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Ysseldyk R, Morton TA, Haslam C, Haslam SA, Boger J, Giau E, Macdonald EP, Matharu A, McCoy M. You've Got E-Mail: A Pilot Study Examining the Feasibility and Impact of a Group-Based Technology-Training Intervention Among Older Adults Living in Residential Care. Can J Aging 2024; 43:45-56. [PMID: 37501571 DOI: 10.1017/s0714980823000375] [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] [Indexed: 07/29/2023] Open
Abstract
Older adults living in residential care often experience challenges in sustaining meaningful social relationships, which can result in compromised health and well-being. Online social networking has the potential to mitigate this problem, but few studies have investigated its implementation and its effectiveness in maintaining or enhancing well-being. This pilot study used a cluster-randomized pre-post design to examine the feasibility of implementing a 12-week group-based technology-training intervention for older adults (n = 48) living in residential care by exploring how cognitive health, mental health, and confidence in technology were impacted. Analysis of variance revealed significant increases in life satisfaction, positive attitudes toward computer use, and self-perceived competence among participants who received the intervention, but increased depressive symptoms for the control group. These findings suggest that, despite challenges in implementing the intervention in residential care, group-based technology training may enhance confidence among older adults while maintaining or enhancing mental health.
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Affiliation(s)
- Renate Ysseldyk
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | | | - Catherine Haslam
- School of Psychology, The University of Queensland, Brisbane, QL, Australia
| | - S Alexander Haslam
- School of Psychology, The University of Queensland, Brisbane, QL, Australia
| | - Jennifer Boger
- Systems Design Engineering, University of Waterloo, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
| | - Emily Giau
- Systems Design Engineering, University of Waterloo, ON, Canada
| | - Erin P Macdonald
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Amy Matharu
- Research Institute for Aging, Waterloo, ON, Canada
| | - Madeline McCoy
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
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2
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Connolly J, Peisah C. Waiting for guardianship in a public hospital geriatric inpatient unit: a mixed methods observational case series. Intern Med J 2023; 53:1339-1346. [PMID: 36031739 DOI: 10.1111/imj.15916] [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: 02/27/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients in acute hospital settings waiting for guardianship and financial management (FM) hearings experience extended length of stay (LOS), with known consequences for frail elderly. This, together with universal agreement that substitute decision-making is a last resort measure, an imperative exists to examine guardianship and FM applications made from within hospital for geriatric inpatients. AIMS This study aims to examine processes around Guardianship applications in a public hospital Geriatric inpatient setting including times to, reasons for and outcomes of referral; and to explore the content of the medical records in relation to criteria for application. METHOD This was a mixed methods observational case series using descriptive data supplemented by qualitative case-note analysis of inpatients referred for guardianship (with/without FM) from 2018 to 2020 in a New South Wales Geriatric Medicine inpatient unit. Medical records were examined for evidence of operationalised criteria for guardianship, aligned with disability, capacity and need/risk common to most Australian jurisdictions. RESULTS Of 45 patients with guardianship applications, 98% were granted guardians and 33 of 37 (89%) FM applications. Multiple risks underpinned applications, most commonly frequent falls (49%) and medication mismanagement (49%). Although only 29% were in receipt of services preadmission, 98% were discharged to residential care. Average hospital LOS was 70 days (interquartile range, 35), contributed to by delays between admission and decision to apply for guardianship/FM (median, 28 inpatient days) and uncertainties around or lack of documented capacity assessments. CONCLUSION This study identifies potential points along pathways towards guardianship in hospital settings, which might be targeted to streamline if not divert some of these applications. Points of intervention include at initiation of applications, with consideration of alternatives to substitute decision-making by addressing patient needs and using supported decision-making, while improving clinician understanding of capacity assessment and guardianship.
