Safety in Housing for Older Adults-A Qualitative Case Study

Housing solutions for older adults aim at providing a safe environment to live in. The construction is heavily based on aspects of physical safety, often disregarding the social aspects of feeling safe. The older adults themselves are looking for a living environment that supports their individual capacities and social networks. The living environment can contribute to their physical, social, and emotional safety by providing accessible housing and spaces for community building. Interviews with older adults who had recently lived through a building fire highlighted the importance of the community in daily life, in emergency as well as in recovery from hazards. The results show that community building is related to access to common-use spaces and daily interaction with neighbors. The shared spaces in the immediate surroundings can enhance community cohesion and generate peer support. The common-use spaces and public facilities in urban environment have a significant role in emergencies and in the process of recovery from adversities.

Leveraging the Contribution of Volunteers: The Critical Role and Economic Value of Volunteers in Older Americans Act Programs

The United States is facing a surge in the aging population, which will increase the demand for services and supports that allow older adults to age independently. This study assessed the size and value of the volunteer labor force in two home- and community-based programs funded under the Older Americans Act (OAA). Using publicly available program data for fiscal years 2015-2019, we calculated the annual contribution of volunteers, based on the total number of volunteer hours and share of labor effort, and estimated the economic value of volunteers in these OAA programs. In fiscal year 2019, volunteers contributed a total value of $1.7 billion in the OAA Title III program and $14.0 million in the Title VII long-term care ombudsman program. These results highlight the value of volunteers in OAA programs and the need for policies to support volunteers in the aging services network.

Patient safety and sense of security when telemonitoring chronic conditions at home: the views of patients and healthcare professionals - a qualitative study

BACKGROUND

Chronic diseases are increasing worldwide, and the complexity of disease management is putting new demands on safe healthcare. Telemonitoring technology has the potential to improve self-care management with the support of healthcare professionals for people with chronic diseases living at home. Patient safety threats related to telemonitoring and how they may affect patients' and healthcare professionals' sense of security need attention. This study aimed to explore patients' and healthcare professionals' experiences of safety and sense of security when using telemonitoring of chronic conditions at home.

METHODS

Semi-structured interviews were conducted with twenty patients and nine healthcare professionals (nurses and physicians), recruited from four primary healthcare centers and one medical department in a region in southern Sweden using telemonitoring service for chronic conditions in home healthcare.

RESULTS

The main theme was that experiences of safety and a sense of security were intertwined and relied on patients´ and healthcare professionals´ mutual engagement in telemonitoring and managing symptoms together. Telemonitoring was perceived to increase symptom awareness and promote early detection of deterioration promoting patient safety. A sense of security emerged through having someone keeping track of symptoms and comprised aspects of availability, shared responsibility, technical confidence, and empowering patients in self-management. The meeting with technology changed healthcare professionals' work processes, and patients' daily routines, creating patient safety risks if combined with low health- and digital literacy and a naïve reliance on technology. Empowering patients' self-management ability and improving shared understanding of the patient's health status and symptom management were prerequisites for safe care and the patient´s sense of security.

CONCLUSIONS

Telemonitoring chronic conditions in the homecare context can promote a sense of security when care is co-created in a mutual understanding and responsibility. Attentiveness to the patient's health literacy, symptom management, and health-related safety behavior when using eHealth technology may enlighten and mitigate latent patient safety risks. A systems approach indicates that patient safety risks related to telemonitoring are not only associated with the patient's and healthcare professionals functioning and behavior or the human-technology interaction. Mitigating patient safety risks are likely also dependent on the complex management of home health and social care service.

In-home environment and happiness among older adults in Thailand

Background

The fact that housing can play a critical role in maintaining the health and independence related to happiness of the older population has been studied in more developed countries. However, research on the effect of housing conditions on happiness is rare in less developed countries. This study aimed to construct and test a structural equation model describing the structural relationship among personal aspects (living alone and physical disability), in-home environment (sleeping place and toilet/bathroom), and happiness among older adults in Thailand.

Method

The data on the population age 75 years or over were extracted from the 2017 national Survey of Older Persons in Thailand (n = 7,829).

Results

The median age of the sample population was 79. Almost 60 percent were women. The structural equation model showed a good fit with the data. Living alone did not directly influence happiness. Physical disability had a statistically significant negative direct effect on happiness. In-home environment not only had an impact on happiness directly, but also moderated the relationship between physical disability and happiness.

Conclusion

The research suggested that interventions to improve happiness of older adults, particularly those with physical disability, should aim to adapt their housing, including sleeping place and toilet design.

Barriers to Aging in Place for Rural, Institutionalized Older Adults: A Qualitative Exploration

OBJECTIVES

Although the majority of older adults wish to "age in place" in their communities, rural contexts pose challenges to maintaining long-term independence. The purpose of this study was to develop an understanding of the experiences of rural older adults who live in Skilled Nursing Facilities (SNFs) and thus have not aged in place. By retrospectively analyzing their pre-institution care situation, we aim to generate foundational knowledge on the barriers to aging in place in rural settings.

