Challenges, Concerns, and Experiences of Community-Dwelling Older Women with Chronic Low Back Pain—A Qualitative Study in Hong Kong, China

Background and Objectives: Although chronic low back pain (CLBP) is known to negatively affect multiple aspects of the lives of older people, prior qualitative studies mainly focused on the lived experiences of older people with CLBP in Western countries. Given cultural and contextual differences and poor understanding of CLBP in older women with CLBP, it is important to better understand the concerns and lived experiences of Chinese older women with CLBP. The current study aimed to investigate the experiences, challenges, concerns, and coping strategies of older women with CLBP in Hong Kong. Research Design and Methods: A total of 15 community-dwelling older women with CLBP aged ≥60 years were recruited from a physiotherapy clinic or a community center for semi-structured interviews. The interviews were audio recorded and transcribed ‘verbatim’. The transcription was imported to NVivo 12 software. Thematic analysis was conducted using Braun and Clarke’s method. Results: Five themes were identified: (1) physical impacts of CLBP on daily life; (2) psychological influences of CLBP; (3) management of CLBP; (4) family support; and (5) social activities and support. Discussion and implications: Negative physical and psychosocial impacts of CLBP were common among older women, and they adopted diverse pain management strategies, although some of their treatment options were influenced by the Chinese culture. Misbeliefs and responses of family and friends also affected their management strategies. Elderly community centers are a significant source of social support for older women with CLBP, making it an ideal platform for establishing self-help groups to facilitate their self-management of CLBP.

The Utilization of Mobile Phones in Health Information Seeking in Rural China

This study aims to investigate the mobile phone utilization for health information seeking among adults who are 45 years or older in rural areas in China. Using Andersen’s Behavioral Model (BM), we examine the factors that influence the target group’s behaviors of online health information seeking and contacting healthcare providers via mobile phones. By using stratified sampling method, we conducted a survey among 607 rural adults who were 45 years or older from six villages in Jiangsu Province, China. The results reveal that participants can be excluded from such services for not using a smartphone. eHealth information literacy could serve as a strong influential factor for online health information seeking and contacting healthcare providers via mobile phones. Participants with lower emotional wellbeing are more inclined to seek health information online via mobile phones. The results indicate variables such as utilization of technological devices and eHealth literacy should be included in Andersen’s model when investigating the utilization of mHealth services. This study contributes to the literature on mHealth adoption in rural areas in China and has implications for practitioners to tailor the mHealth service for socio-economically disadvantaged groups.

Factors associated with the utilization of community-based health services among older adults in China-an empirical study based on Anderson's health behavior model

Taking the modified Anderson health behavior model as the analysis framework and relying on 1136 empirical research data of S District in Foshan City, Guangdong Province of China, this study explores the influence of predisposing factors, enabling factors and need factors on the utilization of community-based health services among older adults in China. The results show that three variables have a significant impact on the use of family health services, which are whether the pension is the main source of living, income surplus, and major expenditure items. Seven variables have a significant impact on the use of preventive health services, which are household registration type, the basic endowment insurance coverage, the nature of the working unit before retirement, the self-rated health status, chronic diseases, self-care ability in daily life, and preventive health care needs.

Utilization of ADCCs and quality of life among older adults: ethno-regional disparities in Israel

Background

Adult day care centers (ADCCs) are a common service provided for frail older adults in the community. We examined the influence of older adults’ utilization of ADCC’s on their quality of life (QoL), and whether ethno-regional disparities are factors in the gaps found concerning QoL in different regions and between different ethnic groups.

Methods

Cross sectional data were collected through structured interviews with 360 older adults attending ADCCs. Participants represented three ethnic groups and three regions in Israel. QoL was assessed by SF-36 questionnaire.

Results

The results revealed a positive correlation between weekly hours at the ADCC, satisfaction with attending ADCC, and QoL. Older adults living in the central region had higher QoL than those living in the southern and northern regions. Veteran Israeli Jews reported higher QoL than FSU immigrants Israeli Arabs in all regions. Connection to one’s residential area was also correlated with QoL. A significant moderating effect of the interaction (ethnicity*area of residence) on QoL was also revealed.

