Caring for Older Adults

Medical students' perceptions of integrating social media into a narrative medicine programme for 5th-year clerkship in Taiwan: a descriptive qualitative study

BACKGROUND

The growing demands in integrating digital pedagogies in learning (e.g., social media) contribute to disrupting many fields, including the medical humanities education. However, the strengths and barriers behind social media and medical humanities context are blurred and contradictive. We examined the perceptions of integrating social media - Facebook - into a narrative medicine (NM) programme for 5th -year clerkship in Taiwan.

METHODS

We used purposive sampling to recruit participants. Sixteen medical students (Female/Male: 7/9) participated in four group interviews. Semi-structured focus group interviews were conducted to explore students' perceptions and experiences of the social media integrated into the NM programme. We analysed the data using a descriptive thematic analysis with a team-based approach. Data were managed and coded using ATLAS.ti version 9.0.

RESULTS

We identified six main themes: (1) Positive experiences of social media integration; (2) Negative experiences of social media integration; (3) Barriers on writing and sharing NM stories in social media; (4) Barriers on reading NM stories in social media; (5) Barriers on reacting contents in social media; (6) Suggestions for future improvement.

CONCLUSIONS

The study revealed the strengths and barriers from medical students' perceptions, when integrating social media into a NM programme. It is important to match students' experiences, barriers, and perceptions towards learning. Understanding participants' suggestions for future improvement are also crucial. With this knowledge, we might better develop the social media integration systems that achieve our desired outcomes based on the medical humanities education curricula.

How Does Confucianism Influence Health Behaviors, Health Outcomes and Medical Decisions? A Scoping Review

The aim of this study is to analyze the influence of Confucianism on health behaviors, health outcomes and medical decisions. The research was conducted using the following databases: PubMed, Scopus, CINHAL, PsycINFO and Web of Science, without restrictions of language and year of publication. The search process identified 833 publications matching the search criteria, and after the review process, 40 articles were included. Family is a central aspect of Confucianism, and it seems to affect participation in medical decisions, taking care of relatives, ethical dilemmas and mental health problems. Although most Confucianist influence seems to be positive, some ways of thinking could increase suffering, burnout and a delay in healthcare seeking. Understanding these values could help health professionals to deal with the growing contingent of patients with different cultures and religious beliefs.

Unpacking the cultural paradox of attentive care for institutionalized people with intellectual disabilities

This study contributes to the under-researched area of culture in institutional care for people with intellectual disabilities in an East Asian context. Drawing upon in-depth interviews with 20 women frontline care workers for institutionalized people with intellectual disabilities in Taiwan, we examined culture-specific caring relations such as the fictive kinships of Confucian care ethics (i.e., respect for elders and affection for the young), the charity paradigm, and religious compassion, which can induce attentive and respectful care in institutional spaces but also relegate residents to stigmatized subordination in a hierarchy of caring relations and legitimatize the voluntary exploitation of women workers. In situating the relational nature of care and the dis-enabling potentials of culture at the disability-care-place intersection, we promote an ethics of engagement that values and dignifies both recipients and providers of care.

Active learning of medical students in Taiwan: a realist evaluation

BACKGROUND

Active learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active learning. We aimed to examine process models of active learning to understand what works, for whom and why.

METHODS

Forty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the 'context-mechanism-outcome' (CMO) configurations.

RESULTS

Three core CMO configurations, including cultural, training and individual domains, were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome) and dare not give their opinions. In the training context of teacher-student familiarity alongside teachers' guidance, the mechanisms of learning motivation, self-regulation and enthusiasm were triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress resulted in recognising active learning and advanced preparation (outcomes).

CONCLUSIONS

We identified three CMO configurations of Taiwanese medical students' active learning. The connections among hierarchical culture, fear, teachers' guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes.

Multi-dimensional approach to end-of-life care: The Welfare Model

Appropriate and balanced decision-making is sentinel to goal setting and the provision of appropriate clinical care that are attuned to preserving the best interests of the patient. Current family-led decision-making in family-centric societies such as those in Singapore and other countries in East Asia are believed to compromise these objectives in favor of protecting familial interests. Redressing these skewed clinical practices employing autonomy-based patient-centric approaches however have been found wanting in their failure to contend with wider sociocultural considerations that impact care determinations. Evaluation of a number of alternative decision-making frameworks set out to address the shortcomings of prevailing atomistic and family-centric decision-making models within the confines of end-of-life care prove these alternative frameworks to be little better at protecting the best interests of vulnerable patients. As a result, we propose the Welfare Model that we believe is attentive to the relevant socio-culturally significant considerations of a particular case and better meets the needs of end-of-life care goals of preserving the welfare of patients. Employing a multi-professional team evaluation guided by regnant psychosocial, legal, and clinical standards and the prevailing practical and clinical realities of the particular patient's setting the Welfare Model provides a clinically relevant, culturally sensitive, transparent, and evidence-based approach to care determinations.

