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Kong D, Lu P, Wu B, Davitt JK, Shelley M. Who Cares for Older Adults? A Cross-National Study of Care Sources for Older Adults With Functional Limitations and Associated Determinants. J Appl Gerontol 2024; 43:1120-1131. [PMID: 38355157 DOI: 10.1177/07334648241232759] [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] [Indexed: 02/16/2024] Open
Abstract
The study compared care source typologies for older adults in China and the United States. Data from the 2014 U.S. Health and Retirement Study and the 2013 China Health and Retirement Longitudinal Study were used. The respondents included community-dwelling older adults aged 65 years or older with at least one limitation in activities of daily living (ADLs) or instrumental ADLs (IADLs) (NChina = 2476, NUS = 2898). Respondents reported whether they received assistance from spouse, child/grandchild, relatives, others, and formal helpers. Latent class analysis and multinomial logistic regression were applied. Four classes were identified in China and the U.S, separately. In both countries, ADLs and IADLs were strong determinants of care source typologies. Care sources were more diverse and included formal assistance among older Americans. Older Chinese relied largely on their spouses and children/grandchildren for support. Policy efforts are needed to expand formal long-term services and supports, particularly in China.
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Affiliation(s)
- Dexia Kong
- The Chinese University of Hong Kong, Hong Kong, China
| | - Peiyi Lu
- University of Hong Kong, Hong Kong, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Joan K Davitt
- School of Social Work, University of Maryland, Baltimore, MD, USA
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Xie Y, Sinclair C, Hamilton M, Peisah C, Temple J, Anstey KJ. Barriers Experienced by Community-Dwelling Older Adults Navigating Formal Care: Evidence From an Australian Population-Based National Survey. J Aging Health 2024:8982643241263132. [PMID: 38914050 DOI: 10.1177/08982643241263132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVES This study aims to identify the relationship between psychosocial factors and unmet needs among community-dwelling older adults who have received or who expect to receive formal home-based aged care services. METHODS A subsample of the national Survey of Disability, Ageing and Carers was used to examine the prevalence of having any unmet needs among older adults navigating care. We also examined associations between older adults' psychosocial factors and their unmet needs using logistic regression. RESULTS Regression analyses highlighted that perceived social isolation (OR = 1.62, 95% CI: 1.30-2.01), high/very high psychological distress (OR = 2.11, 95% CI: 1.52-2.93), and occasional assistance from informal support (OR = 1.92, 95% CI: 1.22-3.05) were associated with increased odds of having unmet needs, after adjusting for other covariates. DISCUSSION Our study suggests that older adults facing psychosocial difficulties or lacking informal support are more likely to encounter barriers in accessing formal care. Future policy should address the psychosocial needs and support networks of older adults.
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Affiliation(s)
- Yuchen Xie
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Craig Sinclair
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Myra Hamilton
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Carmelle Peisah
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jeromey Temple
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kaarin J Anstey
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
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Savard I, Jabbour M, Tchouaket E, Gauthier N, Kilpatrick K. Evaluating the influence of primary healthcare nurse practitioners' interventions in home care on hospitalizations and emergency department transfers. J Eval Clin Pract 2024; 30:440-452. [PMID: 38234169 DOI: 10.1111/jep.13960] [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] [Received: 07/24/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 01/19/2024]
Abstract
RATIONALE Home care allows patients with functional limitations to receive services at home and prevent health decline. Home care can reduce hospitalization and emergency department (ED) transfers. Integrating primary healthcare nurse practitioners (PHCNPs) in home care increases the supply of services, but little is known about their influence on patients' ability to remain at home. AIMS AND OBJECTIVES Evaluate the influence of PHCNPs' interventions on hospitalizations and ED transfers in patients receiving care from interprofessional home care teams with PHCNPs. METHOD The retrospective cohort study employed multiple logistic regression and Cox modelling techniques to assess the influence of PHCNP interventions on hospitalizations and ED transfers. Descriptive and bivariate analyses examined sample characteristics and variable associations. Four purposively selected sites in Québec, Canada, were included. Data were collected from electronic health records of all patients (n = 343) receiving home care from these teams. RESULTS The characteristics of the sites, sample, and PHCNP interventions were described. Planned interventions led to a 5.8% decrease in hospitalizations and ED transfers (adjusted odds ratio [OR]: 0.058, p = 0.039), while unplanned interventions resulted in a 1.5-fold increase in this outcome (adjusted OR: 1.518, p < 0.001). The risk of hospitalization and ED transfers increased by 10.7 times with unplanned interventions (adjusted OR: 10.651, p = 0.002). Furthermore, imaging was associated with a 2-fold increased risk (adjusted OR: 1.954, p = 0.021), consultations with a 1.8-fold increased risk (adjusted OR: 1.849, p = 0.034), and laboratory test-related interventions after 30 or more days reduced the risk by 68.0% (adjusted OR: 0.320, p < 0.001). CONCLUSIONS PHCNPs in interprofessional home care teams show promise in reducing hospitalizations and ED transfers through planned visits. These findings provide valuable insights that can contribute to enhancing home care services for a population with limited access to healthcare and high healthcare needs. Further research is needed in other jurisdictions.
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Affiliation(s)
- Isabelle Savard
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Mira Jabbour
- Maisonneuve-Rosemont Hospital Site, CIUSSS de l'Est-de-l'Île-de-Montréal du Québec, Montréal, Québec, Canada
| | - Eric Tchouaket
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Nathalie Gauthier
- Direction des soins infirmiers et de la santé physique, Centre intégré universitaire de santé et des services sociaux de la Capitale Nationale, Quebec City, Québec, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Maisonneuve-Rosemont Hospital Site, CIUSSS de l'Est-de-l'Île-de-Montréal du Québec, Montréal, Québec, Canada
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
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Xu T, Huang Z, Li B, Jin H, Zhang J, Yang H, Huang Y, Zhang X, Chen C. Association between home and community-based services utilization and self-rated health among Chinese older adults with chronic diseases: evidence from the 2018 China Health and Retirement Longitudinal Study. BMC Public Health 2024; 24:117. [PMID: 38191440 PMCID: PMC10775520 DOI: 10.1186/s12889-023-17535-1] [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: 08/25/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND As global aging intensifies, older adults with chronic diseases are of increasing concern. Home and community-based services (HCBSs) have been proven to promote self-rated health (SRH) in older adults, but no research explored the associations between the use of overall HCBSs, three different types of HCBSs (health care, daily care, and social support services) and SRH among older adults with chronic diseases. Consequently, this study applies a national publicly available database to examine these associations among older adults with chronic diseases. METHODS 8,623 older adults with chronic diseases (≥ 60 years old) were included in this study. SRH was evaluated applying a concise question with a 1 - 5 scale. HCBSs utilization was assessed through the question, "What kind of HCBSs were used in the community?". Univariate general linear regression models aimed to compare the mean values of SRH in terms of HCBSs utilization in each group. This study is a cross-sectional study design and the relationship between HCBSs utilization and SRH was assessed by multilevel linear regression. RESULTS The mean score for SRH among the respondents was 3.19, of whom 20.55% used one or more HCBSs, 19.47% utilized health care services, 2.44% utilized social support services, and only 0.55% utilized daily care services. The use of HCBSs was found to be linked to SRH among older adults with chronic diseases (β = 0.085, SE = 0.025, p < 0.001). SRH among older adults with chronic diseases was strongly linked to the use of health care and social support services (β = 0.068, SE = 0.025, p < 0.001; β = 0.239, SE = 0.063, p < 0.001, respectively). However, there was no significant association between the use of daily care services and SRH among older adults with chronic diseases. CONCLUSION This study revealed that HCBSs utilization was positively and significantly linked to SRH in Chinese older adults with chronic diseases. Furthermore, this study supposes the low utilization of social support and daily care services may be due to a mismatch between supply and demand. The government should offer the targeted HCBSs for older adults with chronic diseases according to their unique features to enhance their health status.
