The experience of transitions in care in very old age: implications for general practice

Willingness and influencing factors of old-age care mode selection among middle-aged and older adults in Henan Province, China

BACKGROUND

The choice of old-age care methods or places plays an important role in improving the quality of life and well-being of older adults. This study aimed to analyze the choices of various old-age care modes (OCMs) among middle-aged and older adults (MOA) aged 40 years and older in Henan Province, China, and to explore the influence of personal health status, perspectives on old-age (POA) and external support received on their choices.

METHODS

This study analyzed the data from the previous survey which included 911 MOA. The mean comparison method was used to analyze the evaluation of MOA prior to selecting OCMs, and the effect of individual characteristics, external support received, and personal health status on the choice of OCM for MOA was assessed by Logistic regression (LR) and Concentration Index. The Mediation Effect Model was used to explore effect manner and scope of MOA' POA in their choice of OCM.

RESULTS

The overall scores for MOA on the choice of the home-based, community-family, retirement village, nursing homes OCM were 4.06 ± 0.81, 3.70 ± 0.88, 3.72 ± 0.90, 3.49 ± 0.97, respectively. The LR model indicated that education level, number of children, relationship between family members and the relationship with neighbors affected the choice of OCM for MOA (P < 0.05). Difference in OCM selection was relatively the largest based on the individual's POA (Concentration index = -0.0895 ~ -0.0606), and it was shown to play a mediating role in other factors influencing the choice of OCM for MOA (Mediation effect = -0.002 ~ 0.013).

CONCLUSIONS

The evaluation of MOA on choosing a non-home OCM was generally, and the number of children and external support received were shown to have a relatively substantial impact on the choice of OCM among MOA, however, their power was affected by MOA' POA. Policy makers could encourage the MOA' selection of non-home OCM by improving the relationship among MOA persons while positively transforming their POA.

How general practitioners perceive the aging trajectory of oldest-old - A qualitative study

BACKGROUND

A new population of older people is growing: the oldest-old. The care of the oldest-old (individuals aged 90 and over) is a new challenge in primary care. This study aimed to analyze the perception of General Practitioners (GP) on (1) the aging process of their patients up to a very advanced age, (2) how to adapt their practice to the care of these patients.

METHODS

We conducted a qualitative study using focus group (face to face) and individual (video call) interviews of GPs in southwest France. The sampling was purposive. We analyzed the interviews using an inductive approach based on the phases of thematic analysis. We used researchers' triangulation during the process. Collection was concluded when saturation was reached.

RESULTS

Three focus groups and one individual interview were conducted with a total of seventeen general practitioners. GP perception concerning aging and very advanced age were based on their personal experience and their daily clinical practice. Aging was perceived as an individual, unconscious, unpredictable and irreversible phenomenon. The shift towards "very old age" appeared inevitable. It could be a physical or psychological shift, or patients neglecting themselves or lacking a project. The care of the oldest-old became more specific and individual, adapted to the wishes of the patient. Those adaptations involve medical disengagement to focus on the most essential outcomes. The objectives of health care needed to be less strict with limited invasive practices. Prevention needed to focus mainly on prevention of falls and limitation of functional decline.

CONCLUSION

GPs identified an inevitable and unpredictable shift from old age to very old age. The adaption of the theory of disengagement allowed us to identify a medical disengagement of the GPs in the care of their oldest patients.

A critique of the marketisation of long-term residential and nursing home care

Long-term care systems across countries within the Organisation for Economic Co-operation and Development have undergone a progressive marketisation and financialisation in recent decades, characterised by the embedding of neoliberal market values such as competition, consumer choice, and the profit motive. In this Personal View, we argue that these make poor guiding principles for the care sector, identifying the dysfunctional dynamics that arise as a result, and reflecting on the clinical implications of each, with a focus on facility-based care. We outline why providers can scarcely respond to competitive forces without compromising care quality. We explain why the promotion of consumer choice cannot effectively motivate improvements to quality of care. And we explore how privatisation opens the door to predatory financial practices. We conclude by considering how far proposals for reform can take us, ultimately arguing for a rejection of neoliberal market ideology, and calling for sector-wide discussions about what principles would be more fitting for a caring economy.

