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Comprehensive Senior Technology Acceptance Model of Daily Assistive Technology for Older Adults with Frailty: Cross-Sectional Study (Preprint). J Med Internet Res 2022; 25:e41935. [PMID: 37036760 PMCID: PMC10131916 DOI: 10.2196/41935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/31/2023] [Accepted: 02/26/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND There are considerable gaps between the need for assistive technologies and the actual adoption of these technologies among older adults, although older adults are among the groups that most need assistive technologies. Consequently, research is needed in this area because older adults' technology acceptance and influencing factors may differ depending on their level of frailty. OBJECTIVE The objective of this study was to compare frail, prefrail, and robust groups of South Korean adults regarding their behavioral intention to use daily living assistive technologies and the affecting factors-namely, technological context factors, health contexts and abilities, and attitudinal factors-based on a comprehensive senior technology acceptance model. METHODS A nationwide sample of 500 older South Korean adults (aged 55-92 years) was analyzed, and multivariate linear regression analyses of the robust, prefrail, and frail groups were performed. The independent and dependent variables consisted of 3 factors based on previous studies. First, technological context factors consisted of gerontechnology self-efficacy, gerontechnology anxiety, and facilitating conditions. Second, health contexts and abilities consisted of self-reported health conditions, cognitive ability, social relationships, psychological function, and physical function. Third and last, attitudinal factors consisted of behavioral intention to use assistive technologies, attitude toward use, perceived usefulness (PU), and perceived ease of use (PEOU). RESULTS The results of the analyses showed that technological context factors such as gerontechnology self-efficacy, health contexts and abilities such as self-reported health conditions and psychological function, and attitudinal factors such as attitude toward use, PU, and PEOU had significant effects on behavioral intention to use daily living assistive technologies. In particular, gerontechnology self-efficacy had a significant relationship with behavioral intention to use these technologies in the robust (r=0.120; P=.03) and prefrail (r=0.331; P<.001) groups. Psychological function (life satisfaction) had a significant relationship with behavioral intention to use these technologies in the robust group (r=-0.040; P=.02). Self-reported health conditions had a significant relationship with behavioral intention to use these technologies in the prefrail group (r=-0.169; P=.01). Although each group had a different significant relationship with the variables, attitudinal factors such as attitude toward use affected all groups (robust group: r=0.190; P=.03; prefrail group: r=0.235; P=.006; and frail group: r=0.526; P=.002). In addition, PU and PEOU in the attitudinal factors had a significant relationship with behavioral intention to use assistive technologies in the robust (PU: r=0.160; P=.01; and PEOU: r=0.350; P<.001) and prefrail (PU: r=0.265; P<.001; and PEOU: r=0.120; P=.04) groups. CONCLUSIONS This study found that the comprehensive senior technology acceptance model of daily living assistive technologies had different associations according to the frailty group. These findings provided insights into the consideration of interventions with daily living assistive technologies for older adults with varying levels of frailty.
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Chitalu P, Tsui A, Searle SD, Davis D. Life-space, frailty, and health-related quality of life. BMC Geriatr 2022; 22:646. [PMID: 35931955 PMCID: PMC9356461 DOI: 10.1186/s12877-022-03355-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Life-space and frailty are closely linked to health-related quality of life and understanding their inter-relationship could indicate potential intervention targets for improving quality of life. We set out to examine the relationship between frailty and life-space and their relative impact on quality of life measures. METHODS Using cross-sectional data from a population-representative cohort of people aged ≥ 70 years, we assessed quality of life with the EuroQol Health Index tool (5-levels) (EQ-5D-5L). We also undertook a life-space assessment and derived a frailty index. Linear regression models estimated EQ-5D-5L scores (dependent variable) using life-space assessment, frailty index and interactions between them. All models were adjusted by age, sex, lifestyle, and social care factors. RESULTS A higher EQ-5D Index was associated with higher life-space (0.02 per life-space assessment score, 95%CI: 0.01 to 0.03, p < 0.01) and decreasing frailty (-0.1 per SD, 95%CI: -0.1 to -0.1, p < 0.01). There was evidence of an interaction between life-space and frailty, where the steepest gradient for life-space and EQ-5D was in those with the highest frailty (interaction term = 0.02 per SD of frailty, 95%CI: 0.01 to 0.03, p < 0.01). CONCLUSION Individuals with the highest frailty were twice as likely to have higher quality of life in association with a larger life-space. Interventions designed to improve quality of life in frail older people could focus on increasing a person's life-space.
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Affiliation(s)
- Petronella Chitalu
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Alex Tsui
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Samuel D Searle
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.,Division of Geriatric Medicine, Dalhousie University, Nova Scotia, Canada
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
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Training Program to Modify Manual Wheelchairs to Simplified Power Wheelchairs for Community Dwelling Elderly People and Caregivers. Occup Ther Int 2022; 2022:5594598. [PMID: 35350128 PMCID: PMC8930241 DOI: 10.1155/2022/5594598] [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: 02/26/2021] [Revised: 09/27/2021] [Accepted: 02/24/2022] [Indexed: 11/17/2022] Open
Abstract
Mobility aids, particularly power wheelchairs, are necessary for elderly individuals who have health problems and disabilities. However, there is a limitation in providing power wheelchairs for such people in the community. The objectives of this study were to develop a prototype for a simplified power wheelchair and develop and evaluate a training program that has the potential to encourage evaluation and modification of the wheelchair for the elderly and their caregivers in the community. Twenty-four participants consist of elderly people and caregivers who were interested in the training program that comprised two sessions: theory and fieldwork experience. Results showed that the elderly people and caregivers, who had no knowledge or experience of wheelchair modification, were able to learn and provide suggestions for wheelchair users in their community. Two themes emerged from evaluating the training program, which included “benefits from the training program” and “improvement of the training program in the future.” Key concepts were elicited and considered in six categories: sufficient knowledge and practical learning to build confidence, values of fieldwork experiences, team support, organizational support, expansion of various contexts, and system of continued connection and services after training.
