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Wang P, Lei L, Cui J, Li J, Zhang L, Sun Y. Trend analysis and influencing factors of healthy aging in middle-aged population in China: a longitudinal study based on the China Health and Retirement Longitudinal Study. Public Health 2024; 233:108-114. [PMID: 38865827 DOI: 10.1016/j.puhe.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/09/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES This study aimed to assess the trends of healthy aging and investigate its determinants in the middle-aged population. STUDY DESIGN This was a longitudinal study. METHODS The sample comprised 3043 participants aged 45-59 years from the China Longitudinal Study of Health and Retirement 2011-2018. We plotted the prevalence across four waves and used ordered logistic models to investigate the determinants of cumulative times of healthy aging. RESULTS We enrolled 3043 middle-aged people in our study. The prevalence of healthy aging is 28.2% at baseline but subsequently decreased to 19.72% at wave 4. Active socializing consistently ranked the lowest among the five dimensions. Participants with older age (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.94-0.97), low monthly income (OR = 0.82, 95% CI: 0.69-0.97) or lived in urban (OR = 0.81, 95% CI: 0.70-0.94) were less likely to have per time increase in healthy aging. Participants with more than primary school degree (OR = 1.79, 95% CI: 1.31-2.46), high life satisfaction (OR = 2.38, 95% CI: 1.86-3.06), and good self-report health (OR = 1.97, 95% CI: 1.66-2.34) were more likely to have healthy aging. CONCLUSION The number of middle-aged individuals in China who achieved healthy aging is declining and eventually less than one in five, which was far from ideal. Particular attention should be paid to older, women, urban dwellers, individuals with low income, low life satisfaction or poor self-report health. It is urgent to develop public health policies to improve the health and well-being of the middle-aged population.
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Affiliation(s)
- Ping Wang
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lubi Lei
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingjing Cui
- Department of Geriatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jingkuo Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanyuan Sun
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Sperling D. Needs, Experiences, and Hopes for Aging Futures among Older Adults in the LGBTQ Communities: A Qualitative Study in Israel. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02938-x. [PMID: 39009741 DOI: 10.1007/s10508-024-02938-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 07/17/2024]
Abstract
Older lesbian, gay, bisexual, trans, and queer (LGBTQ) individuals tend to live alone, mostly without children and with scarce support from nuclear family members or biological kin. Moreover, traditional resources may not suit their specific end-of-life care needs. While studies have examined these topics in general, they lack focus on end-of-life needs, care, and planning in Israel. Moreover, research on this topic among members of LGBTQ communities is specifically lacking. This study, therefore, aimed at identifying and understanding the attitudes, perceptions, and meanings of older LGBTQ individuals in Israel regarding their needs and challenges, as they age and near end of life. The phenomenological qualitative research methodology was applied, following the interpretive approach. Twenty-one middle-aged and older LGBTQ individuals in Israel, aged ≥ 55, participated in the study. In-depth semi-structured interviews, conducted from November 2020 to April 2021, were audio-recorded, transcribed, and de-identified. Five themes emerged from the interviews: (1) Experiences of loneliness, marginalization, and trauma, and coping through liberation; (2) ageism and exclusion of older adults; (3) elastic and challenging relationships; (4) end of life as reverting into the closet and heteronormativity; and (5) death as a source of generativity and creativity. The study demonstrates that loneliness is an existential experience, exacerbated by the intersectionality of LGBTQ communities. In turn, chosen family members play a minimal role in the end-of-life care of their loved ones. While conveying ambivalence toward social services and housing for the aging, participants in this study expressed fear of being discriminated against and having to re-enter the closet as they age. Ageism and end of life do not represent finality and extinction, yet instead, signify hope and revival. Following Sandberg and Marshall's (2017) concept of queering aging futures, this study refines our understanding of life courses, demonstrating that living and thriving in old age could be positive and desirable. As such, ageism and end of life do not necessarily represent finality and extinction, and may instead signify hope and revival. The unique challenges associated with family and social support of older adults who are LGBTQ members, and their implications on care, deserve further research and are important for practice.
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Affiliation(s)
- Daniel Sperling
- The Cheryl Spencer Department of Nursing, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel.