METHODS

A series of individual and group interviews was conducted in SNFs across seven rural communities. A grounded, thematic analysis was used to interpret interview findings, and coding was informed by the socio-ecological model (SEM).

RESULTS

Participants were 32 adults with a mean age of 72 years (SD = 5.7 years) and an average SNF residence of 3.9 years. Two themes emerged as primary barriers to successful aging in place: (1) Caregiver-related support issues and (2) Present focus, or lack of advanced care-planning.

CONCLUSIONS

Findings suggest the importance of specifically supporting caregivers, to ease burden and allow for increased agency for rural older adults. A lack of access to caregiver supports and other services limits the ability of community-dwelling rural older adults to age in place or plan for the future.

CLINICAL IMPLICATIONS

Existing networks of rural community resources and innovative solutions should be leveraged to improve access to services for older adults and their informal caregivers.

What influences informal caregivers' risk perceptions and responses to home care safety of older adults with disabilities: A qualitative study

Objective

This study aimed to explore the factors that influence risk perceptions and responses by informal caregivers of older adults with disabilities.

Methods

A descriptive qualitative study was performed, and the socio-ecological framework was applied to interpret the complex influences on individual risk perceptions and responses. Semistructured interviews were conducted with 16 informal caregivers of older adults with disabilities. The interviews were transcribed verbatim and analyzed using content analysis.

Results

The four levels of the socio-ecological framework successfully allowed for the analysis of influences on the risk perceptions and responses of informal caregivers as follows: at the individual level: previous experiences, personality characteristics, health literacy, and care burden; at the familial level: economic status, emotional connection, informational and decisional support; at the community level: health service accessibility and neighbor communication; and at the social level: responsibility-driven culture, media advocacy, and aging policies.

Conclusions

The establishment of risk perceptions and coping behaviors by informal caregivers was affected by many factors. Using the framework to interpret our findings provided insight into the influence of these varying factors. Comprehensive, realistic, and achievable strategies are needed for improving the risk perceptions of informal caregivers in home care by addressing personal, familial, and social environmental factors.

Healthy Lifetime (HL): An Internet-Based Behavioral Health Coaching Protocol for Older Adults

By 2060, the number of Americans 65 years and older will more than double, comprising nearly one-quarter of the population in the United States. While there are many advantages to living longer, a byproduct of aging is also a growing incidence of chronic illness and functional health limitations associated with a concurrent rise in chronic disease and disability that impair independent living in the community. We describe a personalized, behavioral health coaching protocol for early intervention that is delivered online to enhance a participant's independent functioning and to increase their self-care capacity with a goal to maintain independent living throughout aging. The electronic platform provides secure access to fillable surveys, health tracking, “just in time” communication with coaches and scheduling of two-way videos launched from the platform site. The 2-month protocol used two-way video conferencing which allowed high fidelity communication to sustain a complex behavioral intervention. Participants indicate high satisfaction with the intervention, the use of the platform, and the technology. While many health systems across the U.S. have ramped up virtual delivery of care in a proactive manner with now more than 70% of out-patient visits conducted through virtual delivery modes in some health systems, there remains much unevenness in this capability across the U.S. Our approach is to create a stable, interoperable, virtual outreach system for personalized professional health coaching that is complementary to medically oriented services that supports the health and functioning of participants as they age.

An Overview of Naturally Occurring Retirement Communities (NORCs) for Ageing in Place

As an alternative to ageing at home in the community, naturally occurring retirement communities (NORCs) have great potential to facilitate ageing in place; however, they have not attracted much research attention. This study conducts an overview of NORCs, aiming to examine the previous research in a comprehensive manner in order to explore how NORCs impact ageing in place, with the goal of guiding future research. The research presented here employs the content analysis method to review prior NORC-related studies and categorise research themes and findings following top-down coding principles. A total of 49 articles were selected from the Scopus and Web of Science databases, and the results show that the “social environment”, which was the most discussed topic (n = 24), provides the necessary mental support and physical motivation for older adults to live actively in NORCs, and that NORCs play a positive role in preserving public resources and promoting individual health. The limitations of this study include the fact that there is little public information on NORC programs and the subjective classification of themes, among others. This study acts as a foundation for future research on NORCs, which serve as a perfect model for healthy ageing in place.

