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Northwood M, Didyk N, Hogeveen S, Nova A, Kalles E, Heckman G. Integrating a Standardized Self-Report Tool into Geriatric Medicine Practice during the COVID-19 Pandemic: A Mixed-Methods Study. Can J Aging 2024; 43:12-22. [PMID: 37503824 DOI: 10.1017/s0714980823000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Specialized geriatric services care for older adults (≥ 65 years of age) with dementia and other progressive neurological disorders, frailty, and mental health conditions were provided both virtually and in person during the pandemic. The objective of this study was to implement a software-enabled standardized self-report instrument - the interRAI Check-Up Self-Report - to remotely assess patients. A convergent, mixed-methods research design was employed. Staff found the instrument easy to use and the program-level metrics helpful for planning. Most patients urgently needed a geriatrician assessment (72%) and had moderate to severe cognitive (34%) and functional impairments (34%), depressive symptoms (53%), loneliness (57%), daily pain (32%), and distressed caregivers (46%). Implementation considerations include providing ongoing support and facilitating intersectoral collaboration. The Check Up enhanced the geriatric assessment process by creating a system to track all needs for immediate and future care at both the patient and program level.
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Affiliation(s)
- Melissa Northwood
- School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre, Hamilton, ON, Canada
| | - Nicole Didyk
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sophie Hogeveen
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Amanda Nova
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Elizabeth Kalles
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - George Heckman
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Kim B, Wister A, O'dea E, Mitchell BA, Li L, Kadowaki L. Roles and experiences of informal caregivers of older adults in community and healthcare system navigation: a scoping review. BMJ Open 2023; 13:e077641. [PMID: 38070939 PMCID: PMC10729038 DOI: 10.1136/bmjopen-2023-077641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Informal caregivers are playing a vital role in improving the degree to which older adults access community and healthcare systems in a more seamless and timely manner, thereby fulfilling their complex needs. It is critical to understand their experiences and perspectives while navigating these systems. This review aimed to identify and organise the research findings on the roles and experiences of informal caregivers of older adults while navigating community and healthcare systems. DESIGN This scoping review was undertaken according to the Joanna Briggs Institute's Reviewer manual. Four databases were used: AgeLine, PsycINFO, CINAHL and Medline to capture literature with a focus on informal caregivers whose care recipients are aged 55 years or older. Articles were included if they focused on examining the experience, perspective and/or role of informal caregivers in providing care for their older care recipients, while articles were excluded if they only focused on healthcare professionals or older adults. RESULTS A total of 24 studies were identified that met the study inclusion criteria. This review elucidated the roles of caregivers as a primary system navigator and as an advocate for older adults. Numerous challenges/barriers in system navigation were uncovered, such as lack of consistency in fragmented systems, as well as facilitators, including interface/coordination roles. Finally, recommendations for better system navigation such as caregiver engagement and integration of continuity of care services were identified. CONCLUSION The need to raise the visibility of the roles and experiences of informal caregivers in system navigation was highlighted. Further research needs to focus on implementing interventions for informal caregivers incorporating a care coordinator to fill the care gap within community and healthcare systems. This review has the potential to foster greater integration of community and healthcare systems.
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Affiliation(s)
- Boah Kim
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Andrew Wister
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Eireann O'dea
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Barbara A Mitchell
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Gerontology & Sociology/Anthropology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lun Li
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - Laura Kadowaki
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
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Aggarwal R, Brar S, Goodstadt M, Devitt R, Penny S, Ramachandran M, Underwood D, Taylor CF. Using Comprehensive Geriatric Assessment in Identifying Care Goals and Referral Services in a Frailty Intervention Clinic. Can Geriatr J 2023; 26:530-537. [PMID: 38045879 PMCID: PMC10684302 DOI: 10.5770/cgj.26.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
The proportion of older adults and frail adults in Canada is expected to rise significantly in upcoming years. Currently, a considerable number of older adults do not actively participate in developing their own care plans; prior research has indicated several benefits of patient engagement in this process. Thus, we conducted a mixed methods study that examined the prevalence of rehabilitation goals and identified these for 305 community dwelling older adults referred to a frailty intervention clinic utilizing Comprehensive Geriatric Assessment (CGA) between 2014 and 2018. Top patient concerns included mobility (84%), services, systems, and policies (51%), sensory functions and pain (50%), and self-care or domestic life (47%). The most common referrals or recommendations for patients included further follow-up with a physician or specialist (36%), referral to an onsite falls prevention clinic (31%), and medication modifications (31%). Based upon these findings, we recommend greater utilization of CGA within a team-based approach to improve patient care by allowing for greater collaboration and shared decision-making by health-care providers. Moreover, CGA can be an effective tool to meet the complex and unique health-care needs of frail patients while incorporating patient goals. This is vitally important considering the predicted growth in the population of frail and/or older patients, as well as the current challenges and shortfalls in meeting the health-care needs of this population.