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Affiliation(s)
- Tingke Xu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Zishuo Huang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
- School of Innovation and Entrepreneurship, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Bingzhen Li
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Haojie Jin
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Jiayun Zhang
- The 2nd School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Huiting Yang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Yucheng Huang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Xiangyang Zhang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China.
- Institute for County Chronic Disease Health Management Research, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
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Huang L, Wu H, Zhang F, Zhao H, Chen Y, Feng M, You Y, Peng X, Guan C, Liu Y. Factors associated with the perceived need for assistance from voluntary services in home-based older adults in Chinese urban areas: a cross-sectional study. BMC Geriatr 2023; 23:624. [PMID: 37803264 PMCID: PMC10557159 DOI: 10.1186/s12877-023-04354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/25/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND With China's rapidly aging population, meeting the diverse care needs of senior citizens is becoming more challenging. Although voluntary social services have numerous advantages and are popular among older adults, there is little information on the need for assistance from volunteer-based social services, particularly those with a medical background, and influencing factors among urban home-based older adults. This study aimed to assess the need for assistance from voluntary services and related factors among urban home-based older adults in China. METHODS A cross-sectional study was conducted in 2022 on communities in four cities in China. The 27-item Home-Based Older Adults Assistance Need Scale was used to measure the assistance needs of 498 participants aged 60 and above. Multiple linear regression models were conducted to identify salient variables associated with the need for assistance from voluntary services. RESULTS The mean score of the need for assistance from voluntary services was 88.60 ± 24.37. The mean scores of the items examining four dimensions, namely, health maintenance, visiting communication, social intercourse, and daily life, were 3.64 ± 1.08, 3.49 ± 1.04, 3.33 ± 1.08, and 2.78 ± 1.08, respectively. The level of depression, willingness to assist older adults, attaching importance to health preservation, ability to self-comfort, desire to accept assistance from others, and the presence of more children or none at all were all positively correlated with the perceived need for assistance from voluntary services. In contrast, social care obtained from visiting medical institutions was negatively correlated. These seven factors explained 28.5% of the total variance. CONCLUSIONS Urban home-based older adults in China were found to have significant requirements for assistance from volunteer services, and several complex factors were associated with more significant assistance needs. These findings may encourage the extremely limited numbers of social volunteers, particularly those with a medical background, to identify priorities in providing assistance services to the large numbers of urban home-based older adults and thus improve service delivery.
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Affiliation(s)
- Lei Huang
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongyan Wu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Fengjian Zhang
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huimin Zhao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuqin Chen
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mingjiao Feng
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yanjie You
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao Peng
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chunyan Guan
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yilan Liu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Wrotek M, Kalbarczyk M. Predictors of long-term care use - informal home care recipients versus private and public facilities residents in Poland. BMC Geriatr 2023; 23:512. [PMID: 37620838 PMCID: PMC10463875 DOI: 10.1186/s12877-023-04216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND The population aging, together with the shrinking caring potential of families, is a major challenge for social policy in the coming years. The aim of the study is to identify the factors that determine not only the use of long-term care (LTC) but also the selection of individual types of such care in Poland. METHODS Using unique data collected from inpatient LTC facilities in Poland and the Survey on Health, Ageing and Retirement in Europe (SHARE) database, we estimate logistic regressions explaining the choice of LTC solution. RESULTS Our results suggest that social inequalities play a role in choosing the type of LTC. Better educated people choose private institutions, while people without support network use more often social residential homes. The impact of multimorbidity on choosing different types of inpatient facilities is limited, thus the number of ADL limitations remains a better indicator of long term care utilization. CONCLUSIONS The study confirms that social inequalities influence decisions about the choice of LTC. However, multi-morbidity is a predictor of using LTC to a limited extent. The differences in LTC selection determinants between women and men are noticeable.
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Affiliation(s)
- Małgorzata Wrotek
- Faculty of Economic Sciences, University of Warsaw, Długa 44/50, Warsaw, 00-241, Poland.
| | - Małgorzata Kalbarczyk
- Faculty of Economic Sciences, University of Warsaw, Długa 44/50, Warsaw, 00-241, Poland
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Sonntag J, Schwaizer C, Kreyer C. [Support needs of caregivers of people with dementia: An integrative literature review]. Pflege 2023; 36:77-86. [PMID: 36416381 DOI: 10.1024/1012-5302/a000920] [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] [Indexed: 11/24/2022]
Abstract
Support needs of caregivers of people with dementia: An integrative literature review Abstract: Background: Family caregivers are of great importance in the home care for people with dementia. The care and related stress can have a negative impact on their health. The CSNAT (German: KOMMA) is an approach to support family caregivers in palliative home care that could be used for this group of people. Aim: The aim was to identify support needs for caregivers of people with dementia in the literature and compare these with those that formed the basis for the development of the KOMMA approach. Method: We performed an integrative review. Literature research was conducted in February and March 2021 in the MEDLINE, CINAHL and PsycInfo databases. Relevant studies were identified and assessed using inclusion and exclusion criteria. Using MAXQDA, the data were assigned to categories with a content analytic procedure. Results: 23 studies were included that had been published with peer review procedure. Compared to the KOMMA approach, family caregivers show divergent support needs in the areas of (in)formal assistance, access to knowledge, managing physical and mental health conditions, maintaining the relationship, (temporarily) relinquishing the caregiving role and social integration. Conclusion: The KOMMA tool for identifying support needs cannot be directly adopted for this group of caregivers in its present form. However, given the richness of identified support needs, the development of a person-centered and needs-oriented assessment seems important.
