Exploring the Perspectives of Older People on the Concept of Home

The design elements of outpatient geriatric rehabilitation from patient, healthcare professional, and organizational perspective; a qualitative study

PURPOSE

To gain a rich understanding of the experiences and opinions of patients, healthcare professionals, and policymakers regarding the design of OGR with structure, process, environment, and outcome components.

METHODS

Qualitative research based on the constructive grounded theory approach is performed. Semi-structured interviews were conducted with patients who received OGR (n = 13), two focus groups with healthcare professionals (n = 13), and one focus group with policymakers (n = 4). The Post-acute Care Rehabilitation quality framework was used as a theoretical background in all research steps.

RESULTS

The data analysis of all perspectives resulted in seven themes: the outcome of OGR focuses on the patient's independence and regaining control over their functioning at home. Essential process elements are a patient-oriented network, a well-coordinated dedicated team at home, and blended eHealth applications. Additionally, closer cooperation in integrated care and refinement regarding financial, time-management, and technological challenges is needed with implementation into a permanent structure. All steps should be influenced by the stimulating aspect of the physical and social rehabilitation environment.

CONCLUSION

The three perspectives generally complement each other to regain patients' quality of life and autonomy. This study demonstrates an overview of the building blocks that can be used in developing and designing an OGR trajectory.

Long-term care for community-dwelling older adults: A systematic review of clinical practice guidelines and consensus statements

This review identified clinical practice guidelines (CPGs) and consensus statements (CSs) that include recommendations on long-term care for community-dwelling older adults. Additionally, it assessed their quality using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool to determine high-quality guidelines and synthesis recommendations from high-quality guidelines and evaluate the quality of these guidelines using the AGREE-Recommendation Excellence (AGREE-REX) tool. A systematic search was performed (November 2023) in MEDLINE, PubMed, Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Registered Nurses' Association of Ontario (RNAO), National Guideline Clearinghouse (NGC), and Scottish Intercollegiate Guidelines Network (SIGN). Two reviewers independently selected and assessed the articles using AGREE II. A meeting was held to appraise the quality of the guidelines (AGREE II mean score >70 %) using AGREE-REX. The analysis included 14 CPGs and 2 CSs. Of these, 7 CPGs reached the standard of >70 %, the 'Scope and purpose' domain obtained the highest score with 85.43 (± 17.87), and the 'Applicability' domain scored lowest with 46.93 (± 26.74). Regarding the score of AGREE-REX, the seven CPGs were considered as 'moderate', with the 'Clinical Applicability' domain having the highest score of 61.29 % (±10.80) and the 'Values and Preferences' domain having the lowest score of 38.14 % (±9.26). Four themes were synthesised from the seven high-quality CPGs: planning and delivering person-centred home care, cognitive impairment, and screening for impaired vision and falls. The quality of CPGs and CSs on long-term care for community-dwelling older adults has room for improvement, and higher-quality guidelines are required to meet the long-term care needs of community-dwelling older adults.

'It's where I belong': what does it mean to age in place from the perspective of people aged 80 and above? A longitudinal qualitative study (wave one)

BACKGROUND

Most people want to remain at home as they age. Ageing in place - remaining at home and connected to the community - is a national and international policy priority; however, to better understand how policy might be implemented, a more nuanced understanding is required about older adults' lived experiences of ageing in place, especially the experiences of those aged 80 and above.

OBJECTIVE

To describe and explore the social processes which enable ageing in place from the perspective of community-dwelling older people (80+).

METHODS

Forty-six respondents (80-100+ years) participated in the first wave of a longitudinal qualitative study set in North East England. Semi-structured interviews were conducted in participants' homes between June 2022 and January 2023. Interviews were analysed using reflexive thematic analysis.

RESULTS

Participants positioned their homes as a place of freedom and as the antithesis of a 'care home'. Remaining in place was important for all participants; a key priority for them was to remain physically active to enable this. However, many participants faced significant hurdles to remaining in place. These were primarily related to health and mobility issues. Some participants were able to overcome such barriers by drawing on financial resources and available social networks.