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Affiliation(s)
- Reenika Aggarwal
- Providence Healthcare, Unity Health Toronto, Toronto, ON
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Suraj Brar
- Providence Healthcare, Unity Health Toronto, Toronto, ON
| | - Michael Goodstadt
- Providence Healthcare, Unity Health Toronto, Toronto, ON
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Rachel Devitt
- Providence Healthcare, Unity Health Toronto, Toronto, ON
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Sara Penny
- Providence Healthcare, Unity Health Toronto, Toronto, ON
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Brooks A. Dysphagia and aspiration during a Parkinson's hospitalization: a care partner's perspective and recommendations for improving standards of care. Front Aging Neurosci 2023; 15:1258979. [PMID: 37876878 PMCID: PMC10590889 DOI: 10.3389/fnagi.2023.1258979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/06/2023] [Indexed: 10/26/2023] Open
Abstract
People with Parkinson's disease have a significantly increased incidence and risk of aspiration pneumonia when compared to those without. Aspiration pneumonia associated with dysphagia (swallowing issues), which is the leading cause of death among people with Parkinson's disease, accounting for 25% of Parkinson's deaths. There is relatively limited evidence of the most effective strategies to balance the competing needs of each Parkinson's patient as providers aim to prevent, diagnose, and manage dysphagia. Exacerbated, and in part caused, by the intricacies of dysphagia and Parkinson's disease, there is still limited understanding among hospital providers and the Parkinson's community regarding the most appropriate measures to prevent and manage dysphagia in Parkinson's disease. The Parkinson's Foundation Hospital Care Recommendations identified the prevention and management of dysphagia as a care standard necessary to eliminate harm and attain higher reliability in care. This article discusses key components of dysphagia management in the hospital, provides a case example to demonstrate the challenges that people with PD and their care partners experience in the hospital related to dysphagia, and offers recommendations on how to better manage dysphagia and involve care partners in PD hospital care.
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Affiliation(s)
- Annie Brooks
- Strategic Initiatives, Parkinson's Foundation, New York, NY, United States
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Souza GAD, Giacomin KC, Firmo JOA. "My life is about to take care of myself": therapeutic itineraries of care for frail older adults. CIENCIA & SAUDE COLETIVA 2023; 28:2637-2652. [PMID: 37672453 DOI: 10.1590/1413-81232023289.14372022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/23/2023] [Indexed: 09/08/2023] Open
Abstract
The present study sought to understand how frail older adults perceive their therapeutic care itineraries. This qualitative research was based on Critical Medical Anthropology. Data were collected through interviews in the homes of 22 older adults, whose average age was 79. The emic analysis was guided by the model of Signs, Meanings, and Actions. All interviewees expressed access to professional care in their trajectories, which are understood as insufficient, unprepared, prejudiced, uncomfortable, contradictory, (un)accessible, realization, respectful, and excessive. Therapeutic itineraries were also revealed in the psychosocial and cultural spheres. Several day-to-day actions were evaluated and interpreted in the record of self-care and justified by this end: the time they wake up, sleep, what they eat, and how they behave. They face the lack of care policies in their trajectories, labeling their bodies as undesirable due to physical, symbolic, communicational, attitudinal, systematic, cultural, and political barriers. Thus, they bring to light therapeutic pluralism, challenges, confrontations, insistence, and resistance in maintaining care when experiencing old age with frailties.