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Affiliation(s)
- Julia Sonntag
- Departement für Pflegewissenschaft und Gerontologie, UMIT TIROL - Privatuniversität für Gesundheitswissenschaften und -technologie, Hall in Tirol, Österreich
| | - Claudia Schwaizer
- Departement für Pflegewissenschaft und Gerontologie, UMIT TIROL - Privatuniversität für Gesundheitswissenschaften und -technologie, Hall in Tirol, Österreich
| | - Christiane Kreyer
- Departement für Pflegewissenschaft und Gerontologie, UMIT TIROL - Privatuniversität für Gesundheitswissenschaften und -technologie, Hall in Tirol, Österreich
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‘Can't always get what you want’: Allocation of community-based services for older adults. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Yang W, Xu H, Miao W, Geng Z, Geng G. Effects of transitional care based on the social support theory for older patients with osteoporotic vertebral compression fractures: A quasi-experimental trial. Australas J Ageing 2022; 42:185-194. [PMID: 35996354 DOI: 10.1111/ajag.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to investigate the effects of transitional care (TC) programs on the health outcomes of discharged older patients with osteoporotic vertebral compression fractures (OVCFs). METHODS A total of 160 older patients were recruited from two campuses of a public teaching hospital in China. Patients were grouped according to the campus to which they were admitted. The TC programs commenced one day before discharge and lasted 6 months after discharge. Repeated-measures analysis of variance was used to analyse the effects of the TC programs. RESULTS The TC programs improved the discharge of older patients with OVCF in their activities of daily living (ADLs), pain levels and social support, and decreased fracture recurrence rates. CONCLUSIONS This study provides evidence of concurrent clinical improvements and health outcomes in discharged older patients with OVCFs from the effects of TC programs based on social support theory.
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Affiliation(s)
- Wenwen Yang
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Haiyan Xu
- Department of Nursing, Yancheng First People's Hospital, Yancheng, Jiangsu, China
| | - Weiwei Miao
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Zihan Geng
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Guiling Geng
- School of Medicine, Nantong University, Nantong, Jiangsu, China
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Zheng M, Kane RA, Lightfoot E. Helping Older Residents Remain in Subsidized Housing: Predictive Validity of the Live Well at Home-Rapid Screen (LWAH-RS) in a Real-World Application. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:188-200. [PMID: 34193027 DOI: 10.1080/01634372.2021.1947430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
Common Bond Communities (CBC) is a nonprofit organization that provides housing for low-income individuals and families. CBC utilized the Live Well at Home-Rapid Screen (LWAH-RS) to identify the risks for nursing home admission or assisted living entry among housing residents aged 60 or above. Drawing data from 842 assessments, we studied how well the LWAH-RS predicted moves to nursing homes or assisted living settings. Cox regression models showed that the LWAH-RS did predict which residents would move to a care setting. Every 1-point higher in the LWAH-RS assessment score was associated with a 38% higher risk of moving to a higher-level care facility due to health issues. Given this demonstrated predictive validity in a real-world setting, we suggest more systematic approaches for housing practitioners to combat low assessment completion rates and unclear protocols for actions based on the scores.
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Affiliation(s)
- Mingyang Zheng
- School of Social Work, University of Minnesota, Saint Paul, Minnesota, USA
| | - Rosalie A Kane
- School of Social Work, University of Minnesota, Saint Paul, Minnesota, USA
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Camp N, Johnston J, Lewis MGC, Zecca M, Di Nuovo A, Hunter K, Magistro D. Perceptions of ADLs and In-Home ADL monitoring technology among Community-Dwelling Older Adults: a qualitative study (Preprint). JMIR Aging 2021; 5:e33714. [PMID: 35511248 PMCID: PMC9121226 DOI: 10.2196/33714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/21/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. Objective This study aimed to understand older adults’ perceptions of important ADL and the types of technologies they would be willing to use within their own homes. Methods Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (≥70 years). Results Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. Conclusions Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances.
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Affiliation(s)
- Nicola Camp
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Julie Johnston
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | | | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
| | - Alessandro Di Nuovo
- Institute of Electrical and Electronics Engineers, Sheffield Hallam University, Sheffield, United Kingdom
| | - Kirsty Hunter
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Daniele Magistro
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
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Corry DAS, Doherty J, Carter G, Doyle F, Fahey T, O’Halloran P, McGlade K, Wallace E, Brazil K. Acceptability of a nurse-led, person-centred, anticipatory care planning intervention for older people at risk of functional decline: A qualitative study. PLoS One 2021; 16:e0251978. [PMID: 34015046 PMCID: PMC8136649 DOI: 10.1371/journal.pone.0251978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/06/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND As the population of older adults increases, the complexity of care required to support those who choose to remain in the community amplifies. Anticipatory Care Planning (ACP), through earlier identification of healthcare needs, is evidenced to improve quality of life, decrease aggressive interventions, and prolong life. With patient acceptability of growing importance in the design, implementation, and evaluation of healthcare interventions, this study reports on the acceptability of a primary care based ACP intervention on the island of Ireland. METHODS As part of the evaluation of a feasibility cluster randomized controlled trial (cRCT) testing an ACP intervention for older people at risk of functional decline, intervention participants [n = 34] were interviewed in their homes at 10-week follow-up to determine acceptability. The intervention consisted of home visits by specifically trained registered nurses who assessed participants' health, discussed their health goals and plans, and devised an anticipatory care plan in collaboration with participants' GPs and adjunct clinical pharmacist. Thematic analysis was employed to analyze interview data. The feasibility cRCT involved eight general practitioner (GP) practices as cluster sites, stratified by jurisdiction, four in Northern Ireland (NI) (two intervention, two control), and four in the Republic of Ireland (ROI) (two intervention, two control). Participants were assessed for risk of functional decline. A total of 34 patients received the intervention and 31 received usual care. FINDINGS Thematic analysis resulted in five main themes: timing of intervention, understanding of ACP, personality & individual differences, loneliness & social isolation, and views on healthcare provision. These map across the Four Factor Model of Acceptability ('4FMA'), a newly developed conceptual framework comprising four components: intervention factors, personal factors, social support factors, and healthcare provision factors. CONCLUSION Acceptability of this primary care based ACP intervention was high, with nurses' home visits, GP anchorage, multidisciplinary working, personalized approach, and active listening regarded as beneficial. Appropriate timing, and patient health education emerged as vital.