CONCLUSION

The home is central to understanding older peoples' (80+) experiences of ageing. In a socio-political context which promotes ageing in place, the social factors shaping experiences of ageing in place must be considered. This involves attending to the challenges of later life, particularly health and especially mobility and physical function. Currently, those with resources (social and economic) are better equipped to respond to such challenges, thus potentially exacerbating widening inequalities in ageing. By foregrounding the perspectives of those ageing in place alongside social factors shaping their experiences, our study has important implications for policy and health and social care. We show that a more equitable allocation of resources is vital to fulfil the ageing in place policy agenda. Furthermore, we highlight a need to recognise commitments to ageing in place displayed by people aged 80 and above, especially when remaining in place becomes difficult to achieve.

A qualitative exploration of professionals' perspectives on the implementation of reablement intervention programs in community care

Reablement is considered a complex intervention due to its multicomponent, person-centered, holistic approach promoting older adults' active participation in daily activities. It is important to consider the unique context in which complex interventions are implemented, as contextual factors may interact and influence implementation outcomes. As part of the European TRANS-SENIOR project, this qualitative study aimed to gain insight into professionals' experiences with reablement implementation in Dutch community care. Using the Consolidated Framework for Implementation Research, four focus groups were conducted comprising 32 professionals. Two groups were formed: one at operational level, including therapists, nursing staff, social workers, and domestic support; and one at organizational/strategic level, including project leaders, managers, directors, municipality representatives and health insurers. Participating care organizations had at least 6 months of experience with deploying and implementing reablement. Findings reflected three themes: (1) strength of interdisciplinary collaboration; highlighting significance of sharing goals and beliefs, (2) integrating the reablement philosophy into the organization; underscoring managements role in fostering support across all organizational layers, and (3) achieving a culture change in the healthcare system; emphasizing current funding models impeding value-based care tailored to the individual's goals and needs. The results offer valuable insights for implementation of complex interventions, like reablement.

Common home hazards among healthy older aged adults and potential modifications required for age-friendly housing

INTRODUCTION

The creation of age-friendly home environments enables middle-aged and older aged people to live independently at home while adapting to age-related changes. Little is currently known about existing home hazards that may potentially hinder healthy older people as they age.

METHODS

Prospective cohort study of healthy adults who received an age-friendly home environment assessment conducted by an occupational therapist. Adults aged 60 and over, without significant disability, living in homes within metropolitan Adelaide, South Australia were recruited through community advertising.

RESULTS

Sixty age-friendly home environment assessments were conducted. Common areas where potential hazards were identified, and modifications recommended were bathrooms, toilets and backyards. Gardens were commonly identified as potentially requiring modifications in the future. Participants were more likely to consider moving to new housing if additional modifications were needed to their homes.

CONCLUSION

Affordable and accessible age-friendly housing is required to support an ageing population. Education on age-friendly housing for healthy middle and older aged people is required enabling proactive planning rather than awaiting health crises.

Social Contact and Belonging Among Older People Receiving Home Care Nursing

Purpose

Support of social contact and a sense of belonging may be essential for older persons who need help, to take care of their wellbeing and reduce the feeling of loneliness. The aim of this qualitative study was to explore the features that influence social contact and belonging among older persons who received home care nursing.

Patients and Methods

The study involved nine individual in-depth interviews with older persons residing in Norway. The interviews were analyzed in accordance with a model of content analysis.

Findings

Social contact and belonging among the older persons depended on the availability of necessary resources that foster social activity, contact with family and friends, and housing quality. Interaction with helpers and accommodation of their needs as necessary were important for these persons. Reflecting on the past and considering life in context may be essential as a basis for their present and future life.