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Peterson KF, Adams-Price C. Fear of Dependency and Life-Space Mobility as Predictors of Attitudes Toward Assistive Devices in Older Adults. Int J Aging Hum Dev 2021; 94:273-289. [PMID: 34191644 DOI: 10.1177/00914150211027599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Assistive devices can help older adults remain independent; however, they may hesitate to use them due to fears of appearing dependent by embodying aging stereotypes. Reluctance to use assistive devices may lead to decreased life space mobility. The selective optimization with compensation (SOC) model posits that older adults employ strengths to accommodate for age-related functioning declines. The current study examines the predictive power of health perceptions, dependency fears, aging stereotypes, and life space on older adults' views of assistive devices. Results suggest that older adults with greater life space and dependency fears are more likely to view assistive devices positively.
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Løkkeberg ST, Thoresen G. Experiences of quality of life in people with Multiple Sclerosis who are in a wheelchair. Nurs Open 2021; 9:2217-2226. [PMID: 34053191 PMCID: PMC9190755 DOI: 10.1002/nop2.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022] Open
Abstract
Aim The study includes health‐related quality of life for people in Norway with multiple sclerosis who live at home and are in a wheelchair (N = 6). The purpose is to show how they experience living with a chronic disease such as MS and how they perceive their own situation. How they value their own health and what leads to positive consequences is central to this study. Design The study has a qualitative design to show what health‐related experiences they had while living with MS. Method The interviews were conducted in their home and later transcribed. An interview guide with open‐ended questions was used. The transcribed material was analysed with a thematic analysis. Results Key themes were being free and independent, threat to the self and one's identity, and adaptation to MS. Free and independent in everyday life was essential for all the informants. Being dependent on others for basic needs was something they sought to avoid. Adapting to the new situation of changing roles was a challenge that required a lot of them.
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Affiliation(s)
| | - Gunnar Thoresen
- Faculty of Health and Welfare, Østfold University College, Fredrikstad, Norway
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6
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Maenhout A, Cornelis E, Van de Velde D, Desmet V, Gorus E, Van Malderen L, Vanbosseghem R, De Vriendt P. The relationship between quality of life in a nursing home and personal, organizational, activity-related factors and social satisfaction: a cross-sectional study with multiple linear regression analyses. Aging Ment Health 2020; 24:649-658. [PMID: 30724580 DOI: 10.1080/13607863.2019.1571014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: This study aimed to investigate quality of life in nursing home residents and the relationship with personal, organizational, activity-related factors and social satisfaction.Methods: In a cross-sectional survey study in 73 nursing homes in Flanders, Belgium, 171 cognitively healthy residents were randomly recruited (mean age 85.40 years [±5.88]; 27% men, 73% women). Quality of life, as the dependent/response variable, was measured using anamnestic comparative self-assessment (range -5 to +5). Multiple linear regression (forward stepwise selection) was used (1) to investigate which factors were significantly related to nursing home residents' quality of life and (2) to model the relationship between the variables by fitting a linear equation to the observed data.Results: Nursing home residents reported a quality of life score of 2.12 (±2.16). Mood, self-perceived health status, social satisfaction and educational level were withheld as significant predictors of the anamnestic comparative self-assessment score (p < 0.001), explaining 38.1% of the variance in quality of life.Conclusions: Results suggest that a higher quality of life in nursing homes can be pursued by strategies to prevent depression and to improve nursing home residents' subjective perception of health (e.g. offering good care) and social network. It is recommended that nursing homes prepare for future generations, who will be more educated.
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Affiliation(s)
- Annelies Maenhout
- Research Group Zorginnovatie, Artevelde University College Ghent, Ghent, Belgium
| | - Elise Cornelis
- Research Group Zorginnovatie, Artevelde University College Ghent, Ghent, Belgium.,Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Dominique Van de Velde
- Research Group Zorginnovatie, Artevelde University College Ghent, Ghent, Belgium.,Department of Occupational Therapy, Faculty of Medicine and Health Sciences Rehabilitation Sciences and Physiotherapy, University Ghent, Ghent, Belgium
| | - Valerie Desmet
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Ellen Gorus
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lien Van Malderen
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Ruben Vanbosseghem
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Patricia De Vriendt
- Research Group Zorginnovatie, Artevelde University College Ghent, Ghent, Belgium.,Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
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Liu Z, Han L, Wang X, Feng Q, Gill TM. Disability Prior to Death Among the Oldest-Old in China. J Gerontol A Biol Sci Med Sci 2019; 73:1701-1707. [PMID: 29408957 DOI: 10.1093/gerona/gly010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Indexed: 11/13/2022] Open
Abstract
Background To estimate the prevalence of disability during the last 3 years prior to death among the oldest-old (≥80 years) in China. Methods We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative study of the oldest-old in China. The analytic sample included 23,934 decedents who died between 1998 and 2014 and had at least one interview within the last 3 years of life. Disability was defined as being incontinent or needing assistance in performing one or more of five other essential activities (bathing, transferring, dressing, eating, and toileting). Results About 57.8% (weighted) of the study decedents were female. The prevalence of disability increased modestly from 36 months to 24 months prior to death (20% to 23%), more rapidly from 24-months to 12-months before death (23% to 31%), and substantially from 12 months before death to the last month of life (31% to 48%). The disability rates were lowest for participants who died between 80 and 89 years, intermediate for those who died between 90 and 99 years, and highest for those who died at age 100 or older, although the patterns over the 3-year period were comparable for the three age groups. At each time point prior to death, a higher percentage of women was disabled than men. Conclusions In this large nationally representative sample of the oldest-old in China, the prevalence of disability during the 3 years prior to death is high and is greater in women than men and those who die at the oldest ages.