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Affiliation(s)
- Dagmar A. S. Corry
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Julie Doherty
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Gillian Carter
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Frank Doyle
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Peter O’Halloran
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Kieran McGlade
- School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University Belfast, Dunluce Health Centre, Belfast, Northern Ireland, United Kingdom
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Kevin Brazil
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
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The Carers' Needs Assessment for Dementia (CNA-D): a validation study in the Italian population. Neurol Sci 2021; 43:275-284. [PMID: 33942173 PMCID: PMC8724169 DOI: 10.1007/s10072-021-05285-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022]
Abstract
Background Dementia has devastating consequences for families with important physical, psychological, social, and financial effects. Evaluation of caregiver’s needs may be an important step to reduce the burden of family caregivers of dementia patients. An Austrian scale, the Carers’ Needs Assessment for Dementia, is now available for measuring the caregiver’s needs. The aim of our study was to evaluate the psychometric properties of the Italian version of the CNA-D (iCNA-D). Methods A sample of 214 voluntary caregivers of dementia patients was recruited at the Department of Neuroscience, University of Turin (Italy). All participants were administered the iCNA-D. Validity and reliability of the instrument were evaluated using Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Checklist-90 (SCL-90), and the Italian version of Zarit Burden Interview (I-ZBI). Results The most common unmet need reported for the iCNA-D was “counseling and emotional support” (31.5%). This item demonstrates adequate reliability with moderate internal consistency for all “summary scores” of iCNA-D (α ≥ 0.75) and split-half correlation of more than 0.80 for two of them. We also found positive correlations in two out of three “summary scores” of iCNA-D and in the overall outcomes of BDI, BAI, SCL-90, and I-ZBI. Conclusions The iCNA-D could be a valid and reliable tool for a comprehensive assessment of needs and possible social supports proposed to relatives who take care of patients with dementia. Better understanding of family caregivers’ needs could improve planning of local services and reduce caregivers’ perception of distress and burden.
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Fabius C, Shugrue N, Robison JT. Outcomes Associated with Home and Community-based Service Use Among Older Adults following a Nursing Home Transition. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:807-821. [PMID: 33176611 DOI: 10.1080/01634372.2020.1830328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 09/20/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
We examined relationships between home and community-based services (HCBS) and reinstitutionalization and choice and control in daily activities for older Money Follows the Person (MFP) Rebalancing Demonstration participants in Connecticut. Using Connecticut MFP program and Quality of Life survey data for 647 participants aged 65, and older who transitioned from a nursing home to the community between 2013-2016, we conducted logistic regressions to determine whether HCBS type (traditional HCBS; hourly personal care attendant [PCA]; live-in PCA) was associated with reinstitutionalization and choice and control 12 months after moving into the community. Relative to receiving traditional services, having hourly or live-in PCA services were associated with having lower odds of both reinstitutionalization and choice and control. Findings can help strengthen HCBS delivery for older adults living in the community.
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Affiliation(s)
- Chanee Fabius
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD, USA
| | - Noreen Shugrue
- Center on Aging, UConn Health School of Medicine , Farmington, CT, USA
| | - Julie T Robison
- Center on Aging, UConn Health School of Medicine , Farmington, CT, USA
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15
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Zwingmann I, Dreier-Wolfgramm A, Esser A, Wucherer D, Thyrian JR, Eichler T, Kaczynski A, Monsees J, Keller A, Hertel J, Kilimann I, Teipel S, Michalowsky B, Hoffmann W. Why do family dementia caregivers reject caregiver support services? Analyzing types of rejection and associated health-impairments in a cluster-randomized controlled intervention trial. BMC Health Serv Res 2020; 20:121. [PMID: 32059724 PMCID: PMC7023728 DOI: 10.1186/s12913-020-4970-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although there are a number of support services accessible for most family dementia caregivers, many caregivers reject available and affordable support. Previous research suggests that rejections of support services may result from insufficient fit of available services with caregivers’ unmet needs and a lack of acknowledgement of caregivers’ unmet needs and associated support services. The present study investigates (a) the number, proportion and types of caregivers’ rejection on recommended tailored support, (b) socio-demographic and clinical determinants of caregiver’s rejection of both people with dementia (PwD) and caregivers, and (c) caregivers’ health-related variables related to caregivers’ rejection. Methods Caregivers’ rejection of tailored support services was identified based on a standardized, computerized unmet needs assessment conducted by dementia-specific qualified nurses. The present analysis is based on data of n = 226 dyads of caregivers and their community-dwelling PwD who participated in a general practitioner (GP)-based, cluster-randomized intervention trial. The trial was approved by the Ethical Committee of the Chamber of Physicians of Mecklenburg-Western Pomerania, registry number BB 20/11. Data analyses were conducted using Stata/IC 13.1. We conducted Welch’s t-test, Pearson’s product-moment correlation, and conditional negative binomial regression models with random effects for GP to account for over-dispersed count data. Results In sum, n = 505 unmet needs were identified and the same number of tailored recommendations were identified for n = 171 family dementia caregivers from the intervention group at baseline. For n = 55 family dementia caregivers not a single unmet need and recommendation were identified. A total of 17.6% (n = 89) of the recommendations were rejected by caregivers. Rejection rates of caregivers differed by type of recommendation. Whereas caregivers’ rejection rate on recommendations concerning mental health (3.6%), physical health (2.5%), and social, legal, and financial affairs (0%) were low, caregivers’ rejection rates concerning social integration (especially caregiver supporting groups) was high (71.7%). Thus, the rejections of family dementia caregivers are mainly linked to the delegation to caregiver supporting groups. Caregivers’ rejections were mainly related to personal factors of caregivers (n = 66), service-related factors (n = 6), relational factors (n = 1), and other factors (n = 17). Furthermore, our results showed that the number of caregivers’ rejections was associated with a higher functional status of the PwD and are mainly associated with the rejection of caregiver supporting groups. Thus, caregivers visit supporting groups more often when the PwD shows low abilities in activities of daily living. Importantly, this is independent of the status of cognition and depression of the PwD as well as the physical and mental health of the family dementia caregivers. Conclusions Our results underline the importance of understanding factors that determine caregivers’ rejection of support services. These need to be specifically addressed in tailored solutions for caregivers’ support services. Trial registration ClinicalTrials.gov Identifier: NCT01401582 (date: July 25, 2011, prospective registered).
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Affiliation(s)
- Ina Zwingmann
- European University of Applied Science (EUFH), Werftstrasse 5, 18057, Rostock, Germany.
| | | | - Alexander Esser
- German Alzheimer Association regional association Mecklenburg-Western Pomerania, Rostock, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Anika Kaczynski
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Armin Keller
- German Alzheimer Association regional association Mecklenburg-Western Pomerania, Rostock, Germany.,Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Rostock, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Rostock, Germany.,Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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16
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Chen Q, Amano T, Park S, Kim B. Home and Community-based Services and Life Satisfaction among Homebound and Poor Older Adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2019; 62:708-727. [PMID: 31293224 DOI: 10.1080/01634372.2019.1639094] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 06/09/2023]
Abstract
Little evidence exists regarding the role of Home and Community-Based Services (HCBS) utilization on life satisfaction among older people who are both homebound and low-income. Guided by the personal-environment (P-E) fit perspective, this study aims to: (1) describe characteristics of older people with homebound and low-income status; (2) investigate how the combination of homebound and low-income status is associated with life satisfaction; and (3) examine whether HCBS utilization moderates the association between homebound and low-income status and life satisfaction. Data were drawn from the 2012 Health and Retirement Study, and the sample included respondents who were 51+ years who completed a questionnaire for HCBS utilization (n= 1,662). Results describe sociodemographic, health-related, and environmental characteristics of older adults. Combined homebound and low-income status was a significant predictor of lower life satisfaction (β = -0.15, p< .05), but better life satisfaction when they used HCBS (β = 0.33, p <.10). These findings suggest that promoting HCBS utilization is a promising strategy to enhance well-being among those homebound and poor. Further studies are needed to test the effectiveness of HCBS with longitudinal data and to investigate the details of effective HCBS utilization such as frequency of use and types of services.
