1
|
Tian J, Wang HY, Peng SH, Tao YM, Cao J, Zhang XG. Experiences of older people with multimorbidity regarding self-management of diseases: A systematic review and qualitative meta-synthesis. Int J Nurs Pract 2024; 30:e13289. [PMID: 39075877 DOI: 10.1111/ijn.13289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 07/31/2024]
Abstract
AIM This qualitative systematic review aimed to consolidate existing evidence on the self-management experience of older patients with multimorbidity worldwide. METHODS Nine databases were searched, for papers published from database inception to April 2023. The systematic review was conducted according to the systematic review method of qualitative evidence by the Joanna Briggs Institute (JBI). RESULTS Seven studies were included. Finally, four themes and 12 subthemes were formed: (1) physical level: reduced physical function and lack of coordinated care; (2) psychological level: mental state of anxiety and positive attitude towards life; (3) social level: technical support, support from family, support from healthcare workers and support from others; and (4) practical level: economic burden, lifestyle changes, self-care in daily life and compliance was much lower than expected. CONCLUSIONS To improve self-management in older people with multimorbidity, nurses should provide more guidance to patients to improve their self-management skills, and clinicians should recommend effective self-management behaviours.
Collapse
Affiliation(s)
- Jing Tian
- West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Yan Wang
- Southwest University, Chongqing, China
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
| | - Si Han Peng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yan Min Tao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jun Cao
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
| | | |
Collapse
|
2
|
Yusuf A, Purba JM, Putri DE, Aditya RS, Alruwaili AS, AlRazeeni DM. Family-Centered Care Experiences in Elderly with Chronic Diseases in Communities: Qualitative Study of Patients, Families, Nurses, and Volunteers. Health Equity 2024; 8:338-350. [PMID: 39011075 PMCID: PMC11249130 DOI: 10.1089/heq.2024.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction The family, at community, must be an important part of elderly care. However, most of the elderly experience a decrease in psychological well-being and quality of life. This is not in accordance with the concept of the family-centered care (FCC) model and can endanger the continuity of the elderly with chronic illnesses. Objective The aim of this study was to explore experience of FCC among patients with chronic illness, nurses, families, and volunteers. Methods This study examines the contextual-based FCC model qualitatively. In-depth interviews and focus group discussions were conducted by 12 elderly people, 3 nurses, 10 family members, and 3 volunteers. In total, 36 people, where several were FGD participants, were also interviewed in depth. Data were analyzed using thematic analysis, with codes organized into larger themes. Result In total, 36 interviews and FGDs were conducted. The concept of information interaction, the phenomenon of emotional interaction, the practical interaction, and various factors that can either facilitate or impede interaction, were considered the four significant themes. Conclusion FCC acceptance is found in interactions between parents, nurses, family, and volunteers who are not optimistic. Lack of communication and collaboration was noted between community nurses and volunteers. Offer a new perspective on developing and implementing interventions that facilitate positive interactions, reduce family burdens, provide high-quality treatment for parents with chronic diseases, and improve the quality of care for those with advanced chronic conditions. Recommendation These insights provide a fresh perspective on how to develop and implement effective interventions in this context. It is recommended that future research should employ multiple methodologies to investigate FCC across diverse health practices for the elderly population.
Collapse
Affiliation(s)
- Ah Yusuf
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Dimentia and Aging Care Research Center, Universitas Airlangga, Indonesia
| | - Jenny Marlindawani Purba
- Community and Psychiatric Department, Faculty of Nursing, Universitas Sumatera Utara, Medan, Indonesia
| | - Dewi Eka Putri
- Community and Psychiatric Department, Faculty of Nursing, Universitas Andalas, Padang, Indonesia
| | - Ronal Surya Aditya
- Department of Nursing, Faculty of Medicine, Universitas Negeri, Malang, Indonesia
| | - Abdullah Saleh Alruwaili
- Emergency Medical Services Program, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
- School of Health, University of New England, Armidale, Australia
| | | |
Collapse
|
3
|
Xie Y, Hamilton M, Peisah C, Anstey KJ, Sinclair C. Navigating Community-Based Aged Care Services From the Consumer Perspective: A Scoping Review. THE GERONTOLOGIST 2024; 64:gnad017. [PMID: 37120292 DOI: 10.1093/geront/gnad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The shift to consumer-directed aged care means that older adults need to play a more active role in navigating the complex aged care system for adequate health and social services. Challenges in the navigation process result in unmet needs and difficulty accessing available resources. This scoping review investigates how aged care navigation is conceptualized in literature and interrogates research on the experiences of older adults navigating community-based aged care services with or without support from their informal carers. RESEARCH DESIGN AND METHODS This review follows the Joanna Briggs Institute methodological guidelines. PubMed, Scopus, and ProQuest were searched for relevant literature published from 2008 to 2021, supplemented by grey literature and manual reference list searching. Data were extracted using a predefined data-extraction table and synthesized with an inductive thematic analysis. RESULTS The current conceptualization of aged care navigation focuses on the support provided to older adults, rather than actions taken by older adults themselves. Thematic analysis from the included studies (n = 26) revealed shared themes (lack of knowledge, social networks as information providers, complex care systems) among older adults and informal carers; unique challenges faced by older adults (difficulties with technology, waiting game), and informal carers (structural burden) in aged care navigation. DISCUSSION AND IMPLICATIONS Findings suggest the need to comprehensively assess individual circumstances including social networks and access to informal carers as predictors of successful navigation. Changes that reduce the complexity of the aged care system and improve coordination will relieve the structural burden experienced by consumers.