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Affiliation(s)
- Gislaine Alves de Souza
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou - Fundação Oswaldo Cruz (Fiocruz Minas). R. Uberaba, 780, sala 6, Barro Preto. 30180-080 Belo Horizonte MG Brasil.
| | - Karla Cristina Giacomin
- Núcleo de Estudos em Saúde Pública e Envelhecimento (NESPE), Instituto René Rachou - Fundação Oswaldo Cruz (Fiocruz Minas). Belo Horizonte MG Brasil
- Secretaria Municipal de Saúde, Prefeitura de Belo Horizonte. Belo Horizonte MG Brasil
| | - Josélia Oliveira Araújo Firmo
- Núcleo de Estudos em Saúde Pública e Envelhecimento (NESPE), Instituto René Rachou - Fundação Oswaldo Cruz (Fiocruz Minas). Belo Horizonte MG Brasil
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Canet-Vélez O, Solis-Navarro L, Sitjà-Rabert M, Pérez LM, Roca J, Soto-Bagaria L, Torres-Castro R, Díaz-Gallego F, Vilaró J, Inzitari M. Experience, facilitators, and barriers to the implementation of a multicomponent programme in older people living in the community, +AGIL Barcelona: A qualitative study. Front Public Health 2023; 11:1161883. [PMID: 37064681 PMCID: PMC10097946 DOI: 10.3389/fpubh.2023.1161883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
IntroductionThe +AGIL Barcelona programme is a multicomponent care intervention for frail older adults (FOAs) living in the community. To improve the programme, it is essential to investigate the experience of all participants. Our objective was to explore the perspective of FOA and professionals about the barriers, facilitators, and improvement elements of the development of the +AGIL Barcelona programme. Qualitative descriptive approach. Were included FOA and professionals who participated in the +AGIL Barcelona programme.MethodsThree focus groups and four interviews were conducted. These were analyzed following the qualitative method of content analysis. The criteria of scientific rigor of credibility, dependence, and transferability were ensured throughout the study.ResultsThree themes and seven sub-themes were developed: facilitators (positive experience and perceived benefits), barriers (self-perceived health status, digital divide, and continuity of the programme at home), and improvements elements (programme continuity and adaptation of technology). All the participants felt satisfied, highlighting aspects such as interpersonal relationships and social contact, face-to-face sessions guided by a physiotherapist, and the functional improvement achieved. Some of the difficulties were the self-perception of frailty, the need for technological support, and continuing the exercise programme at home.ConclusionThe FOA who participated in the +AGIL Barcelona programme perceived direct benefits for their health and physical condition due to the development of self-confidence by being able to perform physical exercise despite their baseline condition, and the professionals experienced an improvement in the quality of care due to work in a multidisciplinary team.
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Affiliation(s)
- Olga Canet-Vélez
- Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Research Group Global Health, Gender and Society (GHenderS), Barcelona, Spain
| | - Lilian Solis-Navarro
- Programa de Doctorat-Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Global Research on Wellbeing (GRoW), Barcelona, Spain
| | - Mercè Sitjà-Rabert
- Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Global Research on Wellbeing (GRoW), Barcelona, Spain
- *Correspondence: Mercè Sitjà-Rabert
| | - Laura Mónica Pérez
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d'Hebron Institute (VHIR), Barcelona, Spain
| | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, Lleida, Spain
| | - Luis Soto-Bagaria
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d'Hebron Institute (VHIR), Barcelona, Spain
| | | | - Francisco Díaz-Gallego
- Institut Català de la Salut, Gerència de Barcelona, Barcelona, Spain
- Primary Healthcare Center Bordeta-Magòria, Institut Català de la Salut, Barcelona, Spain
| | - Jordi Vilaró
- Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Global Research on Wellbeing (GRoW), Barcelona, Spain
| | - Marco Inzitari
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d'Hebron Institute (VHIR), Barcelona, Spain
- Faculty of Health Sciences and eHealth Center, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
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Jung I, Bloomfield K, Hikaka J, Tatton A, Boyd M. "Making an effort for the very elderly": The acceptability of a multidisciplinary intervention to retirement village residents. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5356-e5365. [PMID: 35913001 PMCID: PMC10087237 DOI: 10.1111/hsc.13957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/22/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
The retirement village (RV) population is a growing one, with many residents having unmet healthcare needs. Despite this, there is a relative paucity of research in the RV community. We previously performed a randomised controlled trial (RCT) of a multidisciplinary (MD) nurse-led community intervention versus usual care within 33 RVs in Auckland, New Zealand. Participant acceptability is an important aspect in assessing intervention feasibility and effectiveness. The aim of this current qualitative study was to assess the acceptability of the intervention in participating residents. Data were collected using semi-structured interviews designed around the Theoretical Framework of Acceptability. Thematic analysis was undertaken using a general inductive approach. Of the 199 participants in the intervention arm of the original RCT, 27 were invited to take part in this qualitative study. Fifteen participants were recruited with a median age of 89 years, 10 were female and all were of European ethnicity. Participants were generally positive about the intervention and research processes. Three themes were identified: (1) participants' understanding of intervention aims and effectiveness; (2) the importance of older adult involvement and (3) level of comfort in the research process. Despite the MD intervention being deemed acceptable across several domains, results provided learning points for the future design of MD interventions in RV residents and older adults more generally. We recommend that future intervention studies incorporate co-design methodologies which may improve the likelihood of intervention success.