Strategies to support older adults' mental health during the transition into residential aged care: a qualitative study of multiple stakeholder perspectives

Background

The move from home into residential care is one of the most stressful life experiences for older adults. ‘Relocation stress’ is a significant risk factor for anxiety and/or depression in aged care residents. Whether long-term or recently diagnosed, these mood disorders are associated with a decline in overall well-being, daily functioning and independence. The mental health needs of older adults are often poorly recognised and supported, including during the transition into residential care. Despite growing interest in how to facilitate this major life transition, few studies have taken the perspective of multiple stakeholders. The aim of this study was to explore resident, relative and staff experiences of the transition into residential aged care, and to identify strategies to support the mental health of older adults at this time. The role of pastoral care practitioners to facilitate transitions and support residents’ mental health was also examined.

Methods

This phenomenological study involved individual interviews with 35 aged care residents, relatives and staff, between January and April 2021. Participants were selected using purposive sampling. Audio-recorded interviews were transcribed verbatim and supported by field notes. Data analysis followed Giorgi’s steps for qualitative data analysis.

Results

Results were distilled into three main categories related to the overall transition experience, recognising and responding to residents’ mental health needs, and tailoring support to individual needs. A novel contribution of this study relates to the need to address a broad misunderstanding of the role of pastoral care and subsequent under-utilisation of a potentially valuable resource.

Conclusions

By describing transition experiences and the resources to support residents’ mental health, findings of this study provide practical, ‘real world’ suggestions for reducing relocation stress. New resources developed from the findings include guides, checklists and short question-and-answer films, in which current residents and staff describe strategies to support mental health and overall quality of life. Similar resources could be used to support transitions in other care settings.

About me but without me? Older adult's perspectives on interpersonal communication during care transitions from hospital to seniors' residence

BACKGROUND

Transitions in care can be stressful for an older adult. While communication protocols between health care professionals during transitions have been thoroughly studied, there is a need to better understand how older adults transitioning perceive interpersonal communication. Relying on Communication Accommodation Theory, the goal of this study is to explore Canadian older adults' perspectives of interpersonal communication during care transition from acute care in a hospital to a residence and assess if and how communication could improve health and well-being. Using a longitudinal exploratory design, 13 older adults (M_Age = 84 years) transitioning from acute hospital care to a residence were interviewed at three time points: (1) in the hospital, (2) upon arriving at the residence and (3) in the residence, 2-3 months later. A total of 30 interviews were analyzed using thematic content analysis. Five main themes emerged from participants' descriptions of their transition and communication with health care professionals: (1) Interpersonal Communication or Information, (2) Gratefulness & Burden, (3) Acceptance & Resilience, (4) Maintaining Autonomy and (5), Level of satisfaction. Most participants described being informed rather than being an active participant during the transition process. Most also accepted the transition and tried to reduce the burden on family notably by finding ways to maintain autonomy. A major finding of this study is the lack of interpersonal communication taking place during the transition process, which increased older adults' feeling of uncertainty about the future. Many were unclear on why this move was taking place and where they were going. Providing a space for older adults to communicate their perspectives could attenuate the negative outcomes stemming from stressful care transitions.

The Concept of Respite in Palliative Care: Definitions and Discussions

PURPOSE OF THE REVIEW

The definition of respite care remains unclear and its purpose and effectiveness are unproven till date. This paper reviews the current evidence regarding definition and efficacy of respite care, as well as the different programs, models, and interventions employed to deliver the same.

RECENT FINDINGS

A scoping search identified the relevant literature to be included in the review. The current evidence reiterates the lack of clarity in defining and delineating the purpose of respite care. Recent empirical evidence supports the effectiveness of respite care with clear benefits for the carers, patients, their families, and the healthcare system. Along with inpatient, home, and hospice care, respite care is considered as an essential component of palliative care. Evidence, although weak, supports the efficacy of respite care. High-quality studies with clear outlining of the scope of the services and resolution of ambiguities pertaining to its definition are warranted to fill the gaps in knowledge.