Collapse
Affiliation(s)
- Yuchen Xie
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Myra Hamilton
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Specialty of Psychiatry, University of Sydney, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
| | - Craig Sinclair
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Brown GP, Greco C. The Well-Being of Older Offenders on Release in the Community. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024:306624X231219222. [PMID: 38270097 DOI: 10.1177/0306624x231219222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
In Canada and internationally the number of older offenders on parole and living in the community is increasing rapidly. Older offenders in the community are a vulnerable population at high risk for lack of well-being. Semi-structured interviews were conducted with N = 64 offenders aged 50 years and older on conditional release from custody in Canada, including long-term, recidivist, and first-time older offenders. Compared to their non-offender counterparts, older offenders in the community experience many of the same problems of aging and well-being, but are at greater risk for mental health problems, traumatic injuries, and for recidivists, substance abuse. Most long-term and first-time older offenders find themselves living at or below the poverty line. One third of older offenders experience social isolation from community and family due to their criminal history and incarceration. For those with Indigenous ancestry, Indigenous communities, and cultural organizations play a significant role in supporting older offenders.
Collapse
|
5
|
Rohatinsky N, Chauhan U, Currie B, Peacock S, Phalen-Kelly K, Russell B, Tooke N. Older Adults With Inflammatory Bowel Disease in Canada: A Mixed-Methods Exploratory Study of Care Experiences and Health-Related Quality of Life. Gastroenterol Nurs 2024; 47:41-51. [PMID: 37556367 PMCID: PMC10833196 DOI: 10.1097/sga.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/23/2023] [Indexed: 08/11/2023] Open
Abstract
Literature exploring the health-related quality of life and care experiences of older adults with inflammatory bowel disease is limited despite the increasing prevalence in this population. The purpose of this study was to explore the perceived health-related quality of life and care experiences in older adults with inflammatory bowel disease in Canada. This study used a mixed-methods convergent design consisting of a descriptive, cross-sectional survey and qualitative descriptive interviews. Fifty-eight participants completed the survey and 24 participants completed interviews. Older adults reported satisfaction with inflammatory bowel disease-related care, high levels of disease control, moderate health-related quality of life, and low levels of patient-healthcare team interactions. Themes identified were (1) Experiences of inflammatory bowel disease in daily life; (2) Accessibility of inflammatory bowel disease-related health services; and (3) Communication and relationships to facilitate inflammatory bowel disease care. Ultimately, quality inflammatory bowel disease care for older adults is contingent upon communication between patients and providers, access to multidisciplinary clinics, and support networks. By ensuring these factors are present, providers and patients can work together collectively toward positive patient outcomes, enhanced satisfaction with care, and greater perceived quality of care.
Collapse
Affiliation(s)
- Noelle Rohatinsky
- Correspondence to: Noelle Rohatinsky, PhD, RN, College of Nursing, University of Saskatchewan, 4342 Health Sciences Building, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada ()
| | - Usha Chauhan
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Barbara Currie
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shelley Peacock
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kelly Phalen-Kelly
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brooke Russell
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Natasha Tooke
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
6
|
Hjalmarsson A, Östlund G, Asp M, Kerstis B, Holmberg M. A matter of participation? A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services. Int J Qual Stud Health Well-being 2022; 17:2082062. [PMID: 35703409 PMCID: PMC9225717 DOI: 10.1080/17482631.2022.2082062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home. Methods An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure. Results Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS. Conclusions Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.
Collapse
Affiliation(s)
- Anna Hjalmarsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Gunnel Östlund
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Margareta Asp
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Birgitta Kerstis
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
| | - Mats Holmberg
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna Västerås, Sweden
- Faculty of Health and Life Sciences, Linneaus University, Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Ambulance Services, Region Sörmland, Eskilstuna, Sweden
| |
Collapse
|
7
|
Chantakeeree C, Sormunen M, Jullamate P, Turunen H. Understanding perspectives on health-promoting behaviours among older adults with hypertension. Int J Qual Stud Health Well-being 2022; 17:2103943. [PMID: 35912497 PMCID: PMC9347462 DOI: 10.1080/17482631.2022.2103943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose Health-promoting behaviours (HPBs) are considered the key to determining health among older adults with hypertension. Increasing our understanding of older adults’ views on HPBs could facilitate the development of interventions aimed at improving their quality of life. This study aims to describe the perceptions of older adults with high blood pressure concerning their HPBs and associated factors. Methods Semi-structured interviews with 40 individuals in Thailand were used to collect the data, which were analysed using thematic analysis. Results The results were categorized into five main themes related to personal, social, and environmental factors. Older adults explained that their experiences with HPBs involve taking responsibility for controlling blood pressure by following a doctor’s prescription, modifying their lifestyles to be healthier, sustaining social relationships, and experiencing spiritual growth through religious practices for inner peace. Older adults also identified environmental factors that influenced their engagement in HPBs depending on their residential areas. Conclusions The findings of this study highlight the importance of practices in which professionals support and encourage older adults to perform HPBs to maintain health and improve their well-being.