Perceptions of good and bad death among Korean social workers in elderly long-term care facilities

This qualitative study explored the perception of good and bad death among 15 social workers serving in elderly care facilities in Korea. A good death involved dying peacefully without much suffering, dying with family members present, death following a good life, and believing in a better afterlife. A bad death involved burdening children in the dying process, dying after extensive illness, dying isolated from family, and death from suicide. To ensure a good death and avoid a bad death for elders, social workers are encouraged to closely engage with not only elders but also their families.

Intention to Use Long-Term Care Facilities: Differences beween Korean Pre-elderly and Korean Baby-boomers

With the rapidly increasing number of older adults, dealing with long-term care (LTC) needs becomes an emerging issue in South Korea. This study aims to examine factors affecting the intention to use longtermcare facilities with two groups of young-old adults: (1) Korean pre-elderly (KPE) and (2) Korean babyboomers (KBB). Guided by Andersen's behavioral model of health service use and prior research, predisposing characters, enabling resources, need factors, availabilities of informal care and self-care activities were used as predictors. In the final analyses, 803 KPE and 966 KBB were included. The results of logistic regression analyses showed different findings in two groups. Age, education, spouse's physicalhealth, and self-care activities for relationship with family and friends are significantly associated with intention to use LTC facilities among KPE. However, income, physical health of respondents, and relationship satisfaction with children are significantly related to intention of use LTC facilities in the group of KBB. This study suggests different LTC needs between KPE and KBB. Health care professionals and policy makers need to consider such differences to provide quality LTC care for them.

Prevalence and correlates of successful ageing: a comparative study between China and South Korea

Successful ageing is often defined as a later life with less disease and disease-related disability, high level of cognitive and physical functions, and an active life style. Few studies have compared successful ageing across different societies in a non-Western social context. This study aims to compare prevalence and correlates of successful ageing between China and South Korea. The data come from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the Korean Longitudinal Study of Ageing (KLoSA). A total of 19,346 community-dwelling elders over 65 years were included, 15,191 from China and 4,155 from Korea. A multidimensional construct of successful ageing was used, with the criteria of no major comorbidity, being free of disability, good mental health, engaging in social or productive activity, and satisfaction on life. Correlates of successful ageing included demographics (gender, age, and rural/urban residence), socioeconomic features (financial status, education, and spouse accompany), and health behaviours (smoking, alcohol-drinking, and exercising). The results showed that 18.6 % of the older adults in China was successful agers, which was less than 25.2 % in Korea. When gender and age were adjusted, older adults were 51 % less likely to be successful agers in China than Korea (p < 0.001). The association patterns between successful ageing and its correlates are similar between China and Korea. However, before the socioeconomic variables are under control, rural residence was negatively related to successful ageing in China, whereas this is not the case in Korea. And the gender gap of successful ageing was mostly explained by socioeconomic features and health behaviours in Korea, but not in China. In both countries, good financial condition was highly associated with successful ageing. The study suggests that advancement of public health system could better control progression of non-communicable diseases among old people and thus promote successful ageing.

The experience of Chinese immigrant women in caring for a terminally ill family member in Australia

The Chinese community, a heterogeneous, highly visible non-English speaking ethnic group in Australia, remains mostly hidden and underrepresented in palliative care service delivery along with participation in health research despite being the fastest growing such group in the country. There is a lack of Australian research information concerning the impact of migration on the caregiving experience of women carers within the Chinese cultural framework and the Australian palliative care context. This paper aims to explore the influence of Chinese cultural norms and immigration on the experience of immigrant women of Chinese ancestry caring for a terminally ill family member at home in Sydney. This study also seeks to identify factors that may present access barriers to palliative care support services. A qualitative approach was used in this study. Data were collected from semi-structured interviews with five home-based Chinese women carers and were analysed using thematic analysis. Findings identified that the participants found being a carer is a lonely and isolating experience. Sources of isolation and loneliness included social isolation experienced as a solitary carer without meaningful family and social relationships; loss of familiar cultural understandings and family values; and emotional isolators expressed in response to the physical and emotional role commitment and other constraints. The study results suggest the need for palliative care educational programmes designed to help nurses to understand the impact of cultural background within the palliative care context. Results also indicate that health care professionals should provide culturally appropriate and competent palliative care services, sensitive to the diverse socio-cultural influences and individual needs of Chinese migrants.