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Affiliation(s)
- Joanna Connolly
- Rehabilitation and Aged Care Services, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Capacity Australia, Sydney, New South Wales, Australia
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3
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IPA and WPA-SOAP joint statement on the rights of older persons with mental health conditions and psychosocial disabilities. Int Psychogeriatr 2022; 34:943-947. [PMID: 33977896 DOI: 10.1017/s1041610221000454] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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4
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Bacsu JDR, O'Connell ME, Cammer A, Ahmadi S, Berger C, Azizi M, Gowda-Sookochoff R, Grewal KS, Green S, Knight S, Spiteri RJ. Examining the COVID-19 Impact on People with Dementia from the Perspective of Family and Friends. JMIR Aging 2022; 5:e38363. [PMID: 35667087 PMCID: PMC9239564 DOI: 10.2196/38363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/25/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background The COVID-19 pandemic is taking a serious toll on people with dementia. Given the rapidly evolving COVID-19 context, policymakers and practitioners require timely, evidence-informed research to address the changing needs and challenges of people with dementia and their family care partners. Objective Using Twitter data, the objective of this study was to examine the COVID-19 impact on people with dementia from the perspective of their family members and friends. Methods Using the Twint application in Python, we collected 6243 relevant tweets over a 15-month time frame. The tweets were divided among 11 coders and analyzed using a 6-step thematic analysis process. Results Based on our analysis, 3 main themes were identified: (1) frustration and structural inequities (eg, denied dignity and inadequate supports), (2) despair due to loss (eg, isolation, decline, and death), and (3) resiliency, survival, and hope for the future. Conclusions As the COVID-19 pandemic persists and new variants emerge, people with dementia and their family care partners are facing complex challenges that require timely interventions. More specifically, tackling COVID-19 challenges requires revisiting pandemic policies and protocols to ensure equitable access to health and support services, recognizing the essential role of family care partners, and providing financial assistance and resources to help support people with dementia in the pandemic. Revaluating COVID-19 policies is critical to mitigating the pandemic’s impact on people with dementia and their family care partners.
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Affiliation(s)
- Juanita-Dawne R Bacsu
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, CA
| | - Megan E O'Connell
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, CA
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, CA
| | - Soheila Ahmadi
- Department of Computer Science, University of Saskatchewan, Saskatoon, CA
| | - Corinne Berger
- Department of Computer Science, University of Saskatchewan, Saskatoon, CA
| | - Mehrnoosh Azizi
- Department of Computer Science, University of Saskatchewan, Saskatoon, CA
| | | | - Karl S Grewal
- Department of Psychology, University of Saskatchewan, Saskatoon, CA
| | - Shoshana Green
- Department of Psychology, University of Saskatchewan, Saskatoon, CA
| | - Sheida Knight
- Department of Computer Science, University of Saskatchewan, Saskatoon, CA
| | - Raymond J Spiteri
- Department of Computer Science, University of Saskatchewan, Saskatoon, CA
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5
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Dawson WD, Comas-Herrera A. International Dementia Policies and Legacies of the Coronavirus Disease 2019 Pandemic. PUBLIC POLICY & AGING REPORT 2022; 32:72-76. [PMID: 35996432 PMCID: PMC9383947 DOI: 10.1093/ppar/prac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Walter D Dawson
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Global Brain Health Institute, University of California, San Francisco (UCSF), San Francisco, California, USA
- Institute on Aging, College of Urban & Public Affairs, Portland State University, Portland, Oregon, USA
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
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Wamara CK. Social Work Response to Elder Abuse in Uganda: Voices from Practitioners. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:361-381. [PMID: 34412569 DOI: 10.1080/01634372.2021.1968093] [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: 02/16/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
Social workers across the globe are at the forefront of tackling elder abuse, as they are committed to social justice, human rights, and respect for human diversity. However, research on social workers' response to elder abuse in Sub-Saharan Africa remains scarce. This qualitative study assessed how social workers in Uganda have responded to elder abuse. In-depth semi-structured interviews were used to collect data from 21 social workers. The findings suggest that social work in Uganda has not asserted itself in the fight against elder abuse. The few social work interventions aimed at reducing the risk of elder abuse are mostly anti-poverty undertakings. Social workers mainly discussed the drivers of elder abuse, correlating them with their interventions, and challenges such as the absence of a specific law for older people, ignorance of older people's rights, and the underreporting of elder abuse. This study found that advocacy is needed for specific laws that protect the rights of older people, along with public awareness campaigns and the establishment of a research center for aging and later life.
