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Gusoff G, Ringel JB, Bensson-Ravunniarath M, Wiggins F, Lee A, Espinosa CG, Avgar AC, Sarkisian C, Sterling MR. Having a Say in Patient Care: Factors Associated with High and Low Voice among Home Care Workers. J Am Med Dir Assoc 2024; 25:737-743.e2. [PMID: 38432645 PMCID: PMC11262414 DOI: 10.1016/j.jamda.2024.01.021] [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: 08/28/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To identify factors associated with high and low "voice"-or level of input in patient care decisions-among home care workers (HCWs), an often marginalized workforce that provides care in the home to older adults and those with chronic conditions. DESIGN We conducted a secondary analysis of data from a cross-sectional survey assessing experiences of HCWs in caring for adults with heart failure. The survey measured HCWs' voice using a validated, 5-item instrument. SETTING AND PARTICIPANTS The survey was conducted virtually from June 2020 to July 2021 in partnership with the 1199 Service Employees International Union (1199SEIU) Training and Employment Funds, a union labor management fund. English- or Spanish-speaking HCWs employed by a certified or licensed home care agency in New York, NY, were eligible. METHODS HCW voice was the main outcome of interest, which we assessed by tertiles (low, medium, and high, with medium as the referent group). Using multinominal logistic regression, we calculated odds ratios (ORs) and 95% CIs for the relationship between participant characteristics and low and high levels of voice. RESULTS The 261 HCWs had a mean age of 48.4 years (SD 11.9), 96.6% were female, and 44.2% identified as Hispanic. A total of 38.7% had low voice, 37.9% had medium voice, and 23.4% had high voice. In the adjusted model, factors associated with low voice included Spanish as a primary language (OR 3.71, P = .001), depersonalization-related burnout (OR 1.14, P = .04), and knowing which doctor to call (OR 0.19, P < .001). Factors associated with high voice included Spanish as a primary language (OR 2.61, P = .04) and job satisfaction (OR 1.22, P = .001). CONCLUSIONS AND IMPLICATIONS Organizational factors such as team communication practices-including among non-English speakers-may play an important role in HCW voice. Improving HCW voice may help retain HCWs in the workforce, but future research is needed to evaluate this.
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Affiliation(s)
- Geoffrey Gusoff
- National Clinician Scholars Program, University of California, Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | | | | | - Faith Wiggins
- 1199SEIU Training and Employment Fund, New York, NY, USA
| | - Ann Lee
- 1199SEIU Training and Employment Fund, New York, NY, USA
| | - Cisco G Espinosa
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Catherine Sarkisian
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center, Los Angeles, CA, USA
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Möckli N, Simon M, Denhaerynck K, Trutschel D, Martins T, Meyer-Massetti C, Zúñiga F. How external and agency characteristics are related to coordination in homecare - findings of the national multicenter, cross-sectional SPOT nat study. BMC Health Serv Res 2024; 24:367. [PMID: 38519949 PMCID: PMC10960419 DOI: 10.1186/s12913-024-10751-4] [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: 05/25/2023] [Accepted: 02/19/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Homecare client services are often distributed across several interdependent healthcare providers, making proper care coordination essential. However, as studies exploring care coordination in the homecare setting are scarce, serious knowledge gaps exist regarding how various factors influence coordination in this care sector. To fill such gaps, this study's central aim was to explore how external factors (i.e., financial and regulatory mechanisms) and homecare agency characteristics (i.e., work environment, workforce, and client characteristics) are related to care coordination in homecare. METHODS This analysis was part of a national multicentre, cross-sectional study in the Swiss homecare setting that included a stratified random sample of 88 Swiss homecare agencies. Data were collected between January and September 2021 through agency and employee questionnaires. Using our newly developed care coordination framework, COORA, we modelled our variables to assess the relevant components of care coordination on the structural, process, and outcome levels. We conducted both descriptive and multilevel regression analyses-with the latter adjusting for dependencies within agencies-to explore which key factors are associated with coordination. RESULTS The final sample size consisted of 1450 employees of 71 homecare agencies. We found that one explicit coordination mechanism ("communication and information exchange" (beta = 0.10, p <.001)) and four implicit coordination mechanisms-"knowledge of the health system" (beta = -0.07, p <.01), "role clarity" (beta = 0.07, p <.001), "mutual respect and trust" (beta = 0.07, p <.001), and "accountability, predictability, common perspective" (beta = 0.19, p <.001)-were significantly positively associated with employee-perceived coordination. We also found that the effects of agency characteristics and external factors were mediated through coordination processes. CONCLUSION Implicit coordination mechanisms, which enable and enhance team communication, require closer examination. While developing strategies to strengthen implicit mechanisms, the involvement of the entire care team is vital to create structures (i.e., explicit mechanisms) that enable communication and information exchange. Appropriate coordination processes seem to mitigate the association between staffing and coordination. This suggests that they support coordination even when workload and overtime are higher.
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Affiliation(s)
- Nathalie Möckli
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Michael Simon
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Kris Denhaerynck
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Diana Trutschel
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Tania Martins
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology & Toxicology, Department of General Internal Medicine, Inselspital - University Hospital Bern, CH-3010, Freiburgstrasse, Bern, Switzerland
- Institute for Primary Health Care BIHAM, University of Bern, Mittelstrasse 30, CH-3012, Bern, Switzerland
| | - Franziska Zúñiga
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland.
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Idsøe-Jakobsen I, Dombestein H, Brønnick KK, Wiig S. Exploring Norwegian homecare healthcare professionals' perceptions of risk and the link to high-quality care: a qualitative multiple case study. BMJ Open 2024; 14:e080769. [PMID: 38490664 PMCID: PMC10946383 DOI: 10.1136/bmjopen-2023-080769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Homecare is a critical component of the ongoing restructuring of healthcare worldwide, given the shift from institution- to home-based care. The homecare evidence base still contains significant gaps: There is a lack of knowledge regarding quality and safety work and interventions. This study explores how home healthcare professionals perceive and use the concept of risk to guide them in providing high-quality healthcare while maintaining resilience. DESIGN The study design is a qualitative multiple case study. The phenomena explored were risk perception, sensemaking and adaptations of care delivered to patients in their homes. Inductive content analysis was conducted. SETTING The study was conducted in three Norwegian municipalities. Each municipality was defined as a single case. PARTICIPANTS Interviews with healthcare professionals were performed both individually and in focus groups of three to five persons. 19 interviews with 35 informants were conducted: 11 individual semistructured interviews and 8 focus groups. RESULTS Four themes were identified: 'professionalism is constantly prioritising and aligning care based on here-and-now observations' 'teamwork feels safe and enhances quality' 'taking responsibility for system risk' and 'reluctantly accepting the extended expectations from society'. CONCLUSIONS To make sense of risk when aspiring for high-quality care in everyday work, the healthcare professionals in this sample mainly used their clinical gaze, gut feeling and experience to detect subtle changes in the patients' condition. Assessing risk information, not only individually but also as a team, was reportedly crucial for high-quality care. Healthcare professionals emphasised the well-being, safety and soundness of the patients when acting on risk information. They felt obliged to act on their gut feeling, moral compass and clinical understanding of quality.
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Affiliation(s)
| | - Heidi Dombestein
- University of Stavanger Faculty of Health Sciences, Stavanger, Norway
| | | | - Siri Wiig
- University of Stavanger Faculty of Health Sciences, Stavanger, Norway
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Phillips SP, Carver LF. Greatest Risk Factor for Death from COVID-19: Older Age, Chronic Disease Burden, or Place of Residence? Descriptive Analysis of Population-Level Canadian Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7181. [PMID: 38131732 PMCID: PMC10742949 DOI: 10.3390/ijerph20247181] [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: 10/11/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
During the first wave of COVID-19, three-quarters of Canadian deaths were among those age 80 and older. We examined whether age, chronic disease load, sex, or place was the strongest predictor of such deaths. A cross-sectional analysis of administrative data from 1 January 2020 to 30 October 2020 for the population of Ontario (n = 15,023,174) was performed. Using logistic regression analysis, we determined whether place of residence (community dwelling, community dwelling with formal home care, or long-term care facility), age group, sex, or chronic disease burden was most strongly associated with the outcome of death within 60 days of a positive SARS-CoV-2 PCR test. Overall, there were 2766 deaths attributed to COVID-19. The age-related odds of dying increased from 6.1 (age 65-74) to 13.4 (age 85 or older) relative to those aged <65 years. This age effect was dwarfed by an odds ratio of 117.1 for those living in long-term care versus independently in the community, adjusted for age, sex, and chronic disease burden. The risk of death from COVID-19 aligned much more with social realities than individual risks. The disproportionate mortality arising specifically from institutional residence demands action to identify sources and ameliorate the harms of living in such facilities.
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Affiliation(s)
- Susan P. Phillips
- Family Medicine and Public Health Sciences, Queen’s University, Kingston, ON K7L 5E9, Canada
| | - Lisa F. Carver
- Faculty of Health Sciences, Queen’s University, Kingston, ON K7L 5E9, Canada
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Meghani NAA, Hudson J, Stratton G, Mullins J. Older adults' perspectives on physical activity and sedentary behaviour within their home using socio-ecological model. PLoS One 2023; 18:e0294715. [PMID: 37983222 PMCID: PMC10659182 DOI: 10.1371/journal.pone.0294715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND There are few studies that focus explicitly on the impact of the home environment on older adults' sedentary behaviour (SB) and physical activity (PA) using the socio-ecological model (SEM). This study aims to investigate older adults' PA and SB within the home environment integrating the SEM as a theoretical framework. METHODS A qualitative exploratory research design was employed to conduct 33 in-depth interviews (IDIs) and five focus group (FGs; n = 16) with multi-diverse ethnic older adults (mean age 72±5 years). Using reflexive thematic analysis themes were generated from the data set and were interpreted using the SEM. RESULTS The findings indicate that different levels of the SEM had an impact on older adults' PA and SB. These include the 1) Individual level: Attitude, perception and motivation 2) Interpersonal level: Family and Friends: a motive to remain active 3) Organisational level: healthcare institutes, 4) Community level factors: Significance of social groups, 5) Physical Environment: Microenvironment and 6) Policy level factors (lockdown restrictions and healthcare system). This model can be utilised to foster activity within the home by focusing on the facilitators and barriers identified at each of these levels of influence. CONCLUSION The study findings suggest that modifying PA and SB in the home environment is complex and is influenced across different levels of the SEM. Therefore, a holistic approach is required that integrates these multiple influences. This understanding can inform the design of interventions that seek to optimize PA and minimize SB within the home environment.
