Obstacles to access to community care in urban senior-only households: a qualitative study

Association between cooking with solid fuels and depressive symptoms among middle-aged and older adults in China: The mediating effect of the residential environment

BACKGROUND

Depression is a common issue among elderly people in both developing and developed countries. Existing research indicates that cooking with solid fuels has a negative impact on the mental health of middle-aged and elderly people (aged 45 and older). However, the potential role of the residential environment in this process is not yet clear. Clarifying this issue may help identify effective interventions to improve public health for elderly people. This study aimed to explore the association between cooking with solid fuels and depressive symptoms, as well as the potential mediating role of the residential environment in this relationship.

METHOD

This study utilized cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS) for 2020, involving approximately 19,000 respondents aged 45 years and older. Propensity score matching (PSM) was used to explore the association between cooking with solid fuels and depressive symptoms. Additionally, a range of potential covariates were adjusted, and the Sobel test was applied to assess the potential mediating effect of the residential environment on this relationship.

RESULTS

According to the fully adjusted model, cooking with solid fuels was significantly associated with an increased risk of depressive symptoms in middle-aged and older adults (β = 0.315, P < 0.001), and this finding was confirmed through robustness tests using different propensity score matching methods. Heterogeneity analysis revealed that this association was particularly significant among men (β = 0.318, P < 0.001), those aged 60-74 (β = 0.347, P < 0.001), and individuals with a middle school education (β = 0.353, P < 0.001). Mediation effect analysis revealed that indoor cleanliness (β = 0.0090, P < 0.001), indoor broadband coverage (β = 0.0077, P < 0.001), and the installation of indoor air purifiers (β = 0.0010, P < 0.1) mediated the relationships between cooking with solid fuels and depressive symptoms.

CONCLUSION

Given the growing attention given to improving indoor environments and enhancing mental health, the findings of this paper highlight that improving indoor cleanliness, increasing broadband coverage indoors, and installing air purifiers can effectively intervene in and prevent depressive symptoms caused by cooking with solid fuels.

Testing contingency theory to drive organizational change in community care: A case study in the Emilia Romagna Region

PURPOSE

The objective is to test contingency theory among "community homes" in a region in Northern Italy. Community homes constitute an emerging key setting in the Italian primary healthcare system and are emblematic of the most recent organizational solutions in primary care across countries.

METHODS

A case study was carried out through semi-structured interviews administered in community homes to key professionals. Results were validated in two communities of practices.

FINDINGS

Several elements of organizational and managerial variability were detected across the sample of community homes involved in the study, although they were all responding to the same regulations and normative pressures.

ORIGINAL VALUE

The study provides preliminary evidence on the role of contingency theory in the primary healthcare sector, shedding light on its characteristics and providing food for thought on the extent to which organizational variability should be supported, rather than hindered.

Exploring the priorities of ageing populations in Pakistan, comparing views of older people in Karachi City and Thatta

As a lower middle-income country, Pakistan faces multiple issues that influence the course of healthy ageing. Although there is some understanding of these issues and the objective health outcomes of people in Pakistan, there is less knowledge on the perceptions, experiences, and priorities of the ageing population and their caretakers (hereafter, "stakeholders"). The aim of the study was to identify the needs and priorities of older adults and stakeholders across both urban and rural locations. We sought to explore the views of two groups of people, older adults and stakeholders on topics including the definition of ageing as well as areas of importance, services available, and barriers to older people living well. Two-day workshops were conducted in one rural city, Thatta and one urban city, Karachi. The workshops were designed using the Nominal Group Technique, which included plenary and roundtable discussions. The responses were ranked through rounds of voting and a consensus priority list was obtained for each topic and group. Responses were categorized using the socio-ecological framework. Responses were compared between stakeholders and older people and between different geographical areas. 24 urban and 26 rural individuals aged over 60 years and 24 urban and 26 rural stakeholders attended the workshops. There were few areas of agreement with respect to both geographical region and participant group. Comparing older adults' definition of ageing, there was no overlap between the top five ranked responses across urban and rural locations. With respect to areas of importance, there was agreement on free health care as well as financial support. In terms of barriers to healthy ageing, only nation-wide inflation was ranked highly by both groups. In addition, there were relatively few areas of congruence between stakeholder and older adult responses, irrespective of location, although engagement with family, adequate nutrition and monetary benefits were responses ranked by both groups as important for healthy ageing. Both groups ranked issues with the pension system and financial difficulties as barriers. When categorized using the socio-ecological model, across all questions, societal factors were prioritized most frequently (32 responses), followed by individual (27), relationship (15), and environment (14). Overcoming barriers to facilitate healthy ageing will require a multi-faceted approach and must incorporate the priorities of older individuals. Our results may serve as a guide for researchers and policymakers for future engagement and to plan interventions for improving the health of the ageing population in Pakistan.