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Affiliation(s)
- Zuyun Liu
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiaofeng Wang
- Unit of Epidemiology, Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Qiushi Feng
- Department of Sociology, National University of Singapore
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Kahana E, Kahana JS, Kahana B, Ermoshkina P. Meeting Challenges of Late Life Disability Proactively. Innov Aging 2019; 3:igz023. [PMID: 31384671 PMCID: PMC6669282 DOI: 10.1093/geroni/igz023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 11/17/2022] Open
Abstract
Discussions of disability in the gerontological and the disability studies literatures have seldom considered unique perspectives and needs of older adults. Disability has often been stigmatized and viewed as antithetical to successful aging. We call for expansion of prevailing paradigms of disability to address the resilience and continuing human potential of older adults living with disabilities. In addition to recognizing the environmental context of disability, we propose greater attention to adaptive potential of disabled older adults. We discuss 6 types of proactive adaptations that can contribute to empowerment, meaning, enhanced quality of life and psychological well-being among persons living with late-life onset disabilities. These include: (a) helping others, (b) planning for future care, (c) marshaling intergenerational support, (d) self-advocacy for responsive health care, (e) making environmental modifications to improve safety and comfort of the home, and (f) finding strength in spiritual pursuits. Enacting proactive adaptations can contribute to resilience in facing late life impairments and functional limitations. Such efforts can complement utilization of services and obtaining accommodations. Maintaining life satisfaction among older adults living with disabilities also involves focus on transcendent personal goals and acceptance of an altered self. We note how a more integrative view of medical and social dimensions of disability, infused with concepts of human agency, contributes to rapprochement between alternative disciplinary orientations to late life disability. Without negating society’s important responsibilities for accommodating to needs of older adults living with disability, we reaffirm their potential for greater control and self-determination through proactive adaptations.
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Affiliation(s)
- Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey S Kahana
- Department of History, Mount Saint Mary College, Newburgh, New York
| | - Boaz Kahana
- Department of Psychology, Cleveland State University, Ohio
| | - Polina Ermoshkina
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio
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van Leeuwen KM, van Loon MS, van Nes FA, Bosmans JE, de Vet HCW, Ket JCF, Widdershoven GAM, Ostelo RWJG. What does quality of life mean to older adults? A thematic synthesis. PLoS One 2019; 14:e0213263. [PMID: 30849098 PMCID: PMC6407786 DOI: 10.1371/journal.pone.0213263] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Consideration of older adults' quality of life (QoL) is becoming increasingly important in the evaluation, quality improvement and allocation of health and social care services. While numerous definitions and theories of QoL have been proposed, an overall synthesis of the perspective of older adults themselves is lacking. METHODS Qualitative studies were identified in PubMed, Ebsco/Psycinfo and Ebsco/CINAHL, through a search on 28 November 2018. Articles needed to meet all of the following criteria: (i) focus on perceptions of QoL, (ii) older adults living at home as main participants, (iii) use of qualitative methodology, (iv) conducted in a Western country and (v) published in English (vi) not focused on specific patient groups. A thematic synthesis was conducted of the selected studies, using the complete 'findings/results' sections from the papers. RESULTS We included 48 qualitative studies representing the views of more than 3,400 older adults living at home in 11 Western countries. The QoL aspects identified in the synthesis were categorized into nine QoL domains: autonomy, role and activity, health perception, relationships, attitude and adaptation, emotional comfort, spirituality, home and neighbourhood, and financial security. The results showed that although different domains can be distinguished, these are also strongly connected. CONCLUSION QoL can be expressed in a number of domains and related subthemes that are important for older adults living at home. The findings further support that the concept of QoL should be seen as a dynamic web of intertwined domains.
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Affiliation(s)
- Karen M. van Leeuwen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- * E-mail: (KvL); (MvL)
| | - Miriam S. van Loon
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Medical Humanities, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- * E-mail: (KvL); (MvL)
| | - Fenna A. van Nes
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Henrica C. W. de Vet
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Guy A. M. Widdershoven
- Department of Medical Humanities, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Raymond W. J. G. Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Huo M, Graham JL, Kim K, Zarit SH, Fingerman KL. Aging Parents' Disabilities and Daily Support Exchanges With Middle-Aged Children. THE GERONTOLOGIST 2018; 58:872-882. [PMID: 29029164 PMCID: PMC6137346 DOI: 10.1093/geront/gnx144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Aging parents often incur disabilities in activities of daily living, which may limit their ability to give support and necessitate increased support from middle-aged children. Research has predominantly assessed disabled parents' retrospective reports of receiving support, but we know little about their daily support exchanges with middle-aged children. This study examined practical support, emotional support, and advice that aging parents with and without disabilities provided and received from middle-aged children, and links between these support exchanges and parents' daily mood. Research Design and Methods Aging parents (N = 202, Mage = 79.86) from the Family Exchanges Study II indicated their disabilities and background characteristics. They also reported daily exchanges of practical, emotional support, and advice with each middle-aged child and their daily mood for 7 days. Results Multilevel models revealed that aging parents suffering disabilities were equally likely to provide each type of support but more likely to receive practical support. Aging parents' disabilities seemed to buffer the effects of these support exchanges, such that parents with disabilities versus parents without disabilities reported less negative mood when providing practical support or emotional support, and more positive mood when receiving practical support. Discussion and Implications Exploring the role of aging parents' disabilities in their daily support exchanges with middle-aged children expands on the literature of late-life disabilities and parent-child ties. Despite increasing disabilities, aging parents continue to engage in support exchanges with middle-aged children in daily life and these parents appear to benefit from such involvement.
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Affiliation(s)
- Meng Huo
- Department of Human Development and Family Sciences, The University of Texas at Austin
| | - Jamie L Graham
- Department of Human Development and Family Sciences, The University of Texas at Austin
| | - Kyungmin Kim
- Department of Gerontology, University of Massachusetts Boston
| | - Steven H Zarit
- Department of Human Development and Family Studies, The Pennsylvania State University
| | - Karen L Fingerman
- Department of Human Development and Family Sciences, The University of Texas at Austin
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Bain KT, Schwartz EJ, Knowlton OV, Knowlton CH, Turgeon J. Implementation of a pharmacist-led pharmacogenomics service for the Program of All-Inclusive Care for the Elderly (PHARM-GENOME-PACE). J Am Pharm Assoc (2003) 2018; 58:281-289.e1. [PMID: 29602745 DOI: 10.1016/j.japh.2018.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/19/2018] [Accepted: 02/25/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the feasibility of implementing a pharmacist-led pharmacogenomics (PGx) service for the Program of All-Inclusive Care for the Elderly (PACE). SETTING A national centralized pharmacy providing PGx services to community-based PACE centers. PRACTICE DESCRIPTION Individuals 55 years of age and older enrolled in PACE who underwent PGx testing as part of their medical care (n = 296). PRACTICE INNOVATION Pharmacist-led PGx testing, interpreting, and consulting. EVALUATION Implementation processes and roles were ascertained by reviewing policies and procedures for the PGx service and documented observations made by pharmacists providing the service. Genetic variants and drug-gene interactions (DGIs) were determined by interpretations of PGx test results. Types of recommendations provided by pharmacists were ascertained from PGx consultations. Prescribers' acceptance of recommendations were ascertained by documented responses or drug changes made after PGx consultations. RESULTS Challenges to implementation included lack of systems interoperability, limited access to medical electronic health records, determining prescribers' responses, and knowledge and competency gaps in PGx. Pharmacist roles most essential to overcoming challenges were interpreting and applying PGx data, determining how to disseminate those data to prescribers, advocating for appropriate PGx testing, and educating about the application of test results to clinical practice. Participants frequently used drugs posing DGI risks, with the majority (73.6%) reporting more than 1 interaction. The overwhelming majority (89.0%) of pharmacists' recommendations to mitigate risks were accepted by referring prescribers. CONCLUSION Implementing a pharmacist-led PGx service for PACE is feasible. Implementation of this service highlights the leadership role of pharmacists in moving PGx from research to practice.