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Affiliation(s)
- Isabelle Jung
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Katherine Bloomfield
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
- Waitematā District Health BoardAucklandNew Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Annie Tatton
- Waitematā District Health BoardAucklandNew Zealand
| | - Michal Boyd
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
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Giguere A, Holroyd-Leduc JM, Straus SE, Urquhart R, Turcotte V, Durand PJ, Turgeon A. Prioritization of indicators of the quality of care provided to older adults with frailty by key stakeholders from five canadian provinces. BMC Geriatr 2022; 22:149. [PMID: 35197016 PMCID: PMC8864862 DOI: 10.1186/s12877-022-02843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population. Methods In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview. Stakeholders included older adults with frailty and their caregivers, healthcare providers (HCPs), and healthcare administrators or policy/decision makers (DMs). We conducted descriptive statistical analyses of quantitative variables, and deductive thematic qualitative analyses of interview transcripts. Results The 42 participants (8 older adults, 18 HCPs, and 16 DMs) rated six QIs as more important: increasing the patients’ quality of life; increasing healthcare staff skills; decreasing patients’ symptoms; decreasing family caregiver burden; increasing patients’ satisfaction with care; and increasing family doctor continuity of care. Conclusions Key stakeholders prioritized QIs that focus on outcomes targeted to patients and caregivers, whereas the current healthcare systems generally focus on processes of care. Quality improvement initiatives should therefore take better account of aspects of care that are important for older adults with frailty, such as having a chance to express their individual goals of care, receiving quality communications from HCPs, or monitoring symptoms that they might not spontaneously describe. Our results point to the need for patient-centred care that is oriented toward quality of life for older adults with frailty. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02843-9.
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Affiliation(s)
- Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada. .,Quebec Excellence Centre on Aging, Quebec, Canada. .,VITAM - Research Centre on Sustainable Health (Centre de recherche en santé durable), 2480, chemin de la Canardière, QC, G1J 0A4, Québec, Canada.
| | | | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | | | - Pierre J Durand
- Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
| | - Alexis Turgeon
- Population Health and Optimal Health Practices Research Unit, Division of Critical Care Medicine, CHU de Quebec - Université Laval Research Centre, Université Laval, Quebec, Canada
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9
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Carter C, Leanza F, Mohammed S, Upshur REG, Kontos P. A rapid scoping review of end-of-life conversations with frail older adults in Canada. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:e298-e305. [PMID: 34772723 DOI: 10.46747/cfp.6711e298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To explore what is known about end-of-life (EOL) conversations with frail older adults across all settings including primary care in Canada, and to understand the barriers to, and recommendations for, EOL conversations. DATA SOURCES Comprehensive searches were conducted in CINAHL (EBSCO), Embase (Ovid), MEDLINE (Ovid), AgeLine (EBSCO), Sociological Abstracts (ProQuest), and Applied Social Sciences Index and Abstracts (ProQuest). Searches used text words and subject headings (eg, MeSH, Emtree) related to 3 concepts: frailty, Canada, and EOL conversations. STUDY SELECTION Twenty-one English-language articles were selected (ie, 4 reviews, 10 commentaries, 3 quantitative studies, 3 qualitative studies, 1 mixed-methods study) that included information about EOL conversations with frail older adults in the Canadian health care context. SYNTHESIS In terms of having EOL conversations with frail older adults, this study found that many clinicians do not often and adequately discuss frailty and impending death with their older patients. Moreover, patients and their care partners do not have enough knowledge about frailty and death to make informed EOL decisions, leading to patients choosing more aggressive therapies instead of care focused on symptom management. In terms of barriers to EOL discussions, common barriers included a lack of trust between clinician and patient, inadequate EOL training for clinicians, and ineffective clinician communication with patients and families. Recommendations for improving EOL conversations include regular screening for frailty to prompt conversations about care and the use of an interprofessional approach. CONCLUSION More empirical research is needed that uses exploratory methods to shed light on the contextual factors that may act as a barrier to EOL conversations. More research is also needed on the roles and responsibilities of interprofessional teams in screening for frailty and engaging in EOL conversations. Moreover, there is a need to better understand how frail older patients and their families want EOL conversations to unfold and what best facilitates these conversations.