Collapse
Affiliation(s)
- Chonticha Chantakeeree
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Gerontological Nursing Division, Faculty of Nursing, Burapha University, Chon Buri, Thailand
| | - Marjorita Sormunen
- Institute of Public Health and Clinical Nutrition, Department of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Pornchai Jullamate
- Gerontological Nursing Division, Faculty of Nursing, Burapha University, Chon Buri, Thailand
| | - Hannele Turunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Centre of clinical nursing development, education and research, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
8
|
Ravi P, Pfaff K, Ralph J, Cruz E, Bellaire M, Fontanin G. Nurse-pharmacist collaborations for promoting medication safety among community-dwelling adults: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100079. [PMID: 38745597 PMCID: PMC11080473 DOI: 10.1016/j.ijnsa.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/23/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background Despite good evidence that supports improved clinical health outcomes and the cost effectiveness of nurse-pharmacist collaboration for promoting medication safety among adults in acute care settings, there is limited research in community settings. Objective This scoping review examines, maps, and identifies gaps in the existing literature on nurse-pharmacist collaboration to augment medication safety among community-dwelling adults. Design Setting(s): Community setting. Participants This review consists of 3,464 participants across 23 studies. Methods We used the enhanced Arksey and O'Malley framework by Levac and colleagues. Studies from MEDLINE, CINAHL, ProQuest, Scopus, and PubMed databases implementing medication safety through nurse-pharmacist collaboration for community-dwelling adults were included. We extracted data according to country of origin, intervention, and relevance to the current review. Results Twenty-three studies were included in this review. Nurse-pharmacist collaborations in community settings are still evolving and are in a nascent form. Five sub-themes emerged from literature review of collaboration between nurses and pharmacists in community settings for medication safety. They are creating new opportunities to address gaps in community medication safety, enabling complementary interprofessional roles in medication safety, facilitating of efficient and cost-effective measures for medication safety, diverse nature of assessments done by nurses and pharmacists, and incohesive teams due to poor collaborative practices. Conclusions Nurse-pharmacist collaborations in community settings improved disease management, prevented adverse drug events, and reduced hospitalizations. They resulted in early identification and correction of medication safety related issues, reduced wait periods to see general practitioners, and enhanced chronic disease self-management skills among community-dwelling adults. There is a need to improve existing systems and policies through research for sustaining such collaborations especially in community settings.
Collapse
Affiliation(s)
- Padma Ravi
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Kathryn Pfaff
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Jody Ralph
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Edward Cruz
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | | | - Gemma Fontanin
- Faculty of Nursing, University of Windsor, Windsor, Canada
| |
Collapse
|
9
|
Robinson ES, Cyarto E, Ogrin R, Green M, Lowthian JA. Quality of life of older Australians receiving home nursing services for complex care needs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6091-e6101. [PMID: 36200317 DOI: 10.1111/hsc.14046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/04/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.
Collapse
Affiliation(s)
| | - Elizabeth Cyarto
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Rajna Ogrin
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Department of Business Strategy and Innovation, Griffith University, Nathan, Queensland, Australia
| | - Maja Green
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
| | - Judy A Lowthian
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- School of Public Health & Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Murzin K, Racz E, Behrens DM, Conway T, Da Silva G, Fitzpatrick E, Lindsay JD, Walmsley SL. "We can hardly even do it nowadays. So, what's going to happen in 5 years from now, 10 years from now?" The health and community care and support needs and preferences of older people living with HIV in Ontario, Canada: a qualitative study. J Int AIDS Soc 2022; 25 Suppl 4:e25978. [PMID: 36176028 PMCID: PMC9522634 DOI: 10.1002/jia2.25978] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The population of people living with HIV (PLWH) is ageing consequent to effective treatment and a steady stream of new diagnoses among older adults. PLWH experience a greater burden of age‐related comorbidities and poorer social determinants of health compared to their HIV‐negative peers, yet comprehensive requisites for care and support as PLWH age remain poorly understood. Preferences And Needs for Ageing Care among HIV‐positive Elderly people in Ontario, Canada (PANACHE ON), explored the health and community care and social support needs and preferences of a diverse group of older PLWH (age 60+) and described life course experiences among older PLWH that shape these needs and preferences and whether they are met. Methods PANACHE ON was a qualitative community‐based participatory research study. In‐person focus groups using a semi‐structured interview guide were co‐facilitated by pairs of trained older PLWH from July to October 2019. Purposive sampling bolstered the inclusion of communities disproportionately affected by HIV in Ontario. Descriptive analysis was used to summarize demographic data; participatory data analysis was conducted by a subset of the research team, with transcripts double‐coded and analysed using NVIVO 12 Plus. Results A total of 73 PLWH participated, 66% identified as men. The mean age was 64 years (range 55–77) and median time living with HIV was 23 years (range 2–37). The current and anticipated needs of older PLWH, many of which were only partially met, included necessities such as food and housing, mobility and sensory aids, in‐home support, social and emotional support, transportation and information. Three experiences—trauma, stigma and uncertainty—intersected in the lives of many of our participants, shaping their needs for care and support, and impacting the ease with which these needs were met. Conclusions Unmet health and social needs and limited control over the availability and accessibility of ageing‐related care and support due to resource constraints or reduced capacity for self‐advocacy results in anxiety about the future among older PLWH, despite their well‐developed coping strategies and experience navigating systems of care. These study findings will inform the development of the first national needs assessment of older PLWH in Canada.
Collapse
Affiliation(s)
| | | | | | | | | | - Eimear Fitzpatrick
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Joanne D Lindsay
- Realize, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sharon L Walmsley
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
11
|
Lai C, Holyoke P, Plourde KV, Yeung L, Légaré F. Home care providers' perceptions of shared decision-making with older clients (and their caregivers): A cross-sectional study. Nurs Health Sci 2022; 24:487-498. [PMID: 35460164 PMCID: PMC9322282 DOI: 10.1111/nhs.12946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
Interprofessional care teams can play a key role in supporting older adults (and caregivers) in making informed health decisions, yet shared decision making is not widely practiced in home care. Based on an earlier needs assessment with older adults (and caregivers) with home care experience, we aimed to explore the perceptions of home care teams on the decisions facing their clients and their perceived involvement in shared decision making. A cross-sectional study was conducted with 614 home care providers (nurses, personal support workers, rehabilitation professionals) in three Canadian provinces (Quebec, Ontario, and Alberta). Home care providers considered the decision "to stay at home or move" as the most difficult for older adults. Those most frequently involved in decision making with older adults were family members and least involved were physicians. Although all home care providers reported high levels of shared decision-making, we detected an effect of respondent's discipline on self-perceived shared decision-making; nurses and rehabilitation professionals reported significantly higher levels of shared decision making than personal support workers. A more tailored approach is required to support shared decision making in interprofessional care teams.