Conclusion

The results of the present study indicated that a sense of being cared for and supported are important for social contact and belonging. Social activity, engagement in family and contact with friends and neighbors are valued. However, a proportion of older persons are not engaged in such activities. Volunteer help may be a key factor for improving social contact. Moreover, contact and communication with home care nurses are important for recognition as valued persons and as a link to the community.

The timescapes of older adults living alone and receiving home care: An interview study

In this study, we drew on Barbara Adam's (1998) timescape perspective and applied a timescape lens to our analysis of how nine older adults who live alone, receive home care and are considered by home care professionals to be frail, experience living (in) time. Over a period of eight months, we conducted three interviews with each of the nine participants. We analysed the data using reflexive thematic analysis and drew on timescapes to further interpret our preliminary analysis. Our results show that situated everyday time, place across time, and large-scale time interact in the framing and shaping of older adults' everyday lives. Older adults' embodied experiences of being of advanced age, living alone and receiving home care influenced their timescapes. We propose that paying attention to older adults' timescapes can enable home care professionals and other supporters to consider older adults' health, well-being, vulnerabilities and strengths from a broader perspective than the 'here and now' and thereby enhance the provision of person-centred care.

Climate change is a health crisis with opportunities for health care action: A focus on health care providers, patients with asthma and allergic immune diseases, and their families and neighbors

Climate change has increased the frequency of extreme weather events and compounded natural disasters. Heat, wildfires, flooding, and pollen are already threatening public health and disproportionately affecting individuals in susceptible situations and vulnerable locations. In this theme issue of the Journal of Allergy and Clinical Immunology, we address what is known and not known about the biologic as well as clinical upstream and downstream effects of climate change on asthma and allergy development and exacerbation. We present potential actions that individuals can take at the family, neighborhood, community, health care system, and national and international levels to build climate resilience and protect their own health and the health and welfare of others. We emphasize the importance of actions and policies that are context specific and just. We emphasize the need for the health care system, which contributes between 3% and 5% of global greenhouse gas emissions, to reduce its carbon footprint and build resiliency. Health care providers play a pivotal role in helping policymakers understand the effects of climate on the health of our patients. There is still a window to avoid the most serious effects of climate change on human health and our planet.

Middle aged and older adult's perspectives of their own home environment: a review of qualitative studies and meta-synthesis

BACKGROUND

Most people prefer to remain in their homes and communities as long as possible. Staying at home is widely beneficial as ageing within the home promotes independence and costs less than residential aged care. Understanding meanings and drivers of remaining at home is an area of importance.

OBJECTIVE

The objective of this systematic review of qualitative studies was to synthesise middle and older aged adult's perspective of their home environment and determine the factors that are important when making decisions about future housing.

METHODS

This review and meta-synthesis was conducted in accordance with JBI (formally known as the Joanna Briggs Institute) methodology for systematic reviews of qualitative evidence. Meta-aggregation was used as the method of synthesis. Included qualitative studies involved middle and older aged adults and their views about ageing and housing. Published studies were identified in four electronic databases and grey literature. Critical appraisal and extraction were conducted using JBI tools and findings were categorised and synthesised into findings.

RESULTS

A total of 46 papers with 5183 participants on the concept of home were included. Most of the participants were older (> 65 years old) and the perspectives of middle-aged people were largely absent. Factors impacting on future housing decisions among individuals were identified. Seven synthesized findings emerged-independence, finances, stigma, attitudes towards ageing, attachments with home, aesthetics, and family connection.

CONCLUSION

Older people have a greater sense of independence and autonomy if they remain in their own home. Multiple external factors impacted on their perspectives including a sense of stigma about ageing, fear of being a burden to others and their own financial position which in some cases restricted their options. This review provides a comprehensive description of the different factors that need to be considered when planning future housing needs; both for individuals and for communities.

A Digital Tool for the Self-Assessment of Homes to Increase Age-Friendliness: Validity Study

BACKGROUND

Age-friendly environments in homes and communities play an important role in optimizing the health and well-being of society. Older people have strong preferences for remaining at home as they age. Home environment assessment tools that enable older people to assess their homes and prepare for aging in place may be beneficial.