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Affiliation(s)
- Naureen Akber Ali Meghani
- Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Bay Campus, Swansea, United Kingdom
| | - Joanne Hudson
- Professor of Exercise and Sport Psychology, Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Bay Campus, Swansea, United Kingdom
| | - Gareth Stratton
- Chair in Paediatric Exercise Science, Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Bay Campus, Swansea, United Kingdom
| | - Jane Mullins
- College of Human and Health Sciences, Swansea University, Singleton Campus, Swansea, United Kingdom
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Aclan R, George S, Block H, Lane R, Laver K. Middle aged and older adult's perspectives of their own home environment: a review of qualitative studies and meta-synthesis. BMC Geriatr 2023; 23:707. [PMID: 37907851 PMCID: PMC10619279 DOI: 10.1186/s12877-023-04279-1] [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: 09/15/2022] [Accepted: 09/05/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Most people prefer to remain in their homes and communities as long as possible. Staying at home is widely beneficial as ageing within the home promotes independence and costs less than residential aged care. Understanding meanings and drivers of remaining at home is an area of importance. OBJECTIVE The objective of this systematic review of qualitative studies was to synthesise middle and older aged adult's perspective of their home environment and determine the factors that are important when making decisions about future housing. METHODS This review and meta-synthesis was conducted in accordance with JBI (formally known as the Joanna Briggs Institute) methodology for systematic reviews of qualitative evidence. Meta-aggregation was used as the method of synthesis. Included qualitative studies involved middle and older aged adults and their views about ageing and housing. Published studies were identified in four electronic databases and grey literature. Critical appraisal and extraction were conducted using JBI tools and findings were categorised and synthesised into findings. RESULTS A total of 46 papers with 5183 participants on the concept of home were included. Most of the participants were older (> 65 years old) and the perspectives of middle-aged people were largely absent. Factors impacting on future housing decisions among individuals were identified. Seven synthesized findings emerged-independence, finances, stigma, attitudes towards ageing, attachments with home, aesthetics, and family connection. CONCLUSION Older people have a greater sense of independence and autonomy if they remain in their own home. Multiple external factors impacted on their perspectives including a sense of stigma about ageing, fear of being a burden to others and their own financial position which in some cases restricted their options. This review provides a comprehensive description of the different factors that need to be considered when planning future housing needs; both for individuals and for communities.
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Affiliation(s)
- Roslyn Aclan
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Stacey George
- Occupational Therapy, Academic Lead and Research Lead, Allied Health Chair, Northern Adelaide Local Health Network, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Heather Block
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Rachel Lane
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
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Emmesjö L, Gillsjö C, Dahl Aslan AK, Hallgren J. Patients' and next of kin's expectations and experiences of a mobile integrated care model with a home health care physician - a qualitative thematic study. BMC Health Serv Res 2023; 23:921. [PMID: 37644455 PMCID: PMC10466758 DOI: 10.1186/s12913-023-09932-4] [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: 01/31/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The organizational principle of remaining at home has offset care from the hospital to the home of the older person where care from formal and informal caregivers is needed. Globally, formal care is often organized to handle singular and sporadic health problems, leading to the need for several health care providers. The need for an integrated care model was therefore recognized by health care authorities in one county in Sweden, who created a cross-organisational integrated care model to meet these challenges. The Mobile integrated care model with a home health care physician (MICM) is a collaboration between regional and municipal health care. Descriptions of patients' and next of kin's experiences of integrated care is however lacking, motivating exploration. METHOD A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later. RESULTS The participants expected a sense of relief when admitted to MICM, and hoped for shared responsibility, building a personal contact and continuity but experienced lack of information about what MICM was. At the follow-up interview, participants described having an easier daily life. The increased access to the health care personnel (HCP) allowed participants to let go of responsibility, and created a sense of safety through the personalised contact and continuity. However, some felt ignored and that the personnel teamed up against the patient. The MICM structure was experienced as hierarchical, which influenced the possibility to participate. However, the home visits opened up the possibility for shared decision making. CONCLUSION Participants had an expectation of receiving safe and coherent health care, to share responsibility, personal contact and continuity. After six months, the participants expressed that MICM had provided an easier daily life. The direct access to HCP reduced their responsibility and they had created a personalised contact with the HCP and that the individual HCP mattered to them, which could be perceived as in line with the goals in the shift to local health care. The MICM was experienced as a hierarchic structure with impact on participation, indicating that all dimensions of person-centred care were not fulfilled.
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Affiliation(s)
- Lina Emmesjö
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden.
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Catharina Gillsjö
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden
- College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - Anna K Dahl Aslan
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden
| | - Jenny Hallgren
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden
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Søvde BE, Sandvoll AM, Natvik E, Drageset J. Carrying on life at home or moving to a nursing home: frail older people’s experiences of at-homeness. Int J Qual Stud Health Well-being 2022; 17:2082125. [DOI: 10.1080/17482631.2022.2082125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Bente Egge Søvde
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
- Department of Global Public Health and Primary Care, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Anne Marie Sandvoll
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
| | - Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
| | - Jorunn Drageset
- Department of Global Public Health and Primary Care, University of Bergen Faculty of Medicine, BERGEN, Norway
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Campus Bergen, Bergen, Norway
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Matarese M, Mauro L, Notarnicola I, Cinque A, Bonacci S, Covelli G, Casciato S. Experiences of health care personnel with promoting a sense of home for older adults living in residential care facilities: a qualitative systematic review. JBI Evid Synth 2022; 20:2826-2866. [PMID: 35975298 DOI: 10.11124/jbies-21-00452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review was to evaluate the experiences of health care personnel with promoting a sense of home for older adults living in residential care facilities. INTRODUCTION Moving to a residential care facility represents a critical moment for older adults. It disrupts the continuity of their lives and distances them from significant people and objects. Health care personnel working in residential care facilities can help create a sense of home for residents. There is a lack of qualitative reviews reporting health care personnel's experiences with promoting a sense of home for older adults living in residential care settings. INCLUSION CRITERIA Qualitative studies exploring the experiences of health care personnel with promoting a sense of home for people aged 65 and older living in residential care facilities, including, but not limited to, nursing homes, residential care homes, retirement homes, assisted-living facilities, and skilled nursing facilities were included in the review. METHODS This review followed a meta-aggregation approach according to JBI methodology for systematic reviews of qualitative evidence. PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science, and ILISI databases were searched, as well as Google Scholar, OpenGrey, and ProQuest Dissertations and Theses Global. Studies published in English, Italian, French, Portuguese, or Spanish were considered for inclusion. Study selection, critical appraisal, data extraction, and data synthesis were conducted by 2 independent reviewers using the JBI approach and JBI standardized tools. Finally, the ConQual approach was used to assess the confidence level in the study findings. RESULTS Seven studies conducted in Canada, the United States, the United Kingdom, Sweden, and the Netherlands between 2014 and 2020 were included. The studies reported the experiences of nurses, nurse aides, and directors of facilities. From the aggregation of 69 findings, 14 categories were generated that were then grouped into 3 synthesized findings describing the experiences of health care personnel as follows: the promotion of residents' sense of home in residential care facilities is influenced by i) the built environment, including private, single rooms with bathrooms, homelike-domestic spaces, personalization of residents' rooms, homelike interior and exterior design, and non-hospital-like environment; ii) the national and local policy and regulations, and work organization, as well as leadership of managers and directors; and iii) the facilities' care culture, including philosophy of care, maintaining autonomy of residents and ties with the community, participation in domestic and recreational activities, and family relationships. Based on the ConQual scores, the confidence level in the synthesized findings was graded as low. CONCLUSIONS According to health care personnel, the physical environment, interpersonal and social aspects, regulations, work organization, and the facilities' care culture can contribute to creating a sense of home for older adults in residential care facilities. The evidence derived from this review can help health care personnel, facility directors, and policy-makers identify the changes that should be implemented to promote a sense of home in older adults residing in care facilities. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020214383.