Collapse
Affiliation(s)
- Claudia Lai
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Quebec, Canada.,SE Research Centre, SE Health, Markham, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Karine V Plourde
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Quebec, Canada.,VITAM Centre de recherche en santé durable, Quebec, Quebec, Canada.,CHU de Québec Research Centre, Université Laval, Quebec, Quebec, Canada
| | - Lily Yeung
- Participant Partner, Toronto, Ontario, Canada
| | - France Légaré
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Quebec, Canada.,VITAM Centre de recherche en santé durable, Quebec, Quebec, Canada.,CHU de Québec Research Centre, Université Laval, Quebec, Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| |
Collapse
|
12
|
Malmir S, Navipour H, Negarandeh R. Exploring challenges among Iranian family caregivers of seniors with multiple chronic conditions: a qualitative research study. BMC Geriatr 2022; 22:270. [PMID: 35365077 PMCID: PMC8973877 DOI: 10.1186/s12877-022-02881-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background It is believed that seniors with multiple chronic diseases are in dire need of support from their family caregivers; however, it can impose a significant burden on these caregivers. Therefore, it is imperative to take into account caregivers’ needs, as covert patients, along with the needs of patients; besides, it is necessary to develop supportive and health promotion programs for them. There is a critical gap in the knowledge about health problems related to family caregivers of the growing population of these senior citizens. The present study aimed to explain the challenges imposed on family caregivers of seniors with several chronic diseases in Iran. Methods This study was conducted based on the conventional qualitative content analysis method. For this purpose, 13 family caregivers of seniors with several chronic diseases were selected using the purposive sampling method. The study population included those referred to two health centers and outpatient clinics of two public hospitals in Khorramabad, Iran. Data were collected through semi-structured interviews. Data analysis was performed along with data collection using inductive thematic analysis proposed by Elo and Kyngäs. Besides, Guba and Lincoln’s criteria were used to ensure the trustworthiness of the data. Results The analysis of the obtained data led to the identification of challenges of family caregivers of the older patients with multiple chronic diseases; these challenges were classified into six main categories, including the impact of caregiving on family relationships, disruption of social relationships, disruption of personal and occupational plans, physical health-related issues, negative emotions, and dealing with the high costs of care. Conclusions Given that family caregivers may face several challenges while taking care of seniors with multiple chronic diseases, healthcare providers should design and plan various interventions based on such challenges using a caregiver-centered approach.
Collapse
Affiliation(s)
- Sahar Malmir
- Nursing Department, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Hassan Navipour
- Department of Nursing, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
13
|
Gan DRY, Wister AV, Best JR. Environmental Influences on Life Satisfaction and Depressive Symptoms Among Older Adults With Multimorbidity: Path Analysis Through Loneliness in the Canadian Longitudinal Study on Aging. THE GERONTOLOGIST 2022; 62:855-864. [PMID: 35034124 PMCID: PMC9290896 DOI: 10.1093/geront/gnac004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES More older adults with multimorbidity are aging in place than ever before. Knowing how the environment affects their mental well-being could enhance the efficacy of age-friendly interventions for multimorbidity resilience. With reference to the Transdisciplinary Neighborhood Health Framework, we construct and examine a priori models of environmental influences on life satisfaction and depressive symptoms. RESEARCH DESIGN AND METHODS Baseline and follow-up data (after 3 years) were drawn from the Canadian Longitudinal Study on Aging to identify a subsample (n = 14,301) of participants aged at least 65 years with at least 2 chronic diseases. Path analysis examined sociobehavioral attributes (i.e., social support, social participation, walking) and loneliness as primary and secondary mediators, controlling for age, sex, education, and outcomes during baseline. RESULTS Good model fit was found (TFI = 1.00; CFI = 1.00; RMSEA < 0.001; SRMR < 0.001). The total effects of housing quality (rtotal = 0.08, -0.07) and neighborhood cohesion (rtotal = 0.03, -0.06) were weak but statistically significant in the expected direction. The mediators explained 21%-31% of the total effects of housing quality and 67%-100% of the total effects of neighborhood cohesion. Loneliness mediated 27%-29% of these environmental influences on mental well-being, whereas walking mediated a mere 0.4%-0.9% of the total effects. Walking did not explain the relationship between housing quality and mental well-being. DISCUSSION AND IMPLICATIONS Data supported a priori pathways from environment to mental well-being through sociobehavioral attributes and loneliness. If these pathways from neighborhood cohesion to life satisfaction reflect causal effects, community-based age-friendly interventions should focus on enhancing neighborhood cohesion to mitigate loneliness among multimorbid older adults for their mental well-being.