Conclusions

Attending ADCC is a vital community services to promote QoL in later life. Gaps in ADCC utilization between ethnic groups and residential region may cause disparities in QoL, specifically, in minority groups and those living in peripheral regions. Service providers should minimize the disparities by improving accessibility and availability for each person regardless of ethnicity and region of residence.

Social support and loneliness among frail older adults attending daycare centers: A multicultural study in Israel

AIMS

To examine the link between intensity of use of formal support and loneliness among older adults, controlling for family support and covariates; and examine the moderating effect of contact frequency with family on this relationship.

METHODS

Cross-sectional data were collected from September 2016 - April 2017 through structured interviews with 360 older adults attending adult day care centers (ADCCs) and representing three different ethnic groups in Israel. Loneliness was assessed by the UCLA Loneliness Scale. Hierarchical regression was applied to the study variables with loneliness scores as dependent variable, and bootstrapping with resampling strategies tested a moderating effect.

RESULTS

Loneliness was linked negatively with contact frequency with the family network, frequency of ADCC attendance, and greater involvement in social activities at the ADCC. Significant negative correlation between ADCC attendance frequency and loneliness occurred only when family contact was at low-to-average frequency, but not in cases of high-contact frequency.

CONCLUSIONS

Frequent use of ADCCs emerged as a significant contributor beyond the contribution of family support for reducing loneliness in older age, particularly for those with insufficient family contact. Service providers should improve the accessibility and availability of formal community services for the older population.

Physical activity benefits of attending a senior center depend largely on age and gender: a study using GPS and accelerometry data

BACKGROUND

Senior centers offer important opportunities for physical activity and social interaction. Seniors who visit a senior center regularly can gain physical activity from transportation and from specific activities offered within the senior center. However, there is very little knowledge regarding the specific physical activity gains obtained from regular visits to senior centers, and no effort has been made to use device-based measures of physical activity to test the potential physical activity benefits of attending a senior center.

METHODS

To fill this gap, the present study examined the physical activity patterns of 227 seniors living in the Barcelona Metropolitan Area in Spain. Using GPS and Accelerometer 7-day tracking data, and GIS measures we assessed the light physical activity and moderate-to-vigorous intensity physical activity (MVPA) benefits of attending the senior center on a weekly and daily basis.

RESULTS

Seniors who attended a senior center at least once a week did not accumulate significantly more daily physical activity (211.6 min; 95% CI 196.6; 226.6) than seniors without any visit 215.9 min; 95% CI 202.7; 229). However, on a day-to-day basis, it was found that visiting a senior center had positive effects in physical activity and was associated with less sedentary time among younger participants in general (- 18.2 daily min 95% CI - 33.2;-3.3 p = 0.016) and among older female participants in particular (- 19.7 daily min 95% CI -21.06;-18.5 p = 0.011).

CONCLUSIONS

The benefits of attending senior centers in terms of physical activity should not be viewed as universal, but rather as contingent to the demographics of the user, and the type of activity that the visit is replacing.

Day centres for older people: a systematically conducted scoping review of literature about their benefits, purposes and how they are perceived

With a policy shift towards personalisation of adult social care in England, much attention has focused on individualised support for older people with care needs. This article reports the findings of a scoping review of United Kingdom (UK) and non-UK literature, published in English from 2005-2017, about day centres for older people without dementia and highlights the gaps in evidence. This review, undertaken to inform new empirical research, covered the perceptions, benefits and purposes of day centres. Searches, undertaken in October/November 2014 and updated in August 2017, of electronic databases, libraries, websites, research repositories and journals, identified seventy-seven relevant papers, mostly non-UK. Day centres were found to play a variety of roles for individuals and in care systems. The largest body of evidence concerned social and preventive outcomes. Centre attendance and participation in interventions within them impacted positively on older people's mental health, social contacts, physical function and quality of life. Evidence about outcomes is mainly non-UK. Day centres for older people without dementia are under-researched generally, particularly in the UK. In addition to not being studied as whole services, there are considerable evidence gaps about how day centres are perceived, their outcomes, what they offer, to whom and their wider stakeholders, including family carers, volunteers, staff and professionals who are funding, recommending or referring older people to them.

