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Markkanen PK, Gore RJ, Sama SR, Lindberg JE, Galligan CJ, Quinn MM. Coaching Home Care Clients to Prepare Their Homes for Safe Care Visits: A Mixed-Methods Study to Evaluate a Nurse-Led Educational Intervention Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:360. [PMID: 38541359 PMCID: PMC10970455 DOI: 10.3390/ijerph21030360] [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: 01/22/2024] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
Assuring home care (HC) workers' safety is challenging because the work environment is a private home. This paper presents the process evaluation for a proof-of-concept safety intervention study to assess whether nurse-led safety coaching, using motivational interviewing and a safety handbook, could enable HC clients to improve safety in their homes. The process evaluation objectives were to (i) document the intervention's implementation progress and (ii) assess the intervention's dose delivery, dose reception, and fidelity. Five agencies employing liaisons (n = 5) and nurse managers (NMs, n = 8) implemented this study's intervention and control arms. NMs assigned to the intervention arm (n = 6) coached 34 clients. Process evaluation metrics were assessed with mixed-methods data from (i) surveys completed by NMs during the intervention, (ii) postintervention audio-recorded and transcribed interviews (n = 6) with NMs and liaisons, and (iii) study progress tracking tools. The delivered dose efficiency was 85%, measured by the distribution of safety handbook copies to clients. About 94% of clients (n = 32) were considered "engaged" or "maybe engaged" during the safety coaching. Most coached clients (n = 30) were reachable for follow-up by NMs to assess intervention progress. Despite challenges, the intervention was implemented with good fidelity. Safety coaching can be applied in many HC contexts in larger populations.
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Affiliation(s)
- Pia K. Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Rebecca J. Gore
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
- Department of Biomedical Engineering, Francis College of Engineering, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA
| | - Susan R. Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - John E. Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Catherine J. Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Margaret M. Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
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Yoshiyuki N, Ishihara T, Kono A, Fukushima N, Miura T, Kaneko K. Do Home- and Community-Based Services Delay Frailty Onset in Older Adults With Low Care Needs? J Am Med Dir Assoc 2023; 24:1663-1668. [PMID: 37442197 DOI: 10.1016/j.jamda.2023.05.036] [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: 01/03/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To assess whether using adult day services or personal assistance services can delay the onset of frailty among older adults with low care needs during a 5-year follow-up study. DESIGN This prospective cohort study was conducted using long-term care and health insurance claims data. SETTING AND PARTICIPANTS This was a population-based study of 3 municipalities in Osaka, Japan. Initially, 655 nonfrail or prefrail individuals were included from a cohort of 790 population-based adults aged ≥65 years, who were newly certified as being on a support level of the long-term care insurance program from September 2012 to March 2013. METHODS Using long-term care and health insurance claims data from the Southern Osaka Health and Aging Study, conducted between April 2012 and March 2017, monthly usage of adult day and personal assistance services was measured. Data were analyzed from December 2021 to January 2022. RESULTS Of the 655 individuals (median age at baseline: 79 years), 436 (66.6%) were female, 388 (59.2%) were nonfrail, and 267 (40.8%) were prefrail, according to the Veterans Affairs Frailty Index. During the 5-year follow-up period, 222 individuals (33.9%) experienced the onset of frailty. The time-dependent Cox regression models showed that using adult day services lowered the risk of frailty when compared with not using such services [hazard ratio (HR) 0.60, 95% CI 0.42-0.86; P = .006], although personal assistance services usage was not associated with the onset of frailty (HR 0.70, 95% CI 0.48-1.03, P = .07). CONCLUSIONS AND IMPLICATIONS Using adult day services lowered the risk of frailty in older adults with low care needs over the 5-year follow-up period. The findings support the value of providing adult day services to prevent frailty for those in need of long-term care.
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Affiliation(s)
- Noriko Yoshiyuki
- Department of Community-based Integrated Care Science, School of Nursing, Osaka Metropolitan University, Osaka, Japan.