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Šaňáková Š, Čáp J. Dignity from the nurses' and older patients' perspective: A qualitative literature review. Nurs Ethics 2018; 26:1292-1309. [PMID: 29471725 DOI: 10.1177/0969733017747960] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Dignity is one of the most important values sensitively perceived by patients in nursing care. Older patients have been identified as having a high risk of losing their dignity in institutional care. To promote optimum nursing care, a deeper insight into the problem of older patients' dignity is needed. AIM The aim was to identify, analyse and synthesise the qualitative evidence of dignity views and factors affecting it from the nurses' and older patients' perspective in the context of nursing care and to compare synthesised finding from the both perspective. METHODS A literature review of qualitative evidence was chosen as a study design. The ENTREQ statement was implemented to enhance transparency. The CASP - Qualitative checklist and the thematic synthesis for synthesised findings were used. The electronic databases Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE and PROQUEST were used to gather information for qualitative studies. RESULTS A total of 306 papers were retrieved. Fourteen qualitative studies met the inclusion criteria and were included in the review after methodological quality assessment using CASP. Four main themes of dignity from nurses' perspective were synthesised: seeing the patient as a unique person, communication and privacy, involving the patient, and working culture and environment. From the patients' perspective, six main themes were synthesised: autonomy and control, privacy, relationships, care and comfort, communication and identity. The comparison shows that the key difference is that older patients highlighted the theme relationships and nurses underlined the theme working culture and environment. CONCLUSION The model structures of the older patients' dignity from both the nurses' and patients' perspectives support the idea of a multidimensional structure of human dignity. The resulting model might be used in a nursing self-reflection, in the management of the institutions providing all-day care for the older people and in the education and practice.
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Affiliation(s)
- Šárka Šaňáková
- Palacký University Olomouc, Faculty of Health, Czech Republic
| | - Juraj Čáp
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovak Republic
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Abstract
ABSTRACTCulturally, institutional care has been seen to strip older people of their status as full adult members of society and turn them into ‘have-nots’ in terms of agency. The substantial emphasis in gerontology of measuring the activity and functional ability of the elderly has unintentionally fostered these stereotypes, as have traditional definitions of agency that emphasise individuals’ choices and capacities. The aim of this paper is to discover what kind of opportunities to feel agentic exist for people who have reduced functional abilities and therefore reside in assisted living. In this paper, agency is approached empirically from the viewpoint of Finnish sheltered housing residents. The data were gathered using participant observation and thematic interviews. This study suggests that even people with substantial declines in their functional abilities may feel more or less agentic depending on their functional and material surroundings and the support they receive from the staff, relatives and other residents. The perception that residents’ agency in assisted living cannot be reduced to measurable activity has methodological implications for gerontological research on agency. Care providers can utilise our findings in reasserting their residents’ quality of life.
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Cagle JG, McClymont KM, Thai JN, Smith AK. "If You Don't Know, All of a Sudden, They're Gone": Caregiver Perspectives About Prognostic Communication for Disabled Elderly Adults. J Am Geriatr Soc 2016; 64:1299-306. [PMID: 27321609 PMCID: PMC4955663 DOI: 10.1111/jgs.14137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To describe preferences and experiences of caregivers of disabled older adults regarding being included in patient-clinician discussions about life expectancy. DESIGN Qualitative interview study. SETTING Caregivers were recruited from a Program of All-Inclusive Care for the Elderly (PACE), caregiver support groups and an advertisement on a nationwide caregiver advocacy group website. PARTICIPANTS Active and bereaved caregivers whose primary language was either English or Cantonese who had provided care within the last 5 years to a disabled adult aged 65 and older (N = 42, 79% female, 60% white, average age 54). MEASUREMENTS Semistructured telephone interviews were conducted with caregivers who were asked about experiences and preferences related to clinician communication about life expectancy, including preferences for and attitudes toward being included in discussions about life expectancy, how such information should be delivered, and how clinicians should address concerns about uncertainty and hope. Responses were analyzed qualitatively using constant comparison until thematic saturation was reached. RESULTS Twenty-six percent of caregivers had been involved in a conversation with a clinician about life expectancy, even though 79% expressed a preference to have such a discussion. According to caregivers, clinician concerns about taking away hope or the uncertainty of prognostic information should not deter them from bringing up the topic of life expectancy. Thematic analysis suggested several approaches that may facilitate prognosis communication: establishing a relationship with the caregiver and care recipient; delivering the prognosis in clear, plain language; and responding to emotion with empathy. CONCLUSION Caregivers reported a preference for being included in conversations about a care recipient's life expectancy.