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7
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Hollinghurst J, North L, Emmerson C, Akbari A, Torabi F, Williams C, Lyons RA, Hawkes AG, Bennett E, Gravenor MB, Fry R. Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic. Age Ageing 2022; 51:afac072. [PMID: 35291009 PMCID: PMC8992303 DOI: 10.1093/ageing/afac072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND defining features of the COVID-19 pandemic in many countries were the tragic extent to which care home residents were affected and the difficulty in preventing the introduction and subsequent spread of infection. Management of risk in care homes requires good evidence on the most important transmission pathways. One hypothesised route at the start of the pandemic, prior to widespread testing, was the transfer of patients from hospitals that were experiencing high levels of nosocomial events. METHODS we tested the hypothesis that hospital discharge events increased the intensity of care home cases using a national individually linked health record cohort in Wales, UK. We monitored 186,772 hospital discharge events over the period from March to July 2020, tracking individuals to 923 care homes and recording the daily case rate in the homes populated by 15,772 residents. We estimated the risk of an increase in case rates following exposure to a hospital discharge using multi-level hierarchical logistic regression and a novel stochastic Hawkes process outbreak model. FINDINGS in regression analysis, after adjusting for care home size, we found no significant association between hospital discharge and subsequent increases in care home case numbers (odds ratio: 0.99, 95% CI: 0.82, 1.90). Risk factors for increased cases included care home size, care home resident density and provision of nursing care. Using our outbreak model, we found a significant effect of hospital discharge on the subsequent intensity of cases. However, the effect was small and considerably less than the effect of care home size, suggesting the highest risk of introduction came from interaction with the community. We estimated that approximately 1.8% of hospital discharged patients may have been infected. INTERPRETATION there is growing evidence in the UK that the risk of transfer of COVID-19 from the high-risk hospital setting to the high-risk care home setting during the early stages of the pandemic was relatively small. Although access to testing was limited to initial symptomatic cases in each care home at this time, our results suggest that reduced numbers of discharges, selection of patients and action taken within care homes following transfer all may have contributed to the mitigation. The precise key transmission routes from the community remain to be quantified.
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Affiliation(s)
- Joe Hollinghurst
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
| | - Laura North
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
| | | | - Ashley Akbari
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
| | - Fatemeh Torabi
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
| | | | - Ronan A Lyons
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
| | - Alan G Hawkes
- Hawkes Centre for Empirical Finance, Swansea University, Swansea SA2 8PP, UK
| | - Ed Bennett
- Computer Science, Swansea University, Swansea SA2 8PP, UK
| | - Mike B Gravenor
- Swansea University Medical School, Swansea University, Swansea SA2 8PP, UK
| | - Richard Fry
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
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8
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Bacsu JDR, O'Connell ME, Wighton MB. Improving the health equity and the human rights of Canadians with dementia through a social determinants approach: a call to action in the COVID-19 pandemic. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:204-208. [PMID: 35239172 PMCID: PMC8892822 DOI: 10.17269/s41997-022-00618-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/09/2022] [Indexed: 11/17/2022]
Abstract
In 2019, the Canadian Government released a national dementia strategy that identified the need to address the health inequity (e.g., avoidable, unfair, and unjust differences in health outcomes) and improve the human rights of people living with dementia. However, the novel coronavirus disease 2019 (COVID-19) pandemic is having an inequitable impact on people with dementia in terms of mortality and human rights violations. As the new Omicron COVID-19 variant approaches its peak, our commentary highlights the need for urgent action to support people living with dementia and their care partners. More specifically, we argue that reducing COVID-19 inequities requires addressing underlying population-level factors known as the social determinants of health. Health disparities cannot be rectified merely by looking at mortality rates of people with dementia. Thus, we believe that improving the COVID-19 outcomes of people with dementia requires addressing key determinants such as where people live, their social supports, and having equitable access to healthcare services. Drawing on Canadian-based examples, we conclude that COVID-19 policy responses to the pandemic must be informed by evidence-informed research and collaborative partnerships that embrace the lived experience of diverse people living with dementia and their care partners.