| | - Takuma Ishihara
- Advanced Medical Care and Clinical Research Center, Gifu University Hospital, Gifu, Japan
| | - Ayumi Kono
- Department of Community-based Integrated Care Science, School of Nursing, Osaka Metropolitan University, Osaka, Japan
| | - Naomi Fukushima
- Department of Community-based Integrated Care Science, School of Nursing, Osaka Metropolitan University, Osaka, Japan; Life and Welfare Division, Welfare Department, Izumi City Municipal, Osaka, Japan
| | - Takeshi Miura
- Department of Home Health Nursing, School of Nursing, Osaka City University, Osaka, Japan
| | - Katsunori Kaneko
- School of Economics, Osaka Metropolitan University, Osaka, Japan
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Kane L, Leighton C, Limbrick H, Kilinc S, Ling J, Eberhardt J. You clapped, you cheered, but did anybody hear? A mixed-methods systematic review of dementia homecare workers' training and psychosocial needs. Home Health Care Serv Q 2023; 42:282-310. [PMID: 37585717 DOI: 10.1080/01621424.2023.2246415] [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] [Indexed: 08/18/2023]
Abstract
The homecare sector's high turnover rate is linked to poor working conditions and a lack of person-centered practice. Limited research exists on the training and psychosocial needs of homecare workers caring for people living with dementia (PLWD). This systematic review explored these needs and identified 285 studies, of which seven studies met the inclusion criteria. A narrative synthesis identified four themes: "training and education challenges and facilitators;" "social isolation and the importance of peer support;" "emotional attachments and distress experienced by homecare workers;" and "working with families and its emotional impact on homecare workers." This review highlights the unmet educational and psychosocial needs of homecare workers and the negative impacts these unmet needs have. To improve person-centered practice in homecare, workers require dementia-specific training, and concurrent emotional and peer support, alongside support managing relationships with clients' families. Future research is required to implement an intervention to meet these needs.
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Affiliation(s)
- Laura Kane
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Charlotte Leighton
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Helen Limbrick
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Stephanie Kilinc
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Judith Eberhardt
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
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Yin L, Caceres M, Skowronski J, Muramatsu N. Assessing Motor Function in Frail Older Adults in Their Home Settings: Challenges, Strategies and Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6515. [PMID: 37569055 PMCID: PMC10418993 DOI: 10.3390/ijerph20156515] [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: 05/04/2023] [Revised: 07/06/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023]
Abstract
Assessing motor competence is essential for evaluating the effectiveness of physical activity interventions that aim to maintain or improve older adults' function. However, assessing motor competence in older adults who have difficulties walking or standing is challenging, because few instruments or guidelines are appropriate for these frail older adults. This article aims to describe challenges in evaluating motor function among frail older adults, discuss strategies for adapting motor function assessments to their home settings, and provide recommendations for future clinical trials so that older adults with ambulatory difficulties can benefit from motor function assessment and physical activity programs. Data came from the baseline assessment of 116 participants of an ongoing clinical trial, "Promoting Seniors' Health with Home Care Aides (Pro-Home)". Our results demonstrated that the Pro-Home study involved participants who would be typically excluded from clinical trials and that the two instruments selected or developed for Pro-Home (Short Physical Performance Battery, Pro-Home Ankle Range of Motion Measure) captured a wide range of lower extremity motor competence with no or few missing data. Recommendations for future studies include knowing the target population thoroughly, developing trust and rapport with all parties involved, and continuously collaborating with interviewers who conduct assessments.
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Affiliation(s)
- Lijuan Yin
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (M.C.); (J.S.)
| | - Maria Caceres
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (M.C.); (J.S.)
| | - Jordan Skowronski
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (M.C.); (J.S.)
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Naoko Muramatsu
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (M.C.); (J.S.)