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Carnahan JL, Pickett AC. Postacute Care and Long-term Care for LGBTQ+ Older Adults. Clin Geriatr Med 2024; 40:321-331. [PMID: 38521602 PMCID: PMC10960930 DOI: 10.1016/j.cger.2023.10.005] [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] [Indexed: 03/25/2024]
Abstract
LGBTQ + older adults have a high likelihood of accessing nursing home care. This is due to several factors: limitations performing activities of daily living and instrumental activities of daily living, restricted support networks, social isolation, delay seeking assistance, limited economic resources, and dementia. Nursing home residents fear going in the closet, which can have adverse health effects. Cultivating an inclusive nursing home culture, including administration, staff, and residents, can help older LGBTQ + adults adjust and thrive in long-term care.
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Affiliation(s)
- Jennifer L Carnahan
- Indiana University Center for Aging Research, Regenstrief Institute, 1101 West 10th Street, Indianapolis, IN 46202, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Andrew C Pickett
- Department of Health & Wellness Design, Indiana University Bloomington, 1719 East 10th Street, Bloomington, IN 47408, USA
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Robinson L, Matamoros C. Applied patient-level palliative care interventions designed to meet the needs of sexual and gender minorities: A scoping review and qualitative content analysis of how to support sexual and gender minorities at end of life. Palliat Med 2024; 38:69-84. [PMID: 38062858 PMCID: PMC10798012 DOI: 10.1177/02692163231214123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Sexual and gender minorities experience considerable health disparities across the life span. End of life presents unique challenges for this population, further exacerbating existing disparities. AIM We aimed to identify applied patient-level palliative care interventions for sexual and gender minorities and describe how said interventions met the needs of these populations at end of life. DESIGN We conducted a scoping review in keeping with the updated Arksey and O'Malley Framework. All included reports were analyzed qualitatively to describe the intervention and summarize thematically how it met the needs of sexual and gender minorities at end of life. DATA SOURCES We conducted searches in MEDLINE, EMBASE, PsychInfo, and CINAHL from 1946 to June 10, 2023. Reports were eligible for inclusion if they described a palliative care intervention delivered to sexual and gender minorities, and if the palliative care intervention responded to at least one specific need of the sexual and gender minority population(s) in question. RESULTS We included and summarized 27 reports. We identified three overarching themes describing how palliative care interventions responded to the needs of sexual and gender minorities at end of life. CONCLUSIONS This review responds to a need to improve palliative care delivery for sexual and gender minorities. Recommendations derived from these interventions, including how to center and advocate for sexual and gender minorities at end of life, can be applied by any interdisciplinary palliative care provider.
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Affiliation(s)
- Lilian Robinson
- Temmy Latner Centre for Palliative Care, Sinai Health System, Scarborough Health Network, Toronto, ON, Canada
| | - Cam Matamoros
- Scarborough Health Network, Scarborough Center for Healthy Communities, Department of Family and Community Medicine, Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
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Kirjava SA, Sladen DP, DeBacker JR. Providing Mindful and Informed Health Care for Patients Who Are LGBTQ+: Perspectives for Clinical Audiology. Am J Audiol 2023; 32:683-693. [PMID: 37195458 DOI: 10.1044/2023_aja-22-00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
PURPOSE More than 7% of the U.S. population identifies as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other identities), meaning clinical audiologists in all settings are likely to encounter LGBTQ+ patients seeking audiological services. This conceptual clinical focus article (a) introduces contemporary LGBTQ+ terms, definitions, and pertinent issues; (b) summarizes the current state of knowledge on barriers to equitable hearing health care access and utilization for people who identify as LGBTQ+; (c) explores the legal, ethical, and moral obligations for audiologists to provide equitable care to people who identify as LGBTQ+; and (d) provides resources to continue to learn about salient LGBTQ+ issues. CONCLUSIONS This clinical focus article provides actionable guidance to clinical audiologists on providing inclusive equitable care to LGBTQ+ patients. Practical actionable guidance on how clinical audiologists can make their clinical practice more inclusive for their patients who identify as LGBTQ+ is provided.