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Affiliation(s)
- Qingru Chen
- Medical Social Work Department, Huadong Hospital affiliated to Fudan University , Shanghai , China
| | - Takashi Amano
- Brown School, Washington University in St. Louis , St. Louis , MO , USA
| | - Sojung Park
- Brown School, Washington University in St. Louis , St. Louis , MO , USA
| | - Borin Kim
- College of Health and Human Services, University of New Hampshire , Durham , NH , USA
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17
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Olomi JM, Wright NM, Hasche L, DePrince AP. After Older Adult Maltreatment: Service Needs and Barriers. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2019; 62:749-761. [PMID: 31566118 DOI: 10.1080/01634372.2019.1668517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 05/21/2023]
Abstract
Little research is available specific to the service needs or related barriers of maltreated older adults. Further, no studies have asked at-risk older adults directly for their perspectives on service needs and barriers. As part of a larger study, a sample of 40 diverse older adults (M age = 76 years) were recruited from the population of older adults who were involved in an abuse, neglect, and/or financial exploitation case where the offender was in a position of trust to the victim. Responses to open-ended questions about participants' service needs and reasons for not seeking services were thematically coded. The majority of older adults expressed needing more help than currently received, with needs including transportation, housing, food, household assistance, and medical and mental health care. Participants also described reasons their service needs were not being met. The study elaborates on the specifics and descriptive statistics of the themes that emerged. Implications for older-adult victim services, as well as broader older-adult services, are discussed.
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Affiliation(s)
- Julie M Olomi
- Department of Psychology, University of Denver , Denver , Colorado , USA
| | - Naomi M Wright
- Department of Psychology, University of Denver , Denver , Colorado , USA
| | - Leslie Hasche
- Department of Psychology, University of Denver , Denver , Colorado , USA
| | - Anne P DePrince
- Department of Psychology, University of Denver , Denver , Colorado , USA
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18
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Stoop A, Lette M, van Gils PF, Nijpels G, Baan CA, de Bruin SR. Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e549-e566. [PMID: 31225946 PMCID: PMC6852049 DOI: 10.1111/hsc.12793] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person-centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006-2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty-seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty-one different CGAs were identified, of which the EASYcare instrument, RAI-HC/RAI-CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person-centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter-)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel.
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Affiliation(s)
- Annerieke Stoop
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
- Scientific Center for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgthe Netherlands
| | - Manon Lette
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
| | - Paul F. van Gils
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
| | - Giel Nijpels
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
| | - Caroline A. Baan
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
- Scientific Center for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgthe Netherlands
| | - Simone R. de Bruin
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
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19
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Liu H, Lou VWQ. Functional recovery of older stroke patients discharged from hospital to home: The effects of cognitive status and different levels of therapy intensity. J Clin Nurs 2018; 28:47-55. [DOI: 10.1111/jocn.14617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Huiying Liu
- Department of Social Work & Social Administration; University of Hong Kong; Hong Kong China
| | - Vivian W. Q. Lou
- Department of Social Work & Social Administration; University of Hong Kong; Hong Kong China
- Sau Po Center on Ageing; The University of Hong Kong; Hong Kong China
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20
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Weaver RH, Roberto KA. Home and Community-Based Service Use by Vulnerable Older Adults. THE GERONTOLOGIST 2018; 57:540-551. [PMID: 26608335 DOI: 10.1093/geront/gnv149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/16/2015] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study The purpose of this study was to identify different types of clients who use home and community-based services. Design and Methods Enrollment characteristics of 76 clients at risk of nursing home placement and Medicaid spend-down who were enrolled in the Virginia Community Living Program were analyzed. Two-step cluster analysis identified 4 groups of service users. Results Enabling resources (caregiver relationship to participant, participant living arrangement, and length of time caregiver provided assistance to participant) and disability type (physical, cognitive, traumatic brain injury, or other) differentiated the client groups. Groups differed on average service cost per day and likelihood of nursing home placement if services were not provided. Implications Findings point to the value of having practitioners assist vulnerable clients in tailoring services to meet different care needs and the need for refining policies guiding home and community-based care.
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Affiliation(s)
- Raven H Weaver
- Department of Human Development and Center for Gerontology, Virginia Tech, Blacksburg
| | - Karen A Roberto
- Center for Gerontology and The Institute for Society, Culture and Environment, Virginia Tech, Blacksburg
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21
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Access to information on home- and community-based services and functional status. Int J Public Health 2018. [DOI: 10.1007/s00038-017-0990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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22
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van der Heide I, Snoeijs S, Quattrini S, Struckmann V, Hujala A, Schellevis F, Rijken M. Patient-centeredness of integrated care programs for people with multimorbidity. Results from the European ICARE4EU project. Health Policy 2018; 122:36-43. [DOI: 10.1016/j.healthpol.2017.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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23
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Turner JJ, Adams-Price CE, Strawderman L. Formal Alternative Transportation Options for Older Adults: An Assessment of Need. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:619-646. [PMID: 28929943 DOI: 10.1080/01634372.2017.1375590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study measured the need for formal alternative modes of transportation among older adults by applying traditional factors of the Behavioral Model. Survey participants who regularly drove were compared to those who could no longer drive. Race/ethnicity and self-reported health were significant predictors of perceived need for transportation services for both groups. However, income and service awareness were significant predictors only for drivers, while family proximity was a significant predictor only for non-drivers. Results suggest the importance of gaining a better understanding of the factors associated with need for senior-focused transportation services to more effectively plan such programs.
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Affiliation(s)
- Joshua J Turner
- a National Strategic Planning and Analysis Research Center , Mississippi State University , Mississippi State , Mississippi , USA
| | - Carolyn E Adams-Price
- b Department of Psychology , Mississippi State University , Mississippi State , Mississippi , USA
| | - Lesley Strawderman
- c Department of Industrial and Systems Engineering , Mississippi State , Mississippi , USA
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24
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Ross L, Jennings P, Williams B. Psychosocial Support Issues Affecting Older Patients: A Cross-sectional Paramedic Perspective. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2017; 54:46958017731963. [PMID: 28965434 PMCID: PMC5798664 DOI: 10.1177/0046958017731963] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This research aimed to gain an understanding of the psychosocial support needs of older patients in the out-of-hospital setting from the perspective of paramedics. Specifically, we investigate if and how paramedics are able to meet the needs of older adults, and the barriers preventing them from achieving this. This study was a cross-sectional study utilizing a sequential design with both quantitative and qualitative methodologies. All participants agreed or strongly agreed that older patients have needs beyond the physical and that they would like to do more for older patients. Paramedics discussed that psychosocial support issues are rarely in isolation and straightforward but were often coupled with broader, longer term physical health and social support issues. They would like to be able to do more for patients but feel hamstrung by lack of time, resources, and know-how.