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
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Tsui EK, Wyka K, Beato L, Verkuilen J, Baron S. How client death impacts home care aides' workforce outcomes: an exploratory analysis of return to work and job retention. Home Health Care Serv Q 2023; 42:230-242. [PMID: 36739614 DOI: 10.1080/01621424.2023.2175758] [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: 02/06/2023]
Abstract
Home health aides face a range of stressors that may result in departing the workforce. One stressor that has emerged in multiple qualitative studies as potentially influencing retention is client death. Using 2019 data from a single agency in New York City employing approximately 1700 aides, we used logistic and linear regression to explore case and aide factors associated with workforce outcomes after client death. We found that longer case length (Beta = 0.01, p < .001) was associated with longer return to work for aides experiencing client death and longer job tenure (Beta = -0.002, p = .002) was associated with shorter return to work (n = 67). We found no difference in retention between aides who experienced client death and those who did not (n 216). This analysis suggests the importance of research on the period of time following client death and of offering support to aides after clients die, particularly after longer cases.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Latifa Beato
- Cooperative Home Care Associates, Bronx, NY, USA
| | | | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, Queens, NY, USA
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Cho J, Toffey B, Silva AF, Shalev A, Safford MM, Phillips E, Lee A, Wiggins F, Kozlov E, Tsui EK, Dell N, Avgar AC, Andreae SJ, Sterling MR. To care for them, we need to take care of ourselves: A qualitative study on the health of home health aides. Health Serv Res 2023; 58:697-704. [PMID: 36815290 PMCID: PMC10154157 DOI: 10.1111/1475-6773.14147] [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: 02/24/2023] Open
Abstract
OBJECTIVE To understand the perspectives of home health aides (HHAs) toward their own health and health behaviors, and how their job impacts both. DATA SOURCES AND STUDY SETTING Interviews were conducted with 28 HHAs from 16 unique home care agencies from August 2021 to January 2022. The study was conducted in partnership with the 1199SEIU Training and Employment Fund, a labor-management fund of the largest health care union in the US. STUDY DESIGN A qualitative study with English and Spanish-speaking HHAs. Interviews were conducted using a semi-structured topic guide, informed by Pender's Health Promotion Model and the National Institute for Occupational Safety and Health's Total Worker Health Model. To be eligible, HHAs had to be currently employed by a home care agency in New York, NY. DATA COLLECTION/EXTRACTION METHODS Interviews were recorded, professionally transcribed, and analyzed thematically. PRINCIPAL FINDINGS The 28 HHAs had a mean age of 47.6 years (SD 11.1), 39% were non-Hispanic Black, 43% were Hispanic, and they had a mean of 14.1 years (SD 7.8) of job experience. Five themes emerged; HHAs were: (1) Healthy enough to work, but were managing their own chronic conditions while working; (2) Motivated to be healthy, in part driven by their desire to care for others; (3) Worked closely with sick patients, which influenced their perceptions of health; (4) Experienced occupational and patient-level barriers to practicing healthy behaviors; (5) Sought support and resources to improve their health and wellbeing. CONCLUSIONS HHAs have numerous health challenges, many of which are influenced by their job. Culturally and occupationally tailored interventions may mitigate the barriers that HHAs experience to achieve optimal health.
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Affiliation(s)
- Jacklyn Cho
- Renaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Brittany Toffey
- New York Presbyterian Hospital, Weill Cornell MedicineNew YorkNew YorkUSA
| | - Ariel F. Silva
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Ariel Shalev
- New York Presbyterian Hospital, Weill Cornell MedicineNew YorkNew YorkUSA
| | - Monika M. Safford
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Erica Phillips
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Ann Lee
- 1199SEIU Training and Employment FundsNew YorkNew YorkUSA
| | - Faith Wiggins
- 1199SEIU Training and Employment FundsNew YorkNew YorkUSA
| | - Elissa Kozlov
- School of Public HealthRutgers UniversityNew BrunswickNew YorkUSA
| | - Emma K. Tsui
- School of Public HealthCity University of New YorkNew YorkNew YorkUSA
| | | | - Ariel C. Avgar
- School of Industrial Labor RelationsCornell UniversityIthacaNew YorkUSA
| | | | - Madeline R. Sterling
- Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
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Brouillette NM, Markkanen PK, Quinn MM, Galligan CJ, Sama SR, Lindberg JE, Karlsson ND. Aide and Client Safety "Should Go Hand-In-Hand": Qualitative Findings From Home Care Aides, Clients, and Agency Leaders. J Appl Gerontol 2023; 42:571-580. [PMID: 36565062 PMCID: PMC9996781 DOI: 10.1177/07334648221146769] [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] [Received: 04/27/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
Retention of the home care (HC) aide workforce is essential to meet the needs of our aging population. Some studies suggest that improving HC safety could increase job retention. This study objective was to explore qualitatively the connection between aide and client safety and factors impacting this care relationship. Data consisted of audio-recorded, verbatim responses to open-ended questions of two focus groups with aides (n = 10), two in-person interviews with HC agency managers, and 37 phone interviews with those working in (aides, n = 16; managers, n = 12) and receiving (clients, n = 9) HC. Clients reported home layout and accessibility as safety concerns. Aides and managers reported that client family members can make the care job more challenging. The aide-client connection was affected by communication style, family and HC agency support, allotted care time, and job task boundaries. Interventions that address the safety of both clients and aides can influence HC job satisfaction and retention.