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Affiliation(s)
- Maria Matarese
- CECRI Evidence-based practice group for Nursing Scholarship: A JBI Affiliated Group, Rome, Italy.,Research Unit of Nursing Sciences (RUNS), Campus Bio-Medico University of Rome, Rome, Italy
| | - Lucia Mauro
- CECRI Evidence-based practice group for Nursing Scholarship: A JBI Affiliated Group, Rome, Italy.,San Camillo-Forlanini Hospital of Rome, Italy
| | - Ippolito Notarnicola
- CECRI Evidence-based practice group for Nursing Scholarship: A JBI Affiliated Group, Rome, Italy.,Centre of Excellence for Nursing Scholarship, Ordine delle Professioni Infermieristiche (OPI) of Rome, Italy
| | - Alessandro Cinque
- CECRI Evidence-based practice group for Nursing Scholarship: A JBI Affiliated Group, Rome, Italy.,Giovanni-Addolorata Hospital of Rome, Italy
| | - Sara Bonacci
- Azienda Regionale Emergenza Sanitaria (ARES) 118, Rome, Italy
| | | | - Stefano Casciato
- CECRI Evidence-based practice group for Nursing Scholarship: A JBI Affiliated Group, Rome, Italy.,Centre of Excellence for Nursing Scholarship, Ordine delle Professioni Infermieristiche (OPI) of Rome, Italy
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Lindquist LA, Miller-Winder AP, Schierer A, Murawski A, Opsasnick L, Kim KY, Ramirez-Zohfeld V. Improvement in self-efficacy among older adults aging-in-place during COVID-19. J Am Geriatr Soc 2022; 70:3318-3321. [PMID: 35838195 PMCID: PMC9349408 DOI: 10.1111/jgs.17946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Lee A. Lindquist
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amber P. Miller-Winder
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Allison Schierer
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alaine Murawski
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren Opsasnick
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kwang-Youn Kim
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Vanessa Ramirez-Zohfeld
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Ornstein KA, Ankuda CK, Leff B, Rajagopalan S, Siu AL, Harrison KL, Oh A, Reckrey JM, Ritchie CS. Medicare-funded home-based clinical care for community-dwelling persons with dementia: An essential healthcare delivery mechanism. J Am Geriatr Soc 2022; 70:1127-1135. [PMID: 34936087 PMCID: PMC8986555 DOI: 10.1111/jgs.17621] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the past decade, medical care has shifted from institutions into home settings-particularly among persons with dementia. Yet it is unknown how home-based clinical services currently support persons with dementia, and what factors shape access. METHODS Using the National Health and Aging Trends Study linked to Medicare claims 2012-2017, we identified 6664 community-dwelling adults age ≥ 70 years enrolled in fee-for-service Medicare. Annual assessment of dementia status was determined via self-report, cognitive interview, and/or proxy assessment. Receipt of four types of home-based clinical care (home-based medical care (HBMC) (i.e., nurse practitioner, physician, or physician assistant visits), skilled home health care (SHHC), podiatry visits, and other types of home-based clinical services (e.g., behavioral health)) was assessed annually. We compared age-adjusted rates of home-based clinical care by dementia status and determined sociodemographic, health, and environmental characteristics associated with utilization of home-based clinical care among persons with dementia. RESULTS Nearly half (44.4%) of persons with dementia received any home-based clinical care annually compared to only 14.4% of those without dementia. Persons with dementia received substantially more of each type of home-based clinical care than those without dementia including a 5-fold increased use of HBMC (95% CI = 3.8-6.2) and double the use of SHHC (95% CI = 2.0-2.5). In adjusted models, Hispanic/Latino persons with dementia were less likely to receive HBMC (OR = 0.32; 95% CI = 0.11-0.93). Use of HBMC, podiatry, and other home-based clinical care was significantly more likely among those living in residential care facilities, in the Northeast and in metropolitan areas. CONCLUSION Although almost half of community-dwelling persons with dementia receive home-based clinical care, there is significant variation in utilization based on race/ethnicity and environmental context. Increased understanding as to how these factors impact utilization is necessary to reduce potential inequities in healthcare delivery among the dementia population.
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Affiliation(s)
- Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Claire K Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, The Center for Transformative Geriatric Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Subashini Rajagopalan
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Albert L Siu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Krista L Harrison
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Anna Oh
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Jennifer M Reckrey
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Christine S Ritchie
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
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12
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Ornstein KA, Liu SH, Husain M, Ankuda CK, Bollens-Lund E, Kelley AS, Garrido MM. Prospective assessment of dementia on transitions in homeboundness using multistate Markov models. J Am Geriatr Soc 2022; 70:1117-1126. [PMID: 34951008 PMCID: PMC8986556 DOI: 10.1111/jgs.17631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/26/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND One in 20 older adults in the United States is homebound and rarely/never leaves home. Although being homebound decreases the quality of the lived experience of individuals with serious illnesses, little is known about the frequency or likelihood of transitions in or out of homebound status. The objective of this study was to characterize the probability of transitions to and from homebound status among older adults and examine the relationship between dementia status and homebound transitions. METHODS Using 2011-2018 data from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal study of aging in the United States, we identified 6375 community-dwelling Medicare beneficiaries. Homebound status (independent, semi-homebound (leaving home but with difficulty or help), homebound (rarely or never leaving home), nursing home resident, dead) was assessed annually via self-report. Transition probabilities across states were assessed using a multistate Markov model. RESULTS Less than half of homebound individuals remain homebound (probability = 41.5% [95% CI: 39.2%, 43.5%]) after 1 year. One out of four dies (24% [22.3%, 26.0%]) and there is a low probability (3.2% [2.5%, 4.1%]) of transition to a nursing home. Dementia status was associated with increased risk of progression from independence to homebound status (HR: 1.83 [1.01, 3.34]). Dementia was consistently associated with increased probabilities of transitions to death including a two-fold increased hazards of progression from homebound to death (HR: 2.18 [1.69, 2.81]). Homebound individuals with dementia have a 34.2% [25.8%, 48.1%] probability of death in 5 years, compared with 17.4% [13.7%, 24.3%] among those without dementia. DISCUSSION Dementia is associated with greater risk of transitioning across homebound states. There is a greater need to support home-based care for patients with dementia, especially as the ongoing COVID pandemic has raised concerns about the need to invest in alternative models to nursing home care.
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Affiliation(s)
- Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Shelley H. Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Mohammed Husain
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Claire K. Ankuda
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Amy S. Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
- James J Peters Veterans Affairs Medical Center, Bronx, NY
| | - Melissa M. Garrido
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Boston VA Healthcare System, Boston, MA
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13
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Roos J, Koppen G, Vollmer DTC, Van Schijndel-Speet DM, Dijkxhoorn DY. Unlimited Surrounding: A Scoping Review on the Impact of the Built Environment on Health, Behavior, and Quality of Life of Individuals With Intellectual Disabilities in Long-Term Care. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:295-314. [PMID: 35285333 DOI: 10.1177/19375867221085040] [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: 11/16/2022]
Abstract
OBJECTIVES To identify available literature on the impact of built environments on health, behavior, and quality of life of individuals with intellectual disabilities in long-term care. Additionally, we aimed to map the available literature, (re)frame the overall research situation in this area, and formulate recommendations. BACKGROUND Long-term care facilities in the Netherlands are planned without using knowledge from research regarding evidence-based design because it is unclear what evidence is available about the impact of long-term care built environments on individuals with intellectual disabilities receiving 24/7 care. METHODS Twelve scientific databases were searched for keyword combinations. After systematically screening 3,095 documents, 276 were included in the analysis. RESULTS There is an underrepresentation of research and publications in intellectual disabilities, compared to other user groups living in long-term care facilities. A total of 26 design components were found in all groups; as for intellectual disabilities, research was available on only seven of them. Community care, home-likeness, and variety seem to have a positive effect on health, behavior, and quality of life. There are conflicting results regarding the effects of house size. CONCLUSIONS Although individuals with intellectual disabilities live in long-term care facilities, sometimes for life, little research has been conducted on the impact of the built environment on them. In the future, more empirical research should be conducted, addressing all aspects of quality of life and specific design components, with hypotheses based on needs assessments and the use of good research designs. This requires an investment of time and funding.
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Affiliation(s)
| | - Gemma Koppen
- Kopvol Architecture & Psychology, Rotterdam, the Netherlands
| | - Dr Tanja C Vollmer
- Architectural Psychology and Health Care Design, Faculty of Architecture, Technical University Munich, Munich, Germany
| | | | - Dr Yvette Dijkxhoorn
- Faculty of Social Sciences, Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, the Netherlands
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14
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Bjerkmo L, Helgesen AK, Larsen TA, Blix BH. "Falling off the wagon": older adults' experiences of living with frailty in rural arctic communities. Int J Circumpolar Health 2021; 80:1957569. [PMID: 34382501 PMCID: PMC8366667 DOI: 10.1080/22423982.2021.1957569] [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] [Indexed: 01/16/2023] Open
Abstract
Most populations around the world are ageing. The proportion of older adults in the population is larger and is growing more rapidly in rural communities than in urban areas. Longevity increases the risk of frailty. Our aim was to explore how single-living frail older adults experience living with frailty in everyday life in rural Arctic areas. Over eight months, we conducted a series of three interviews with eight older adults identified as frail by home care services in two rural municipalities in northern Norway. We conducted a thematic analysis. We generated three themes. Frailty as a dynamic phenomenon indicated that the participants’ experiences of frailty varied over time. Frailty as part of old age referred to the findings that many participants tried to adapt to the changing circumstances, while others found it more challenging to accept the experienced limitations. Frailty in a rural Arctic context concerned the findings that the rural Arctic environment affected the participants’ experiences of frailty due to its long, snowy winters; long distances between communities and municipal centres; and out-migration. Our results demonstrate that frailty is a consequence of the interplay between ageing persons and their physical and social environments.