Safety risks among frail older people living at home in the Netherlands - A cross-sectional study in a routine primary care sample

Frail older people face a range of problems and risks that could undermine their ability to live safely at home. A comprehensive overview of these risks, from a multidimensional perspective, is currently lacking. This study aims to examine the prevalence of risks in multiple domains of life among frail older people living at home. We used cross-sectional data from 824 people aged 65 years and older, who received a comprehensive geriatric assessment (the interRAI Home Care [interRAI-HC]) between 2014 and 2018, as part of routine care from 25 general practices in the region of West-Friesland, the Netherlands. The interRAI-HC identifies amenable risks related to people's clinical conditions, functioning, lifestyle and behaviour, and social and physical environment. Descriptive statistics were used to examine population characteristics (age, gender, marital status, living arrangements and presence of chronic conditions) and prevalence of risks. Most common risks were related to people's clinical conditions (i.e cardio-respiratory health, urinary incontinence, pain), functioning (i.e. limitations in instrumental activities of daily living and mood) and social environment (i.e. limitations in informal care and social functioning). More than 80% of frail older people faced multiple risks, and often on multiple domains of life simultaneously. People experiencing multiple risks per person, and on multiple domains simultaneously, were more often widowed and living alone. The multidimensional character of risks among frail older people living at home implies that an integrated approach to care, comprising both health and social care, is necessary. Insight in the prevalence of these risks can give direction to care allocation decisions.

Prioritizing supports and services to help older adults age in place: A Delphi study comparing the perspectives of family/friend care partners and healthcare stakeholders

Background

Aging in place (AIP) is a policy strategy designed to help older adults remain in their community. While planners internationally have modified aspects of the older adult care continuum (e.g., home care, assisted living, nursing homes) to facilitate AIP, further improvements to community-based supports and services are also required. This study compared and constrasted the community-based factors (e.g., supports, services and personal strategies or characteristics) that family/friend care partners and healthcare stakeholders (i.e., planners/providers) view as most important to help older adults successfully AIP.

Methods

An initial list of factors shown to influence AIP was created from the academic literature. These factors were used to develop a Delphi survey implemented separately on care partners and healthcare stakeholders. Respondents rated the importance of each factor using a 10-point Likert Scale (1 = not important; 10 = absolutely critical). Consensus in each group was defined when at least 80% of participants scored a factor ≥8 (“very important”), with an interquartile range ≤2. Respondents suggested additional factors during Delphi round one.

Results

Care partners (N = 25) and healthcare stakeholders (N = 36) completed two and three Delphi rounds, respectively. These groups independently agreed that the following 3 (out of 27) factors were very important to help older adults age in place: keeping one’s home safe, maintaining strong inter-personal relationships, and coordinating care across formal providers. While healthcare stakeholders did not reach consensus on other factors, care partners agreed that 7 additional factors (e.g., access to affordable housing, having mental health programs) were important for AIP.

Conclusions

Compared to healthcare stakeholders, care partners felt that more and diverse community-based factors are important to support older adults to successfully AIP. Future research should replicate these findings in other jurisdictions, examine the availability and accessibility of the priority factors, and develop sustainable solutions to enhance their effectiveness.

Aging in place among older adults with histories of traumatic experiences: A scoping review

BACKGROUND AND OBJECTIVES

Adverse childhood and adult experiences can have far-reaching impacts, and when coupled with typical aging-related changes, may impede achievement of a suitable person-environment fit for aging adults. The objective of our study was to determine if extant literature connects older adults with trauma history to successfully aging in place.

RESEARCH DESIGN AND METHODS

We proposed a conceptual model regarding trauma history, adaptive capacity of aging adults, and trauma-informed supports for aging in place. We conducted a scoping review using six databases [key words older adult(s), aging in place, housing, trauma], with a full review of 32 articles.

RESULTS

Insights included: 1) Aging in place does not have to mean living in the same house over time. 2) The uncertainty of the aging process can be traumatic and can be exacerbated by previous traumatic experiences. 3) Environmental sensitivities can result from previous traumatic experiences and cause further trauma. 4) Housing precarity is a traumatic experience. 5) Permanent supportive housing is an important resource for people in crisis. 6) Community supports are critical to aging in place.

DISCUSSION AND IMPLICATIONS

Our review revealed insights about aging in place and trauma, but did not connect the vulnerabilities specific to aging adults with personal trauma histories to aging in place. Research is needed that confirms the relationship between history of traumatic experiences and difficulties with aging in place as well as trauma-informed approaches that can mitigate housing-related stressors and foster community living environments that provide equitable access to aging in place.

Factors Related to Self-Confidence to Live Alone in Community-Dwelling Older Adults: A Cross-Sectional Study

BACKGROUND

Many older adults prefer to live alone in their own homes, with age-related issues in physical movement, regardless of their cultural background. Importantly, however, to identify the features of successfully ageing in place (AIP), and foster independent living among these individuals, this study explored their level of self-confidence to live alone and its related factors.

METHODS

We conducted a cross-sectional study using secondary data from an earlier study with older adults living alone in South Korea recruited by convenience sampling methods (N = 936, mean age = 77.1 years, 76.1% female). Data regarding the general, health-related, and social characteristics as well as self-confidence to live alone were collected via face-to-face interviews in 2019. Self-confidence to live alone was measured with a numeric rating scale of 0 to 10.