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Affiliation(s)
| | - Keelan M. McClymont
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Julie N. Thai
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
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Mitoku K, Masaki N, Ogata Y, Okamoto K. Vision and hearing impairments, cognitive impairment and mortality among long-term care recipients: a population-based cohort study. BMC Geriatr 2016; 16:112. [PMID: 27233777 PMCID: PMC4884419 DOI: 10.1186/s12877-016-0286-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/19/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Vision and hearing impairments among elders are common, and cognitive impairment is a concern. This study assessed the association of vision and hearing impairments with cognitive impairment and mortality among long-term care recipients. METHODS Data of 1754 adults aged 65 or older were included in analysis from the Gujo City Long-Term Care Insurance Database in Japan for a mean follow-up period of 4.7 years. Trained and certified investigators assessed sensory impairments and cognitive impairment using a national assessment tool. Five-level scales were used to measure vision and hearing impairments. Cognitive performance was assessed on two dimensions, namely communication/cognition and problem behaviors. We performed logistic regression analysis to estimate odd ratios (ORs) and 95 % confidence intervals (CIs) for the association of vision and hearing impairments with cognitive impairment. Using Cox proportional hazard regression models, we obtained hazard ratios (HRs) for mortality. RESULTS Of 1754 elders, 773 (44.0 %) had normal sensory function, 252 (14.4 %) vision impairment, 409 (23.3 %) hearing impairment, and 320 (18.2 %) dual sensory impairment. After adjusting for potential cofounders, ORs of cognitive impairment were 1.46 (95 % CI 1.07-1.98) in individuals with vision impairment, 1.47 (95 % CI 1.13-1.92) in those with hearing impairment, and 1.97 (95 % CI 1.46-2.65) in those with dual sensory impairment compared to individuals with normal sensory function. The adjusted HR of overall mortality was 1.29 (95 % CI 1.01-1.65) in individuals with dual sensory impairment and cognitive impairment relative to normal sensory and cognitive functions. CONCLUSIONS Cognitive impairment was most common in individuals with dual sensory impairment, and those with dual sensory impairment and cognitive impairment had increased mortality.
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Affiliation(s)
- Kazuko Mitoku
- Department of Community Nursing, Graduate School of Nursing, University of Human Environments, 3-220, Ebata-cho, Obu City, Aichi, 444-0035, Japan.
| | - Naoko Masaki
- Department of Community Nursing, Graduate School of Nursing, Japanese Red Cross Hiroshima College of Nursing, 1-2, Ajinadai-higashi, Hatsukaichi City, Hiroshima, 738-0052, Japan
| | - Yukiko Ogata
- Department of Community Nursing, Faculty of Nursing, Fukuoka Prefectural University, 4395, Ita-cho, Tagawa City, Fukuoka, 825-8585, Japan
| | - Kazushi Okamoto
- Department of Epidemiology, Graduate School of Nursing and Health, Aichi Prefectural University, Togoku, Kamishidami, Moriyama-ku, Nagoya, Aichi, 463-8502, Japan
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16
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Vaismoradi M, Skär L, Söderberg S, Bondas TE. Normalizing suffering: A meta-synthesis of experiences of and perspectives on pain and pain management in nursing homes. Int J Qual Stud Health Well-being 2016; 11:31203. [PMID: 27173102 PMCID: PMC4865782 DOI: 10.3402/qhw.v11.31203] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 11/14/2022] Open
Abstract
Older people who live in nursing homes commonly suffer from pain. Therefore, relieving suffering among older people that stems from pain demands knowledge improvement through an integration of international knowledge. This study aimed to integrate current international findings and strengthen the understanding of older people's experiences of and perspectives on pain and pain management in nursing homes. A meta-synthesis study using Noblit and Hare's interpretative meta-ethnography approach was conducted. Empirical research papers from journals were collected from various databases. The search process and appraisal determined six articles for inclusion. Two studies were conducted in the US and one each in Iceland, Norway, the UK, and Australia. The older people's experiences of pain as well as perspectives on pain management from all involved (older people, their family members, and healthcare staff) were integrated into a theoretical model using three themes of "identity of pain," "recognition of pain," and "response to pain." The metaphor of "normalizing suffering" was devised to illustrate the meaning of pain experiences and pain management in nursing homes. Society's common attitude that pain is unavoidable and therefore acceptable in old age in society-among older people themselves as well as those who are responsible for reporting, acknowledging, and relieving pain-must change. The article emphasizes that pain as a primary source of suffering can be relieved, provided that older people are encouraged to report their pain. In addition, healthcare staff require sufficient training to take a person-centered approach towards assessment and management of pain that considers all elements of pain.
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Affiliation(s)
| | - Lisa Skär
- Faculty of Professional Studies, Nord University, Bodø, Norway.,Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Siv Söderberg
- Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden
| | - Terese E Bondas
- Faculty of Professional Studies, Nord University, Bodø, Norway;
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Van Malderen L, De Vriendt P, Mets T, Gorus E. Active ageing within the nursing home: a study in Flanders, Belgium. Eur J Ageing 2016; 13:219-230. [PMID: 27610053 PMCID: PMC4992500 DOI: 10.1007/s10433-016-0374-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nursing homes should support residents' quality of life (QoL). It remains vague, however, how these facilities can create a QoL enhancing environment. Active ageing (AA) is a useful framework in this context, since it provides a multidimensional set of determinants that enhance QoL. This study examined the current status of AA in nursing homes in Flanders, Belgium. A sample of 383 randomly recruited residents was surveyed on the subjective importance and experienced reality of the AA determinants as well as on QoL. Based on descriptive analyses, residents appeared to have a positive QoL and a moderately positive appraisal of the extent to which nursing homes provide a multidimensional environment to enhance their QoL. Multivariate analyses showed that residents' nursing home active ageing (NHAA) experience was positively related to their QoL and explained 20 % of its variance. Specifically, psychological factors and participation related positively to QoL. Demographic variables showed no relationships with QoL, while educational level related negatively to the NHAA experience. Currently, in Flanders, nursing homes are on their way to working according to the AA vision, but further efforts are still needed.
