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Au A, Murad-Kassam S, Mukanoheli V, Idrees S, Ben Mabrouk E, Abdi K, Kennedy M, Whitfield K, Salma J. Immigrant Older Adults' Experiences of Aging in Place and Their Neighborhoods: A Qualitative Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:904. [PMID: 39063481 PMCID: PMC11277252 DOI: 10.3390/ijerph21070904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024]
Abstract
Engaging in one's neighborhood fosters independence, promotes social connectedness, improves quality of life, and increases life expectancy in older adults. There is a lack of evidence synthesis on immigrant older adults' neighborhood perceptions and experiences, essential for addressing neighborhood-level influences on aging in place. This study systematically synthesizes qualitative evidence on immigrant older adults' perceptions and experiences of their neighborhoods. A comprehensive search was conducted from inception to 5 April 2023, in multiple databases. This review considered studies including immigrant older adults aged ≥60 years, included studies from any country where the neighborhood was the focus, and only considered qualitative data while excluding review studies, theoretical publications, and protocols. Eligible studies were appraised using the JBI critical appraisal checklist for qualitative research. The Joanna Briggs Institute meta-aggregation approach was used to synthesize findings, and the ConQual approach established confidence in the synthesis. A total of 30 studies were included. Most studies were conducted in North America and explored phenomena such as aging in place, social capital, social cohesion, sense of community, and life satisfaction. Key contextual factors were walkable safe access to social spaces, accessible transportation to amenities, social cohesion with neighbors, and pre-migration neighborhood experiences. Immigrant older adults have varied experiences related to their sense of belonging and social cohesion. Factors such as racial discrimination, feeling unsafe, and social isolation contributed to negative perceptions. This review highlights the need for inclusive neighborhoods that align with the needs and values of immigrant older adults aging in place.
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Affiliation(s)
- Alesia Au
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.M.-K.); (V.M.); (S.I.); (E.B.M.); (K.A.); (J.S.)
| | - Sadaf Murad-Kassam
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.M.-K.); (V.M.); (S.I.); (E.B.M.); (K.A.); (J.S.)
| | - Vestine Mukanoheli
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.M.-K.); (V.M.); (S.I.); (E.B.M.); (K.A.); (J.S.)
| | - Sobia Idrees
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.M.-K.); (V.M.); (S.I.); (E.B.M.); (K.A.); (J.S.)
| | - Esra Ben Mabrouk
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.M.-K.); (V.M.); (S.I.); (E.B.M.); (K.A.); (J.S.)
| | - Khadija Abdi
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.M.-K.); (V.M.); (S.I.); (E.B.M.); (K.A.); (J.S.)
| | - Megan Kennedy
- Geoffrey & Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Kyle Whitfield
- Faculty of Science, School of Urban and Regional Planning, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Jordana Salma
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.M.-K.); (V.M.); (S.I.); (E.B.M.); (K.A.); (J.S.)
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Daniel EV, Wiese LAK, Holt JK. Assessing Alzheimer's Disease Knowledge and Cognitive Risk Among a Rural Older Afro-Caribbean Cohort. J Community Health Nurs 2024; 41:1-10. [PMID: 37705286 PMCID: PMC10841183 DOI: 10.1080/07370016.2023.2257199] [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: 09/15/2023]
Abstract
PURPOSE Older, rural Afro-Caribbeans are a growing subset of the Black population who face increased risk for Alzheimer's disease and related dementias (ADRD), but research targeting ADRD is scarce in this group. The purpose of this study was to investigate dementia risk among older Afro-Caribbeans living in a rural area. We also examined age, sex, and years of education, and knowledge about Alzheimer's disease as potential predictors of dementia risk. DESIGN A pre-post, correlational design was employed. METHODS Cognitive screenings were conducted using Nasreddine's Mini-MoCA, with tests of language fluency/orientation/recall, and linear regression analysis. A basic knowledge of Alzheimer's disease survey (BKAD) was also administered. FINDINGS A total of 55 Afro-Caribbean participants (67.0 +10.8y (M ± SD), 65.5% with 10y or less of education residing in a rural area within the last 20 years were included.Over 50% of the convenience sample scored in the cognitive risk range. Significant associations were found between Mini-MoCA Total and Language scores and education (p < 0.01). Further, there was a significant change from pretest to posttest in BKAD scores. BKAD pretest and posttest scores were also significantly higher for those without dementia risk based on the Mini-MoCA Total. CONCLUSION While the Mini-MoCA showed good reliability in less-educated older Afro-Caribbeans, scores were strongly dependent on years of education. Offering a limited intervention resulted in increased BKAD scores in this Afro-Caribbean sample, and a low BKAD score was associated with a higher dementia risk category. CLINICAL EVIDENCE This study contributes to the limited but growing body of research about Alzheimer's disease knowledge, cognitive risk, and dementia detection among Afro-Caribbeans. The use of language-neutral cognitive assessments is recommended among rural older immigrants.