RESULTS

The average self-confidence score to live alone was 6.59. A regression analysis showed that mould exposure at home, depression, emergency department visits, and loneliness hinder self-confidence to live alone. Meanwhile, such self-confidence was facilitated by independency in instrumental activities of daily living (IADL), interactions with family members, social service utilisation, and social support.

CONCLUSIONS

This study suggests that healthcare providers need to consider the importance of self-confidence to live alone and influencing functional, mental, social, and environmental factors to promote quality of life as well as successful AIP for older adults living alone. Further, self-confidence to live alone could be a new practical index in the field of health and ageing to screen the successful AIP of older adults living alone.

The Association of Neighborhood Medical Facilities with Aging in Place and Risk of Incident Myocardial Infarction

Objectives: Aging in place (residential stability) is a desirable means of aging where adults remain in their homes, even when facing challenges that impair their capacity for self-care. Residential stability, especially following acute health challenges, depends on individual and community factors, possibly including proximity to medical facilities. Methods: We explored the association between the density of medical facilities around homes with risk of incident myocardial infarction (MI) and with aging in place following incident MI. Results: Densities of neighborhood pharmacies were not associated with aging in place or time to MI. High densities of neighborhood clinical care facilities were significantly associated with decreased residential stability. Discussion: The lack of significant associations between medical facility exposures and MI-related outcomes, coupled with prior findings, casts doubt on their salience and may indicate that other neighborhood features are more strongly associated with these outcomes.

Supporting Older People to Live Safely at Home - Findings from Thirteen Case Studies on Integrated Care Across Europe

Introduction

While many different factors can undermine older people's ability to live safely at home, safety as an explicit aspect of integrated care for older people living at home is an underexplored topic in research. In the context of a European project on integrated care, this study aims to improve our understanding of how safety is addressed in integrated care practices across Europe.

Methods

This multiple case study included thirteen integrated care sites from seven European countries. The Framework Method guided content analyses of the case study reports. Activities were clustered into activities aimed at identifying and managing risks, or activities addressing specific risks related to older people's functioning, behaviour, social environment, physical environment and health and social care receipt.

Results

Case studies included a broad range of activities addressing older people's safety. Although care providers felt they sufficiently addressed safety issues, older people were often concerned and insecure about their safety. Attention to the practical and social aspects of safety was often insufficient.

Conclusions and discussion

Integrated care services across Europe address older people's safety in many ways. Further integration of health and social care solutions is necessary to enhance older people's perceptions of safety.

Addressing safety risks in integrated care programs for older people living at home: a scoping review

BACKGROUND

Many older people live at home, often with complex and chronic health and social care needs. Integrated care programs are increasingly being implemented as a way to better address these needs. To support older people living at home, it is also essential to maintain their safety. Integrated care programs have the potential to address a wide range of risks and problems that could undermine older people's ability to live independently at home. The aim of this scoping review is to provide insight into how integrated care programs address safety risks faced by older people living at home - an area that is rather underexplored.

METHODS

Safety was conceptualised as preventing or reducing the risk of problems, associated with individual functioning and behaviour, social and physical environments, and health and social care management, which could undermine older people's ability to live independently at home. For this scoping review a systematic literature search was performed to identify papers describing integrated care programs where at least one intervention component addressed safety risks. Data were extracted on the programs' characteristics, safety risks addressed, and the activities and interventions used to address them.

RESULTS

None of the 11 programs included in this review explicitly mentioned safety in their goals. Nevertheless, following the principles of our conceptual framework, the programs appeared to address risks in multiple domains. Most attention was paid to risks related to older people's functioning, behaviour, and the health and social care they receive. Risks related to people's physical and social environments received less attention.

CONCLUSION

Even though prevention of safety risks is not an explicit goal of integrated care programs, the programs address a wide range of risks on multiple domains. The need to address social and environmental risks is becoming increasingly important given the growing number of people receiving care and support at home. Prioritising a multidimensional approach to safety in integrated care programs could enhance the ability of health and social care systems to support older people to live safely at home.

Impact of Natural Disasters on Health Outcomes and Cancer Among Older Adults

There is growing evidence that older adults exposed to natural disasters are at disproportionate risk for adverse health events such as all-cause mortality, injury, hospital admissions, stroke, displacement, cardiopulmonary distress, stress-related mental health problems, and exacerbation of chronic illnesses. Typically, analyses of the health consequences of natural disasters focus only on the populations impacted for the duration and immediate aftermath of the disaster. With few exceptions, the long-term effects of natural disasters on older adult health have not been examined. This article describes the potential consequences of exposure to natural disasters that contribute to cancer and disruption of cancer care treatment systems for older adults. It is argued that exposures to floods and wildfires in particular present an underestimated threat to the onset and/or progression of cancer and cancer care management in older adults. We propose that these impacts should be examined not only from an emergency preparedness perspective during the event but also from a public health focus that prospectively assesses risks for cancer and other health disparities. Recommendations for comprehensive longitudinal risk assessment and emergency preparedness models that address the full impact of natural disasters on the health and well-being of vulnerable, at risk, older adults are offered.

