study designs varied, including priority setting exercises, surveys, interviews, focus groups and literature reviews. Identified priorities and unmet needs were organised into themes: prevention and management, improving health and care service provision, improving daily life, meeting carers' needs and planning ahead.

DISCUSSION

Many priority areas were raised by older people, carers and health/care professionals, but few were identified explicitly by/for frail older people. An overarching need was identified for tailored, collaborative provision of care and support.

CONCLUSION

Review findings provide a valuable resource for researchers and health/care staff wishing to focus their research or service provision on areas of importance for older people.

Older People's Perspective about Their Participation in Health Care and Social Care Services: A Systematic Review

Participation is a right and a key pillar of the active aging paradigm. This systematic review aimed to understand how older people's participation is conceptualized and to detail results regarding older people's perspective about their participation in the context of social and health care services. Twenty-one articles published between 1996 and 2015 were analyzed. The main findings suggested that diverse terminology is used to conceptualize older people's participation; however, all shared a vision of respecting a citizen's autonomy. Older people tend to have a paternalistic perspective although most seek more information and discussion on treatment options. Positive relations with providers enabled negotiation to address individual aspirations, though services tended to be pre-formatted suggesting low levels of adjustment to individual needs and aspirations. Thus, older people and those working with them need training in order to enable participation. In addition, services need to be more flexible to allow users to participate.

Caring responsibility from the perspectives of older persons whose adult children are their caregivers

AIM

To describe lifeworld insights into the phenomenon of caring responsibility from the perspectives of persons aged 80+ years living alone with chronic illness, physical frailty and dependency on adult children.

DESIGN

A phenomenological inquiry inspired by Reflective Lifeworld Research.

METHOD

Semi-structured lifeworld interviews with 11 persons aged 80+ years were conducted following their discharge. The interviews lasted 35-83 min, were audio-recorded and transcribed verbatim. Both interviews and the analysis followed the epistemological and methodological principles of Reflective Lifeworld Research.

FINDINGS

We identified the essential meaning 'It means everything' and four constituents illuminating different aspects inherent in the complex phenomenon of caring responsibility; 'A life-constraining transition,' 'Trusting the children to fill the gaps and be the glue,' 'Tacit responsibility, agreement and acceptance' and 'Depending on the children and knowing they are burdened by you.'

CONCLUSIONS

Caring responsibility is based on a trusting relationship and tacit agreements indicating an understanding of interdependence and acceptance of dependence on adult children. However, a paradox appears when older persons express a deep-rooted perception of autonomy and independence as they have difficulties with their growing dependency and feelings of being burdensome. Older persons try to balance the continuum of autonomy, their existential self-image and actual capability. The practical part of caring responsibility seems to dominate and strongly affect the parent-child relationship because the child needs to take care of practical issues related to healthcare management and instrumental activities of daily living, leaving less time for meaningful togetherness.

IMPLICATIONS FOR PRACTICE

Older persons want their adult children to be involved and acknowledged when planning care and treatment because they often seem to serve as the 'glue' that makes it possible for the parent to remain in his/her own home.

'Holding on to life': An ethnographic study of living well at home in old age

In recent years, much attention has been paid to how older people living at home can remain independent and manage their illness themselves, while less attention has been given to those who have become frail and need assistance with challenges of everyday life. In this article, I drew on Latimer's formulation of care for frail older people as relational and world-making and on Foucault's work related to the care of the self in developing an understanding of how frail older persons manage to live well at home in the final years of their lives. I use data from an ethnographic study of home care nursing in the homes of 15 frail older people to develop an understanding of how their care at home can be developed. The participants were holding on to life, which reflected their vitality and vulnerability as well as agency in continuing to explore ways to preserve and build their world at home. With declining ability and stamina relations with material things, relatives and official care workers become of central importance in holding on to life. Home care services can be thought of as part of life, as world-forming, where workers contribute to daily activities that support living well at home.

The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

INTRODUCTION

Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission.

METHODS

The qualitative methodological approach was interpretive description. Data were gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward.

RESULTS

Four main categories were identified: "The system," "Keeping a social life," "Being in everyday life," and "Handling everyday life." These categories affected the way the frail elderly experienced daily life and these elements resulted in a general feeling of well-being or non-well-being. The transition to home was experienced as unsafe and troublesome especially for the more frail participants, whereas the less frail experienced this less.

CONCLUSION AND DISCUSSION

Several elements and stressors were affecting the well-being of the participants in daily life 1 week after discharge. In particular, contact with the health care system created frustrations and worries, but also physical disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged. Stakeholders should evaluate present practice to seek to improve care across health care sectors.

'I'm happy that I can still walk'--Participation of the elderly in home care as a specific group with specific needs and wishes

BACKGROUND

Taking the needs, wishes and experiential knowledge of clients into account is considered to result in a better fit between the supply and demand of modern health care, contributing to the improvement of individual care, organizations, institutions and policy. However, the current generation of the elderly have had little experience of consumer-oriented public services. They are said to be less likely to discuss their needs and wishes with individual caregivers and health-care organisations. As a result, they might not receive care matching their needs and wishes.

AIM

To examine how the elderly themselves refer to their age and their needs and wishes for individual and collective participation in home-based care to get a better understanding of their participation in their own health care.

METHODS

Content analysis of 20 semi-structured in-depth interviews with elderly recipients of care in the Netherlands.

RESULTS

The need and ability of the elderly to discuss their experiences are strongly affected by physical and mental limitations, social cultural characteristics and their experiences of life. As a result, the elderly encounter many limitations in discussing their experiences with their individual caregivers and their home-care organisation. However, this does not mean that the elderly do not have needs and wishes that they want taken into account.

CONCLUSION

The challenge is to create a more responsive environment and to find new, creative ways of facilitating the expression of the needs and wishes of the elderly, according to the specific values and norms of their generation.