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Affiliation(s)
- Linda Ross
- 1 Monash University, Frankston, Victoria, Australia
| | - Paul Jennings
- 1 Monash University, Frankston, Victoria, Australia.,2 Ambulance Victoria, Melbourne, Australia
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Park S, Kim B, Kwon E, Lee H. Trajectories of Community-Based Service Use: The Importance of Poverty and Living Arrangements. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:355-376. [PMID: 28489489 DOI: 10.1080/01634372.2017.1328477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined how older adults' living arrangements and poverty status affected their use of in-home health, functional, and out-of-home services over time. Using eight waves of data from the Korea Welfare Panel Study, we employed a logistic mixed-effect model to analyze how poverty and living arrangements affect community-based service use. Living-alone older adults and elder-only couples were more likely than co-residing households to use services. Elder-only couples, when poor, were more likely to use in-home and out-of-home services over time. Understanding predictors of community-based service use over time enables researchers and policymakers to better understand the process of aging-in-place.
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Affiliation(s)
- Sojung Park
- a George Warren Brown School of Social Work , Washington University , Saint Louis , Missouri , USA
| | - BoRin Kim
- b University of New Hampshire , Durham , New Hampshire , USA
| | - Eunsun Kwon
- c Center for Social Science , Seoul National University , Gwanak-gu , Seoul , South Korea
| | - Hyunjoo Lee
- d Department of Social Work, Daegu University , Gyeongsan-si , Gyeongsangbuk-do , Republic of Korea
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26
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Bakk L, Cadet T, Lien L, Smalley A. Home Modifications among Community-Dwelling Older Adults: A Closer Look at Race and Ethnicity. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:377-394. [PMID: 28657880 DOI: 10.1080/01634372.2017.1341444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study investigated racial and ethnic differences in home modification use. Data from the 2011 National Health and Aging Trends Study were used (n=6,764). Compared with non-Hispanic Whites, Hispanics were less likely to have a grab bar (odds ratio (OR) = 0.6), bath seat (OR = 0.8), or raised toilet (OR = 0.6). Non-Hispanic Blacks were less likely to have a grab bar (OR = 0.7) or bath seat (OR = 0.7) than non-Hispanic Whites, but more likely to have a raised toilet (OR = 1.3). English proficiency largely explained ethnic differences, while health status partially accounted for racial disparities.
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Affiliation(s)
- Louanne Bakk
- a Institute on Innovative Aging Policy and Practice, School of Social Work , University at Buffalo , Buffalo , New York , USA
| | - Tamara Cadet
- b Simmons College , School of Social Work , Boston , Massachusetts , USA
- c Oral Health Policy and Epidemiology, HSDM-Oral Health Policy and Epidemiology , Harvard School of Dental Medicine , Boston , Massachusetts , USA
| | - Laura Lien
- d Chief Education Office, State of Oregon , Salem , Oregon , USA
| | - Angela Smalley
- e Department of Rehabilitation Science, School of Public Health and Health Professions , University at Buffalo , Buffalo , New York , USA
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27
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Kim B, Park S, Bishop-Saucier J, Amorim C. Community-Based Services and Depression from Person-Environment Fit Perspective: Focusing on Functional Impairments and Living Alone. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:270-285. [PMID: 28339325 DOI: 10.1080/01634372.2017.1310166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Guided by the Person-Environment Fit perspective, we investigated the extent to which personal and environmental factors influence depression among community-dwelling adults. The data came from the special section about community-based service utilization in the 2012 Health and Retirement Study (N=1,710). Although community-based service was not significantly associated with depression after controlling for covariates, respondents with functional limitations and living alone were less likely to be depressed when using community-based services. This study demonstrates the different associations between community-based services and depression depending on personal needs. It discusses the importance of community-based services for aging-in-place policy, particularly among vulnerable populations.
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Affiliation(s)
- BoRin Kim
- a University of New Hampshire , Durham , New Hampshire , USA
| | - Sojung Park
- b George Warren Brown School of Social Work , Washington University in St. Louis , Missouri , USA
| | | | - Carrie Amorim
- c The Institute of Professional Practice, Inc. , Concord , New Hampshire , USA
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[Users and utilization of support groups among caregivers of dementia patients : Results of a naturalistic observational study]. Z Gerontol Geriatr 2015; 50:14-20. [PMID: 26667126 DOI: 10.1007/s00391-015-1002-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/09/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Caring for patients with Alzheimer's disease (AD) is frequently associated with an increased burden for the caregiving relatives (CG). While therapeutic options and low threshold assistance offers for a reduction of the burden have become well established, data on the utilization of support groups (SG) are still lacking. MATERIAL AND METHODS In the outpatient neurological and psychiatric routine treatment, AD patients were enrolled with their accompanying CG in a 2-stage study. Firstly, each patient was clinically documented by the treating physician and each CG was asked to fill out a questionnaire on the current care situation at the patient's home. In stage two, each CG was additionally assessed with a standardized interview and screened for depression with the depression screening questionnaire (DSQ). Each CG also rated the current CG burden, life satisfaction and health condition on a visual analogue scale (VAS). RESULTS Overall, 14.8 % of CGs attended an SG. The CGs who visited an SG showed a tendency to report a severe CG burden more often than CGs who did not (71.9 % vs. 56.3 %, p = 0.060) and more frequently a lower satisfaction with life (33.3 vs. 17.2 %, p < 0.01). They also reported higher rates of verbal and physical aggression by the patients (51.5 % vs. 34.0 %, p < 0.05 and 39.4 % vs. 12.7 %, p < 0.01, respectively) and appraised their health condition to be lower (VAS score 66.0 % vs. 54.0, p < 0.01). Depressive disorders occurred in both groups at similar rates (54.1 % and 42.1 %, p = 0.317). CONCLUSION The data suggest that the decision to join an SG is influenced more by behavioral and non-cognitive symptoms of the AD rather than its duration or severity.
