Care arrangement decisions for frail older women: quantitative and qualitative perspectives

Stakeholder involvement in care transition planning for older adults and the factors guiding their decision-making: a scoping review

OBJECTIVE

To synthesise the existing literature on care transition planning from the perspectives of older adults, caregivers and health professionals and to identify the factors that may influence these stakeholders' transition decision-making processes.

DESIGN

A scoping review guided by Arksey and O'Malley's six-step framework. A comprehensive search strategy was conducted on 7 January 2021 to identify articles in five databases (MEDLINE, Embase, CINAHL Plus, PsycINFO and AgeLine). Records were included when they described care transition planning in an institutional setting from the perspectives of the care triad (older adults, caregivers and health professionals). No date or study design restrictions were imposed.

SETTING

This review explored care transitions involving older adults from an institutional care setting to any other institutional or non-institutional care setting. Institutional care settings include communal facilities where individuals dwell for short or extended periods of time and have access to healthcare services.

PARTICIPANTS

Older adults (aged 65 or older), caregivers and health professionals.

RESULTS

39 records were included. Stakeholder involvement in transition planning varied across the studies. Transition decisions were largely made by health professionals, with limited or unclear involvement from older adults and caregivers. Seven factors appeared to guide transition planning across the stakeholder groups: (a) institutional priorities and requirements; (b) resources; (c) knowledge; (d) risk; (e) group structure and dynamic; (f) health and support needs; and (g) personality preferences and beliefs. Factors were described at microlevels, mesolevels and macrolevels.

CONCLUSIONS

This review explored stakeholder involvement in transition planning and identified seven factors that appear to influence transition decision-making. These factors may be useful in advancing the delivery of person and family-centred care by determining how individual-level, group-level and system-level values guide decision-making. Further research is needed to understand how various stakeholder groups balance these factors during transition planning in different health contexts.

What Quality Paid Home Care Means to Family Caregivers

The authors investigate the meanings of paid home care for family caregivers to frail older adults, comparing and contrasting what good and poor quality home care means to their caregiving efforts. Semistructured interviews were conducted with caregivers and were analyzed qualitatively, using McCracken’s (1988) five-step method for analysis of long interviews. Data from two studies were combined because of similarities in sample characteristics and interview questions and because data from the second study included both positive and negative experiences with home care providers. The authors find that caregivers perceived that good-quality paid home care facilitated enhanced quality of life for care recipients and improved perceptions of their performances as caregivers. When paid home care was of poor quality, caregivers felt more stress and increased their monitoring of providers. Caregiver circumstances, as well as care recipient needs, should be considered in making decisions about who receives formal home care services.

Health Literacy and Social Support Among Elderly Medicare Enrollees in a Managed Care Plan

This study examined health literacy, social support, and their relations to health status and health care use among older adults. The survey design and data were from a project that examined the prevalence of low health literacy among community-dwelling Medicare beneficiaries enrolled in a national managed care organization. Results indicate that compared to the high health literacy group, enrollees with low health literacy were more likely to receive medical information support and health reminder support. However, they were less likely to receive tangible support for their health care needs. In both health literacy groups, medical information support and health reminder support were associated with lower physical health and mental health status. Tangible support was associated with higher physical and mental health status. Health reminder support was associated with more doctor visits and a lower likelihood of hospitalization in the high health literacy group. Implications for reducing the adverse health consequences of low health literacy among older adults are discussed.

How well do family caregivers know their relatives' care values and preferences?

Purpose: This study examines the psychometric properties of the Values and Preferences Scale (VPS) and compares the responses of 267 persons with cognitive impairment with the responses of their family caregivers to determine the accuracy of the caregivers' perceptions of their relatives' care values and preferences.

Design and Methods: Exploratory factor analyses examined whether a consistent factor structure could be found for the VPS for both persons with cognitive impairment (PWCIs) and family caregivers. Analyses also determined whether family caregivers were accurate in their perceptions of their relative's care preferences.

Results: Results indicated that the VPS was best divided into four factors or subscales (i.e., Burden, Safety/Quality of Care, Autonomy, and Social Interactions) all of which were found to have adequate internal consistency for persons with cognitive impairment and family caregivers. Caregivers generally had a good sense of what preferences were most important to their relatives (i.e., issues of safety and quality of care), but often underestimated the importance of certain values and preferences.

Implications: These findings support previous work suggesting that practitioners consider incorporating an assessment of values and preferences for everyday care when working with persons with cognitive impairment and their family caregivers. Further application and testing of the Values and Preferences Scale should prove useful to practitioners who assist cognitively impaired persons and their caregivers with health care decision making and planning.

According to need? Predicting the amount of municipal home help allocated to elderly recipients in an urban area of Sweden

Given the cutbacks which have been carried out in the Swedish welfare state despite the unchanged official policy of allocation of home help services according to needs, it is essential to evaluate the factors which guide the allocation of home help today. Whereas numerous studies have identified factors which predict entry into the home help system, the present paper concentrates on predictors of the amount of home help amongst those allocated assistance. Data were obtained from the population-based care and services section of the 2002 Swedish National Study of Aging and Care-Kungsholmen (SNAC-K). All home help recipients (> or = 65 years of age) living in an inner city district of Stockholm (Kungsholmen) were analysed with ordinary least squares regressions to identify predictors of the number of hours of home help (n = 943). Need indicators, i.e. dependency in activities of daily living (ADLs) and instrumental ADLs (IADLs), and cognitive impairment (Berger scale) were the strongest predictors of more hours of home help. The addition of sociodemographic (i.e. age, gender and income), environmental (i.e. informal care, housing adaptations and housing accessibility) and structural (i.e. variations in allocation decisions between one care manager and another) factors contributed only marginally to the explained variance. Hours of help entitlement increased slightly with greater age. Co-residing individuals were allocated significantly fewer home help hours than those living alone. Income and regular access to informal care were not significant predictors. The fact that services are provided according to need criteria does not necessarily mean that the provided services are adequate to meet needs. On the macro level, social policy decisions and available economic and manpower resources determine the allotment of municipal home help. However, this study in an urban sample suggests that, within the available resources, the amount of home help allocated is guided mainly by need indicators amongst those given assistance.

Dementia and depressive symptoms as predictors of home help utilization among the oldest old: population-based study in an urban area of Sweden

OBJECTIVE

The objective of this article is to investigate predictors of public home help utilization, particularly mental health problems such as dementia and depressive symptoms.

METHODS

A population-based sample of community-dwelling people aged 81-100 was interviewed and assessed with medical examinations (N = 502).

RESULTS

Dementia increased the odds of receiving public home help among people residing alone. Among coresiding people, it increased the odds of receiving home help, but only among those who had extra residential care. Depressive symptoms decreased the odds of receiving home help among people with lower levels of education who lived alone. Depressive symptoms among highly educated people who lived alone and among coresiding people of any educational level were not related to receipt of home help.

DISCUSSION

Improvement of screening activities for public home help needs of community-dwelling elders might allow better targeting of limited social resources to the most needy.