The SUSTAIN Project: A European Study on Improving Integrated Care for Older People Living at Home

Introduction

Integrated care programmes are increasingly being put in place to provide care to older people who live at home. Knowledge of how to further develop integrated care and how to transfer successful initiatives to other contexts is still limited. Therefore, a cross-European research project, called Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN), has been initiated with a twofold objective: 1. to collaborate with local stakeholders to support and monitor improvements to established integrated care initiatives for older people with multiple health and social care needs. Improvements focus on person-centredness, prevention orientation, safety and efficiency; 2. to make these improvements applicable and adaptable to other health and social care systems, and regions in Europe. This paper presents the overall structure and approach of the SUSTAIN project.

Methods

SUSTAIN uses a multiple embedded case study design. In three phases, SUSTAIN partners: (i) conduct interviews and workshops with stakeholders from fourteen established integrated care initiatives to understand where they would prefer improvements to existing ways of working; (ii) collaborate with local stakeholders to support the design and implementation of improvement plans, evaluate implementation progress and outcomes per initiative, and carry out overarching analyses to compare the different initiatives, and; (iii) translate knowledge and experience to an online roadmap.

Discussion

SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home.

"People are Getting Lost a Little Bit": Systemic Factors that Contribute to Falls in Community-Dwelling Octogenarians

Octogenarians living in the community are the fastest-growing demographic in Canada. Simultaneously, they have the highest prevalence of falls and nine times greater risk of injury due to a fall. To understand how to improve the safety of octogenarians' aging-in-place, a systems approach is essential. Understanding how societal factors interact and affect the older adult can help care custodians identify and remove safety deficiencies that bring about falls. The purpose of this study was to identify system-wide factors contributing to falls in community-dwelling octogenarians. Eight falls were investigated using the systemic falls investigative method. Participants ranged in age from 83-90 years. Across-case analyses identified 247 contributing factors, grouped within four distinct themes: (a) everyday living has become risky; (b) supervision limitations; (c) health care system disconnects; and (d) poor fall risk identification and follow-up. This qualitative study provides systemic insights into how and why falls occur in community-dwelling octogenarians.

Nonpharmacological therapies and provision of aids in outpatient dementia networks in Germany: utilization rates and associated factors

Background

Nonpharmacological therapies and the provision of aids are described to be supportive in the treatment of persons with dementia (PWDs). These aim to maintain individuals’ participation in daily activities as long as possible, to slow the progression of their disease, and to support their independent living at home. However, there is a lack of knowledge about the utilization of therapies and aids among community-dwelling PWDs.

Objective

The aims of the study were a) to describe the utilization of nonpharmacological therapies and aids among community-dwelling PWDs and b) to analyze the factors associated with utilization.

Method

As part of a cross-sectional study of n=560 caregivers of PWDs in dementia networks throughout Germany, we assessed sociodemographics, clinical variables, and the utilization of nonpharmacological therapies (physiotherapy [PT], occupational therapy [OT]), and aids (sensory, mobility, and others), using face-to-face interviews and questionnaires.

Results

Approximately every fourth PWD received PT and every seventh PWD received OT. Sensory aids were utilized by 91.1%, personal hygiene aids by 77.2%, mobility aids by 58.6%, and medical aids by 57.7% of the sample. Regression analysis revealed that the utilization of PT and medical aids was associated with comorbidities (odds ratio [OR] 1.17 and OR 1.27, respectively) and that the utilization of OT and sensory aids was associated with age (OR 1.06 and OR 0.95, respectively).

Conclusion

The utilization of nonpharmacological therapies and aids among community-dwelling people served by dementia networks is more frequent than that reported for people in other settings. This result indicates that PWDs in integrated care models such as dementia networks receive better health care.

Identifying naturally occurring retirement communities: a spatial analysis

OBJECTIVES

Guided by the concept of "aging in place" and potential policy implications, the study analyzed naturally occurring retirement communities (NORCs; 40% or greater house owners and renters aged 65 years and older) and whether there were spatiotemporal patterns in Ohio between 2000 and 2010.

METHOD

Data were derived from the 2000 and 2010 census tracts. Geovisualization was used to visually examine the distribution of NORCs in 2000 and 2010. Global Moran's I was used to quantify the spatial distribution of NORCs in Ohio and Local Moran's I was used to identify clusters of NORCs (i.e., hot spots).