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Affiliation(s)
- Celina Carter
- PhD candidate in the Dalla Lana School of Public Health at the University of Toronto in Ontario.
| | - Francesco Leanza
- Family physician and Assistant Professor in the Department of Family and Community Medicine at the University of Toronto
| | - Shan Mohammed
- Assistant Professor, Teaching Stream, in the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto, and a faculty member in the Global Institute of Psychosocial, Palliative and End-of-Life Care, at the University Health Network in Toronto
| | - Ross E G Upshur
- Family physician and Professor in the Department of Family and Community Medicine and the Dalla Lana School of Public Health at the University of Toronto, Head of the Division of Clinical Public Health at the Dalla Lana School of Public Health, and Scientific Director of the Bridgepoint Collaboratory for Research and Innovation
| | - Pia Kontos
- Senior Scientist in the KITE-Toronto Rehabilitation Institute at the University Health Network, and Professor in the Dalla Lana School of Public Health at the University of Toronto
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10
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Silva AMDM, Mambrini JVDM, Andrade JM, Andrade FBD, Lima-Costa MF. [Frailty in elderly individuals and perception of problems in indicators of attributes of primary healthcare: results of the ELSI-Brasil]. CAD SAUDE PUBLICA 2021; 37:e00255420. [PMID: 34586170 DOI: 10.1590/0102-311x00255420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
This study aimed to examine the association between frailty syndrome and the perception of problems in indicators of attributes in primary healthcare (PHC) among elderly Brazilians. This was a cross-sectional study with 5,432 participants 60 years or older in the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brasil), conducted in 2015 and 2016. Frailty, the independent variable, was defined according to the theoretical framework of the frailty phenotype, and the indicators of problems in PHC attributes, the dependent variables, were obtained from questions related to health services use. Access, longitudinal care, coordination, comprehensiveness, family orientation, and cultural adequacy were the target attributes. For the data analysis, logistic regression models were used, adjusted for predisposing, enabling, and need factors for use of health services. Among the participants, 55.1% were females, 57.9% were 60 to 69 years of age, and 51.8% reported multimorbidity. Frail and pre-frail elders accounted for 13.4% and 54.5% of the sample, respectively. Multivariate analyses showed that frail elders (compared to robust elders) showed higher odds of reporting problems with access (OR = 1.45; 95%CI: 1.08-1.93), longitudinal care (OR = 1.54; 95%CI: 1.19-2.00), and comprehensive care (OR = 1.45; 95%CI: 1.14-1.85), in addition to more problems with attributes of PHC (OR = 1.38; 95%CI: 1.05-1.82, for 5 or more). The study suggests the occurrence of inequities in the care provided by Brazilian PHC for frail elders, particularly in the attributes of access, longitudinal care, and comprehensiveness.
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Affiliation(s)
| | | | | | | | - Maria Fernanda Lima-Costa
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.,Programa de Pós-graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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11
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Srizongkhram S, Chiadamrong N, Shirahada K. Critical Success Factors in Adoption of Wearable Technology Devices for Seniors in Thailand. INTERNATIONAL JOURNAL OF INNOVATION AND TECHNOLOGY MANAGEMENT 2021. [DOI: 10.1142/s0219877021500206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The adoption of wearable devices has been proposed as a promising approach to improve the well-being of senior in Thai care services. This study aims to find the critical success factors (CSFs) in adopting wearable technology from the stakeholder perspective. We collected data from total 27 participants from three groups of stakeholders: formal caregivers, informal caregivers, and seniors. Using the grounded theory approach, we found four types of CSFs and its variety in according to devices and stakeholders’ viewpoints. Based on the findings, this paper also discusses how to develop wearable devices to satisfy stakeholder requirements and improve their wellbeing.