Collapse
Affiliation(s)
- Daniel R Y Gan
- Address correspondence to: Daniel R. Y. Gan, PhD, Gerontology Research Centre, Simon Fraser University, #2800-515 West Hastings Street, Vancouver, BC V6B 5K3, Canada. E-mail:
| | - Andrew V Wister
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - John R Best
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
14
|
Van Wilder L, Pype P, Mertens F, Rammant E, Clays E, Devleesschauwer B, Boeckxstaens P, De Smedt D. Living with a chronic disease: insights from patients with a low socioeconomic status. BMC FAMILY PRACTICE 2021; 22:233. [PMID: 34789153 PMCID: PMC8598397 DOI: 10.1186/s12875-021-01578-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022]
Abstract
Background Little is known about how patients with low socioeconomic status (SES) experience their chronic disease, and how it impacts health-related quality of life (HRQoL). Compared to their more affluent counterparts, worse outcomes have been reported. A better understanding of the domains of HRQoL that are relevant to these specific populations is therefore needed. We explored the experiences of living with a chronic disease in low SES persons. Methods A qualitative interview study was performed in Flanders, Belgium. Semi-structured interviews were conducted in chronically ill patients, selected through purposive sampling. Interviews were audio-recorded and transcribed verbatim. Analysis followed an inductive and iterative approach. Results Fifteen patients were interviewed. Six major themes were identified: a heavy bag to carry, loss of autonomous life, inner and outer loneliness, emotional imbalance, unmet need for support, and coping strategies. Patients experienced their illness as an additional problem on top of all other problems (i.e. financial/social problems, traumatic life events). In general, the disease burden and non-disease burden were mutually reinforcing, resulting in greater dependency, greater risk of social isolation, greater psychological distress, and greater risk of impaired HRQoL. Conclusions This study is the first to provide detailed insight into the experiences of living with a chronic disease in low SES persons. A conceptual model is proposed that can be used in daily clinical practice to raise awareness among clinicians and health care providers that the patient’s needs go beyond the disease itself. Future research is needed to validate and test the model. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01578-7.
Collapse
Affiliation(s)
- Lisa Van Wilder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Fien Mertens
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | | | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| |
Collapse
|
15
|
Sultan N, Swinglehurst D. Self-Management in Older Pakistanis Living With Multimorbidity in East London. QUALITATIVE HEALTH RESEARCH 2021; 31:2111-2122. [PMID: 34110228 PMCID: PMC8552379 DOI: 10.1177/10497323211019355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this article, we explore how older British Pakistani people experience multimorbidity (defined as the coexistence of two or more medical conditions) and engage with self-management within the context of their life histories and relationships. We conducted biographical narrative interviews in Urdu and/or English with 15 first-generation Pakistani migrants living with multimorbidity, at their homes in East London. Our analysis showed that the triadic construct of family, faith, and health was central to how participants made sense of their lives, constituting notions of "managing" in the context of multimorbidity. For Pakistani patients, the lived experience of health was inseparable from a situated context of family and faith. Our findings have implications for existing public health strategies of self-management, underpinned by neoliberal discourses that focus on individual responsibility and agency. Health care provision needs to better integrate the importance of relationships between family, faith, and health when developing services for these patients.
Collapse
Affiliation(s)
- Najia Sultan
- Queen Mary University of London, London, United Kingdom
| | | |
Collapse
|
16
|
Brandberg C, Ekstedt M, Flink M. Self-management challenges following hospital discharge for patients with multimorbidity: a longitudinal qualitative study of a motivational interviewing intervention. BMJ Open 2021; 11:e046896. [PMID: 34330857 PMCID: PMC8327841 DOI: 10.1136/bmjopen-2020-046896] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe challenges in self-management activities among people with multimorbidity during a 4-week post-discharge period. DESIGN This is a longitudinal qualitative study using data from a randomised controlled trial (RCT) of motivational interviewing (MI) sessions. SETTING The RCT was conducted at six wards in two hospitals-one university hospital and one general hospital in Stockholm, Sweden, during 2016-2018. PARTICIPANTS Sixteen participants from the intervention group, diagnosed with heart failure or chronic obstructive pulmonary disease and at least one other chronic condition, were purposively selected for this study. INTERVENTIONS Each participant had four or five post-discharge MI sessions with a trained social worker during a period of approximately 4 weeks. The sessions were recorded digitally and analysed using content analysis. Altogether, 70 recorded sessions were analysed. RESULTS Self-management after hospital discharge was a dynamic process with several shifting features that evolved gradually over time. Patients with multimorbidity experienced two major challenges with self-management in the first 4 weeks following hospital discharge: 'Managing a system-centred care' and 'Handling the burden of living with multiple illnesses at home post-discharge'. CONCLUSIONS Self-management for patients with multimorbidity in the first post-discharge period does not equate to a fixed set of tasks, but varies over the post-discharge period. Self-management challenges include not only the burden of the disease itself, but also that of navigating and understanding the healthcare system. Hence, self-management support post-discharge involves both aiding patients with care coordination and meeting their gradually shifting disease-related needs. TRIAL REGISTRATION NUMBER NCT02823795.