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Affiliation(s)
- Lena Bjerkmo
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway
| | - Ann Karin Helgesen
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway.,Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Toril Agnete Larsen
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway
| | - Bodil H Blix
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway
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15
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Cater D, Tunalilar O, White DL, Hasworth S, Winfree J. “ Home is Home:” Exploring the Meaning of Home across Long-Term Care Settings. JOURNAL OF AGING AND ENVIRONMENT 2021. [DOI: 10.1080/26892618.2021.1932012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Diana Cater
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, Oregon, USA
| | - Ozcan Tunalilar
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, Oregon, USA
- Nohad A. Toulan School of Urban Studies and Planning, Portland State University, Portland, Oregon, USA
| | - Diana L. White
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, Oregon, USA
| | - Serena Hasworth
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, Oregon, USA
| | - Jaclyn Winfree
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, Oregon, USA
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16
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Lindquist LA, Muhammad R, Miller-Winder AP, Opsasnick L, Kim KY, Benavente JY, Wolf M, Ramirez-Zohfeld V. Rationale and study design for decision making & implementation of aging-in-place/long term care plans among older adults. Contemp Clin Trials Commun 2021; 22:100756. [PMID: 33869887 PMCID: PMC8040099 DOI: 10.1016/j.conctc.2021.100756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/06/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Remaining in one's own home and community is a priority for many older adults as they age. Decision-making and planning is critical to ensure successful aging-in-place (AIP), especially when individuals experience age-related changes such as cognitive decline. Objectives: We are testing how decision-making and planning for AIP is impacted by changes in older adults' cognition and function, chronic conditions, social influences, environmental factors and identifying the mediating/moderating interactions between factors. We will also assess whether decision-making and planning for AIP translates into timely adoption of plans and goal concordance between older adults and their surrogate/caregiver decision makers. METHODS We will conduct a longitudinal single-group interventional clinical trial of community-dwelling older adults who are enrolled in LitCog, (R01AG03611) and expose them to an online intervention, PlanYourLifespan.org, which facilitates decision-making and planning for AIP. Enrolled participants (n = 398) will complete interviews at baseline, one month, and every six months up to 42 months in conjunction with the LitCog study, where cognitive, social, functional, and health literacy data is collected. Additionally, we will collect data on decision-making, resource use, communication of plans, timing of plan implementation, and goal concordance. PROJECTED OUTCOMES Findings from this study may generate evidence on how age-related changes in older adults may affect decision-making and implementation in relation to AIP as well as the impact of social relationships and support. Ultimately these findings may help shape the design of programs and practices that may improve the lives of older adults and the capacity of institutions to adapt to societal aging and AIP.
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Affiliation(s)
- Lee A. Lindquist
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ruqayyah Muhammad
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amber P. Miller-Winder
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren Opsasnick
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kwang-Youn Kim
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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17
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Meng D, Xu G, Davidson PM. Perceived unmet needs for community-based long-term care services among urban older adults: A cross sectional study. Geriatr Nurs 2021; 42:740-747. [PMID: 33872858 DOI: 10.1016/j.gerinurse.2021.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to explore the perceived unmet needs for community-based long-term care services among older urban adults in China. We analyzed the cross-sectional data of 5,201 urban community respondents ≥65 years of age from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The chi-squared automatic interaction detection technique was used to examine the variables associated with older adults' unmet needs for four common types of community-based services: personal care, grocery shopping, home visits, and psychological consulting. We found that the majority of the older adults perceived that they needed the four services, but only 9%-27.4% of the respondents reported that their perceived needs were met. There was a high prevalence of unmet community-based service needs (51.3%-55.5%) among urban older adults in China. Factors associated with unmet needs included depression status, ADL (activities of daily living) limitations, self-rated health, number of surviving children, educational attainment, and marital status. The results suggest that policy makers should develop services targeting specific segments of the older population, increasing the adequacy of services provided.
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Affiliation(s)
- Dijuan Meng
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
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18
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Aging in Place with Age-Related Cognitive Changes: The Impact of Caregiving Support and Finances. SOCIETIES 2021. [DOI: 10.3390/soc11020031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the United States, aging in place is a common concept that refers to older adults’ desire to remain in their homes as they age. However, this ability to age in place is a complex process that is not only impacted by the home’s accessibility or individual functional abilities. This paper aims to examine different factors, such as home environment and home modification, caregivers, finances, and other supports present in the participants’ lives, that impact older adults with age-related cognitive changes (ARCC) (in)ability to age in place. Qualitative interviews with older adults with ARCC (n = 5) and their caregivers (n = 5) were conducted. The participants’ experiences while aging in place indicate that finances and caregiving support greatly impacted their lives at home and ability to age in place. Personal finances dictated where some of the participants could age and the support, they could afford from home health aides. Additionally, informal and formal caregivers were an important source of support that aided in the older adults’ ability to remain home. As researchers, we need to continue to address personal finances and the support that the individual has in their lives to most effectively promote aging in place and their life at home.
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19
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Möckli N, Simon M, Meyer-Massetti C, Pihet S, Fischer R, Wächter M, Serdaly C, Zúñiga F. Factors associated with homecare coordination and quality of care: a research protocol for a national multi-center cross-sectional study. BMC Health Serv Res 2021; 21:306. [PMID: 33823850 PMCID: PMC8025374 DOI: 10.1186/s12913-021-06294-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The persistent fragmentation of home healthcare reflects inadequate coordination between care providers. Still, while factors at the system (e.g., regulations) and organisational (e.g., work environment) levels crucially influence homecare organisation, coordination and ultimately quality, knowledge of these factors and their relationships in homecare settings remains limited. OBJECTIVES This study has three aims: [1] to explore how system-level regulations lead to disparities between homecare agencies' structures, processes and work environments; [2] to explore how system- and organisation-level factors affect agency-level homecare coordination; and [3] to explore how agency-level care coordination is related to patient-level quality of care. DESIGN AND METHODS This study focuses on a national multi-center cross-sectional survey in Swiss homecare settings. It will target 100 homecare agencies, their employees and clients for recruitment, with data collection period planned from January to June 2021. We will assess regulations and financing mechanisms (via public records), agency characteristics (via agency questionnaire data) and homecare employees' working environments and coordination activities, as well as staff- and patient-level perceptions of coordination and quality of care (via questionnaires for homecare employees, clients and informal caregivers). All collected data will be subjected to descriptive and multi-level analyses. DISCUSSION The first results are expected by December 2021. Knowledge of factors linked to quality of care is essential to plan and implement quality improvement strategies. This study will help to identify modifiable factors at multiple health system levels that might serve as access points to improve coordination and quality of care.
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Affiliation(s)
- Nathalie Möckli
- Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, CH-4056, Basel, Switzerland
| | - Michael Simon
- Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, CH-4056, Basel, Switzerland.,Nursing Research Unit, Inselspital Bern, Freiburgstrasse 18, CH-3010, Bern, Switzerland
| | - Carla Meyer-Massetti
- Department of Pharmaceutical Sciences, Clinical Pharmacy & Epidemiology, c/o University Hospital Basel, Spitalstrasse 26, CH-4031, Basel, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, CH-3012, Bern, Switzerland
| | - Sandrine Pihet
- University of Applied Sciences and Arts of Western Switzerland, School of Nursing, Route des Arsenaux 16a, CH-1700, Fribourg, Switzerland
| | - Roland Fischer
- Centre for Primary Health Care, University of Basel, Rheinstrasse 26, CH-4410, Liestal, Switzerland
| | - Matthias Wächter
- Institute for Business and Regional Economics IBR, Lucerne University, Zentralstrasse 9, CH-6002, Luzern, Switzerland
| | - Christine Serdaly
- serdaly&ankers snc, Route de Florissant 210, CH-1231, Conches, Switzerland
| | - Franziska Zúñiga
- Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, CH-4056, Basel, Switzerland.
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20
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Helgesen AK, Larsen DW, Grøndahl VA. Quality of Care in a Nursing Home as Experienced by Patients with Dementia. J Multidiscip Healthc 2020; 13:1947-1955. [PMID: 33364776 PMCID: PMC7751599 DOI: 10.2147/jmdh.s285668] [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: 10/07/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background Dementia care is one of the most rapidly growing areas in health care. Despite this, relatively little is known about the experiences of persons with dementia in relation to quality of care. Objective The aim of this study was to describe how persons with dementia in nursing homes experience the quality of care. Design A cross-sectional design was used. Setting and Participants The study was conducted in a nursing home in Norway. A total of 33 persons with dementia participated. Results Respondents’ mean age was 86.7 years. More than 80% reported their health as bad/neither good nor bad. Concerning their satisfaction with staying in the nursing home, two in ten were satisfied. Nearly half answered that they received or sometimes received good help and support when anxious. More than 50% reported that they only sometimes received or never received good help and support when they felt lonely. The majority perceived that the nurses came/or sometimes came when needed (79%) and that the nurses had time/sometimes had time to talk with them (73%). Conclusion This study reveals that the voice of persons with dementia must be listened to, in order to increase the quality of care in nursing homes. The challenge concerning how living in nursing homes can be more satisfying must be addressed by leaders and nurses in nursing homes, as well as researchers. Special attention must be paid to anxiety, loneliness, and going outdoors.
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Affiliation(s)
- Ann Karin Helgesen
- Faculty of Health and Welfare Sciences, Østfold University College, Halden, Norway
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21
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Heggestad AKT, Magelssen M, Pedersen R, Gjerberg E. Ethical challenges in home-based care: A systematic literature review. Nurs Ethics 2020; 28:628-644. [PMID: 33334250 DOI: 10.1177/0969733020968859] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Because of the transfer of responsibility from hospitals to community-based settings, providers in home-based care have more responsibilities and a wider range of tasks and responsibilities than before, often with limited resources. The increased responsibilities and the complexity of tasks and patient groups may lead to several ethical challenges. A systematic search in the databases MEDLINE, CINAHL, and SveMed+ was carried out in February 2019 and August 2020. The research question was translated into a modified PICO (Population, Intervention, Comparison, and Outcome) worksheet. A total of 40 articles were included. The review is conducted according to the Vancouver Protocol. The main findings from the systematic literature review show that ethical challenges experienced by healthcare and social care providers in home-based care are related to autonomy and balancing ethical principles, decisions regarding intensity of care, challenges related to priority settings, truth-telling, and balancing the professional role. Findings regarding ethical challenges within home-based care are in line with findings from institutional healthcare and social care settings. However, some significant differences from the institutional context are also highlighted.