OBJECTIVE

This study aims to establish the validity of a digital self-assessment tool by assessing it against the current gold standard, an occupational therapy home assessment.

METHODS

A cohort of adults aged ≥60 years living in metropolitan Adelaide, South Australia, Australia, assessed their homes using a digital self-assessment tool with 89 questions simultaneously with an occupational therapist. Adults who were living within their homes and did not have significant levels of disabilities were recruited. Cohen κ and Gwet AC1 were used to assess validity.

RESULTS

A total of 61 participants (age: mean 71.2, SD 7.03 years) self-assessed their own homes using the digital self-assessment tool. The overall levels of agreement were high, supporting the validity of the tool in identifying potential hazards. Lower levels of agreement were found in the following domains: steps (77% agreement, Gwet AC1=0.56), toilets (56% agreement, κ=0.10), bathrooms (64% agreement, κ=0.46), and backyards (55% agreement, κ=0.24).

CONCLUSIONS

Older people were able to self-assess their homes using a digital self-assessment tool. Digital health tools enable older people to start thinking about their future housing needs. Innovative tools that can identify problems and generate solutions may improve the age-friendliness of the home environment.

Considering the home environment and planning for the future: A qualitative exploration of the views of older adults and individuals with older relatives

BACKGROUND

Successful ageing-in-place is dependent on the design and features of the home. In some cases, home modifications or relocation may be required. Accessible, affordable, age-friendly housing for older adults is required to encourage forward planning.

AIMS/OBJECTIVES

To understand the views of middle and older aged adults and individuals with older relatives, about home safety, ageing in place and housing accessibility.

MATERIAL AND METHODS

A qualitative descriptive approach, using reflexive thematic analysis was used. Data were gathered through semi-structured interviews with 16 participants, comprising eight middle- older aged people and eight individuals with older relatives.

RESULTS

Seven themes were identified. Most participants accepted the ageing process and could recognise home environment hazards and potential future housing needs. Others were determined to remain independent at home and resistant to making future changes until necessary. Participants were interested in obtaining more information about how to improve home safety or services to support ageing-in-place.

CONCLUSION

Most older adults are open to conversations about planning for ageing-in-place and would like further information on home safety and home modifications. Educational forums and tools (such as flyers or checklists) which assist older people to plan future housing needs are recommended.

SIGNIFICANCE

Many older people are living in homes that present hazards and limited accessibility as they age. Earlier planning could lead to home modifications which will improve the capacity to age in place. Action to provide earlier education is needed as the population ages and suitable housing for older people is limited.Key points for occupational therapyDecision-making around home safety among the ageing population can be compromised by lack of awareness, inadequate access to information and the sudden onset of age-related changes.An education guide or tool to support forward planning and housing decisions may improve early awareness among the ageing population.

Passive Remote Monitoring and Aging in Place: A Scoping Review

Passive remote monitoring is a relatively new technology that may support older adults to age in place. However, current knowledge about the effectiveness of this technology in extending older adults' independence is lacking. Therefore, we conducted a scoping review of studies examining passive remote monitoring to systematically synthesize evidence about the technology's effectiveness as an intervention. Our initial search of Embase, CINAHL, PubMed, and Scopus databases identified 486 unique articles. Of these, 14 articles met our inclusion criteria. Results show that passive remote monitoring technologies are being used in innovative and diverse ways to support older adults aging in place and their caregivers. More high-quality research on this topic is needed.

Enacting person-centred care in home care services for people with dementia

AIMS AND OBJECTIVES

To develop the theoretical understanding of the process of providing person-centred home care for people with dementia.

BACKGROUND

People with dementia are increasingly cared for at home by family members and home care staff. Care of people with dementia should be person-centred; however, little is known about how home care staff understand and enact person-centred care in their daily work.

DESIGN

Grounded theory.