Collapse
Affiliation(s)
- Carina Brandberg
- Department of Learning, Informatics, Managmenet and Ethics (LIME), Karolinska Institute, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Managmenet and Ethics (LIME), Karolinska Institute, Stockholm, Sweden
- School of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Kalmar, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
17
|
Hoel KA, Rokstad AMM, Feiring IH, Lichtwarck B, Selbæk G, Bergh S. Person-centered dementia care in home care services - highly recommended but still challenging to obtain: a qualitative interview study. BMC Health Serv Res 2021; 21:723. [PMID: 34294078 PMCID: PMC8299610 DOI: 10.1186/s12913-021-06722-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia is one of the main causes of disability and dependence in older people, and people with dementia need comprehensive healthcare services, preferably in their own homes. A well-organized home care service designed for people with dementia is necessary to meet their needs for health- and social care. Therefore, it is important to gain knowledge about how people with dementia experience the home care service and if the service responds to their wishes and needs. The aim of this study was to explore the experience of home care services among people with dementia, to understand the continuity in services, how the service was adapted to people with dementia, and how the patient experienced person-centered care and shared decision-making. METHODS We used a qualitative, exploratory design based on a phenomenological-hermeneutic approach and performed individual in-depth interviews with persons with dementia. A convenience sample of 12 persons with moderate to severe degrees of dementia from four Norwegian municipalities participated in the study. The interviews were conducted in February 2019. RESULTS The findings identified that the participants appreciated the possibility to stay safely in their own homes and mostly experienced good support from staff. They expressed various views and understanding of the service and experienced limited opportunities for user involvement and individualized, tailored service. The overall theme summarizing the findings was: "It is difficult for people with dementia to understand and influence home care services, but the services facilitate the possibility to stay at home and feel safe with support from staff." CONCLUSION The participants did not fully understand the organization of the care and support they received from the home care services, but they adapted to the service without asking for changes based on their needs or desires. Although person-centered care is recommended both nationally and internationally, the participants experienced little inclusion in defining the service they received, and it was perceived as unclear how they could participate in shared decision-making.
Collapse
Affiliation(s)
- Kari-Anne Hoel
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway.
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway.
| | - Anne Marie Mork Rokstad
- The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Hjorth Feiring
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Bjørn Lichtwarck
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Geir Selbæk
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
- The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sverre Bergh
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
| |
Collapse
|
18
|
Yoshioka-Maeda K, Kono A. Factors related to complex care needs of older adults in community-based integrated care centers in Japan: A cross-sectional study. Jpn J Nurs Sci 2021; 18:e12440. [PMID: 34196480 DOI: 10.1111/jjns.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to identify the factors related to complex care needs of older adults in community-based integrated care centers. METHODS We sent 936 self-reported questionnaires to community-based integrated care center directors in the Kinki region of Japan. These questionnaires included questions not only about the directors' demographic data, but also regarding the sociodemographic, psychosocial, and family-related dimensions of the older adults in the community centers. The directors divided their cases into two categories: "Complex cases" and "Straightforward cases." We compared the intergroup differences and examined the factors related to complex care needs in older adults. RESULTS A total of 232 directors responded. Complex cases were significantly associated with younger age, poor health conditions, and having a family member who needs care, as compared to straightforward cases where these associations were not present. Logistic regression showed that in older adults, factors of refusing support or social services, social isolation, and trouble with neighbors were associated with their complexities. Additionally, family members with a high likelihood of refusing social services, older adults without a key family member, and difficulties in forming their consensus regarding care were associated with older adults' complexities. CONCLUSION Older adults with complex care needs could have the risk of self-neglect, and their families faced difficulties in supporting them as family members. Healthcare professions should carefully assess these factors and develop needs-oriented services for them without their family support as an upstream intervention.
Collapse
Affiliation(s)
- Kyoko Yoshioka-Maeda
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan
| | - Ayumi Kono
- Department of Home Health Nursing, Osaka City University, Osaka, Japan
| |
Collapse
|
19
|
Kuluski K, Reid RJ, Baker GR. Applying the principles of adaptive leadership to person-centred care for people with complex care needs: Considerations for care providers, patients, caregivers and organizations. Health Expect 2020; 24:175-181. [PMID: 33340393 PMCID: PMC8077079 DOI: 10.1111/hex.13174] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/16/2020] [Accepted: 11/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background Health systems in many countries see person‐centred care as a critical component of high‐quality care but many struggle to operationalize it in practice. We argue that models such as adaptive leadership can be a critical lever to support person‐centred care, particularly for people who have multiple complex care needs. Objective To reflect on two concepts: person‐centred care and adaptive leadership and share how adaptive leadership can advance person‐centred care at the front‐line care delivery level and the organizational level. Findings The defining feature of adaptive leadership is the separation of technical solutions (ie applying existing knowledge and techniques to problems) from adaptive solutions (ie requiring shifts in how people work together, not just what they do). Addressing adaptive challenges requires identifying key assumptions that may limit motivations for change and the behaviours influenced by these assumptions. Thus, effective care for patients, particularly those with multiple complex care needs, often entails helping care providers and patients to examine their relationships and behaviours not just identifying technical solutions. Addressing adaptive challenges also requires a supportive and enabling organizational context. We provide illustrative examples of how adaptive leadership principles can be applied at both the front line of care and the organization level in advancing person‐centred care delivery. Conclusions Advancing person‐centred care at both the clinical and organizational levels requires a growth mindset, a willingness to try (and fail) and try again, comfort in being uncomfortable and a commitment to figure things out, in partnership, in iterative ways. Patients, caregivers, care providers and organizational leaders all need to be adaptive leaders in this endeavour.