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22
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Palmér L, Nyström M, Carlsson G, Gillsjö C, Eriksson I, Dalheim-Englund AC. The intertwining of reconciliation and displacement: a lifeworld hermeneutic study of older adults' perceptions of the finality of life. Int J Qual Stud Health Well-being 2020; 15:1799588. [PMID: 32762422 PMCID: PMC7482777 DOI: 10.1080/17482631.2020.1799588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE This study aimed to explain and understand the existential meaning of the finality of life from the perspective of healthy older adults. METHOD Participants were recruited from a major project on older adults' life situations. They were interviewed about their thoughts on the end of life, and their responses were interpreted using a lifeworld hermeneutic approach. RESULTS The findings showed that thinking about the inevitable finality of life involves feelings of liberation, frightening thoughts, a comforting promise of something beyond death, acceptance of the concept of death as a companion in life and a desire to live. Philosopher Simone de Beauvoir's existential ideas about ageing and death were then used to further explain and understand the meaning of the finality of life and to support a comprehensive understanding. de Beauvoir suggests that when the temporal horizon of existence shrinks, one lives closer to the finality of life. For a comprehensive understanding, attributing meaning to the finality of life required the intertwining of reconciliation and displacement. The interpretations were further discussed using ideas from the fields of existential philosophy and caring science in order to develop a basis for caring practice. CONCLUSIONS The conclusions suggested that professional health care for older adults would benefit from a lifeworld-led caring science approach that includes readiness for a caring dialogue that focuses on existential issues.
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Affiliation(s)
- Lina Palmér
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Maria Nyström
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Gunilla Carlsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Catharina Gillsjö
- School of Health and Education, University of Skövde, Skövde, Sweden
- College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - Irene Eriksson
- School of Health and Education, University of Skövde, Skövde, Sweden
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23
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Reckrey JM, Tsui EK, Morrison RS, Geduldig ET, Stone RI, Ornstein KA, Federman AD. Beyond Functional Support: The Range Of Health-Related Tasks Performed In The Home By Paid Caregivers In New York. Health Aff (Millwood) 2020; 38:927-933. [PMID: 31158023 DOI: 10.1377/hlthaff.2019.00004] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Paid caregivers (for example, home health aides and personal care attendants) are formally tasked with helping older adults with functional impairment meet their basic needs at home. This study used thirty semistructured interviews with dyads of patients or their proxies and their paid caregivers in New York City to understand the range of health-related tasks that paid caregivers perform in the home and determine whether these tasks are taught in the New York State Department of Health's curriculum. We found that patients, proxies, and paid caregivers all reported that paid caregivers performed a wide range of health-related tasks that were often not part of their formal training. Creating clear competencies for paid caregivers that reflect the full breadth of health-related tasks they may perform in the home could help maximize the positive impact of the paid caregiver workforce on the lives of patients living at home with functional impairment.
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Affiliation(s)
- Jennifer M Reckrey
- Jennifer M. Reckrey ( ) is an associate professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City
| | - Emma K Tsui
- Emma K. Tsui is an assistant professor of community health and social sciences at the City University of New York School of Public Health, in New York City
| | - R Sean Morrison
- R. Sean Morrison is a professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Emma T Geduldig
- Emma T. Geduldig is a student in the Department of Medical Education, Icahn School of Medicine at Mount Sinai
| | - Robyn I Stone
- Robyn I. Stone is senior vice president for research at LeadingAge, in Washington, D.C
| | - Katherine A Ornstein
- Katherine A. Ornstein is an assistant professor in the Department of Geriatrics and Palliative Medicine and the Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
| | - Alex D Federman
- Alex D. Federman is a professor in the Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai
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24
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Hedén L, Berglund M, Gillsjö C. Effects of the Intervention "Reflective STRENGTH-Giving Dialogues" for Older Adults Living with Long-Term Pain: A Pilot Study. J Aging Res 2020; 2020:7597524. [PMID: 32953174 PMCID: PMC7481915 DOI: 10.1155/2020/7597524] [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: 03/02/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Long-term musculoskeletal pain is a major, often undertreated, disabling health problem among an increasing number of older adults. Reflective STRENGTH-giving dialogues (STRENGTH) may be a tool to support older adults living with long-term pain. The main aim of this pilot study was to investigate the immediate and longitudinal effect of the intervention STRENGTH on levels of pain, wellbeing, occurrence of depression symptoms, and sense of coherence (SOC) among community-dwelling older adults suffering from musculoskeletal pain compared to a control group. METHODS The study was semiexperimental with an intervention group and a control group. The effect of a single STRENGTH intervention was reported on the Numeric Rating Scale (NRS) regarding pain and wellbeing. To evaluate the longitudinal effect of STRENGTH, using the Brief Pain Inventory-Short Form (BPI-SF), the Geriatric Depression Scale-20 (GDS-20), SOC-13 at baseline (T1), and six months after the intervention/no intervention (T2), a total of 30 older adults, aged 72 to 97 years (Mdn 86 years), were included consecutively and fulfilled the intervention series (n = 18) or untreated controls (n = 12). RESULTS The intervention with STRENGTH decreases pain (NRS 6 Mdn versus NRS 4 Mdn, p < 0.001) and increases wellbeing (NRS 7 Mdn versus NRS 8 Mdn, p < 0.001). After a six-month study period with STRENGTH, no longitudinal effect difference was found compared to baseline. Compared to the control group, there was an increasing trend between decreased pain level and increased SOC level for STRENGTH intervention. CONCLUSIONS This pilot study supports STRENGTH's effect as a pain-alleviating model that provides a decrease in pain levels and an increase of wellbeing in older adults with long-term pain. STRENGTH dialogues could be a useful intervention to provide individually holistic care in older adults living with long-term pain.
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Affiliation(s)
- Lena Hedén
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Mia Berglund
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Catharina Gillsjö
- School of Health Sciences, University of Skövde, Skövde, Sweden
- College of Nursing, University of Rhode Island, South Kingstown, RI, USA
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Ramirez-Zohfeld V, Seltzer A, Ramirez A, Muhammad R, Lindquist LA. Longitudinal Follow-Up of Long-Term Care Planning Using PlanYourLifespan.org. J Appl Gerontol 2020; 40:536-540. [PMID: 32686545 DOI: 10.1177/0733464820943066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Many older adults wish to age-in-place but do not have long-term care plans for when they may require more assistance. PlanYourLifespan.org (PYL) is an evidence-based tool that helps older adults understand and plan for their long-term care needs. We examined the long-term effects of PYL use on user perceptions and planning of long-term care services. Individuals who previously accessed PYL were invited to complete an online, nation-wide mixed methodology survey about end-user outcomes related to PYL. Among 115 completed surveys, users found PYL helpful with long-term planning for their future needs. Over half of website users reported having conversations with others because of PYL use. However, 40% of respondents reported not having a conversation with others about their plans; common themes for barriers to planning included procrastination and a lack of immediate support needs. Although PYL helps with planning, many people are still not communicating their long-term care plans.
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26
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Frantsman-Spector A, Shoshana A. The home-self and out-of-home placement: The home concept among adults educated in their childhood at a residential care setting. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1583-1602. [PMID: 32227360 DOI: 10.1002/jcop.22351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 06/10/2023]
Abstract
This study proposes to examine the phenomenology of home among 46 Israeli adults who had been deemed "at-risk children" and removed from their home by court order in their childhood on the grounds of parental mistreatments, such as abuse and neglect. For a comprehensive understanding of the long-term impact of out-of-home placement, adults of different ages were interviewed. The research findings reflect the close connection between home concept and self-concept, a long-standing internal dialectic between the home that did not exist and the home (as an internal-emotional space) that the adults would have liked to have. Furthermore, our findings reveal what we term the life career of the home concept, that is, the various diachronic phenomenological definitions that adults grant to the home-self in childhood, anchored in the family home, during their time in a residential care setting, their adolescence, and their adulthood. The discussion addresses the unique self-concept and home concept of care leavers.
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Affiliation(s)
| | - Avihu Shoshana
- Faculty of Education, University of Haifa, Haifa, Israel
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27
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Aldridge MD, Ornstein KA, McKendrick K, Moreno J, Reckrey JM, Li L. Trends In Residential Setting And Hospice Use At The End Of Life For Medicare Decedents. Health Aff (Millwood) 2020; 39:1060-1064. [PMID: 32479223 PMCID: PMC8045974 DOI: 10.1377/hlthaff.2019.01549] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As more people live and die in the community despite complex health needs and functional impairment, the need for hospice increases. We found high and increasing penetration of hospice in community-based residential settings, compared with hospice use in private residences and nursing homes.
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Affiliation(s)
- Melissa D Aldridge
- Melissa D. Aldridge is a professor in the Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, in New York City, and the James J. Peters Bronx Veterans Affairs Medical Center, in the Bronx, New York
| | - Katherine A Ornstein
- Katherine A. Ornstein is an associate professor in the Department of Geriatrics and Palliative Medicine and the Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
| | - Karen McKendrick
- Karen McKendrick is a senior data analyst in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Jaison Moreno
- Jaison Moreno is a data analyst in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Jennifer M Reckrey
- Jennifer M. Reckrey is an associate professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Lihua Li
- Lihua Li is an assistant professor in the Department of Population Health, Icahn School of Medicine at Mount Sinai
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28
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Harkin DJ, O'Connor CMC, Birch M, Poulos CJ. Perspectives of Australian family carers of people with dementia on the 'cottage' model of respite: Compared to traditional models of residential respite provided in aged care facilities. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:850-861. [PMID: 31863540 PMCID: PMC7187172 DOI: 10.1111/hsc.12916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/29/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Abstract
The majority of people living with dementia reside in the community and are often reliant on the support of informal carers to do so. Family carers face many challenges in supporting the person with dementia to remain at home, and short-term respite care is a valued service that offers a temporary break from the role. Respite cottages provide short-term care in a residential home-like setting with a limited number of clients and is a more flexible approach to accessing the service. Disproportionate use of cottage respite in Australia suggests this model is preferred over traditional respite within residential aged care facility (RACF) settings, yet limited research exists to compare these models. This study sought to understand the perceptions of carers who had used cottage respite in comparison to other models, and explore the contribution of cottage respite for supporting carers to continue in their role and maintain their care recipient (CR) living at home. Semi-structured interviews were conducted with 126 family carers who had used one of two New South Wales-based respite cottages within a 2-year period; 67 of whom had also used RACF respite. Thematic analysis revealed four main themes around the benefits of cottage respite: (a) an effective essential service, (b) flexibility, (c) familiarity and (d) appropriateness, especially for early stage or younger onset dementia. Carers indicated that the more homely, familiar and intimate cottage model of respite care was preferential to that of the larger, institutional-style RACF respite setting. Carers credited the cottage model of respite service with delaying their need for permanent residential placement by over 12 months. The cottage respite model provides an important avenue to supporting the individual needs of dementia dyads, with potential to delay permanent placement, and should be offered more broadly to provide people with more choice about their care.