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Affiliation(s)
- Shayarath Srizongkhram
- School of Knowledge Science, Japan Advanced Institute of Science and Technology, Asahidai, Nomi, Ishikawa 923-1211, Japan
- School of Manufacturing Systems and Mechanical Engineering (MSME), Sirindhorn International Institute of Technology (SIIT), Thammasat University, Paholyothin Highway Khlong Luang, Pathum Thani 12120, Thailand
| | - Navee Chiadamrong
- School of Manufacturing Systems and Mechanical Engineering (MSME), Sirindhorn International Institute of Technology (SIIT), Thammasat University, Paholyothin Highway Khlong Luang, Pathum Thani 12120, Thailand
| | - Kunio Shirahada
- School of Knowledge Science, Japan Advanced Institute of Science and Technology, Asahidai, Nomi, Ishikawa 923-1211, Japan
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12
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Kennedy F, Galvin R, Horgan NF. Managing frailty in an Irish primary care setting: A qualitative study of perspectives of healthcare professionals and frail older patients. J Frailty Sarcopenia Falls 2021; 6:1-8. [PMID: 33817445 PMCID: PMC8017349 DOI: 10.22540/jfsf-06-001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Little is known about the views of key stakeholders on frailty in Primary Care in Ireland. The aim of this study was to explore the views of Irish healthcare professionals and patients on frailty and its management in Primary Care. METHODS A qualitative descriptive design was used. Seventeen healthcare professionals and three patients were recruited using purposive sampling. Data were collected using semi-structured interviews which were analysed thematically. RESULTS Three themes were identified: (i) Perceptions of Frailty (ii) Current Management of Frailty and (iii) Comprehensive Geriatric Assessment in Primary Care. The results demonstrated variability in perspectives on frailty. Healthcare professionals described a fragmented service often delivering substandard care to frail older patients. The general consensus was that frailty management required an adequately resourced Primary Care service. Support for frailty screening and Comprehensive Geriatric Assessment was evident while the suitability of the current pathway for patients requiring assessment was questioned. CONCLUSION This study highlights an absence of a shared and complete understanding of frailty among healthcare professionals and a fragmented model of care for community-dwelling frail older patients. Based on these findings, inter-professional training, investment in Primary Care, the development of a frailty pathway and an interface service is recommended.
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Affiliation(s)
- Fiona Kennedy
- Meath Primary Care Services, Community Health Organisation (CHO) 8, Health Service Executive (HSE), Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick (UL), Ireland
| | - N. Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), Ireland
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Rasmussen RL, Holst M, Nielsen L, Villumsen M, Andreasen J. The perspectives of health professionals in Denmark on physical exercise and nutritional interventions for acutely admitted frail older people during and after hospitalisation. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2140-2149. [PMID: 32483900 DOI: 10.1111/hsc.13025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
Frailty is associated with several negative health outcomes, such as readmissions to hospital. Physical exercise, including strength training and nutritional optimisation are essential parts of documented interventions for frail older people in preventing or minimising frailty. Further knowledge is necessary to ensure feasible and successful interventions encompassing both physical exercise and nutritional optimisation. The aim of this qualitative study was to investigate the perspectives of health professionals on which factors may affect interventions, including physical exercise and nutrition, for frail older people in relation to discharge after acute admission to hospital. Data were gathered in two semi-structured focus groups, totalling 11 health professionals working with frail older people in a Danish university hospital and a municipality. The sampling of participants was purposive and the interviews were facilitated by a semi-structured interview guide. Data were analysed applying a six-step data-driven thematic analysis. Findings showed that health professionals experienced working with nutritional optimisation and physical exercise within a frail older population as challenging, and they mostly used extrinsic motivation, such as incentives, deals or intensified messages, as external factors in their approaches as to affect specific behaviours. A discourse on the importance of activity- and functional training was prevalent, while diverging perspectives were present in relation to strength training, which was considered less feasible or meaningful in a community-dwelling setting. Organisational barriers such as communication between sectors and time limitations affected negatively the work of health professionals, as they hindered co-ordinated and adequate interventions from the health professionals. Findings and theory-based knowledge indicate that health professionals should work towards a person-centred approach, which includes goal-setting, to improve physical training and nutritional interventions for frail older people. Furthermore, health professionals may need more support in order to incorporate strength training in interventions. In addition to this, improved co-ordination between sectors is warranted.
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Affiliation(s)
- Rikke L Rasmussen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Holst
- Center for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurine Nielsen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Villumsen
- Department of Elderly and Health, Section of Training and Activity, Aalborg Municipality, Aalborg, Denmark
- SMI®, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
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