Factors Influencing Residents' Willingness to Contract With General Practitioners in Guangzhou, China, During the GP Policy Trial Phase: A Cross-Sectional Study Based on Andersen's Behavioral Model of Health Services Use

This study aimed to investigate the current contract rate and residents’ willingness to contract with general practitioner (GP) services in Guangzhou, China, during the policy trial phase, and also to explore the association of behavior contract and contract willingness with variables based on Andersen’s Behavioral Model of Health Services Use (ABM). In total, 160 residents from community health centers (CHCs) and 202 residents from hospitals were recruited in this study. The outcome variables were behavior contract and contract willingness. Based on the framework of ABM, independent variables were categorized as predisposing factors, enabling factors, need factors, and CHC service utilization experiences. Univariate and multivariate logistic regression analysis models were applied to explore the associated factors. Out of 362 participants, 14.4% had contracted with GP services. For those who had not contracted with GP services, only 16.4% (51 out of 310) claimed they were willing to do so. The contract rate for community-based participants was significantly higher than that for hospital-based participants. Major reasons for not choosing to contract were perceiving no benefit from the service and concerns about the quality of CHCs. Community health center experiences and satisfaction were significantly associated with contracting among hospital-based participants. A need factor (diagnosed with hypertension or diabetes) and CHC service utilization experiences (have gotten services from the same doctor in CHCs) were significantly associated with contract willingness among CHC-based participants. Intervention to improve awareness of GP services may help to promote this service. Different intervention strategies should be used for varying resident populations.

Functionality and Risk of Falls in Elders Followed in a Day Care Center in Brazil

Adult day centers provide comprehensive care for older adults and may enhance autonomy, well-being, and socialization. This quasi-experimental study evaluated the impact of such multidisciplinary day care on functionality, fear of falling, and risk of falls in community elders. Fifty-two seniors who attended day services were followed for 1 year. During the year, the adults maintained functionality for activities of daily living, presented improvement in instrumental activities of daily living, and no longer presented high risk for falls. No association was found between the risk of falling and fear of falling, however. Results are discussed in terms of the positive outcomes of attending day services.

Older Adults' Social Relationships and Health Care Utilization: A Systematic Review

BACKGROUND

Deficiencies in older people's social relationships (including loneliness, social isolation, and low social support) have been implicated as a cause of premature mortality and increased morbidity. Whether they affect service use is unclear.

OBJECTIVES

To determine whether social relationships are associated with older adults' use of health services, independently of health-related needs.

SEARCH METHODS

We searched 8 electronic databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, the Cochrane Library, and the Centre for Reviews and Dissemination) for data published between 1983 and 2016. We also identified relevant sources from scanning the reference lists of included studies and review articles, contacting authors to identify additional studies, and searching the tables of contents of key journals.

SELECTION CRITERIA

Studies met inclusion criteria if more than 50% of participants were older than 60 years or mean age was older than 60 years; they included a measure of social networks, received social support, or perceived support; and they reported quantitative data on the association between social relationships and older adults' health service utilization.

DATA COLLECTION AND ANALYSIS

Two researchers independently screened studies for inclusion. They extracted data and appraised study quality by using standardized forms. In a narrative synthesis, we grouped the studies according to the outcome of interest (physician visits, hospital admissions, hospital readmissions, emergency department use, hospital length of stay, utilization of home- and community-based services, contact with general health services, and mental health service use) and the domain of social relationships covered (social networks, received social support, or perceived support). For each service type and social relationship domain, we assessed the strength of the evidence across studies according to the quantity and quality of studies and consistency of findings.

MAIN RESULTS

The literature search retrieved 26 077 citations, 126 of which met inclusion criteria. Data were reported across 226 678 participants from 19 countries. We identified strong evidence of an association between weaker social relationships and increased rates of readmission to hospital (75% of high-quality studies reported evidence of an association in the same direction). In evidence of moderate strength, according to 2 high-quality and 3 medium-quality studies, smaller social networks were associated with longer hospital stays. When we considered received and perceived social support separately, they were not linked to health care use. Overall, the evidence did not indicate that older patients with weaker social relationships place greater demands on ambulatory care (including physician visits and community- or home-based services) than warranted by their needs.