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Affiliation(s)
- Lien Van Malderen
- Research Foundation Flanders (FWO-Vlaanderen), Brussels, Belgium
- Gerontology Department, Frailty in Ageing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Patricia De Vriendt
- Gerontology Department, Frailty in Ageing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Arteveldehogeschool, Voetweg 66, 9000 Ghent, Belgium
| | - Tony Mets
- Gerontology Department, Frailty in Ageing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Geriatric Department, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ellen Gorus
- Gerontology Department, Frailty in Ageing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Geriatric Department, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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18
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Sjölund BM, Wimo A, Engström M, von Strauss E. Incidence of ADL Disability in Older Persons, Physical Activities as a Protective Factor and the Need for Informal and Formal Care--Results from the SNAC-N Project. PLoS One 2015; 10:e0138901. [PMID: 26407207 PMCID: PMC4583409 DOI: 10.1371/journal.pone.0138901] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 09/04/2015] [Indexed: 12/02/2022] Open
Abstract
Background The aim of the study was to examine 1) the incidence of disability in Activities of Daily Living (ADL), in persons 78 years and older 2) explore whether being physical active earlier is a significant predictor of being disability free at follow-up and 3) describe the amount of informal and formal care in relation to ADL-disability. Methods Data were used from a longitudinal community-based study in Nordanstig (SNAC-N), a part of the Swedish National Study on Aging and Care (SNAC). To study objectives 1) and 2) all ADL-independent participants at baseline (N = 307) were included; for objective 3) all participants 78 years and older were included (N = 316). Data were collected at baseline and at 3- and 6-year follow-ups. ADL-disability was defined as a need for assistance in one or more activities. Informal and formal care were measured using the Resource utilization in Dementia (RUD)-instrument. Results The incidence rates for men were similar in the age groups 78-81and 84 years and older, 42.3 vs. 42.5/1000 person-years. For women the incidence rate for ADL-disability increased significantly from the age group 78–81 to the age group 84 years and older, 20.8 vs.118.3/1000 person-years. In the age group 78–81 years, being physically active earlier (aOR 6.2) and during the past 12 month (aOR 2.9) were both significant preventive factors for ADL-disability. Both informal and formal care increased with ADL-disability and the amount of informal care was greater than formal care. The incidence rate for ADL-disability increases with age for women and being physically active is a protective factor for ADL-disability. Conclusion The incidence rate for ADL-disability increases with age for women, and being physical active is a protective factor for ADL-disability.
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Affiliation(s)
- Britt-Marie Sjölund
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
- * E-mail:
| | - Anders Wimo
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Maria Engström
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Eva von Strauss
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- The Swedish Red Cross University College, Stockholm, Sweden
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19
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Vouri SM, Seaton SM, Sutcliffe S, Austin S. Changes in Mood in New Enrollees at a Program of All-Inclusive Care for the Elderly. THE CONSULTANT PHARMACIST : THE JOURNAL OF THE AMERICAN SOCIETY OF CONSULTANT PHARMACISTS 2015; 30:463-71. [PMID: 26260643 PMCID: PMC4605402 DOI: 10.4140/tcp.n.2015.463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine changes in mood after nine months of enrollment in a Program of All-Inclusive Care for the Elderly (PACE). DESIGN Cohort study. SETTING Alexian Brothers PACE, St. Louis, Missouri. PARTICIPANTS Newly enrolled patients 55 years of age and older, living in the PACE service area, eligible for nursing facility care and able to live safely in the community, with continuous care, for at least nine months (N = 182). MAIN OUTCOME MEASURES Geriatric Depression Scale (GDS)-15 score at the pre-admission evaluation (PAE) and the nine-month evaluation (9ME). RESULTS Of the 182 patients evaluated, 27% (n = 49) met the definition of depression as defined by the GDS-15 score of ≥ 6 at the PAE. At the 9ME, only 11% of patients met the depression criteria (P < 0.001). Of the patients who met the criteria for depression at the PAE, 80% of patients (n = 39) no longer met these criteria at the 9ME (P = 0.029). Similar findings were observed by age, gender, and race. Greater improvement was observed among those who were depressed at the PAE; the depressed cohort improved by 5.0 points (P < 0.001) on the GDS-15 scale from the PAE to the 9ME, whereas the nondepressed cohort improved by 0.6 points (P = 0.003). CONCLUSION The use of PACE as an alternative intervention may be a good option to improve mood in older adults.
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Affiliation(s)
- Scott Martin Vouri
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, Phone: 314-446-8551 Fax: 314-446-8550
| | - Stephanie M. Seaton
- St. Louis College of Pharmacy 4588 Parkview Place, St. Louis, MO 63110, Phone: 314-446-8199
| | - Siobhan Sutcliffe
- Washington University School of Medicine, 660 S. Euclid Ave., Box 8100, Rm 208S, St. Louis, MO 63110, Phone: 314-362-3788
| | - Shane Austin
- St. Louis College of Pharmacy 4588 Parkview Place, St. Louis, MO 63110, Phone: 314-446-8551
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20
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‘Old but not that old’: Finnish community-dwelling people aged 90+ negotiating their autonomy. AGEING & SOCIETY 2015. [DOI: 10.1017/s0144686x15000525] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTAutonomy is a pervasive concept in Western lifestyles today. However, people in the fourth age are assumed not to be autonomous but dependent on other people. The data of this study consisted of interviews with Finnish community-dwelling 90–91-year-old people. The study aim was to examine how these people see their own autonomy in their everyday lives. The analysis was based on membership categorisation analysis. Our respondents considered their autonomy through three distinct themes. Functional ability was considered in terms of being physically capable of managing daily tasks. Independence in decision making was based on material and financial self-sufficiency and on the respondents' supposition that they were capable of making decisions due to an absence of memory disorders. Additionally, autonomy was considered as contesting norms of age-appropriateness. Among respondents, chronological age seemed to have been replaced by functional and cognitive ability as a definer of categorisations; age-others became ability-others. Our study revealed that the perceptions of autonomy also included gendered features as they were linked with differing gendered ideals, roles and life domains of women and men. The results highlight the internal diversity among the oldest old and challenge the third/fourth age division. Instead, they suggest the existence of a certain ‘grey area’ within old age, and urge an analysis on the subtle meaning making involved in older people's constructions of age-categorisations.
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21
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Simmons SF, Durkin DW, Rahman AN, Schnelle JF, Beuscher LM. The value of resident choice during daily care: do staff and families differ? J Appl Gerontol 2014; 33:655-71. [PMID: 25143465 PMCID: PMC4142524 DOI: 10.1177/0733464812454010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Allowing long-term care (LTC) residents to make choices about their daily life activities is a central tenet of resident-centered care. This study examined whether staff and family rated care episodes involving choice differently from care episodes not involving choice. Seventeen nurse aide and 15 family participants were shown paired video vignettes of care interactions. Participants were asked to rate their preferred care vignette using a standardized forced-choice questionnaire. Focus groups were held separately for staff and family members following this rating task to determine reasons for their preferences. Both staff and family rated the vignettes depicting choice as "strongly" preferred to the vignettes without choice. Reasons provided for the preference ratings during the focus group discussions related to resident well-being, sense of control, and respondents' own personal values. These findings have implications for LTC staff training related to resident-centered care to promote choice.