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Affiliation(s)
- Juanita-Dawne R Bacsu
- Department of Psychology, Rural Dementia Action Research (RaDAR) Team, Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, Saskatchewan, S7N 5A5, Canada.
| | - Megan E O'Connell
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Pfabigan J, Wosko P, Pichler B, Reitinger E, Pleschberger S. Under Reconstruction: The Impact of COVID-19 Policies on the Lives and Support Networks of Older People Living Alone. INTERNATIONAL JOURNAL OF CARE AND CARING 2022; 6:211-228. [PMID: 36865632 PMCID: PMC7614259 DOI: 10.1332/239788221x16308602886127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The Austrian government introduced in spring 2020 COVID-19 containment policies that had various impacts on older people living alone (OPLA) and their care arrangements. Seven qualitative telephone interviews with OPLA were conducted to explore how they were affected by these policies. The findings show that the management of everyday life and support was challenging for OPLA even though they did not perceive the pandemic as a threat. To better address the needs of OPLA, it would be important to actively negotiate single measures in the area of conflict between protection, safety and assurance of autonomy.
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Affiliation(s)
- Johanna Pfabigan
- Austrian National Public Health Institute (Gesundheit Österreich GmbH), Austria
| | - Paulina Wosko
- Austrian National Public Health Institute (Gesundheit Österreich GmbH), Austria
| | | | | | - Sabine Pleschberger
- Austrian National Public Health Institute (Gesundheit Österreich GmbH), Austria
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10
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Benbow SM, Bhattacharyya S, Kingston P, Peisah C. Invisible and at-risk: older adults during the COVID-19 pandemic. J Elder Abuse Negl 2021; 34:70-76. [PMID: 34913852 DOI: 10.1080/08946566.2021.2016535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
During the COVID-19 pandemic the risks to older adults of systemic abuse and neglect have become amplified, alongside increasing abuse and neglect in the community. Novel risks have also evolved involving cybercrime and the use of remote technologies in health and social care related to the pandemic. This commentary brings together lessons to be learned from these developments and initial ideas for actions to mitigate future risks.
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Affiliation(s)
- Susan M Benbow
- Westminster Centre for Research on Ageing, Mental Health and Veterans, University of Chester, Chester, UK.,Older Mind Matters Ltd, Manchester, UK
| | - Sarmishtha Bhattacharyya
- Westminster Centre for Research on Ageing, Mental Health and Veterans, University of Chester, Chester, UK.,Betsi Cadwaladr University Health Board, Wales, UK
| | - Paul Kingston
- Westminster Centre for Research on Ageing, Mental Health and Veterans, University of Chester, Chester, UK
| | - Carmelle Peisah
- University of New South Wales, Capacity Australia; Sydney, Australia
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11
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Steele L. Dementia: The International Journal of Social Research and Practice Book Review. DEMENTIA 2021. [DOI: 10.1177/14713012211052709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Wand A, Verbeek H, Hanon C, de Mendonça Lima CA, Rabheru K, Peisah C. Is Suicide the End Point of Ageism and Human Rights Violations? Am J Geriatr Psychiatry 2021; 29:1047-1052. [PMID: 34272155 DOI: 10.1016/j.jagp.2021.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022]
Abstract
Ageism and human rights violations may pervade each of the potential factors underlying suicidal ideation or behavior in older persons, including physical and mental health, disability, relationships, and social factors. We outline how infringements of human rights and ageism may create or exacerbate risk factors associated with suicide in older persons. Strategies to address these issues are discussed, including tackling ageism, psychosocial interventions and education. A United Nations convention on the rights of older persons would create a uniform standard of accountability across health and social systems. Future studies are needed to evaluate the effects of alleviating ageism and human rights violations on suicide.
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Affiliation(s)
- Anne Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney (AW), NSW, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales (AW, CP), Australia; Ageing Futures Institute, University of New South Wales (AW, CP), Australia.