RESULTS

The number of NORCs slightly decreased despite the overall increase of the older population from 2000 to 2010. NORCs were identified in one of the 3 most populous counties (i.e., Cuyahoga) and its neighboring counties. A number of hot spots were identified in Cuyahoga County (among Ohio's most populous and NORC-rich counties), both in 2000 and 2010. There were different patterns including emerging, disappearing, and enduring NORCs and disproportionate distributions of NORCs across the state between 2000 and 2010.

DISCUSSION

Locating NORCs could aid governments to create "aging in place" sensitive policies to address issues of independence, social care, health care, volunteerism, and community participation.

A framework for understanding outcomes of integrated care programs for the hospitalised elderly

INTRODUCTION

Integrated care has emerged as a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integrated care delivery. Therefore, we developed a framework to identify the underlying mechanisms of integrated care delivery. We should understand how they operate and interact, so that integrated care programmes can enhance the quality of care and eventually patient outcomes.

THEORY AND METHODS

Interprofessional collaboration among professionals is considered to be critical in integrated care delivery due to many interdependent work requirements. A review of integrated care components brings to light a distinction between the cognitive and behavioural components of interprofessional collaboration.

RESULTS

Effective integrated care programmes combine the interacting components of care delivery. These components affect professionals' cognitions and behaviour, which in turn affect quality of care. Insight is gained into how these components alter the way care is delivered through mechanisms such as combining individual knowledge and actively seeking new information.

CONCLUSION

We expect that insight into the cognitive and behavioural mechanisms will contribute to the understanding of integrated care programmes. The framework can be used to identify the underlying mechanisms of integrated care responsible for producing favourable outcomes, allowing comparisons across programmes.

Clinical trial of a home safety toolkit for Alzheimer's disease

This randomized clinical trial tested a new self-directed educational intervention to improve caregiver competence to create a safer home environment for persons with dementia living in the community. The sample included 108 patient/caregiver dyads: the intervention group (n = 60) received the Home Safety Toolkit (HST), including a new booklet based on health literacy principles, and sample safety items to enhance self-efficacy to make home safety modifications. The control group (n = 48) received customary care. Participants completed measures at baseline and at twelve-week follow-up. Multivariate Analysis of Covariance (MANCOVA) was used to test for significant group differences. All caregiver outcome variables improved in the intervention group more than in the control. Home safety was significant at P ≤ 0.001, caregiver strain at P ≤ 0.001, and caregiver self-efficacy at P = 0.002. Similarly, the care receiver outcome of risky behaviors and accidents was lower in the intervention group (P ≤ 0.001). The self-directed use of this Home Safety Toolkit activated the primary family caregiver to make the home safer for the person with dementia of Alzheimer's type (DAT) or related disorder. Improving the competence of informal caregivers is especially important for patients with DAT in light of all stakeholders reliance on their unpaid care.

The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients

Aim

To identify predictors of relational coordination among professionals delivering care to older patients.

Background

Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood.

Design

This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands.

Methods

This study was performed in spring 2010 among team members delivering care to older hospitalized patients (192 respondents; 44% response rate) in one hospital. Relational coordination was measured by the Relational Coordination survey; team climate by the Team Climate Inventory and questions were asked about participation in multidisciplinary team meetings and disciplines represented in these meetings. To account for the hierarchical structure, a multilevel analysis was performed.

Results

Correlation analysis revealed a positive relationship among being female, being a nurse and relational coordination; medical specialists showed a negative relationship. The number of disciplines represented during multidisciplinary team meetings and team climate were positively related with relational coordination. The multilevel analysis showed a positive relationship between the number of disciplines represented during multidisciplinary team meetings and team climate with relational coordination.

Conclusions

The enhancement of team climate and attendance of diverse professionals during multidisciplinary team meetings are expected to improve relational coordination. Furthermore, this study underscores the importance of enhancing relational coordination between medical specialists and other professionals.

Aging in Place in a Retirement Community: 90+ Year Olds

Aging in place, an image of growing old in one's home and maintaining one's daily routine, is desired by most older adults. To identify variables promoting such independent living in the oldest-old, we examined the association between living situation of a population-based cohort of 90+ year olds with health and lifestyle variables. Of 1485 participants, 53% still lived in their home at a retirement community designed to foster wellness. Those living at home tended to be healthier, with smaller proportions having chronic diseases or hospitalizations in the preceding year and a greater proportion having normal functional ability. Dementia was the chronic disease most significantly related to living situation. In addition to not having dementia, not using a wheelchair or bath aid, receiving meals on wheels, and being married were jointly related to living at home. With the help of family and friends and with a medical and social support system, many 90+ year olds can age in place. This is often because they have a caregiving spouse or paid caregiver.