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Affiliation(s)
- Sandra F Simmons
- Vanderbilt University, Nashville, TN, USA VA Medical Center, Geriatric Research, Education and Clinical Center, Nashville, TN, USA
| | | | | | - John F Schnelle
- Vanderbilt University, Nashville, TN, USA VA Medical Center, Geriatric Research, Education and Clinical Center, Nashville, TN, USA
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22
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Min L, Reuben D, Karlamangla A, Naeim A, Prenovost K, Lee P, Wenger N. Abbreviated care-process quality indicator sets linked with survival and functional status benefit in older adults under ambulatory care. J Am Geriatr Soc 2014; 62:1442-50. [PMID: 25041473 DOI: 10.1111/jgs.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify subsets of ambulatory care (outpatient only) quality indicators (QIs) associated with better survival and physical function outcomes. DESIGN Observational cohort study. SETTING Pooled data from the Assessing Care of Vulnerable Elders (ACOVE)-1 study, which measured quality of care using 140 care-process QIs, and the subsequent ACOVE-2 study, which reduced the QIs to 69 ambulatory care QIs. PARTICIPANTS Older adults receiving ambulatory care (N=1,015). MEASUREMENTS To prioritize and reduce the QIs into subsets, an expert panel rated each of 69 ambulatory care QIs for the strength of the link between process and benefit, defined as direct trial evidence on older adults or high expectation of benefit if a trial were conducted in older adults. This resulted in three reduced QI sets, reflecting their intended benefit: 17 QIs for survival (ACOVE Quality for Survival (AQS)-17), five QIs to preserve function (AQF-5), and 16 QIs to improve quality-of-life related to physical health and symptoms (AQQ-16). Whether AQS-17 would predict 3-year survival was first tested in 1,015 pooled ACOVE-1 and ACOVE-2 participants. Second, whether AQF-5 (n=74) and AQQ-16 (n=359) would predict change in the Physical Component Summary (PCS) score of the Medical Outcomes Study 12-item Short-Form Survey at 1 year was tested in the ACOVE-2 cohort. Control variables were age, function-based vulnerability, and comorbidity. RESULTS Each 20-percentage-point increment in AQS-17 was associated with survival (hazard ratio (HR)=0.83, P=.01) up to 500 days but not thereafter. AQF-5, but not AQQ-16, predicted 1-year improvement in PCS score (1.13-points per 20%-point increment in AQF-5, P=.02). CONCLUSION Subsets of care processes can be linked with outcomes important to older adults. The AQS-17 and AQF-5 are potential tools for improving ambulatory care of older adults.
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Affiliation(s)
- Lillian Min
- Division of Geriatric and Palliative Medicine, Department of Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan; Geriatrics Research, Education and Clinical Care Center, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan
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Predicting non return to work after orthopaedic trauma: the Wallis Occupational Rehabilitation RisK (WORRK) model. PLoS One 2014; 9:e94268. [PMID: 24718689 PMCID: PMC3981787 DOI: 10.1371/journal.pone.0094268] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/14/2014] [Indexed: 01/01/2023] Open
Abstract
Background Workers with persistent disabilities after orthopaedic trauma may need occupational rehabilitation. Despite various risk profiles for non-return-to-work (non-RTW), there is no available predictive model. Moreover, injured workers may have various origins (immigrant workers), which may either affect their return to work or their eligibility for research purposes. The aim of this study was to develop and validate a predictive model that estimates the likelihood of non-RTW after occupational rehabilitation using predictors which do not rely on the worker’s background. Methods Prospective cohort study (3177 participants, native (51%) and immigrant workers (49%)) with two samples: a) Development sample with patients from 2004 to 2007 with Full and Reduced Models, b) External validation of the Reduced Model with patients from 2008 to March 2010. We collected patients’ data and biopsychosocial complexity with an observer rated interview (INTERMED). Non-RTW was assessed two years after discharge from the rehabilitation. Discrimination was assessed by the area under the receiver operating curve (AUC) and calibration was evaluated with a calibration plot. The model was reduced with random forests. Results At 2 years, the non-RTW status was known for 2462 patients (77.5% of the total sample). The prevalence of non-RTW was 50%. The full model (36 items) and the reduced model (19 items) had acceptable discrimination performance (AUC 0.75, 95% CI 0.72 to 0.78 and 0.74, 95% CI 0.71 to 0.76, respectively) and good calibration. For the validation model, the discrimination performance was acceptable (AUC 0.73; 95% CI 0.70 to 0.77) and calibration was also adequate. Conclusions Non-RTW may be predicted with a simple model constructed with variables independent of the patient’s education and language fluency. This model is useful for all kinds of trauma in order to adjust for case mix and it is applicable to vulnerable populations like immigrant workers.
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Ament BHL, de Vugt ME, Verhey FRJ, Kempen GIJM. Are physically frail older persons more at risk of adverse outcomes if they also suffer from cognitive, social, and psychological frailty? Eur J Ageing 2014; 11:213-219. [PMID: 28804327 DOI: 10.1007/s10433-014-0308-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Frailty is considered a predictor for negative outcomes such as disability, decreased quality of life, and hospital admission. Frailty measures have been developed that include different dimensions. We examined whether people who are physically frail are more at risk for negative outcomes of frailty if they also suffer from psychological, cognitive, or social frailty. Frailty was measured at baseline by means of the Groningen Frailty Indicator (GFI), which comprises a physical, cognitive, social, and psychological dimension. Only frail persons were included in the study (GFI ≥ 5) that, in addition, had to be frail in the physical dimension (i.e., ≥1 on this dimension). IADL disability and quality of life were measured at baseline and at 12 months. Hospital admission was assessed during this period. In this, physically frail sample effects of the other three frailty dimensions were studied in regression models. The sample (n = 334, mean age 78.1, and range 70-92) included 40.1 % frail men and 59.9 % frail women. Overall, no additional effects for the cognitive, social, or psychosocial dimensions were found: other frailty dimensions did not have an additional impact on disability, quality of life, or hospital admission in people who already suffered from physical frailty. Higher scores of physical frailty were significantly related to IADL disability (p < 0.05) and hospital admission (p < 0.05). Additional analysis showed that the physical frailty score predicted IADL disability and hospital admission better than the GFI overall score. Results of this study suggest that persons, who are physically frail, according to the GFI, are not more at risk for negative outcomes of frailty (i.e., IADL disability, decreased quality of life, and hospital admission) if they in addition suffer from cognitive, social, or psychological frailty. In addition, for the prediction of IADL disability or hospital admission, the focus for screening should be on the physical frailty score instead of the GFI overall score including different dimensions.