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences (HV), Maastricht, The Netherlands
| | - Cecile Hanon
- Regional Resource Centre of old age Psychiatry - AP-HP Centre - Université de Paris (CH), France
| | | | | | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, University of New South Wales (AW, CP), Australia; Ageing Futures Institute, University of New South Wales (AW, CP), Australia; Capacity Australia (CP), New South Wales, Australia
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Human Rights to Inclusive Living and Care for Older People With Mental Health Conditions. Am J Geriatr Psychiatry 2021; 29:1015-1020. [PMID: 34226135 DOI: 10.1016/j.jagp.2021.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022]
Abstract
Although older persons wish to age at home, many older persons with mental health conditions and psychosocial disability (MHC-PSD) spend the last few years of their life in residential facilities. This paper will examine the impact of ageism and human rights violations manifested in environmental design, specifically regarding social isolation, loneliness, inadequate psychosocial, environmental, recreational and spiritual support. This is compounded by failure to meet basic care needs-nutrition, hydration, pain and medication support. This paper highlights two innovative initiatives from the Netherlands, which show that older persons' rights can be maintained in innovative, collective living arrangements. It is concluded that the creation of inclusive and safe environments for older persons with MHC-PSD can facilitate the enjoyment of Human Rights.
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Peisah C, Sampson EL, Rabheru K, Wand A, Lapid M. The Human Rights of Older People With Mental Health Conditions and Psychosocial Disability to a Good Death and Dying Well. Am J Geriatr Psychiatry 2021; 29:1041-1046. [PMID: 34175232 DOI: 10.1016/j.jagp.2021.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022]
Abstract
The human right to a good death and dying well is as important as the right to life. At stake at the end of life are human rights to dignity, autonomy, self-determination and respect for will and preferences, equitable access to quality health care that is needs-based, and respect for family and relationships. Older people with dementia, those with serious mental illness, and those with intellectual disability are vulnerable to "bad deaths" due to violations of these rights. In this paper we explore why this is so and examine existing and potential solutions. A human rights-approach to end-of-life care and policy for older persons with mental health conditions and psychosocial disability is one that is needs-based, encompassing physical and mental health, palliative care, social, and spiritual support services provided in the context of inclusive living. Most importantly, end of life care must be self-determined, and not "one size fits all." An important remedy to existing violations is to strengthen human rights frameworks to cater specifically to older persons' needs with a UN convention on the rights of older persons. Finally, as health professionals we have important contributions to make at the coalface by accepting our responsibilities in the area of death and dying. With the concept of the palliative psychiatrist gaining traction and recognition that death is our business, we add that human rights is also our business.
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Affiliation(s)
- Carmelle Peisah
- School of Psychiatry, Faculty Medicine & Ageing Futures Institute, University of New South Wales, Capacity Australia (CP), Sydney, Australia.
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Unit, Division of Psychiatry, University College London (ELS), London, United Kingdom
| | | | - Anne Wand
- Specialty of Psychiatry, Faculty Medicine and Health, University of Sydney (AW), Sydney, Australia; Discipline of Psychiatry, Faculty of Medicine, University of New South Wales (AW), New South Wales, Australia
| | - Maria Lapid
- Department of Psychiatry and Psychology, Mayo Clinic (ML), Rochester, MN
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15
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O'Cionnaith C, Wand APF, Peisah C. Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness. Clin Interv Aging 2021; 16:1315-1325. [PMID: 34285476 PMCID: PMC8285123 DOI: 10.2147/cia.s311773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this case series is to illustrate the complexity of considerations across health (physical and mental), ethical, human rights and practical domains when an older adult with chronic symptoms of mental illness refuses treatment for a serious medical comorbidity. A broad understanding of these considerations may assist health care professionals in navigating this challenging but common aspect of clinical practice. Case Presentation Three detailed case reports are described. Participants were older adults with an acute presentation of a chronic mental illness, admitted to a specialized older persons mental health inpatient unit (OPMHU) in an Australian metropolitan hospital. Significant comorbid medical issues were detected or arose during the admission and the patient refused the recommended medical intervention. Data extracted from patients' medical records were analyzed and synthesized into detailed case reports using descriptive techniques. Each patient was assessed as lacking capacity for healthcare and treatment consent and did not have relatives or friends to assist with supported decision-making. Multifaceted aspects of decision-making and management are highlighted. Conclusion There are multiple complex issues to consider when an older adult with chronic symptoms of mental illness refuses treatment for serious comorbid medical conditions. In addition to optimizing management of the underlying mental illness (which may be impairing capacity to make healthcare decisions), clinicians should adopt a role of advocacy for their patients in considering the potential impact of ageism and stigma on management plans and inequities in physical healthcare. Consultation with specialist medical teams should incorporate multifaceted considerations such as potentially inappropriate treatment and optimum setting of care. Equally important is reflective practice; considering whether treatment decisions may infringe upon human rights or cause trauma.