Incidents when older homebound women tried to reach help quickly

During a longitudinal study of the experience of reaching help quickly, 34 homebound women (ages 85 to 97) who lived alone reported 106 reach-help-quickly incidents (RHQIs). The purpose of this study was to expand knowledge about RHQIs and intentions relative to them and to compare those facets of experience for subscribers to a personal emergency response system (PERS) and non-subscribers. We used a descriptive phenomenological method to analyze interview data, discerning six types of RHQIs, including finding myself down right here, realizing that I might not be alright after falling and getting up on my own, and realizing that something I cannot explain is or could be wrong with me. Intentions were focused on self-help before help seeking. The overall phenomenon was Handling a Situation When I Am Alone at Home and Probably Need Help Quickly. Practitioners should explore intentions about handling specific types of RHQIs and offer appropriate anticipatory guidance.

Informal and formal support among community-dwelling Japanese American elders living alone in Chicagoland: an in-depth qualitative study

A key public health approach to promote independent living and avoid nursing home placement is ensuring that elders can obtain adequate informal support from family and friends, as well as formal support from community services. This study aims to describe the use of informal and formal support among community-dwelling Nikkei elders living alone, and explore perceived barriers hindering their use of such support. We conducted English and Japanese semi-structured, open-ended interviews in Chicagoland with a convenience sample of 34 Nikkei elders age 60+ who were functionally independent and living alone; 9 family/friends; and 10 local service providers. According to participants, for informal support, Nikkei elders relied mainly on: family for homemaking and health management; partners for emotional and emergency support; friends for emotional and transportation support; and neighbors for emergency assistance. Perceived barriers to informal support included elders' attitudinal impediments (feeling burdensome, reciprocating support, self-reliance), family-related interpersonal circumstances (poor communication, distance, intergenerational differences); and friendship/neighbor-related interpersonal situations (difficulty making friends, relocation, health decline/death). For formal support, Nikkei elders primarily used adult day care/cultural programs for socializing and learning and in-home care for personal/homemaking assistance and companionship. Barriers to formal support included attitudinal impediments (stoicism, privacy, frugality); perception of care (incompatibility with services, poor opinions of in-home care quality); and accessibility (geographical distance, lack of transportation). In summary, this study provides important preliminary insights for future community strategies that will target resources and training for support networks of Nikkei elders living alone to maximize their likelihood to age in place independently.

Is collective efficacy age graded? The development and evaluation of a new measure of collective efficacy for older adults

Objectives. Community processes are key determinants of older adults' ability to age in place, but existing scales measuring these constructs may not provide accurate, unbiased measurements among older adults because they were designed with the concerns of child-rearing respondents in mind. This study examines the properties of a new theory-based measure of collective efficacy (CE) that accounts for the perspectives of older residents. Methods. Data come from the population-based Chicago Neighborhood Organization, Aging and Health study (N = 1,151), which surveyed adults aged 65 to 95. Using descriptive statistics, correlations, and factor analysis, we explored the acceptability, reliability, and validity of the new measure. Results. Principal component analysis indicated that the new scale measures a single latent factor. It had good internal consistency reliability, was highly correlated with the original scale, and was similarly associated with neighborhood exchange and disorder, self-rated health, mobility, and loneliness. The new scale also showed less age-differentiated nonresponse compared to the original scale. Discussion. The older adult CE scale has reliability and validity equivalent to that of the existing measure but benefits from a more developed theoretical grounding and reduced likelihood of age-related differential nonresponse.

The importance of social connectedness in building age-friendly communities

The purpose of this paper is to further elucidate the importance of social relationships and social connectedness with aging in place and in developing elder-friendly communities. The process used in this study was inclusive of younger adults (age 40-65) as well as older adults (65+) in order to further understand how they envision a community that could support their own aging in place. A community forum, using the World Café format, was conducted in order to engage community members, 40 years and older, in conversation about the importance of social connectedness in elder-friendly communities. A second purpose of this forum was to obtain data on what would keep aging boomers in their community as they age. Three major themes emerged from qualitative analysis of the forum: social reciprocity, meaningful interactions, and structural needs/barriers. The results of this study reinforce the importance of social connectedness in creating and maintaining elder-friendly communities for older adults, as well as soon-to-be retired individuals, wishing to maintain life connectedness to their community. The study suggests the possibility of using more nontraditional research techniques (such as the World Café process) for gathering community level data.

Challenges to Aging in Place: Understanding Home Maintenance Difficulties

Age-related declines in capabilities may compromise older adults' ability to maintain their homes thus threatening successful aging in place. Structured interviews were conducted with forty-four independently living older adults (M(age) = 76.1, SD = 4.7) to discuss difficult home maintenance tasks and how they managed those tasks. Solutions to managing difficulties were categorized as person-related or environment-related. The majority (85%) of responses were person-related solutions. An understanding of the specific challenges that older adults face in maintaining their homes can guide redesign efforts and interventions to effectively support older adults' desire to age in place.