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Affiliation(s)
- Bart H L Ament
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.,Alzheimer Centre Limburg, MHeNS School for Mental Health and NeuroScience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Marjolein E de Vugt
- Alzheimer Centre Limburg, MHeNS School for Mental Health and NeuroScience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Frans R J Verhey
- Alzheimer Centre Limburg, MHeNS School for Mental Health and NeuroScience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Abstract
IMPORTANCE Whereas many persons at advanced ages live independently and are free of disability, we know little about how likely older people are to be disabled in the basic activities of daily living that are necessary for independent living as they enter the last years of life. OBJECTIVE To determine national estimates of disability during the last 2 years of life. DESIGN Prospective cohort study. SETTING A nationally representative study of older adults in the United States. PARTICIPANTS Participants 50 years and older who died while enrolled in the Health and Retirement Study between 1995 and 2010. Each participant was interviewed once at a varying time point in the last 24 months of life. We used these interviews to calculate national estimates of the prevalence of disability across the 2 years prior to death. We modeled the prevalence of disability in the 2 years prior to death for groups defined by age at death and sex. MAIN OUTCOMES AND MEASURES Disability was defined as need for help with at least 1 of the following activities of daily living: dressing, bathing, eating, transferring, walking across the room, and using the toilet. RESULTS There were 8232 decedents (mean [SD] age at death, 79 [11] years; 52% women). The prevalence of disability increased from 28% (95% CI, 24%-31%) 2 years before death to 56% (95% CI, 52%-60%) in the last month of life. Those who died at the oldest ages were much more likely to have disability 2 years before death (ages 50-69 years, 14%; 70-79 years, 21%; 80-89 years, 32%; 90 years or more, 50%; P for trend, <.001). Disability was more common in women 2 years before death (32% [95% CI, 28%-36%]) than men (21% [95% CI, 18%-25%]; P < .001), even after adjustment for older age at death. CONCLUSIONS AND RELEVANCE Those who live to an older age are likely to be disabled, and thus in need of caregiving assistance, many months or years prior to death. Women have a substantially longer period of end-of-life disability than men.
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Affiliation(s)
- Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco2Veterans Affairs Medical Center, San Francisco, California
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26
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Yoo JW, Seol H, Kim SJ, Yang JM, Ryu WS, Min TD, Choi JB, Kwon M, Kim S. Effects of hospitalist-directed interdisciplinary medicine floor service on hospital outcomes for seniors with acute medical illness. Geriatr Gerontol Int 2013; 14:71-7. [DOI: 10.1111/ggi.12056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Ji Won Yoo
- Department of Internal Medicine and Institute of Gerontology; University of Michigan Medical School; Ann Arbor Michigan USA
- Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
| | - Haesun Seol
- Federally Qualified Health Center; VNA Health Center; Bensenville Illinois USA
| | - Sun Jung Kim
- School of Public Health; Yonsei University; Seoul Korea
| | - Janet Miyoung Yang
- Department of Internal Medicine; Saint Joseph Mercy Hospital; Ann Arbor Michigan USA
| | - Woo Sang Ryu
- Center of Clinical Research; Korea University College of Medicine; Seoul Korea
| | - Too Dae Min
- Center of Clinical Research; Korea University College of Medicine; Seoul Korea
| | - Jong Bum Choi
- Center for Clinical Research; Yonsei University College of Medicine; Seoul Korea
| | - Minkyung Kwon
- Center for Clinical Research; Yonsei University College of Medicine; Seoul Korea
| | - Sulgi Kim
- Department of Epidemiology; School of Public Health; University of Washington; Seattle Washington USA
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Schnelle JF, Rahman A, Durkin DW, Beuscher L, Choi L, Simmons SF. A controlled trial of an intervention to increase resident choice in long term care. J Am Med Dir Assoc 2013; 14:345-51. [PMID: 23294967 DOI: 10.1016/j.jamda.2012.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/28/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate an intervention to improve staff offers of choice to nursing home residents during morning care. DESIGN A controlled trial with a delayed intervention design. SETTING Four community, for-profit nursing homes. PARTICIPANTS A total of 169 long-stay nursing home residents who required staff assistance with morning care and were able to express their care preferences. INTERVENTION Research staff held weekly training sessions with nurse aides (NAs) for 12 consecutive weeks focused on how to offer choice during four targeted morning care areas: when to get out of bed, when to get dressed/what to wear, incontinence care (changing and/or toileting), and where to dine. Training sessions consisted of brief video vignettes illustrating staff-resident interactions followed by weekly feedback about how often choice was being provided based on standardized observations of care conducted weekly by research staff. MEASUREMENTS Research staff conducted standardized observations during a minimum of 4 consecutive morning hours per participant per week for 12 weeks of baseline and 12 weeks of intervention. RESULTS There was a significant increase in the frequency that choice was offered for 3 of the 4 targeted morning care areas from baseline to intervention: (1) out of bed, 21% to 33% (P < .001); dressing, 20% to 32% (P < .001); incontinence care, 18% to 23%, (P < .014). Dining location (8% to 13%) was not significant. There was also a significant increase in the amount of NA staff time to provide care from baseline to intervention (8.01 ± 9.0 to 9.68 ± 9.9 minutes per person, P < .001). CONCLUSION A staff training intervention improved the frequency with which NAs offered choice during morning care but also required more time. Despite significant improvements, choice was still offered one-third or less of the time during morning care.
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Affiliation(s)
- John F Schnelle
- Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN, USA.
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Takagi E, Whittington FJ. What Should Be the Next Steps for the Field of Gerontology? THE GERONTOLOGIST 2012. [DOI: 10.1093/geront/gns114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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