Collapse
Affiliation(s)
- Kerry Kuluski
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert J Reid
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
20
|
Ploeg J, Garnett A, Fraser KD, Baird LG, Kaasalainen S, McAiney C, Markle-Reid M, Dufour S. The complexity of caregiving for community-living older adults with multiple chronic conditions: A qualitative study. JOURNAL OF COMORBIDITY 2020; 10:2235042X20981190. [PMID: 33403202 PMCID: PMC7739080 DOI: 10.1177/2235042x20981190] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/19/2020] [Indexed: 11/15/2022]
Abstract
Background: Older adults with multiple chronic conditions (MCC) rely heavily on caregivers for assistance with care. However, we know little about their psychosocial experiences and their needs for support in managing MCC. The purpose of this study was to explore the experiences of caregivers of older adults living in the community with MCC. Methods: This qualitative study was a secondary analysis of previously collected data from caregivers in Ontario and Alberta, Canada. Participants included caregivers of older adults (65 years and older) with three or more chronic conditions. Data were collected through in-depth, semi-structured interviews. Interview transcripts were coded and analyzed using Thorne’s interpretive description approach. Results: Most of the 47 caregiver participants were female (76.6%), aged 65 years of age or older (61.7%), married (87.2%) and were spouses to the care recipient (68.1%). Caregivers’ experiences of caring for community-living older adults with MCC were complex and included: (a) dealing with the demands of caregiving; (b) prioritizing chronic conditions; (c) living with my own health limitations; (d) feeling socially isolated and constrained; (e) remaining committed to caring; and (f) reaping the rewards of caregiving. Conclusions: Healthcare providers can play key roles in supporting caregivers of older adults with MCC by providing education and support on managing MCC, actively engaging them in goal setting and care planning, and linking them to appropriate community health and social support services. Communities can create environments that support caregivers in areas such as social participation, social inclusion, and community support and health services.
Collapse
Affiliation(s)
- Jenny Ploeg
- School of Nursing, McMaster University, Canada.,Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, McMaster University, Canada
| | - Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Kimberly D Fraser
- Faculty of Nursing, University of Alberta, Canada.,Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Lisa Garland Baird
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Carrie McAiney
- Schlegel-UW Research Institute for Aging, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, Canada.,Aging, Community and Health Research Unit, McMaster University, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sinéad Dufour
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
21
|
Larkin J, Foley L, Smith SM, Harrington P, Clyne B. The experience of financial burden for people with multimorbidity: A systematic review of qualitative research. Health Expect 2020; 24:282-295. [PMID: 33264478 PMCID: PMC8077119 DOI: 10.1111/hex.13166] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/08/2020] [Indexed: 12/27/2022] Open
Abstract
Background Multimorbidity prevalence is increasing globally. People with multimorbidity have higher health care costs, which can create a financial burden. Objective To synthesize qualitative research exploring experience of financial burden for people with multimorbidity. Search strategy Six databases were searched in May 2019. A grey literature search and backward and forward citation checking were also conducted. Inclusion criteria Studies were included if they used a qualitative design, conducted primary data collection, included references to financial burden and had at least one community‐dwelling adult participant with two or more chronic conditions. Data extraction and synthesis Screening and critical appraisal were conducted by two reviewers independently. One reviewer extracted data from the results section; this was checked by a second reviewer. GRADE‐CERQual was used to summarize the certainty of the evidence. Data were analysed using thematic synthesis. Main results Forty‐six studies from six continents were included. Four themes were generated: the high costs people with multimorbidity experience, the coping strategies they use to manage these costs, and the negative effect of both these on their well‐being. Health insurance and government supports determine the manageability and level of costs experienced. Discussion Financial burden has a negative effect on people with multimorbidity. Continuity of care and an awareness of the impact of financial burden of multimorbidity amongst policymakers and health care providers may partially address the issue. Patient or public contribution Results were presented to a panel of people with multimorbidity to check whether the language and themes ‘resonated’ with their experiences.
Collapse
Affiliation(s)
- James Larkin
- HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Barbara Clyne
- HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland.,Health Information and Quality Authority, Dublin, Ireland
| |
Collapse
|
22
|
McDermott CL, Engelberg RA, Khandelwal N, Steiner JM, Feemster LC, Sibley J, Lober WB, Curtis JR. The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity. Am J Hosp Palliat Care 2020; 38:954-962. [PMID: 33084357 DOI: 10.1177/1049909120968527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Multimorbidity is associated with increased intensity of end-of-life healthcare. This association has been examined by number but not type of conditions. Our purpose was to understand how intensity of care is influenced by multimorbidity within specific chronic conditions to provide guidance for interventions to improve end-of-life care for these patients. METHODS We identified adults cared for in a multihospital healthcare system who died between 2010-2017. We categorized patients by 4 primary chronic conditions: heart failure, pulmonary disease, renal disease, or dementia. Within each condition, we examined the effect of multimorbidity (presence of 4 or more chronic conditions) on hospital and ICU admission in the last 30 days of life, in-hospital death, and advance care planning (ACP) documentation >30 days before death. We performed logistic regression to estimate associations between multimorbidity and end-of-life care utilization, stratified by the presence or absence of ACP documentation. RESULTS ACP documentation >30 days before death was associated with lower odds of in-hospital death for all 4 conditions both in patients with and without multimorbidity. With the exception of patients with renal disease without multimorbidity, we observed lower odds of hospitalization and ICU admission for all patients with ACP >30 days before death. CONCLUSIONS Patients with dementia and multimorbidity had the highest odds of high-intensity end-of-life care. For patients with dementia, heart failure, or pulmonary disease, ACP documentation >30 days before death was associated with lower likelihood of in-hospital death, hospitalization, and ICU use at end-of-life, regardless of multimorbidity.