The costs and outcomes of falls: what's a nursing administrator to do?

Falls affect older people in every healthcare setting, causing significant morbidity and mortality. With the aging population, we can expect rates of falling to increase. Nurses and nursing administrators are challenged to prevent injuries and address this multifactorial problem, and nurses are on the front lines of care and in a position to make a difference. Evidence-based measures have been identified, but implementation and management of falls continue to be difficult. Nursing administrators need a clear understanding of the dynamics of falling and the current evidence for their particular setting to ensure that their nurses have the tools to implement appropriate programs and interventions.

Intentions of older homebound women to reduce the risk of falling again

PURPOSE

Researchers have tested interventions to prevent recurrent falls for older people without exploring their intentions to prevent another fall. Lack of knowledge about such intentions is an impediment to intervention effectiveness. The purpose was to describe intentions to prevent another fall as discerned during a study with older homebound women.

METHODS

Data were obtained during a series of four in-home interviews over 18 months with monthly telephone contacts between interviews; fall history was updated at each contact. A descriptive phenomenological method was used to analyze data.

FINDINGS

Of the 40 women, 36 (aged 85 to 98 years) had fallen at home at least once before enrolling in the study, or had a subsequent or initial fall during the study. The overall intention was reducing my risk of falling again at home, with its components figuring out the reason that I fell and changing my ways to reduce my risk of falling again at home. Most women explained reasons for a fall and voiced intentions to prevent a similar fall. Women who viewed falls as unexpected events were uncertain that they could prevent a fall or felt unable to do so and voiced few preventive intentions. A few women voiced generalized preventive intentions to change health-related behaviors or habits.

CONCLUSIONS

Most intentions were tied directly to the situation in which a fall had occurred. Such specificity could limit effectiveness of personal efforts to prevent falls in other situations.

CLINICAL RELEVANCE

Practitioners should converse with older women who have fallen about their intentions to prevent another fall and weigh the need to help them generalize both the risk of falling again and their risk reduction intentions.

Stability and changes in living arrangements: relationship to nursing home admission and timing of placement

OBJECTIVES

To examine whether stability of living arrangements and changes in household composition-both types and frequency-influence nursing home placement or timing to entry among older people.

METHODS

Data from the first 5 waves of the Assets and Health Dynamics of the Elderly (1993-2002) on 8,093 persons aged 70 years or older at baseline are used in probit and hazard models to predict nursing home entry and time to entry.

RESULTS

Stable living arrangements carry different risks of institutionalization. Those living continuously alone or with others were at highest risk; at lowest risk were those living continuously with a spouse or the same child (lowest overall). Changes in household composition were protective against nursing home entry and slowed time to entry; types of change were not influential when number of changes was taken into account.

DISCUSSION

Results suggest that stability of living arrangements in and of itself is not protective against institutionalization. Having options that allow one to change living arrangements over time in response to changing needs for assistance is of importance if the goal is to avoid institutional care or extend community residence prior to entry.

Family caregivers' viewpoints towards quality of long-term care services for community-dwelling elders in Taiwan

The population of elderly people in Taiwan is increasing rapidly, and long-term gerontology care has become an important issue in this greying society. The purpose of this study is to explore family caregivers' viewpoints and opinions regarding the long-term care services for community-dwelling older adults in Taiwan. A qualitative study was conducted between August and December of 2005. Fifty family caregivers agreed to participate in this study. Data were collected by focus group interviews, in order to obtain the experience and expectation of family caregivers concerning long-term care services in their daily lives. Through content analysis and peer discussion,the data were categorized into five major themes: (1) praise for the services;(2) flexibility of long-term care services; (3) comprehensiveness of long-term services; (4) linkage and extension of existing resources; and (5) activeness of service provision. Study findings from the family caregivers' viewpoints should contribute to the improvement of long-term care services and provide a basis for designing suitable programmes to enhance community-dwelling in situ elderly people care.

Web 3D for public, environmental and occupational health: early examples from second life

Over the past three years (2006–2008), the medical/health and public health communities have shown a growing interest in using online 3D virtual worlds like Second Life^® (http://secondlife.com/) for health education, community outreach, training and simulations purposes. 3D virtual worlds are seen as the precursors of ‘Web 3D’, the next major iteration of the Internet that will follow in the coming years. This paper provides a tour of several flagship Web 3D experiences in Second Life^®, including Play2Train Islands (emergency preparedness training), the US Centers for Disease Control and Prevention—CDC Island (public health), Karuna Island (AIDS support and information), Tox Town at Virtual NLM Island (US National Library of Medicine - environmental health), and Jefferson’s Occupational Therapy Center. We also discuss the potential and future of Web 3D. These are still early days of 3D virtual worlds, and there are still many more untapped potentials and affordances of 3D virtual worlds that are yet to be explored, as the technology matures further and improves over the coming months and years.