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Affiliation(s)
- Cathal O'Cionnaith
- Older Persons Mental Health Service, Jara Unit, Concord Centre for Mental Health, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Anne P F Wand
- Older Persons Mental Health Service, Jara Unit, Concord Centre for Mental Health, Concord Repatriation General Hospital, Concord, NSW, Australia.,Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Capacity Australia, Crows Nest, NSW, Australia
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Hollinghurst J, Lyons J, Fry R, Akbari A, Gravenor M, Watkins A, Verity F, Lyons RA. The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016-2020. Age Ageing 2021; 50:25-31. [PMID: 32951042 PMCID: PMC7546151 DOI: 10.1093/ageing/afaa207] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing. Aim to analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years. Study Design and Setting we used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020. Methods we calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted HRs for age, gender, social economic status and prior health conditions. Results survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020. Conclusions the survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.
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Affiliation(s)
- Joe Hollinghurst
- Address correspondence to Joe Hollinghurst, Data Science Building, Swansea University (Singleton Campus), Swansea, UK.
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Kotzé C, Roos JL, Ehlers R. End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness. Front Psychiatry 2021; 12:752897. [PMID: 34630189 PMCID: PMC8492912 DOI: 10.3389/fpsyt.2021.752897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The study's main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness. Methods: A cross-sectional, observational study, was done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness. The Mini-Cog and a semi-structured clinical assessment of end-of-life decision-making capacity was done before a standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardized instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values. Results: The Assessment of Capacity to Consent to Treatment scores correlated (p < 0.001) with the outcomes of the semi-structured decision-making capacity evaluation. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p < 0.001); a duration of serious mental illness of 30-39 years (p = 0025); having a diagnosis of schizophrenia spectrum disorders (p = 0.0007); and being admitted involuntarily (p < 0.0001). A main finding was that 65% of participants had decision-making capacity for end-of-life decisions, were able to express their values and engage in advance care discussions. Discussion and Conclusion: Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Many older patients with serious mental illness can engage in end-of-life discussions and can make autonomous decisions about preferred end-of-life care. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.
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Affiliation(s)
- Carla Kotzé
- Department of Psychiatry, Faculty of Health Sciences, School of Medicine, Weskoppies Psychiatric Hospital, University of Pretoria, Pretoria, South Africa
| | - Johannes Lodewikus Roos
- Department of Psychiatry, Faculty of Health Sciences, School of Medicine, Weskoppies Psychiatric Hospital, University of Pretoria, Pretoria, South Africa
| | - René Ehlers
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
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Okamura T, Ura C, Sugiyama M, Kugimiya Y, Okamura M, Ogawa M, Miyamae F, Edahiro A, Awata S. Defending community living for frail older people during the COVID-19 pandemic. Psychogeriatrics 2020; 20:944-945. [PMID: 32803837 PMCID: PMC7460990 DOI: 10.1111/psyg.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Tsuyoshi Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Chiaki Ura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Mika Sugiyama
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yukiko Kugimiya
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Mutsuko Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Madoka Ogawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Fumiko Miyamae
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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