Awareness and use of home- and community-based long-term care by rural American Indian and white elderly with co-morbid diabetes

Integrative review: Patient safety among older people with diabetes in home care services

AIMS

To identify diabetes specific patient safety domains that need to be addressed to improve home care of older people; to assess research from primary studies to review evidence on patient safety in home care services for older people with diabetes.

DESIGN

An integrative review.

DATA SOURCES

Domains for patient safety in diabetes home care settings were identified by conducting two searches. We performed searches in: CINAHL, Medline, Embase, and Cochrane Library for the years 2000-2017.

REVIEW METHODS

The first search identified frameworks or models on patient safety in home care services published up to October 2017. The second search identified primary studies about older people with diabetes in the home care setting published between 2000-2017.

RESULTS

Data from the 21 articles populated and refined 13 predetermined domains of patient safety in diabetes home care. These were used to explore how the domains interact to either increase or reduce risk. The domains constitute a model of associations between aspects of diabetes home care and adverse events. The results highlight a knowledge gap in safety for older persons with diabetes, influenced by e.g. hypoglycaemia, falls, pain, foot ulcers, cognitive impairment, depression, and polypharmacy. Moreover, providers' inadequate diabetes-specific knowledge and assessment skills contribute to the risk of adverse events.

CONCLUSION

Older persons with diabetes in home care are at risk of adverse events due to their reduced ability to self-manage their condition, adverse medication effects, the family's ability to take responsibility or home care service's suboptimal approaches to diabetes care.

National Health Data and Older American Indians and Alaska Natives

The population of older American Indians and Alaska Natives (AI/ANs) is growing rapidly, but few population-based reports of the health of older AI/ANs exist. The objective was to assess the representation of older AI/ANs in population based health data sets. Health- and aging-related population-based data sets were reviewed for inclusion of AI/AN adults. Data sets were identified using online searches of the Inter-University Consortium for Political and Social Research and the National Archive of Computerized Data on Aging, and federal health care and research agencies. Unweighted sample sizes of AI/ANs were collected for each study by age group. Of 190 data sets reviewed, only 25 (13%) contained at least 100 AI/ANs ages 65 years or older, and less than 5% contained 500 or more. Older AI/ANs are underrepresented in national data sets. Concerted efforts to improve data collection regarding the health and health care needs of this population are needed.

Functional status assessment for community long-term care: preliminary observations

The Community Long-Term Care (CLTC) program in South Carolina offers services to nursing home eligible persons that allow them to remain at home and receive help with activities of daily living. Variation in the ways potential clients are evaluated often produces inconsistent eligibility determinations. We developed a simple, objective assessment tool to complement CLTC evaluations. A conceptual framework, based on Nagi's model of disablement, was tested on community-dwelling healthy older adults and CLTC clients. Three simple physiologic tasks assessing mobility, functional leg strength, and manual dexterity discriminated between community-dwelling older adults and CLTC clients, classifying them with 80% to 90% accuracy.

Depression and its psychosocial correlates among older Asian immigrants in North America: a critical review of two decades' research

OBJECTIVE

This article critically reviews two decades of empirically based depression studies on older Asian immigrants (OAIs) in North America published in English. The Psychosocial Model of Late-Life Depression is proposed as the conceptual roadmap to help interpret the findings across studies.

METHODS

Using multiple bibliographic databases, this review systematically summarized and evaluated findings in 24 studies in terms of: (a) the prevalence and severity of depression; (b) demographic, psychosocial, cultural, and health risk factors of depression; and (c) methodological approaches and designs.

RESULTS

The results showed that depression is prevalent among OAIs and is linked to gender, recency of immigration, English proficiency, acculturation, service barriers, health status, relationship with children and family, and social support. However, considerable variability in the results, the sample sizes, and the use of measurements were also found across studies.

DISCUSSION

Recommendations for future research and the provision of clinical and community services are discussed within the psychosocial model.

Access, relevance, and control in the research process: lessons from Indian country

OBJECTIVE

To illustrate successful strategies in working with American Indian (AI) and Alaska Native (AN) communities in aging and health research by emphasizing access, local relevance, and decision-making processes.

METHODS

Case examples of health studies involving older AIs (greater than or equal to 50 years) among Eastern Band Cherokee Indians, a federally recognized reservation; the Cherokee Nation, a rural, nonreservation, tribal jurisdictional service area; and Lakota tribal members living in Rapid City, South Dakota.

RESULTS

Local review and decision making reflect the unique legal and historical factors underpinning AI sovereignty. Although specific approval procedures vary, there are common expectations across these communities that can be anticipated in conceptualizing, designing, and implementing health research among native elders.

CONCLUSIONS

Most investigators are unprepared to address the demands of health research in AI communities. Community-based participatory research in this setting conflicts with investigators' desire for academic freedom and scientific independence. Successful collaboration promises to enhance research efficiencies and move findings more quickly to clinical practice.