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Affiliation(s)
| | - Claire M. C. O'Connor
- Centre for Positive AgeingHammondCareSydneyNSWAustralia
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNSWAustralia
| | | | - Christopher J. Poulos
- Centre for Positive AgeingHammondCareSydneyNSWAustralia
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNSWAustralia
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Maenhout A, Cornelis E, Van de Velde D, Desmet V, Gorus E, Van Malderen L, Vanbosseghem R, De Vriendt P. The relationship between quality of life in a nursing home and personal, organizational, activity-related factors and social satisfaction: a cross-sectional study with multiple linear regression analyses. Aging Ment Health 2020; 24:649-658. [PMID: 30724580 DOI: 10.1080/13607863.2019.1571014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: This study aimed to investigate quality of life in nursing home residents and the relationship with personal, organizational, activity-related factors and social satisfaction.Methods: In a cross-sectional survey study in 73 nursing homes in Flanders, Belgium, 171 cognitively healthy residents were randomly recruited (mean age 85.40 years [±5.88]; 27% men, 73% women). Quality of life, as the dependent/response variable, was measured using anamnestic comparative self-assessment (range -5 to +5). Multiple linear regression (forward stepwise selection) was used (1) to investigate which factors were significantly related to nursing home residents' quality of life and (2) to model the relationship between the variables by fitting a linear equation to the observed data.Results: Nursing home residents reported a quality of life score of 2.12 (±2.16). Mood, self-perceived health status, social satisfaction and educational level were withheld as significant predictors of the anamnestic comparative self-assessment score (p < 0.001), explaining 38.1% of the variance in quality of life.Conclusions: Results suggest that a higher quality of life in nursing homes can be pursued by strategies to prevent depression and to improve nursing home residents' subjective perception of health (e.g. offering good care) and social network. It is recommended that nursing homes prepare for future generations, who will be more educated.
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Affiliation(s)
- Annelies Maenhout
- Research Group Zorginnovatie, Artevelde University College Ghent, Ghent, Belgium
| | - Elise Cornelis
- Research Group Zorginnovatie, Artevelde University College Ghent, Ghent, Belgium.,Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Dominique Van de Velde
- Research Group Zorginnovatie, Artevelde University College Ghent, Ghent, Belgium.,Department of Occupational Therapy, Faculty of Medicine and Health Sciences Rehabilitation Sciences and Physiotherapy, University Ghent, Ghent, Belgium
| | - Valerie Desmet
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Ellen Gorus
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lien Van Malderen
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Ruben Vanbosseghem
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Patricia De Vriendt
- Research Group Zorginnovatie, Artevelde University College Ghent, Ghent, Belgium.,Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
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‘It gives you more to life, it's something new every day’: an Interpretative Phenomenological Analysis of wellbeing in older care home residents who keep a personal pet. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x19001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThere is a substantial amount of literature that suggests that animals, and specifically animals kept as pets, can have a positive effect on wellbeing. Research exploring the impact of animals on wellbeing in care homes mainly concerns visiting animals as well as shared communal pets. In light of the lack of research regarding personal pets in care homes, the aim of this study was to explore what the experience of keeping a personal pet in a care home means for residents’ sense of wellbeing. Semi-structured interviews were conducted with seven care home residents who were currently living with their pet in a care home. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Analysis revealed four master themes deemed to be relevant to participants’ wellbeing. these were: ‘sense of self and identity’, ‘responsibility and ownership’, ‘motivation and desire to live’ and ‘feeling content in the care home’. The analysis indicated that living with a personal pet in a care home has the potential to enhance residents’ wellbeing. At the same time, it also found that the benefits of keeping a personal pet may be dependent on specific circumstances, such as the attitudes of staff and fellow residents at the care home. This study indicates that it may be advisable for more care homes to accept personal pets.
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Reckrey JM, Morrison RS, Boerner K, Szanton SL, Bollens-Lund E, Leff B, Ornstein KA. Living in the Community With Dementia: Who Receives Paid Care? J Am Geriatr Soc 2020; 68:186-191. [PMID: 31696511 PMCID: PMC6957088 DOI: 10.1111/jgs.16215] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Paid caregivers (eg, home health aides and personal care attendants) provide hands-on care that helps individuals with dementia live in the community. This study (a) characterizes paid caregiving among community-dwelling individuals with dementia and (b) identifies factors associated with receipt of paid care. DESIGN Cross-sectional analysis. SETTING The 2015 National Health and Aging Trends Study (NHATS), a nationally representative study of Medicare recipients aged 65 years and older. PARTICIPANTS Community-dwelling individuals with dementia (n = 899). MEASUREMENTS Paid and family caregiving support was determined by participant or proxy report of help received with functional tasks. Multivariable logistic regression was used to examine factors associated with receipt of paid care. NHATS population sampling weights were used to produce national paid caregiving prevalence estimates. RESULTS Only 25.5% of community-dwelling individuals with dementia received paid care, and 10.8% received 20 hours or more of paid care per week. For those who received it, paid care accounted for approximately half of the 83 total caregiving hours (paid and family) that they received each week. Among the subgroup of individuals with advanced dementia (those with impairment in dressing, bathing, toileting, and managing medications and finances), nearly half (48.3%) received paid care. Multivariable analysis, adjusting for sociodemographic, family caregiving support, functional, and clinical characteristics, found that the odds of receiving paid care were higher among men (odds ratio [OR] = 1.91; 95% confidence interval [CI] = 1.24-2.95), the unmarried (OR = 2.20; 95% CI = 1.31-3.70), those with Medicaid (OR = 2.16; 95% CI = 1.27-3.66), and those requiring more help with activities of daily living (ADLs) (OR = 1.32; 95% CI = 1.18-1.48) and instrumental ADLs (OR = 1.29; 95% CI = 1.14-1.46). CONCLUSIONS New ways of making paid caregiving more accessible throughout the income spectrum are required to support family caregivers and respect the preferences of individuals with dementia to remain living in the community. J Am Geriatr Soc 68:186-191, 2019.
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Affiliation(s)
- Jennifer M. Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - R. Sean Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
- James J. Peters VA Medical Center, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston
| | - Kathrin Boerner
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston
| | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Center for Transformative Geriatric Research, Johns Hopkins School of Medicine
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Bruce Leff
- Department of Medicine, Division of Geriatrics, Center for Transformative Geriatric Research, Johns Hopkins School of Medicine
| | - Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
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32
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Leikas J. Aesthetic Well-Being and Ethical Design of Technology. HUMAN–COMPUTER INTERACTION SERIES 2020. [DOI: 10.1007/978-3-030-53483-7_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Creating conditions for a sense of security during the evenings and nights among older persons receiving home health care in ordinary housing: a participatory appreciative action and reflection study. BMC Geriatr 2019; 19:351. [PMID: 31842776 PMCID: PMC6915921 DOI: 10.1186/s12877-019-1372-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today many older persons in ordinary housing receive home health care. It is stipulated that the care is to provide security; however, deficiencies in home health care are reported in many countries. It may be difficult to implement a sense of security among older persons receiving home health care in ordinary housing, especially during the evenings and nights, due to a lack of knowledge. METHODS This study is part of a larger project with a participatory appreciative action and reflection (PAAR) approach. We invited older persons, relatives, nurse assistants, registered nurses, and their managers to co-create knowledge with us on how conditions for a sense of security can be created during evenings and nights among older persons receiving home health care in ordinary housing. We performed thematic analysis of the data. RESULTS Five subthemes were developed that gave structure to two main themes. The first main theme, To confirm the self-image, has the following subthemes: To see the home as a reflection of the person's identity and To maintain self-determination. The second main theme, To create interaction in a sheltered place, has these subthemes: To undress the power, To create control and lifelines, and To create a good sleeping environment. The two themes interact and are each other's conditions. The person's self-image must be confirmed in order to create interaction in a sheltered place and through the interaction, the self-image is confirmed. CONCLUSION Conditions necessary for older persons to have a sense of security are living in a familiar environment, having habits and routines maintained, and having self-determination. Other conditions are equality, the prevention of falls, and an individualized sleeping environment. Older people's self-determination should be honored, and they should not being excluded from decision-making. We need to ask them if the conditions are sufficient and their sense of security is great enough to allow them to continue living in their ordinary housing.