Trajectories of the multidimensional dying experience for terminally ill cancer patients

CONTEXT

Studies exploring the trajectories of physical-psychological-social-spiritual dying experiences frequently treat changes in these experiences as consistent across different domains and over time.

OBJECTIVE

This prospective, longitudinal investigation was designed to characterize trajectories of the multidimensional dying experience for cancer patients in their last year of life.

METHODS

Trajectories of physical-psychological-social-spiritual/existential dimensions and overall quality of life (QOL) were identified among 313 cancer patients using mixed-effects models to test for linear, quadratic, or cubic changes. Changes in each variable were evaluated for clinical significance using minimal important difference.

RESULTS

When patients transitioned to their end of life, symptom distress, functional dependence, anxiety, and depressive symptoms slightly increased, followed by a stable status for approximately four to six months, and accelerated dramatically to the first clinically significant changes at three to four months before death. Perceived social support and post-traumatic growth declined gradually to clinically significant changes at one and four months before death, respectively. Perceived sense of burden to others increased steadily in the last year of life, with no clinically significant changes identified. Overall QOL deteriorated gradually in the last year but did not reach a clinically significant change until 2.5 months before death.

CONCLUSION

All dimensions deteriorated in the last year of life but with distinctive physical-psychological-social-spiritual/existential and overall QOL trajectories. Recognizing trajectory patterns and tipping points of accelerating deterioration in each dimension can help clinicians anticipate times of increased distress, initiate timely, effective interventions to relieve patient suffering, and facilitate high-quality end-of-life care tailored to patients' needs and preferences.

Successful aging in the United States and China: a theoretical basis to guide nursing research, practice, and policy

Successful aging is gaining increasing attention given the growth in the older adult population. Criteria and definitions within multiple disciplines vary greatly in Western literature, with no consensus on its meaning. Sociocultural, economic, and political differences between the Western view of successful aging and its view in China add to the confusion. Similarities and differences in the meaning of successful aging in the United States and China are examined, and potential for a common definition useful to nursing in both countries is explored. Using concept analysis, shared criteria for successful aging were the following: decreased incidence of disease and disability, life satisfaction, meaning and purpose in life, and ability to cope effectively to achieve goals based on personal values and priorities. A comprehensive, multidimensional definition of successful aging for nursing and a midrange nursing theory of successful aging were identified that may be useful to guide nursing research, practice, and policy.

Longitudinal changes and predictors of caregiving burden while providing end-of-life care for terminally ill cancer patients

BACKGROUND

The effect of caring for a dying cancer patient on caregiving burden has been explored primarily in Western-based studies with small samples or in studies that did not follow up until the patient's death, but has not yet been investigated in Taiwan.

OBJECTIVE

The study's goals were (1) to identify the trajectory of caregiving burden for family caregivers (FCs) of terminally ill cancer patients in Taiwan, and (2) to investigate the determinants of caregiving burden in a large sample and with longitudinal follow-ups, until the patient's death.

METHOD

A prospective, longitudinal study was conducted among 193 FCs. The trajectory and determinants of caregiving burden were identified by a generalized estimation equation approach.

RESULTS

Caregiving burden did not change as the patient's death approached. FCs experienced heavy caregiving burden when their relative suffered from greater symptom distress or if they were spousal caregivers; provided high intensity of assistance to the patient while spending fewer hours providing care; reported financial insufficiency; or had lower social support, fewer psychological resources, or less confidence in caregiving.

CONCLUSIONS

Taiwanese family caregivers' carry moderate caregiving burden which did not change significantly as the patients' death approached. The effects of caregiving burden while providing EOL care to terminally ill cancer patients may be tempered substantially by enhancing family caregivers caregiving confidence, social support, and psychological resources.

Rasch Validation of a Combined Measure of Basic and Extended Daily Life Functioning After Stroke

Background. Tools used to measure poststroke functional status must include basic and instrumental activities of daily living and reflect the patient’s and the clinician’s perspective of the disease and its effect on daily living performance. Objective. The authors combined the Functional Independence Measure (FIM) and the Nottingham Extended Activities of Daily Living (NEADL) to create a scale providing a comprehensive evaluation of ADLs functional status in patients with stroke. Methods. The study participants were 188 patients completing the FIM and the NEADL. The psychometric properties of the combined measure were examined with Rasch analysis. Results. A 3-point scale and a dichotomous scale were suggested for use in the FIM and the NEADL, respectively. The combined 40 items worked consistently to reflect a single construct, and “bladder management” and “bowel management” were highly related. After “bowel management” was removed from the combined scale, all but 3 items fit the model’s expectations, and the 39-item scale showed reasonable item difficulty hierarchy, with high reliability. The 3 misfit items were removed, and no differences in unidimensionality, differential item functioning, and reliability were found between the 36-item and 39-item scales. Conclusions. The combined measure of the FIM and the NEADL provides a comprehensive picture of ADLs. It extends the utility of the FIM and the NEADL and is recommended for use to measure the independence of patients after discharge home.