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Affiliation(s)
- Natalie M Brouillette
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Pia K Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Margaret M Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Catherine J Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Susan R Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - John E Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Nicole D Karlsson
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
- Environmental Public Health Tracking Program, Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, NH, USA
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Shalev A, Ringel JB, Riegel B, Vellone E, Stawnychy MA, Safford M, Goyal P, Tsui E, Franzosa E, Reckrey J, Sterling M. Does Connectedness Matter? The Association Between Mutuality and Job Satisfaction Among Home Health Aides Caring for Adults With Heart Failure. J Appl Gerontol 2023; 42:747-757. [PMID: 36541188 PMCID: PMC9992152 DOI: 10.1177/07334648221146772] [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: 12/24/2022] Open
Abstract
Home health aides (HHAs) provide care to many adults with heart failure (HF) in the home. As the demand for HHAs increases, there is a need to promote HHAs' job satisfaction and retention. In this cross-sectional community-partnered study, we examined whether mutuality (e.g., quality of the HHA-patient relationship), is associated with job satisfaction among HHAs caring for adults with HF. Mutuality was assessed with the Mutuality Scale, which measures overall mutuality and its four domains (reciprocity, love and affection, shared pleasurable activities, and shared values). Our final sample of 200 HHAs was primarily female. The mean overall mutuality score was 2.92 out of 4 (SD 0.79). In our final model, overall mutuality and each of the four domains were associated with increased job satisfaction; however, only the shared pleasurable activities domain was significant (aPR: 1.15 [1.03-1.32]). Overall, mutuality may play a role in promoting job satisfaction among HHAs.
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Affiliation(s)
- Ariel Shalev
- 12295Weill Cornell Medical College, New York, NY, USA
| | | | - Barbara Riegel
- 16142University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ercole Vellone
- University of Rome Tor Vergata, Italy; Wroclaw Medical University, Poland
| | | | | | - Parag Goyal
- 12295Weill Cornell Medical College, New York, NY, USA
| | - Emma Tsui
- CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Emily Franzosa
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mänttäri S, Säynäjäkangas P, Selander K, Laitinen J. Increased physical workload in home care service is associated with reduced recovery from work. Int Arch Occup Environ Health 2023; 96:651-660. [PMID: 36808567 DOI: 10.1007/s00420-023-01960-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/04/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE This study investigated the physical workload of home care service workers and determined whether the different intensities of physical work strain experienced by home care nurses have different impacts on their recovery from work. METHODS Physical workload and recovery were measured among 95 home care nurses based on heart rate (HR) and heart rate variability (HRV) recordings during one work shift and the following night. Differences in the physical work strain were compared between younger (≤ 44-year-old) and older (≥ 45-year-old) employees and between morning and evening shifts. To determine the effects of occupational physical activity on recovery, HRV at all time points (during the workday, when awake and asleep, and whole measurement) in relation to the amount of occupational physical activity was examined. RESULTS The average physiological strain during the work shift, measured as metabolic equivalent (MET), was 1.8 ± 0.5. Moreover, the occupational physical demands in relation to maximal capacity were higher for the older employees. The results of the study showed that a higher occupational physical workload reduced the HRV of home care workers during the workday, leisure time, and sleep. CONCLUSIONS These data indicate that increased occupational physical workload is associated with reduced recovery among home care workers. Therefore, decreasing occupational strain and ensuring sufficient recovery is recommended.
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Affiliation(s)
- Satu Mänttäri
- Finnish Institute of Occupational Health, Oulu, Finland.
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10
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Bibbo J, Johnson J, Drost JC, Sanders M, Nicolay S. Pet ownership issues encountered by geriatic professionals: Preliminary findings from an interdisciplinary sample. Front Psychol 2022; 13:920559. [PMID: 36248534 PMCID: PMC9559856 DOI: 10.3389/fpsyg.2022.920559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022] Open
Abstract
Pets often factor in older adults’ health behaviors and decisions. However, the degree to which issues related to pet ownership are encountered or addressed by professionals working with this population remains unknown. The aim of this study was to identify specific issues stemming from pet ownership professionals had encountered in their work with older adults, people living with dementia, and care partners. An interdisciplinary (e.g., social services and healthcare) sample (N = 462, 89.13% female, Mage = 53.02, SDage = 12.18) completed an online survey addressing pet ownership issues encountered in their work. Descriptive statistics, t-tests, and repeated measures ANOVAs were used to analyze quantitative data. A conventional content analysis was used to analyze open-ended responses to an item asking about “other” issues encountered in their work with these populations. The professionals estimated 46.29% of clients had been pet owners, 41.23% regularly asked about pets, and 79.22% had encountered issues related to pet ownership. Specific issues raised to the professionals varied by type of client. The professionals reported older adults most often raised getting pet items into the home and concerns about their pets’ health. The issues most often raised by people living with dementia to the professionals were planning for the pet due to a housing transition and basic pet care. Care partners focused on basic pet care and planning for the pet due to a housing transition. The professionals themselves most often raised the issues of basic pet care, concerns about falling, and the pets’ behavior. Professionals who entered clients’ homes were more likely to raise issues stemming from pet ownership compared to those who reported they did not enter clients’ homes in their current job, t(429.40) = 5.59, p < 0.00001. The eleven new issues identified by the content analysis (e.g., pets impeding care, people refusing care due to the pet) underscored how the health and wellbeing of people and their pets are linked. The results of this study provide strong evidence that professionals do encounter issues related to pet ownership. Including issues stemming from pet ownership into procedures, policies, and programs is likely to have positive impacts on those served by and working in the geriatric workforce.