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Rantanen T, Äyräväinen I, Eronen J, Lyyra T, Törmäkangas T, Vaarama M, Rantakokko M. The effect of an outdoor activities' intervention delivered by older volunteers on the quality of life of older people with severe mobility limitations: a randomized controlled trial. Aging Clin Exp Res 2015; 27:161-9. [PMID: 24952472 DOI: 10.1007/s40520-014-0254-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Older community-living disabled people often have unmet activity needs and participation restrictions potentially reducing their quality of life (QoL). AIMS We examined the effects of an individualized out-of-home activity intervention delivered by volunteers on QoL among community-living older people, who have difficulty accessing the outdoors independently. METHODS Volunteering, Access to Outdoor Activities and Wellbeing in Older People (VOW; ISRCTN56847832) was a two-arm randomized single-blinded, controlled effectiveness trial (RCT) in Jyväskylä, Finland. The inclusion criteria were: age 65 or over, severe mobility limitation, able to communicate, and agree to participate in a RCT. Each intervention group member was assigned a trained volunteer with whom out-of-home activities were done once a week for 3 months (e.g., running errands or recreational activities). The primary outcome was the environmental subscore of QoL assessed with WHOQOL-BREF. Secondary outcomes were the overall QoL, physical capacity, psychological well-being, and social relationships assessed with WHOQOL_BREF and lower-extremity performance assessed with Short Physical Performance Battery (SPPB). RESULTS 121 people aged 67-92 years (mean age 81.9 years, SD 5.9, 90 % women) were randomized. No treatment effect on the environmental QoL subscore was observed, but for physical capacity subscore a significant treatment effect was observed (General Linear Model, Group by Time p = 0.001). No effects were observed for the other QoL subscores or for SPPB score. DISCUSSION This study suggests that individualized out-of-home activity intervention delivered by volunteers may influence the QoL of old severely mobility-limited community-living people in a positive way. CONCLUSION Further studies are needed to better understand how to improve QoL of older disabled community-living people and potentially buffer them against more severe care needs and institutionalization.
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Affiliation(s)
- Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P.O. BOX 35, 40014, Jyväskylä, Finland,
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Disability trajectories and associated disablement process factors among older adults in Taiwan. Arch Gerontol Geriatr 2015; 60:272-80. [DOI: 10.1016/j.archger.2014.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 11/18/2022]
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Kang SB, Kim H. The Relationship between Home-Visit Nursing Services and Health Care Utilization among Nursing Service Recommended Beneficiaries of the Public Long-Term Care Insurance. HEALTH POLICY AND MANAGEMENT 2014. [DOI: 10.4332/kjhpa.2014.24.3.283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Zanjani F, Downer BG, Hosier AF, Watkins JD. Memory banking: a life story intervention for aging preparation and mental health promotion. J Aging Health 2014; 27:355-76. [PMID: 25239929 DOI: 10.1177/0898264314551170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study is to examine the feasibility of Memory Banking (MB), a life story development intervention within the context of aging preparation. Individuals participate in MB to strategically document and share their life story, including mapping out future dreams, aspirations, plans, and decisions. METHOD Data (2010-2012) from eight MB workshops were examined to determine the impact of the intervention on mental health, social support, and quality of life. RESULTS Recruitment efforts resulted in n = 72 participants, primarily female (72%), White/Caucasian (93%), average age of 70 years. Data indicated intervention effects showing improvements in depression (p = .041), mood disturbance (p = .0067), and cognitive performance (p = .0045). DISCUSSION MB outcomes indicate that the intervention is promising and supports continued investigation and development in the area of life story development for aging preparation and improving late life mental health distress in a community setting. Future research is needed to examine the versatility and long-term effects of the MB intervention.
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Ferris RE, Glicksman A, Kleban MH. Environmental Predictors of Unmet Home-and Community-Based Service Needs of Older Adults. J Appl Gerontol 2014; 35:179-208. [DOI: 10.1177/0733464814525504] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 02/02/2014] [Indexed: 01/01/2023] Open
Abstract
Home- and community-based services (HCBS) for many older adults are an essential component of aging-in-place. Andersen developed the contemporary model used to predict service use. Researchers have modified the model to examine need. Studies that attempt to predict unmet needs have explained only 10% to 15% of the variance. This study is based on the supposition that lack of accounting for environmental factors has resulted in such small explanatory power. Through the use of 2008 Southeastern Pennsylvania Household Health Survey data, this exploratory study modeled predictors of unmet HCBS needs. Findings reveal that lack of access to healthy foods and poor housing quality have a significant relationship to unmet HCBS needs. This model predicted 54% of the variance. Results reveal environmental questions to ask, a way to identify older adults with unmet HCBS needs and environmental barriers that if addressed may reduce older adults’ eventual need for health services and HCBS.
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A Model of Risk Reduction for Older Adults Vulnerable to Nursing Home Placement. Res Theory Nurs Pract 2014; 28:162-92. [DOI: 10.1891/1541-6577.28.2.162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status. Important factors include socioeconomic status, having a caregiver, the availability and use of home- and community-based support services, race, acute illness particularly if hospitalization is required, medications, dementia, multiple chronic conditions, functional disability, and falls. Few intervention studies were identified. Development of evidence-based interventions and creation of policies to address modifiable risk factors are important next steps.
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Orellano E, Colón WI, Arbesman M. Effect of occupation- and activity-based interventions on instrumental activities of daily living performance among community-dwelling older adults: a systematic review. Am J Occup Ther 2013; 66:292-300. [PMID: 22549594 DOI: 10.5014/ajot.2012.003053] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
This systematic review examines the effectiveness of occupation- and activity-based interventions on community-dwelling older adults' performance of instrumental activities of daily living (IADLs). It was conducted as part of the American Occupational Therapy Association's Evidence-Based Practice Project. Forty studies met the inclusion criteria and were critically appraised and synthesized. Within occupation-based and client-centered interventions, the evidence that multicomponent interventions improve and maintain IADL performance in community-dwelling older adults is strong. The results also indicate that client-centered, occupation-based interventions can be effective in improving and maintaining IADL performance. The evidence is moderate for functional task exercise programs and limited for simulated IADL interventions to improve IADL performance. In the area of performance skills, the evidence related to physical activity and cognitive skills training is mixed, and the evidence that vision rehabilitation interventions improve IADL performance in older adults with low vision is moderate. Implications for practice, education, and research are also discussed.
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Affiliation(s)
- Elsa Orellano
- Occupational Therapy Program, School of Health Professions, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067, USA.
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McCord LR. Attention HIV: older African American women define sexual risk. CULTURE, HEALTH & SEXUALITY 2013; 16:90-100. [PMID: 23927657 DOI: 10.1080/13691058.2013.821714] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Understanding sexual-risk behaviours as defined by a culture presents new challenges for human service professionals. Older African American women constitute the fastest growing group of new cases of HIV in the USA. With heterosexual sex as the primary mode of transmission among this group, there exist minimal programmes that are culture and age-specific in terms of primary and secondary prevention. In an attempt to address this gap in knowledge, this study examined how a group of older African American women defined sexual-risk behaviour. A focus group was conducted with seven women age 45 and older, who were recruited from a community centre. This paper examines the way that sexual-risk behaviour was defined through thematic analysis and conceptualises the locus of sexual risk behaviour as defined by the participants. The major theme of the study was social prescription, how to behave sexually as an ageing adult. Underlying ideas that arose were that unprotected sex occurred out of habit, that impulsivity was associated with risky sex and that older women needed to be aware of warning signs and behaviours of potential mates. Micro- and macro-level implications for human service professionals are discussed.