A simple measure with complex determinants: investigation of the correlates of self-rated health in older men and women from three continents

Background

Self-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea.

Methods

Cross-sectional data were drawn from large surveys of older respondents (≥ 65 years) in Australia (n = 7,355), USA (n = 10,358), Japan (n = 3,541) and South Korea (n = 3,971), collected between 2000 and 2006. Harmonized variables were developed to represent socioeconomic, lifestyle and health indicators. We then assessed whether these variables, and their potentially different impact in different countries, could account for cross-national differences in levels of SRH.

Results

SRH differed significantly between countries, with older Koreans reporting much poorer health than those in the other three nations. This was not the result of biases in response patterns (for example central versus extreme tendency). Health-related correlates of SRH were similar across countries; those with more medical conditions, functional limitations or poor mental health gave poorer ratings. After accounting for the differential impact of determinants in different national contexts, Australians reported better SRH than other nations.

Conclusions

We conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country, and possibly cohort specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health.

Best interests determination within the Singapore context

Familialism is a significant mindset within Singaporean culture. Its effects through the practice of familial determination and filial piety, which calls for a family centric approach to care determination over and above individual autonomy, affect many elements of local care provision. However, given the complex psychosocial, political and cultural elements involved, the applicability and viability of this model as well as that of a physician-led practice is increasingly open to conjecture. This article will investigate some of these concerns before proffering a decision-making process based upon a multidisciplinary team approach. It will be shown that such a multidimensional and multiprofessional approach is more in keeping with the inclusive and patient-centred ethos of palliative care than prevailing practices. It will be shown that such an approach will also be better placed to deliver holistic, coherent and sensitive end-of-life care that palliative care espouses.

Cross-national insights into the relationship between wealth and wellbeing: a comparison between Australia, the United States of America and South Korea

The positive relationship between wealth and wellbeing has received considerable attention over the last three decades. However, little is known about how the significance of wealth for the health and wellbeing of older adults may vary across societies. Furthermore, researchers tend to focus mainly on income rather than other aspects of financial resources even though older adults often rely on fixed income, particularly after retirement. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey (N=1,431), the Health and Retirement Study (HRS) in the United States of America (USA; N=4,687), and the Korean Longitudinal Study of Ageing (KLoSA; N=5,447), this exploratory cross-national study examined the relationship between wealth satisfaction and objective wealth and wellbeing (measured as self-rated health and life satisfaction) among older Australians, Americans and Koreans (50+ years). Regression analyses showed that wealth satisfaction was associated with wellbeing over and above monetary wealth in all three countries. The relationship between monetary wealth and self-rated health was larger for the US than Australian and Korean samples, while the additional contribution of wealth satisfaction to life satisfaction was larger for the Korean than the Australian and US samples. These findings are discussed in terms of the cultural and economic differences between these countries, particularly as they affect older persons.

Mothers and daughters-in-law: a prospective study of informal care-giving arrangements and survival in Japan

Background

Daughters-in-law have played an important role in informal care-giving arrangements within East Asian traditional norms. The aim of this study was to measure the impact of daughter-in-law care-giving on the survival of care recipients. We prospectively examined the associations between different types of kinship relationship between the main family caregiver and the care recipient in relation to survival among care recipients.

Methods

A questionnaire was administered to Japanese community-dwelling seniors who were eligible to receive national long-term care insurance (LTCI) community-based services. Among 191 individuals whose informal care-giving arrangement was definitively determined, we observed 58 care recipients receiving care from spouses, 58 from daughters-in-law, 27 from biological daughters, 25 from other relatives, and 23 care recipients living alone.

Results

During 51 months of follow-up from December 2001, 68 care recipients died, 117 survived, and 6 moved. Hazard ratios of each care-giving arrangement were estimated by Cox proportional hazard models adjusted for care recipients' demographic factors, their care needs level based on their physical and cognitive functioning and their service use, caregivers' demographic factors, and household size. The highest risk of mortality was found for female elders receiving care from daughters-in-law (HR 4.15, 95% CI 1.02-16.90) followed by those receiving care from biological daughters (HR 1.64, 95% CI 0.37-7.21), compared to women receiving spousal care. By contrast, male elders receiving care from daughters-in-law tended to live longer than those receiving care from their spouses.

Conclusions

Our finding suggests that there may be a survival "penalty" for older Japanese women who are cared for by their daughters-in-law.