The experiences and needs of older adults receiving voluntary services in Chinese nursing home organizations: a qualitative study

BACKGROUND

Older adults living in nursing home organizations are eager to get voluntary help, however, their past experiences with voluntary services are not satisfactory enough. To better carry out voluntary services and improve the effectiveness of services, it is necessary to have a deeper understanding of the experiences and needs of older adults for voluntary services.

METHODS

The purposive sampling method was used to select 14 older adults from two nursing home organizations in Hangzhou and conduct semi-structured interviews, Collaizzi's seven-step method was used to analyze the data.

RESULTS

Older adults in nursing home organizations have both beneficial experiences and unpleasant service experiences in the process of receiving voluntary services; Beneficial experiences include solving problems meeting needs and feeling warmth and care, while unpleasant service experiences include the formality that makes it difficult to benefit truly, lack of organization, regularity, sustainability, and the mismatch between service provision and actual demands. The needs for voluntary services mainly focuses on emotional comfort, Cultural and recreational, and knowledge acquisition.

CONCLUSION

Older adults in nursing home organizations have varied voluntary experiences, and their voluntary service needs are diversified. Voluntary service needs of older adults should be accurately assessed, and voluntary service activities should be focused upon.

Knowledge, familiarity, and impact of the COVID-19 pandemic on barriers to seeking mental health services among older people: a cross-sectional study

AIM

The COVID-19 pandemic caused drastic changes in older people's daily activities with a negative impact on their mental health, yet older people are less likely to seek mental health services. This study aims to explore the relationship between knowledge of and familiarity with mental health services, along with the impact of the COVID-19 pandemic, and barriers to seeking mental health services among older people.

METHODS

A descriptive cross-sectional study was conducted with a convenience sample of 352 older people, recruited among community-dwelling adults who attended randomly selected postal offices and pension outlets. Three tools were used: a structured interview schedule for sociodemographic and clinical characteristics of older people, the revised version of the Knowledge and Familiarity of Mental Health Services Scale (KFFMHS-R), and the Barriers to Mental Health Services Scale Revised (BMHSS-R).

RESULTS

All participants reported experiencing mental health distress during the COVID-19 pandemic. Intrinsic barriers had a higher mean score than extrinsic barriers, and 27.4% of the variance of overall barriers to seeking mental health could be explained through regression analysis by familiarity, knowledge of mental health services, and age. Overall barriers explained 24.4% of the variance of older people's perceived distress as an impact of the COVID-19 pandemic (F = 22.160, P < 0.001).

CONCLUSIONS

Knowledge of mental health services was the most significant predictor of barriers to seeking mental health services during the COVID-19 pandemic. Higher barriers predicted higher distress as an impact of the COVID-19 pandemic. The results of the study suggest the need for a multidisciplinary mental health team for older people.

A Scoping Review of the Factor Associated with Older Adults' Mobility Barriers

The phenomenon of ageing may contribute to the rise of the dependent population. Due to the obstacles and difficulties they confront, the elderly's mobility decreases significantly. The aim of this article is to identify factors associated with mobility barriers in older adults. The method employed is an examination of articles published between 2011 and 2022 to identify common themes in previous studies. Four search engines were being used, and 32 articles have been included. This study demonstrated that health is a major factor associated with decreased mobility. This review identified four types of barriers which are health, built environment, socio-economic background and social relation change. This review could help policy makers and gerontologist in identifying solutions to resolve the mobility issues in older people.

Clinical Effect of Application of Interventional Treatment Models for Improvement of Quality of Postoperative Recovery in Elderly Patients with Total Hip Arthroplasty

OBJECTIVE

To investigate the application value of the interventional treatment model for improving the recovery of elderly patients after total hip arthroplasty (THA).

METHODS

A total of 50 patients who received THA were randomly divided into the control group (25 cases) undergoing traditional treatment and the experimental group (25 cases) undergoing intervention of cognition, emotion, environment, education, nutrition, and sleep. The mini-mental state examination (MMSE) score, the incidence and duration of postoperative cognitive dysfunction (POCD), the out-of-bed activity time, hospital stays, and the satisfaction degree of patients were compared between the two groups.

RESULTS

There was no statistically significant difference in basic information between the two groups. On days 7 and 14 after surgery, the MMSE score of the control group was significantly lower than that of the experimental group (P <0.05). The incidence of POCD in the experimental group was lower and its duration was shorter than in the control group but without statistical significance. Besides, the significantly decreased out-of-bed activity time, the reduced length of hospital stay, and the higher satisfaction degree were observed in the experimental group (P <0.05).