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Göransson C, Wengström Y, Ziegert K, Langius-Eklöf A, Blomberg K. Self-care ability and sense of security among older persons when using an app as a tool for support. Scand J Caring Sci 2019; 34:772-781. [PMID: 31769888 DOI: 10.1111/scs.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/02/2019] [Indexed: 01/01/2023]
Abstract
THE STUDY'S RATIONALE The need for home care among older persons is increasing, and mHealth is evolving to help meet the challenge. When developing an app to help maintain their health, it is essential to incorporate older persons' preferences. AIMS AND OBJECTIVES To describe and evaluate the experiences of self-care support and sense of security among older persons using an interactive app to report health concerns. METHODOLOGICAL DESIGN AND JUSTIFICATION The study had a descriptive and evaluative design. Qualitative and quantitative methods were applied to achieve a broader understanding. ETHICAL ISSUES AND APPROVAL Ethical approval was obtained from the Regional Ethical Review Board. The older persons received verbal and oral information about the study and gave written informed consent. RESEARCH METHODS Questionnaires (n = 17 older persons) answered at baseline, end of the intervention and at a 6-month follow-up were analysed with statistical analysis. Interviews (n = 17 older persons) conducted at the end of the intervention were analysed using a qualitative directed approach. MEASUREMENTS AND INTERVENTION The questionnaire included the Appraisal of Self-care Agency Scale and a question concerning sense of security. For 3 months, the older persons used an app for regular reporting of health concerns. The app included self-care advice, graphs and a risk assessment model that generated alerts directly to the nurses. RESULTS The older persons described how self-care and sense of security increased at the end of intervention, but statistically, it was shown to decrease afterwards. STUDY LIMITATIONS The small sample size for statistical analysis. CONCLUSIONS This study shows that an app can be a complementary tool to conventional home care that can increase older persons' sense of security and self-care ability. The results mirror the older persons' awareness that the support they received with the app was only temporary. Larger studies are needed for generalisation.
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Affiliation(s)
- Carina Göransson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.,School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Yvonne Wengström
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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35
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Scheduling Sustainable Homecare with Urban Transport and Different Skilled Nurses Using an Approximate Algorithm. SUSTAINABILITY 2019. [DOI: 10.3390/su11226210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The essential characteristics that distinguish homecare services from other routing and scheduling problems are relatively few patients being spread out over a large urban area, long transport times and several different services being provided. The approach that the authors present herein was developed to solve planning homecare services according to the criterion of increasing social sustainability and incorporating environmentally sustainable transport systems. The objective of this paper is to present a tool to plan the daily work carried out by a homecare service with assigned patients with specific care requirements. It relies on the resources of nurses with different qualifications by assuming costs that depend on both offering the service and the different chosen transport modes. The algorithm manages several priority rules by ensuring that homecare provider goals and standards are met. The developed algorithm was tested according to the weekly homecare schedule of a group of nurses in a medium-sized European city and was successfully used during validation to improve homecare planning decisions. The results, therefore, are not generalisable but its modular structure ensures its applicability to different cases. The algorithm provides a patient-centred visiting plan and improves transport allocation by offering nurses a better route assignment by considering the required variables and each nurse’s daily workload.
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Olsen CF, Bergland A, Debesay J, Bye A, Langaas AG. Striking a balance: Health care providers' experiences with home-based, patient-centered care for older people-A meta-synthesis of qualitative studies. PATIENT EDUCATION AND COUNSELING 2019; 102:1991-2000. [PMID: 31160128 DOI: 10.1016/j.pec.2019.05.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The aim of this article was to synthesize research findings about health care providers' experiences of patient-centered care in the home setting. METHODS This is a meta-synthesis of qualitative findings using the analytical method of meta-ethnography developed by Noblit and Hare. We performed a systematic literature search in seven databases and assessed potential studies against eligibility criteria and quality. Subsequently, 10 primary studies were included for analysis. RESULTS The core theme "being a balance artist" emerged from the synthesis, incorporating the participants' experiences when faced with conflicting and competing responsibilities and needs. Two subthemes-"balancing the older clients' needs against organizational demands" and "balancing the older clients' needs against professional standards"-further elaborated on this core theme. CONCLUSION Health care providers' experiences indicate that organizational factors play a crucial role in shaping the conditions for patient-centered care for older people in the home setting. PRACTICE IMPLICATIONS To motivate and facilitate health care providers to move to a more patient-centered practice, it is important to expand the values of patient-centered care beyond the clinical encounter into the organization.
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Affiliation(s)
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Anne G Langaas
- Department of Physiotherapy, OsloMet- Oslo Metropolitan University, Oslo, Norway
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Alvariza A, Mjörnberg M, Goliath I. Palliative care nurses’ strategies when working in private homes—A photo‐elicitation study. J Clin Nurs 2019; 29:139-151. [DOI: 10.1111/jocn.15072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/12/2019] [Accepted: 08/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Anette Alvariza
- Department of Health Care Sciences Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Capio Palliative Care Unit Stockholm Sweden
| | - Maria Mjörnberg
- Department of Health Care Sciences Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Gröndal District Health Care Centre Home Care Stockholm County Council Sweden
| | - Ida Goliath
- Division of Innovative Care Research Department of Learning Informatics, Management and Ethics Karolinska Institutet Stockholm Sweden
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Contro D, Elli S, Castaldi SI, Formili M, Ardoino I, Caserta AV, Panella L. Continuity of care for patients with hip fracture after discharge from rehabilitation facility. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:385-393. [PMID: 31580331 PMCID: PMC7233737 DOI: 10.23750/abm.v90i3.8872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 01/12/2023]
Abstract
Background and aims of the work: Hip fracture is a dramatic event especially in the elderly and the return to the pre-fracture functional and social state is often difficult to achieve. In the post-acute, the intensive rehabilitation period aims to recover as much autonomy as possible to these patients, but not always its duration is sufficient to ensure an effective and lasting result in returning home, hence the need for additional rehabilitation services. Our aim was to evaluate the use of additional rehabilitation services by patients who underwent hip fracture after an intensive rehabilitation treatment period performed at our hospital. Methods: This is a retrospective cohort study. We involved patients aged 45 years and older, admitted at our intensive rehabilitation, who joined a rehabilitation program for a hip fracture. Results: Our results showed how the use of further physiotherapy is associated with the type of surgical intervention and with higher Cumulative Illness Rating Scale CIRS scores. Similarly, the loss of autonomy is associated with the type of intervention, the increase in CIRS and the duration of the physiotherapy, and negatively associated with the duration of each session. The re-hospitalizations for each cause is positively associated with CIRS and negatively associated with the further use of physiotherapy. Conclusions: Our conclusion is that rehabilitation needs a personalized schedule, because the real discriminating factor in the management of frail patients should therefore be the quality, and not the quantity (i.e. longer session), of the rehabilitative intervention prescribed. (www.actabiomedica.it)
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Affiliation(s)
- Diego Contro
- School of Specialization in Physical and Rehabilitation Medicine, University of Milan.
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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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Home First: Exploring the Impact of Community-based Home Care for Older Adults and Their Family Caregivers. Can J Aging 2019; 39:432-442. [PMID: 31464180 DOI: 10.1017/s0714980819000461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Given the rapidly expanding older adult population, finding health care approaches that support older adults to age in their choice of place, with an accompanying philosophical re-orientation of health services, is becoming more urgent. We studied the Home Care Home First - Quick Response Project to understand how clients over age 75 and their family caregivers perceived the enhanced community-based services delivered through Home First. Using interpretive description as the methodological design, we explored the experiences of eight older adults and 11 family caregivers; all older adults were enrolled in Home First due to a significant change in their health status. We identified four themes: growing older in chosen places with support, philosophy of care, processes of Home First, and the significance of Home First for clients. Overall, clients and family caregivers responded positively to the Home First services. Clients valued their independence and growing older in places they had specifically chosen.
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Hale K, Østbye T, Perera B, Bradley R, Maselko J. A Novel Adaptation of the HOME Inventory for Elders: The Importance of the Home Environment Across the Life Course. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2826. [PMID: 31398802 PMCID: PMC6719999 DOI: 10.3390/ijerph16162826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/27/2019] [Accepted: 07/28/2019] [Indexed: 12/14/2022]
Abstract
The context in which dependents, regardless of age, receive care affects their health. This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory, originally designed for child development research, to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka. Whether the adapted domains correlated with indicators of health and well-being in ways consistent with the child development literature was then examined. Through mixed-methods research based on 248 household surveys, four focus groups, and 15 interviews, three domains emerged: Physical Environment, Variety of Stimulation, and Emotional and Verbal Responsiveness. Regression modeling revealed that a higher quality physical home environment correlated with two measures of cognitive function after adjusting for covariates, but no consistent association with two psychological well-being scales. In contrast, higher Variety of Stimulation scores correlated with better cognitive function and lower psychological distress. There was no consistent correlation between Responsiveness and selected health outcomes. Qualitative data indicate that elders are active household contributors who strive to achieve harmonious relations with coresident kin. These findings reveal notable synergies between early and late life efforts to improve cognitive and psychological health, and highlight household considerations for future healthy aging research.
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Affiliation(s)
- Kathryn Hale
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC 27710, USA
- Center for Aging Research and Education, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Bilesha Perera
- Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka
| | - Robert Bradley
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA
| | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Reckrey JM, Federman AD, Bollens-Lund E, Morrison RS, Ornstein KA. Homebound Status and the Critical Role of Caregiving Support. J Aging Soc Policy 2019; 32:590-603. [PMID: 31242823 DOI: 10.1080/08959420.2019.1628625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The homebound population relies on both paid and family caregivers to meet their complex care needs. In order to examine the association between intensity of caregiving support and leaving the home, we identified a population of community-dwelling, homebound Medicare beneficiaries age ≥65 (n = 1,852) enrolled in the 2015 National Health and Aging Trends Study and measured the support they received from paid and family caregivers. Those who had ≥20 h of caregiving support per week had 50% less odds of being "exclusively homebound" (rarely or never leave home) (OR 0.56, p < .01). Policies that facilitate increased support for family caregivers and better access to paid caregivers may allow homebound individuals who would otherwise be isolated at home to utilize existing community-based long-term care services and supports.