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Affiliation(s)
- E Valerie Daniel
- Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Boca Raton, Florida, USA
| | - Lisa Ann Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Janet K Holt
- Academic Researcher, Southern Illinois University Edwardsville, C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
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Leung B, Pilleron S, Bastiaannet E, Coombs LA, Jin R, Kantilal K, Kantilal K, Kenis C, Kobekyaa F, Kosmari L, Krok-Schoen JL, Li J, Mac Eochagain C, Newton L, Ruegg T, Stolz-Baskett P, Zhao Y, Bradley C, Puts M, Haase KR. Cancer treatment-related decision-making among culturally and linguistically diverse older adults with cancer: A scoping review by the International Society of Geriatric Oncology Nursing and Allied Health Interest Group. J Geriatr Oncol 2023; 14:101607. [PMID: 37633779 DOI: 10.1016/j.jgo.2023.101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Countries with large economies are observing a growing number of culturally and linguistically diverse (CALD) older adults, many of whom will be affected by cancer. Little is known about the experiences and factors that influence cancer treatment decision-making in this population. The purposes of this scoping review are: (1) to summarize the published literature on cancer treatment-related decision-making with this population; and (2) to identify potential differences in how cancer treatment decisions are made compared to non-CALD older adults with cancer. MATERIALS AND METHODS We conducted a scoping review following Arksey and O'Malley and Levac methods, Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Guidelines. We conducted a comprehensive multidatabase search, screening 1,139 titles/abstracts. Following data abstraction, we analyzed the data using tabular and narrative summary. RESULTS We extracted data from six studies that met the inclusion criteria: four quantitative and two qualitative; five from the United States and one from Canada. Three themes were identified: (1) barriers to decision-making, (2) the influence of family and friends on decisionmaking, and (3) differences in uptake and types of treatment received between CALD and non-CALD older adults. DISCUSSION This comprehensive review of treatment decision-making among CALD older adults with cancer highlights the paucity of research in this area. The findings are limited to North American populations and may not represent experiences in other regions of the world. Future research should focus on studying their treatment-related decision-making experiences to improve the quality of care for this vulnerable population.
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Affiliation(s)
- Bonnie Leung
- Department of Medical Oncology, BC Cancer, Vancouver, Canada; Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, Canada.
| | - Sophie Pilleron
- Ageing, Cancer, and Disparities Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Esther Bastiaannet
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Lorinda A Coombs
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - Rana Jin
- Princess Margaret Cancer Centre, Toronto, Canada
| | - Kavita Kantilal
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Kumud Kantilal
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Francis Kobekyaa
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Juan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Lorelei Newton
- School of Nursing, University of Victoria, Victoria, Canada
| | | | - Petra Stolz-Baskett
- Institute of Nursing, Zurich University of Applied Sciences SHAW, Winterthur, Switzerland; School of Nursing, Midwifery & Health Practice, Te Herenga Waka/Victoria University of Wellington, Wellington, New Zealand
| | - Yue Zhao
- Department of General, Visceral, Tumor and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Cara Bradley
- Dr. John Archer Library, University of Regina, Regina, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, Canada
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Vestgarden LA, Dahlborg E, Strunck J, Aasen EM. Nurses' discursive construction of older adult immigrant patients in hospitals. BMC Health Serv Res 2023; 23:586. [PMID: 37286985 DOI: 10.1186/s12913-023-09590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The immigrant population across Europe is ageing rapidly. Nurses will likely encounter an increasing number of patients who are older adult immigrants. Moreover, access to and equal provision of healthcare is a key issue for several European countries. The relationship between nurses and patients is asymmetrical with unequal power relations; however, the way nurses construct the patient through language and discourse can help maintain or change the balance of power. Unequal power relations can affect access and be a hindrance to equal healthcare delivery. Hence, the aim of this study is to explore how older adult immigrants are discursively constructed as patients by nurses. METHODS An exploratory qualitative design was used. Data were collected through in-depth interviews with a purposive sample of eight nurses from two hospitals. The nurses' narratives were analysed using critical discourse analysis (CDA) as described by Fairclough. RESULTS The analysis identified an overarching, stable, and dominant discursive practice; 'The discourse of the other', with three interdiscursive practices: (1) 'The discourse on the immigrant patient versus an ideal patient'; (2) 'The expert discourse'; and (3) 'The discourse of adaption'. Older immigrant adults were constructed as 'othered' patients, they were different, alienated, and 'they' were not like 'us'. CONCLUSION The way nurses construct older adult immigrants as patients can be an obstacle to equitable health care. The discursive practice indicates a social practice in which paternalism overrides the patient's autonomy and generalization is more prevalent than a person-centred approach. Furthermore, the discursive practice points to a social practice wherein the nurses' norms form the basis for normal; normality is presumed and desirable. Older adult immigrants do not conform to these norms; hence, they are constructed as 'othered', have limited agency, and may be considered rather powerless as patients. However, there are some examples of negotiated power relations where more power is transferred to the patient. The discourse of adaptation refers to a social practice in which nurses challenge their own existing norms to best adapt a caring relationship to the patient's wishes.
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Affiliation(s)
- Lisbeth Alnes Vestgarden
- Department of Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Box 1517, Aalesund, 6025, Norway.
| | - Elisabeth Dahlborg
- Department of Health Sciences, University West, Trollhättan, 46132, Sweden
| | - Jeanne Strunck
- Department of Culture and Learning, Faculty of Social Sciences and Humanities, Aalborg University, Kroghstraede 3, Aalborg, 9220, Denmark
| | - Elin Margrethe Aasen
- Department of Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Box 1517, Aalesund, 6025, Norway
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