AUTHORS' CONCLUSIONS

Current evidence does not support the view that, independently of health status, older patients with lower levels of social support place greater demands on ambulatory care. Future research on social relationships would benefit from a consensus on clinically relevant concepts to measure. Public Health Implications. Our findings are important for public health because they challenge the notion that lonely older adults are a burden on all health and social care services. In high-income countries, interventions aimed at reducing social isolation and loneliness are promoted as a means of preventing inappropriate service use. Our review cautions against assuming that reductions in care utilization can be achieved by intervening to strengthen social relationships.

Older Adults' Coping With the Stress Involved in the Use of Everyday Technologies

PURPOSE

This study was conducted to examine the frequency of reported use of everyday technologies (EDT) and its associations with self-efficacy, stress appraisal, and coping strategies.

DESIGN AND METHODS

Cross-sectional data were collected from 150 participants (aged ≥ 65 years), measuring use of EDT by means of self-report questionnaires and a computerized simulator of an automatic teller machine (ATM), and EDT-related self-efficacy, stress appraisal, and coping strategies questionnaires.

RESULTS

Structured equation modeling analysis showed that EDT-related self-efficacy was related to higher use of EDT, through the mediation of EDT-related stress and coping strategies. Logistic regression showed that use of ATM simulator was predicted by self-efficacy, younger age, and female gender.

IMPLICATIONS

Enhancing EDT-self efficacy is suggested to increase the use of EDT among elder adults. The use of simulators may be an efficient mean to promote EDT self-efficacy and use.

Quality of life among disabled older adults without cognitive impairment and its relation to attendance in day care centres

Day care centres intend to improve the quality of life of disabled older adults. The aims of the paper are to: (a) examine the extent to which users of day care centres experience higher levels of quality of life compared to their peers who are non-users; and (b) to explore the relationships between the length of use and frequency of weekly attendance at day care centres and quality of life. This is a case-control study with a sample of 817 respondents, of whom 417 were users of day care centres and 400 were non-users, matched by age, gender and family physician. The study was conducted in 12 day care centres in the southern region of Israel. Data collection included face-to-face interviews using a structured questionnaire. Quality of life was found to be significantly related to the use of day care centres, but length and frequency of attendance were insignificant in explaining quality of life among users of day care centres. The study demonstrated that users of day care centres have a higher quality of life, but in a cross-sectional study we cannot prove causality. Therefore, more research using quasi-experimental and longitudinal research designs is necessary to assess causality between use and attendance at day care centres on users' quality of life.

Attendance in adult day care centers of cognitively intact older persons: reasons for use and nonuse

The article aims to (a) examine the reasons for nonuse of ADCC, and (b) explore the reasons for use of adult day care centers (ADCCs) among users. The sample includes 819 respondents of whom 417 are users of 13 day care centers and 402 are nonusers, matched by age, gender, and family physician in the southern region of Israel. Data collection includes interviews that used a structured questionnaire. The most frequent reasons for nonuse of ADCCs are accessibility barriers, characteristics of participants and of the ADCCs, "no need for this service," and personal difficulties. Those who use this service report that it improved their well-being, met their needs, enabled them to establish social relationships, and alleviated their family caregivers' burden. ADCCs should be more responsive to the needs of various constituencies of frail older adults and be more accessible to those who do not use this type of service.

Attendance in adult day care centers and its relation to loneliness among frail older adults

BACKGROUND

Loneliness is widespread among older adults, in particular among those who are chronically ill and functionally limited. The aims of the paper are: (i) to examine the extent to which users of day care centers experience loneliness compared to their peers who are non-users; and (ii) to explore the relationships between length of use and frequency of weekly attendance at day care centers and loneliness among users of day care centers.

METHODS

A case-control study was used with a sample of 817 respondents of whom 417 were users of 13 day care centers and 400 were non-users, matched by age, gender, and family physician in the southern region of Israel. Data collection included face-to-face interviews using a structured questionnaire.

RESULTS

The vast majority in both groups (79.3% and 76.3%, respectively) reported moderate to severe levels of loneliness. Perceived economic status and self-rated health were the most significant variables in explaining loneliness. No significant differences were found between users and non-users of day care centers in the level of loneliness. Attendance at day care centers, as well as length and frequency of use, had no significant association with loneliness.

CONCLUSION

More research, which will include quasi-experimental and longitudinal research designs, is necessary to examine the causal relationships between attendance at day care centers and loneliness. This can provide information on the effectiveness of day care centers in reducing loneliness among frail older adults.