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Affiliation(s)
- Jennifer M Reckrey
- Associate Professor, Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, NY, USA.,Associate Professor, Department of Medicine Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | - Alex D Federman
- Professor, Department of Medicine Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | - Evan Bollens-Lund
- Data Analytics Manager, Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | - R Sean Morrison
- Professor, Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | - Katherine A Ornstein
- Associate Professor, Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, NY, USA
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Hermer L, Bryant NS, Pucciarello M, Mlynarczyk C, Zhong B. Does Comprehensive Culture Change Adoption via the Household Model Enhance Nursing Home Residents' Psychosocial Well-being? Innov Aging 2018; 1:igx033. [PMID: 30480119 PMCID: PMC6177048 DOI: 10.1093/geroni/igx033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives Several studies suggest that to substantially improve residents’ psychosocial well-being, traditional-model nursing homes should redesign themselves as small, homelike “households” along with comprehensively adopting other aspects of “culture change,” a set of reforms meant to improve residents’ quality of life. But this evidence mainly comes from qualitative studies. This comparative, observational study tested quantitatively whether residents in a household-model nursing home that had comprehensively adopted culture change reforms displayed greater positive affect, increased cognitive engagement, more extensive social interactions with staff and greater use of the environment than did residents at partial culture-change-adopting facilities with traditional, institutional environments. Research Design and Methods Household-model residents were matched on clinical and demographic factors with residents at two institutional control facilities that had partially adopted culture change and were observed for 8 hours each. To provide potentially converging evidence, aides and nurses were also observed. Finally, a culture change implementation assessment was conducted. Results The implementation assessment showed that the household-model home had implemented culture change beyond national norms, whereas the control facilities were U.S.-typical partial adopters. It also revealed that household-model staff cared for residents in a more person-centered manner. Observation analyses revealed that household-model residents spent less time idle and less time stationary at wheelchair hubs. Moreover, although household-model residents did not spend the most time in the dining area overall, they spent the greatest percentage of time there talking with staff, displaying positive affect, and displaying active engagement. Finally, household-model residents and staff spent the most time in task-oriented interactions, including personal care. Discussion and Implications These results suggest that the intended psychosocial benefits materialize in household-model facilities, particularly in the dining area and in resident–staff relationships. The findings raise the possibility that facilities may be able to achieve these outcomes without entirely redesigning their environment.
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Affiliation(s)
- Linda Hermer
- Center for Applied Research, LeadingAge, Washington, DC
| | | | - Madeline Pucciarello
- Department of Public Health, Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ
| | - Carolina Mlynarczyk
- Department of Public Health, Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ
| | - Bridget Zhong
- Department of Public Health, Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ
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Bielsten T, Lasrado R, Keady J, Kullberg A, Hellström I. Living Life and Doing Things Together: Collaborative Research With Couples Where One Partner Has a Diagnosis of Dementia. QUALITATIVE HEALTH RESEARCH 2018; 28:1719-1734. [PMID: 30033851 DOI: 10.1177/1049732318786944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The aim of this study is to identify relevant content for a self-management guide by using the outcomes of previous research in combination with knowledge and experiences from couples where one partner has a diagnosis of dementia. The study was carried out in three phases: (a) literature search of previous research related to well-being and couplehood in dementia; (b) interviews with couples with dementia based on the findings of the literature search; and (c) further authentication of the findings within expert groups of people with dementia and carers. For analysis of data, we used a hybrid approach of thematic analysis with combined deductive and inductive approaches. The findings of this study indicated that the four main themes "Home and Neighborhood," "Meaningful Activities and Relationships," "Approach and Empowerment," and "Couplehood" with related subthemes could be appropriate targets for a self-management guide for couples where one partner has a diagnosis of dementia.
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Affiliation(s)
| | - Reena Lasrado
- 2 University of Manchester, Manchester, United Kingdom
| | - John Keady
- 2 University of Manchester, Manchester, United Kingdom
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Lindquist LA, Ramirez-Zohfeld V, Forcucci C, Sunkara P, Cameron KA. Overcoming Reluctance to Accept Home-Based Support from an Older Adult Perspective. J Am Geriatr Soc 2018; 66:1796-1799. [DOI: 10.1111/jgs.15526] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Lee A. Lindquist
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Chris Forcucci
- Aging and In-Home Services of Northeast Indiana; Fort Wayne Indiana
| | - Priya Sunkara
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Kenzie A. Cameron
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine; Northwestern University; Chicago Illinois
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Abstract
Despite the growing homebound population and the development of innovative models of care that work to bring care to people in their homes, home visits are not a routine part of education for many healthcare providers. This manuscript describes the experience of Mount Sinai Visiting Doctors teaching home-based primary care to learners of various disciplines and reports the results of a survey performed to assess trainee experience. Mount Sinai Visiting Doctors is the largest academic home-based primary care program in the country and trainees of various disciplines have nearly 1,700 contact days annually of directly supervised clinical teaching. In order to improve trainee education and meet our practice needs, trainees: 1) independently conduct urgent visits, 2) carry longitudinal panels of homebound patients, and 3) perform subspecialist consultations. Mount Sinai Visiting Doctors has exposed thousands of trainees to home-based primary care in the past 20 years and trainees report positive reviews of their experiences. As the need to train future providers in home-based primary care grows, we will be challenged to provide trainees with adequate exposure to multidisciplinary teams and to teach about the importance of continuity of care.
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Affiliation(s)
- Jennifer M Reckrey
- Jennifer M. Reckrey, MD, is an Assistant Professor, Department of Geriatrics and Palliative Medicine, and Department of Medicine Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Katherine A. Ornstein, PhD, is an Assistant Professor, Department of Geriatrics and Palliative Medicine, and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York. Ania Wajnberg, MD, is an Associate Professor, Department of Medicine Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. M. Victoria Kopke, MD, is an Assistant Professor, Department of Medicine Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Linda V. DeCherrie, MD, is an Associate Professor, Department of Geriatrics and Palliative Medicine, and Department of Medicine Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Shishehgar M, Kerr D, Blake J. A systematic review of research into how robotic technology can help older people. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.smhl.2018.03.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berglund M, Gillsjö C, Svanström R. Keys to person-centred care to persons living with dementia - Experiences from an educational program in Sweden. DEMENTIA 2018; 18:2695-2709. [PMID: 29368533 DOI: 10.1177/1471301218754454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Growing old entails an increased risk of disabilities and illnesses such as dementia. The orientation in Sweden on national level is that individuals remain in their own homes if desired and receive person-centred home care. The aim of this study was to describe the experience of an educational program and its influence on daily provision of care to persons with dementia. A life-world approach was used. Data were collected through group interviews with care providers in the context of home. The findings are presented in five themes: Increased knowledge about dementia and treatment, Relationship-building in order to provide good care, Open and flexible approach conveys calm, Continuity and flexibility are cornerstones in the care and Perceived improvements. This person-centred educational intervention resulted in a care that was based on each individual’s personality, preferences and priorities in life. Education given with continuity over time is key to improving provision of care to person with dementia.
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Affiliation(s)
- Mia Berglund
- School of Health and Education, University of Skövde, Sweden
| | - Catharina Gillsjö
- School of Health and Education, University of Skövde, Sweden; College of Nursing, University of Rhode Island, USA
| | - Rune Svanström
- School of Health and Education, University of Skövde, Sweden
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Cary MP, Prvu Bettger J, Jarvis JM, Ottenbacher KJ, Graham JE. Successful Community Discharge Following Postacute Rehabilitation for Medicare Beneficiaries: Analysis of a Patient-Centered Quality Measure. Health Serv Res 2017; 53:2470-2482. [PMID: 29134630 DOI: 10.1111/1475-6773.12796] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the sociodemographic and clinical characteristics as well as health services use associated with successful community discharge. DATA SOURCE Inpatient Rehabilitation Facility-Patient Assessment Instrument and Medicare Provider Analysis and Review files. STUDY DESIGN We retrospectively examined 167,664 Medicare beneficiaries discharged from inpatient rehabilitation facilities (IRFs) in 2013 to determine the sociodemographic and clinical characteristics as well as health services use associated with successful community discharge. PRINCIPAL FINDINGS In the multivariable model, sociodemographic (younger age, no disability, social support), clinical (higher motor and cognitive functional status at admission), and health services use (fewer acute care days and longer IRF days) variables were associated with successful community discharge. CONCLUSIONS Remaining in the community is an important patient-centered outcome that could complement other postacute rehabilitation quality measures.
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Affiliation(s)
| | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC
| | - Jessica M Jarvis
- University of Illinois, College of Applied Health Sciences, Chicago, IL
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX
| | - James E Graham
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX
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Impact of Living Alone on Depressive Symptoms in Older Korean Widows. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101191. [PMID: 28991166 PMCID: PMC5664692 DOI: 10.3390/ijerph14101191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 11/17/2022]
Abstract
We examined the relationship between living alone and the prevalence of depressive symptoms in older Korean widows and assessed the individual contributions of health, social ties, and socioeconomic factors to the development of depressive symptoms. The study was a secondary analysis using data from widows, 65 years of age and older, who participated in the Living Profiles of Older People Survey (LPOPS). A logistic regression analysis was used to evaluate the contributions of health, social ties, and socioeconomic factors to the development of depressive symptoms. Working status and equivalent household income were significantly associated with depressive symptoms in both those living with others and those living alone. Adjustment for health status and social ties did not change the impact of living alone on the prevalence of depressive symptoms. However, adjustment for equivalent household income eliminated the negative association between living alone and depressive symptoms. Our findings indicate that economic resources are more important than health and social ties for alleviating the negative impact of living alone on the development of depressive symptoms in older widows.
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