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Affiliation(s)
- Laneshia R McCord
- a Kent School of Social Work, University of Louisville , Louisville , KY , USA
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Kim H, Kwon S, Yoon NH, Hyun KR. Utilization of long-term care services under the public long-term care insurance program in Korea: Implications of a subsidy policy. Health Policy 2013; 111:166-74. [PMID: 23706386 DOI: 10.1016/j.healthpol.2013.04.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 04/01/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES South Korea introduced public long-term care insurance (LTCI) in 2008. This study examined the patterns of and factors associated with public long-term care (LTC) utilization among older LTCI beneficiaries in Korea, with special attention to the policy for subsidizing the co-payments of lower income populations. METHODS Using a 5% national representative sample of 280,290 older people aged 65 or older obtained from the 2010 national LTCI claims database, we examined socio-demographic and health factors associated with service utilization decisions, service type chosen, and the intensity of service use. RESULTS About 5.48% of older adults in 2010 utilized the LTC provided under the Korean public LTCI, among which about 26.1% received a subsidy. Compared to their counterparts, the subsidized users were more likely to be low-income, female, and living alone. They were more likely to choose institutionalized care and spend to their monthly benefit limit while paying a lower co-payment. The factors associated with pattern and intensity of LTC utilization were not the same between subsidized and non-subsidized users. CONCLUSION The findings imply the subsidy policy promotes equity of access to public LTC services. Further evaluation is necessary on the impact of the policy on the effectiveness of LTC utilization by socially marginalized populations.
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Affiliation(s)
- Hongsoo Kim
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul 151-742, South Korea.
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Stijnen MMN, Duimel-Peeters IGP, Jansen MWJ, Vrijhoef HJM. Early detection of health problems in potentially frail community-dwelling older people by general practices--project [G]OLD: design of a longitudinal, quasi-experimental study. BMC Geriatr 2013; 13:7. [PMID: 23331486 PMCID: PMC3570480 DOI: 10.1186/1471-2318-13-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 12/12/2012] [Indexed: 12/04/2022] Open
Abstract
Background Due to the ageing of the population, the number of frail older people who suffer from multiple, complex health complaints increases and this ultimately threatens their ability to function independently. Many interventions for frail older people attempt to prevent or delay functional decline, but they show contradicting results. Recent studies emphasise the importance of embedding these interventions into existing primary care systems and tailoring care to older people’s needs and wishes. This article presents the design of an evaluation study, aiming to investigate the effects and feasibility of the early detection of health problems among community-dwelling older people and their subsequent referral to appropriate care and/or well-being facilities by general practices. Methods/Design A longitudinal, quasi-experimental study is designed comparing 13 intervention practices with 11 control practices. General practices select eligible community-dwelling older people (≥ 75 years). Practice nurses from intervention practices (1) visit older people at home for a comprehensive assessment of their health and well-being; (2) discuss results with the GP; (3) formulate – if required – a care and treatment plan together with the patient; (4) refer patient to care and/or well-being facilities; and (5) monitor and coordinate care and follow-up. Control practices provide usual care and match the intervention practices on the presence of different primary care professionals within the practice. Primary outcome measures are health-related quality of life and disability. Additionally, attitude towards ageing, care satisfaction, health care utilisation, nursing home admission and mortality are measured. Some outcomes are assessed by means of a postal questionnaire (at baseline and after 6, 12, and 18 months follow-up), others through continuous registration over the 18-month period. A profound process evaluation will provide insight into barriers and facilitators for implementing the intervention protocol within general practices from both the patient and caregiver perspective. Discussion The proposed approach requires redesigning care delivery within general practices for accomplishing appropriate care for older people. A quasi-experimental design is chosen to closely resemble a real-life situation, which is desirable for future implementation after this innovation proves to be successful. Results of the effect and process evaluation will become available in 2013. Trial registration The Netherlands National Trial Register NTR2737
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Affiliation(s)
- Mandy M N Stijnen
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Swan JH, Turner K, Shashidhara S, Sanders D. Increased physical activity, physician recommendation, and senior center participation. Health (London) 2013. [DOI: 10.4236/health.2013.512a002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mast ME. To Use or Not to Use: A Literature Review of Factors that Influence Family Caregivers’ Use of Support Services. J Gerontol Nurs 2013; 39:20-8; quiz 29. [DOI: 10.3928/00989134-20121107-02] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chen YM, Berkowitz B. Older adults' home- and community-based care service use and residential transitions: a longitudinal study. BMC Geriatr 2012; 12:44. [PMID: 22877416 PMCID: PMC3444350 DOI: 10.1186/1471-2318-12-44] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 07/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background As Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and community-based services and their residential transitions. Methods The study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults’ residential status at the three follow-up interviews, four residential transitions were tracked: (1) Community-Community-Community (CCC: Resided in community during the entire study period); (2) Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3); (3) Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3); (4) Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.). Results Older adults’ use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults’ use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS) and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other services, such as senior center services or meal services, were associated with different directions in residential transition, such as CIC and CII respectively. Conclusions Older adults’ differing HCBS use patterns may be the key to explaining older adults’ transitions. Attention to older adults’ HCBS use patterns is recommended for future practice. However, this was an exploratory study and the analyses cannot establish causal relationships.
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Affiliation(s)
- Ya-Mei Chen
- National Taiwan University, College of Public Health, Institute of Health Policy and Management, Room 633, No.1 7, Xu-Zhou Road, Taipei 100, Taiwan.
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A conceptual framework for examining the promise of the NORC program and Village models to promote aging in place. J Aging Stud 2012. [DOI: 10.1016/j.jaging.2012.01.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Casado BL, van Vulpen KS, Davis SL. Unmet Needs for Home and Community-Based Services Among Frail Older Americans and Their Caregivers. J Aging Health 2010; 23:529-53. [PMID: 21084723 DOI: 10.1177/0898264310387132] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study examined unmet needs for home- and community-based services (HCBS) among frail older Americans. Method: Using population-based sample from the National Long-Term Care Survey, a hierarchical logistic regression analysis was conducted to examine the predictors of unmet needs for seven types of HCBS. Results: Lack of awareness, reluctance, unavailability, and affordability of services were the main reasons for unmet needs for HCBS. Factors that were associated with unmet needs included Black race/ethnicity, greater care needs (functional limitations and behavioral problems), and less informal support (substitute help and family agreement). Discussion: It is important to identify risk factors that may lead to older adults’ unmet needs for HCBS. The findings of this study charge researchers to look beyond service utilization and give more attention to service needs among those who did or could not access the services.
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Affiliation(s)
| | | | - Stacey L. Davis
- University of Maryland School of Social Work, Baltimore, MD, USA
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