Collapse
Affiliation(s)
- Cara L McDermott
- Division of Pulmonary, Critical Care and Sleep Medicine, 7284University of Washington, Seattle, WA, USA
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care and Sleep Medicine, 7284University of Washington, Seattle, WA, USA
| | - Nita Khandelwal
- Division of Anesthesiology and Pain Medicine, 7284University of Washington, Seattle, WA, USA
| | - Jill M Steiner
- Division of Cardiology, 7284University of Washington, Seattle, WA, USA
| | - Laura C Feemster
- Division of Pulmonary, Critical Care and Sleep Medicine, 7284University of Washington, Seattle, WA, USA.,VA Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - James Sibley
- Department of Biobehavioral Nursing and Health Informatics, 7284University of Washington, Seattle, WA, USA
| | - William B Lober
- Department of Biobehavioral Nursing and Health Informatics, 7284University of Washington, Seattle, WA, USA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care and Sleep Medicine, 7284University of Washington, Seattle, WA, USA
| |
Collapse
|
23
|
Kuluski K. Relationships and Communication-the core components of person-centred care. Health Expect 2020; 23:977-978. [PMID: 33459463 PMCID: PMC7696278 DOI: 10.1111/hex.13153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Kerry Kuluski
- Institute for Better HealthTrillium Health PartnersOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
| |
Collapse
|
24
|
Foo KM, Sundram M, Legido-Quigley H. Facilitators and barriers of managing patients with multiple chronic conditions in the community: a qualitative study. BMC Public Health 2020; 20:273. [PMID: 32106838 PMCID: PMC7045577 DOI: 10.1186/s12889-020-8375-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/19/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Approximately one-third of all adults worldwide are diagnosed with multiple chronic conditions (MCCs). The literature has identified several challenges facing providers and patients coping with managing MCCs in the community, yet few studies have considered their viewpoints in combination. A qualitative study involving healthcare providers and users was thus conducted to examine facilitators and barriers of managing patients with MCCs in the community in Singapore. METHODS This study involves 26 semi-structured interviews with 10 physicians, 2 caregivers and 14 patients seeking treatment in the polyclinics that provide subsidised primary care services. Topic guides were developed with reference to the literature review, Chronic Care Model (CCM) and framework for patient-centred access to healthcare. RESULTS Despite the perceived affordability and availability of the support system, some patients still encountered financial difficulties in managing care. These include inadequacy of the nation-wide medical savings scheme to cover outpatient treatment and medications. Half of healthcare users did not know where to seek help. While patients could access comprehensive services in polyclinics, those who did not visit the clinics might not receive timely care. Furthermore, patients reported long consultation waiting time. Physicians were able to propose and drive quality improvement projects to improve care quality. However, there were challenges to delivering safe and quality care with limited consultation duration due to the need to manage high patient load and waiting time, inadequate communication with specialists to coordinate care, and resource constraints in managing complex patients. Although providers could equip patients with self-management and lifestyle-related guidelines, patients' actions are influenced by multiple factors, including work requirements, beliefs and environment. CONCLUSIONS There were barriers on care access, delivery and self-management. It is crucial to adopt a whole-of-society approach involving individuals, community, institutions and policymakers to improve and support MCC management. This study has also highlighted the importance of considering the different viewpoints of healthcare providers and users in policy formulation and community care planning.
Collapse
Affiliation(s)
- Kah Mun Foo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore.
- National University Polyclinics, Singapore, 1 Jurong East Street 21, Singapore, 609606, Singapore.
| | - Meena Sundram
- National University Polyclinics, Singapore, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
- London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| |
Collapse
|
25
|
Ploeg J, Yous ML, Fraser K, Dufour S, Baird LG, Kaasalainen S, McAiney C, Markle-Reid M. Healthcare providers' experiences in supporting community-living older adults to manage multiple chronic conditions: a qualitative study. BMC Geriatr 2019; 19:316. [PMID: 31744477 PMCID: PMC6862842 DOI: 10.1186/s12877-019-1345-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 11/04/2019] [Indexed: 01/07/2023] Open
Abstract
Background Living with multiple chronic conditions (MCC), the coexistence of two or more chronic conditions, is becoming more prevalent as the population ages. Primary care and home care providers play key roles in caring for older adults with MCC such as facilitating complex care decisions, shared decision-making, and access to community health and support services. While there is some research on the perceptions and experiences of these providers in caring for this population, much of this literature is focused specifically on family physicians. Little is known about the experiences of other primary care and home care providers from multiple disciplines who care for this vulnerable group. The purpose of this study was to explore the experiences of primary and home care healthcare providers in supporting the care of older adults with MCC living in the community, and identify ways of improving care delivery and outcomes for this group. Methods The study used an interpretive descriptive design. A total of 42 healthcare providers from two provinces in Canada (Ontario and Alberta) participated in individual semi-structured, face-to-face 60-min interviews. Participants represented diverse disciplines from primary care and home care settings. Inductive thematic analysis was used for data analysis. Results The experiences and recommendations of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), supporting caregivers, (4) using a team approach for holistic care delivery, (5) encountering challenges and rewards, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers identified the need for a more comprehensive, integrated system of care to improve the delivery of care and outcomes for older adults with MCC and their family caregivers. Conclusions Study findings suggest that community-based healthcare providers are using many relevant and appropriate strategies to support older adults living with the complexity of MCC, such as implementing person-centred care, supporting caregivers, working collaboratively with other providers, and addressing social determinants of health. However, they also identified the need for a more comprehensive, integrated system of care.
Collapse
Affiliation(s)
- Jenny Ploeg
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences and Associate Member, Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Marie-Lee Yous
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences and Associate Member, Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Kimberly Fraser
- Faculty of Nursing, University of Alberta, Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada
| | - Sinéad Dufour
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main Street West, IAHS -403, Hamilton, ON, L8S 4K1, Canada
| | - Lisa Garland Baird
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, C1A4P3, Charlottetown, PEI, Canada
| | - Sharon Kaasalainen
- Faculty of Nursing, University of Alberta, Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada
| | - Carrie McAiney
- Schlegel Research Chair in Dementia, School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| |
Collapse
|