CONCLUSION

Interventional treatment model could significantly increase the MMSE score, accelerate the recovery of elderly patients after THA, and increase their satisfaction degree.

Experiences and expectations of receiving volunteer services among home-based elderly in Chinese urban areas: A qualitative study

BACKGROUND

The various complex needs for assistance among home-based older adults have increased dramatically. Thus, it would be advantageous to recruit volunteers with medical knowledge and a better understanding to support and assist the elderly living in urban communities.

AIM

This study aimed to explore the experiences and expectations of receiving volunteer services among the home-based elderly in Chinese urban areas. DESIGN, SETTING AND PARTICIPANTS: A descriptive qualitative study was conducted following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. This study was performed in two communities in Wuhan, Hubei Province. A purposive sampling method, which includes criterion and maximum variation sampling, was used to identify and select a diverse range of participants. Semistructured face-to-face interviews with 20 older adults (aged 62-90 years old) were performed. The conventional content analysis method was used for thematic analysis.

RESULTS

Three categories with associated subcategories were identified: experiences of receiving volunteer services including negative and positive experiences; specific needs for volunteer services involving physiological, psychosocial, health-related behaviours and environmental domains; characteristics of expected volunteer services including availability, formats, recipients, providers and service strategies.

CONCLUSIONS

The volunteer services provided to the home-based elderly were found to be unsatisfactory, and lacking relevance and effectiveness. Due to a lack of family support or difficulty in meeting some high-level needs, the home-based elderly expressed a strong demand for volunteer services involving physiological, psychosocial, health-related behaviours and environmental domains. This finding can provide a basis for developing training plans beneficial to volunteers. Furthermore, the present research clarifies the criteria for selecting volunteers and the necessity of supervising and managing volunteers. Improving the effectiveness and accessibility of urban-community volunteer service may reduce the burden on care institutions and home caregivers while enhancing the quality of life and well-being of the elderly.

PATIENT OR PUBLIC CONTRIBUTION

Developing research questions, study design, management and conduct and interpretation of evidence.

Factors Associated with Poor Self-Rated Health among Older Women Living Alone

BACKGROUND

The study aimed to identify the differences in self-rated health (SRH) and the factors associated with poor SRH among older women who live alone, based on their sociodemographic and health characteristics.

METHODS

The sample consisted of 812 older women living alone and was obtained from the Seventh Korean National Health and Nutrition Examination Survey (Ⅶ-1, Ⅶ-2, Ⅶ-3). Complex sample analysis was performed using the independent t-test, the Chi-square test, and multiple logistic regression in SPSS/WIN 24.0 program.

RESULTS

The study found that SRH status in older women living alone differed according to age, education level, income, occupation, walking practices, sleeping hours, perceived stress, experiencing depression, diabetes, arthritis, and restrictions in daily functions. As the factors associated with poor SRH among older women living alone, a lower education level (OR = 1.89, CI = 1.19-3.02), higher perceived stress (OR = 4.92, CI = 1.84-13.16), experiencing arthritis (OR = 1.52, CI = 1.07-2.16), and higher restrictions in functioning (OR = 6.20, CI = 4.01-9.59) increased the likelihood of rating the poor SRH.

CONCLUSION

SRH is an indicator of overall health status, and physical, psychological, and economic factors affect each other. Therefore, it is necessary to develop effective health education and intervention programs for vulnerable groups, including older women living alone with poor SRH.

Why do older adults living alone in cities cease seeking assistance? A qualitative study in China

BACKGROUND

Against the background of an aging population, older adults living alone in cities are increasingly dependent. However, their use of home and community-based services in China is unsatisfactory. This study attempted to figure out why older adults living alone in cities do not actively seek assistance in China.

METHODS

In-depth interviews were conducted. A total of 29 older adults were recruited. Content analysis was used to analyze the interview data.

RESULTS

Three themes were identified. (1) Desire for independence, despite hardship: The lives of older adults involve many inconveniences, but they preferred to solve problems by themselves, instead of asking for help; (2) Desire to not overburden jiaren (meaning family in Chinese): older adults did not want to disturb families or burden children with caring responsibilities. Moreover, previous experience of failing to obtain care made them reluctant to seek help from jiaren; (3) Desire to not bother wairen (meaning people other than family in Chinese): The lack of trust caused by being unfamiliar with wairen, and the fear of being a burden to others if they were not able to reciprocate, made older adults reluctant to seek help from wairen.

CONCLUSIONS

Changes in social, economic, and demographic structures have led to gradual failure of family care. Older adults accustomed to an "acquaintance society" have not yet adapted to seeking help from the community. When addressing the problem of care for older adults living alone in cities, it is important to focus on the profound impact of social change.