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Affiliation(s)
- Jessica Bibbo
- Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, OH, United States
- *Correspondence: Jessica Bibbo,
| | - Justin Johnson
- Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, OH, United States
| | - Jennifer C. Drost
- Senior Health, Complex Care Institute, Summa Health, Akron, OH, United States
| | - Margaret Sanders
- Family & Community Medicine, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Sarah Nicolay
- Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, OH, United States
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Simeone S, Vellone E, Virgolesi M, Sterling MR, Alvaro R, Pucciarelli G. "I found myself alone" - A phenomenological study of the home care workers' experience during the COVID-19 pandemic. Nurs Health Sci 2022; 24:395-404. [PMID: 35220652 PMCID: PMC9115411 DOI: 10.1111/nhs.12935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 12/15/2022]
Abstract
Home care workers (HCWs) are a highly heterogeneous population in Italy in terms of their professional qualifications. HCWs play an important role in helping patients affected by chronic diseases and their families. Although many investigators have studied the lived experiences of family caregivers, few have been conducted "to give a voice" to HCWs and even fewer have examined the experiences of HCWs during the present COVID-19 pandemic. We investigated the lived experiences of HCWs during the first wave of the pandemic in Italy. Cohen's phenomenological research approach was used to conduct this study. In our study, we enrolled and interviewed 19 HCWs who were female, and most were married, with an average age of 52 years. The participants were enrolled from September 2020 to November 2020, after the first COVID-19 wave in Italy. Four main themes emerged from the analysis of the data: (1) "I found myself alone"; (2) from invisibility to visibility; (3) a fear of getting sick and infecting others; and (4) "Health or work? That is the question." Understanding HCWs' lived experiences, especially those related to the COVID-19 pandemic, is a first step in giving a voice to this important but vulnerable population in the healthcare workforce.
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Affiliation(s)
- Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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12
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Tsui EK, LaMonica M, Hyder M, Baron S. "We want to hear your problems and fix them": A case study of pandemic support calls for home health aides. Home Health Care Serv Q 2022; 41:124-138. [PMID: 35212257 DOI: 10.1080/01621424.2022.2035295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Home health aides and home care agencies, who operate in a high work stress environment under normal conditions, were placed under extraordinary demands during the COVID-19 pandemic. In this paper, we examine the unfolding effort at one agency in New York City to offer phone-based support calls to aides. We used a qualitative, single case study design involving semi-structured interviews with call staff and agency leaders (n = 9) and analysis of one year of thematic notes from the calls. We found that the calls resulted in multidirectional communication between agency staff and aides, an increased sense of empathy among staff, and a greater integration of aides into the agency's overall infrastructure. We explore how these calls might contribute to aide retention, worker voice, and mental health. We note the facilitators and barriers to implementing this type of job-based support to help other agencies that may be considering similar models.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health and Health Policy, U.S.A
| | - Marita LaMonica
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health and Health Policy, U.S.A
| | | | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, U.S.A
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Tsui EK, LaMonica M, Hyder M, Landsbergis P, Zelnick J, Baron S. Expanding the Conceptualization of Support in Low-Wage Carework: The Case of Home Care Aides and Client Death. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:367. [PMID: 35010626 PMCID: PMC8744702 DOI: 10.3390/ijerph19010367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022]
Abstract
Home care aides are a rapidly growing, non-standard workforce who face numerous health risks and stressors on the job. While research shows that aides receive limited support from their agency employers, few studies have explored the wider range of support that aides use when navigating work stress and considered the implications of these arrangements. To investigate this question, we conducted 47 in-depth interviews with 29 home care aides in New York City, focused specifically on aides' use of support after client death. Theories of work stress, the social ecological framework, and feminist theories of care informed our research. Our analysis demonstrates aides' extensive reliance on personal sources of support and explores the challenges this can create in their lives and work, and, potentially, for their communities. We also document aides' efforts to cultivate support stemming from their home-based work environments. Home care aides' work stress thus emerges as both an occupational health and a community health issue. While employers should carry responsibility for preventing and mitigating work stress, moving toward health equity for marginalized careworkers requires investing in policy-level and community-level supports to bolster employer efforts, particularly as the home care industry becomes increasingly fragmented and non-standard.