METHODS

Home care staff (n = 29) were recruited from home care services specialised in providing care for people with dementia. Group interviews were conducted, and a tentative theoretical model for providing person-centred home care to people with dementia was outlined. Nine of the participants were then individually interviewed to further develop the model. The analysis was conducted parallel to the data collection, and hypotheses concerning the evolving theoretical model were continuously tested in the following interviews. The COREQ checklist for qualitative studies was used in reporting the study.

RESULTS

Person-centred home care of people with dementia was conceptualised as a series of processes: Getting ready, getting in, giving care, getting out and finalising the story, each with subprocesses. Theatre metaphors were used to describe how the care was provided. A core process, Enacting and re-enacting familiarity, was at centre in all processes.

CONCLUSIONS

In the person-centred care of people with dementia, familiarity had to be established and continuously fostered. When familiarity was in place, the care recipient and the home care staff acted as a team to perform the care. The theoretical works of Goffman were used to interpret the results.

RELEVANCE TO CLINICAL PRACTICE

The study provides a model for person-centred care of people with dementia at home that deepens the understanding of its processes, prerequisites and outcomes. The model can inform education and administration of home care for people with dementia.

What kind of home is your care home? A typology of personalised care provided in residential and nursing homes

This paper examines how care home managers in England conceptualised the approach to delivering personalised care in the homes they managed. We conducted interviews with care home managers and mapped the approaches they described on two distinct characterisations of personalised care prominent in the research and practitioner literature: the importance of close care relationships and the degree of resident choice and decision-making promoted by the care home. We derived three ‘types’ of personalised care in care homes. These conceptualise the care home as an ‘institution’, a ‘family’ and a ‘hotel’. We have added a fourth type, the ‘co-operative’, to propose a type that merges proximate care relationships with an emphasis on resident choice and decision-making. We conclude that each approach involves trade-offs and that the ‘family’ model may be more suitable for people with advanced dementia, given its emphasis on relationships. While the presence of a range of diverse approaches to personalising care in a care home market may be desirable as a matter of choice, access to care homes in England is likely to be constrained by availability and cost.

Effects of the Intervention "Reflective STRENGTH-Giving Dialogues" for Older Adults Living with Long-Term Pain: A Pilot Study

BACKGROUND

Long-term musculoskeletal pain is a major, often undertreated, disabling health problem among an increasing number of older adults. Reflective STRENGTH-giving dialogues (STRENGTH) may be a tool to support older adults living with long-term pain. The main aim of this pilot study was to investigate the immediate and longitudinal effect of the intervention STRENGTH on levels of pain, wellbeing, occurrence of depression symptoms, and sense of coherence (SOC) among community-dwelling older adults suffering from musculoskeletal pain compared to a control group.

METHODS

The study was semiexperimental with an intervention group and a control group. The effect of a single STRENGTH intervention was reported on the Numeric Rating Scale (NRS) regarding pain and wellbeing. To evaluate the longitudinal effect of STRENGTH, using the Brief Pain Inventory-Short Form (BPI-SF), the Geriatric Depression Scale-20 (GDS-20), SOC-13 at baseline (T1), and six months after the intervention/no intervention (T2), a total of 30 older adults, aged 72 to 97 years (Mdn 86 years), were included consecutively and fulfilled the intervention series (n = 18) or untreated controls (n = 12).

RESULTS

The intervention with STRENGTH decreases pain (NRS 6 Mdn versus NRS 4 Mdn, p < 0.001) and increases wellbeing (NRS 7 Mdn versus NRS 8 Mdn, p < 0.001). After a six-month study period with STRENGTH, no longitudinal effect difference was found compared to baseline. Compared to the control group, there was an increasing trend between decreased pain level and increased SOC level for STRENGTH intervention.

CONCLUSIONS

This pilot study supports STRENGTH's effect as a pain-alleviating model that provides a decrease in pain levels and an increase of wellbeing in older adults with long-term pain. STRENGTH dialogues could be a useful intervention to provide individually holistic care in older adults living with long-term pain.