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Affiliation(s)
| | - Douglas P Sladen
- Department of Communication Sciences and Disorders, Western Washington University, Bellingham, WA
| | - J Riley DeBacker
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR
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Rosa WE, Roberts KE, Braybrook D, Harding R, Godwin K, Mahoney C, Mathew S, Atkinson TM, Banerjee SC, Haviland K, Hughes TL, Walters CB, Parker PA. Palliative and end-of-life care needs, experiences, and preferences of LGBTQ+ individuals with serious illness: A systematic mixed-methods review. Palliat Med 2022; 37:460-474. [PMID: 36475950 PMCID: PMC10171330 DOI: 10.1177/02692163221124426] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals experience discrimination throughout the care continuum, including during serious illness and at end of life. High-quality palliative care requires that health professionals deliver individualized services that reflect the needs, experiences, and preferences of LGBTQ+ persons. AIM To identify and appraise existing evidence related to the needs, experiences, and preferences for palliative and end of life care among LGBTQ+ individuals with serious illness. DESIGN Data-based convergent synthesis design reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES PubMed, Embase, Cochrane CENTRAL, PsycINFO, CINAHL, and Scopus from January 1, 2010 to November 6, 2020. RESULTS Of 4875 results captured, 69 articles underwent full-text review and 13 were retained for analysis. Most studies were from North America with trans individuals represented in 10 of 13 studies. Needs (n = 6) included increased social support, institutional safety, economic and legal supports, and advocacy to mitigate health barriers.Experiences (n = 12) were driven by fear and worry associated with discrimination/stigma,providers' hetero-/cisnormative assumptions, homophobia and transphobia, social isolation, and an undignified death. Preferences (n = 6) pertained to inclusion of chosen families in decision-making, disclosure of LGBTQ+ identity based on safety of the clinical environment, and a desire to maintain autonomy. CONCLUSIONS The robustness of the science has improved regarding the needs, experiences, and preferences of trans individuals. Actionable, inclusive policies coupled with sustained and integrated cultural sensitivity training for health workers are mandatory. Interventional research is critical to enhance tailored palliative care for LGBTQ+ people and their chosen families.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kailey E Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, England, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, England, UK
| | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cassidy Mahoney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shiyon Mathew
- Lienhard School of Nursing, College of Health Professions, Pace University, New York, NY, USA
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kelly Haviland
- Advanced Practice Provider Division, Professional Development, Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tonda L Hughes
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, NY, USA
| | - Chasity B Walters
- Patient Education & Engagement, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Roberts NJ, Harvey LA, Poulos RG, Ní Shé É, Dillon Savage I, Rafferty G, Ivers R. Lesbian, gay, bisexual, transgender and gender diverse and queer (LGBTQ) community members' perspectives on palliative care in New South Wales (NSW), Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5926-e5945. [PMID: 36121264 PMCID: PMC10087150 DOI: 10.1111/hsc.14024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/12/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Lesbian, gay, bisexual, transgender and gender diverse people, and queer people (LGBTQ people) are at increased risk of some chronic diseases and cancers. NSW Health palliative care health policy prioritises equitable access to quality care, however, little is known about community members' perspectives on palliative care. This study aimed to understand LGBTQ community views and preferences in palliative care in NSW. A community survey and follow-up interviews with LGBTQ people in NSW were conducted in mid-2020. A total of 419 people responded to the survey, with 222 completing it. Six semi-structured phone interviews were conducted with participants who volunteered for follow-up. The sample included LGBTQ people with varied levels of experience in palliative care. Thematic analysis was conducted on survey and interview data, to identify perceived barriers and enablers, and situate these factors in the socio-ecological model of health. Some perceived barriers from community members related to considering whether to be 'out' (i.e., making one's sexual orientation and gender known to services), knowledge and attitudes of staff, concern about potential substandard care or mistreatment (particularly for transgender health), decision making, biological family as a source of tension, and loneliness and isolation. Perceived enablers related to developing and distributing inclusive palliative care information, engaging with community(ies), fostering inclusive and non-discriminatory service delivery, ensuring respectful approaches to person-centred care, and staff training on and awareness building of LGBTQ needs and issues. Most of the participants who had experienced palliative care recounted positive interactions, however, we identified that LGBTQ people require better access to knowledgeable and supportive services. Palliative care information should be inclusive and services respectful and welcoming. Particular consideration should be given to how services respond to and engage with people from diverse population groups. These insights can support ongoing policy and service development activities to further enhance palliative care.
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Affiliation(s)
- Nick J. Roberts
- NSW Ministry of HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lara A. Harvey
- Neuroscience Research AustraliaUniversity of New South WalesSydneyNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
| | | | - Éidín Ní Shé
- Royal College of Surgeons in IrelandDublinIreland
| | | | - Gemma Rafferty
- NSW Ministry of HealthSt LeonardsNew South WalesAustralia
| | - Rebecca Ivers
- University of New South WalesSydneyNew South WalesAustralia
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