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Affiliation(s)
- Emma K. Tsui
- Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY 10027, USA;
| | - Marita LaMonica
- Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY 10027, USA;
| | - Maryam Hyder
- Barnard College, Columbia University, New York, NY 10027, USA;
| | - Paul Landsbergis
- Department of Environmental and Occupational Health Sciences, School of Public Health, State University of New York (SUNY)-Downstate Health Sciences University, New York, NY 11203, USA;
| | - Jennifer Zelnick
- Graduate School of Social Work, Touro College, New York, NY 10001, USA;
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York (CUNY), New York, NY 11365, USA;
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Sterling MR, Li J, Cho J, Ringel JB, Silver SR. Prevalence and Predictors of Home Health Care Workers' General, Physical, and Mental Health: Findings From the 2014‒2018 Behavioral Risk Factor Surveillance System. Am J Public Health 2021; 111:2239-2250. [PMID: 34878879 PMCID: PMC8667821 DOI: 10.2105/ajph.2021.306512] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 12/27/2022]
Abstract
Objectives. To determine the prevalence and predictors of US home health care workers' (HHWs') self-reported general, physical, and mental health. Methods. Using the 2014-2018 Behavioral Risk Factor Surveillance System, we analyzed the characteristics and health of 2987 HHWs (weighted n = 659 000) compared with 2 similar low-wage worker groups (health care aides and health care support workers, not working in the home). We conducted multivariable logistic regression to determine which characteristics predicted HHWs' health. Results. Overall, 26.6% of HHWs had fair or poor general health, 14.1% had poor physical health, and 20.9% had poor mental health; the prevalence of each outcome was significantly higher than that of the comparison groups. Among HHWs, certain factors, such as low household income, an inability to see a doctor because of cost, and a history of depression, were associated with all 3 aspects of suboptimal health. Conclusions. HHWs had worse general, physical, and mental health compared with low-wage workers not in home health. Public Health Implications. Increased attention to the health of HHWs by public health experts and policymakers is warranted. In addition, targeted interventions appropriate to their specific health needs may be required. (Am J Public Health. 2021;111(12):2239-2250. https://doi.org/10.2105/AJPH.2021.306512).
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Affiliation(s)
- Madeline R Sterling
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Jia Li
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Jacklyn Cho
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Joanna Bryan Ringel
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
| | - Sharon R Silver
- Madeline R. Sterling, Jacklyn Cho, and Joanna Bryan Ringel are with the Division of General Internal Medicine, Weill Cornell Medicine, New York, NY. Jia Li and Sharon R. Silver are with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Cincinnati, OH. Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, CDC
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15
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Grasmo SG, Liaset IF, Redzovic SE. Home care workers' experiences of work conditions related to their occupational health: a qualitative study. BMC Health Serv Res 2021; 21:962. [PMID: 34521407 PMCID: PMC8438557 DOI: 10.1186/s12913-021-06941-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing. Methods A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors. Results HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users’ homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting. Conclusions This study suggests that unpredictable working conditions at users’ home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users’ homes, HCWs’ perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.
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Affiliation(s)
- Sunniva Grønoset Grasmo
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Tungasletta 2, N-7047, Trondheim, Norway.
| | - Ingeborg Frostad Liaset
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Tungasletta 2, N-7047, Trondheim, Norway
| | - Skender Elez Redzovic
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Tungasletta 2, N-7047, Trondheim, Norway
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16
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Vauhkonen A, Saaranen T, Honkalampi K, Järvelin-Pasanen S, Kupari S, Tarvainen MP, Perkiö-Mäkelä M, Räsänen K, Oksanen T. Work community factors, occupational well-being and work ability in home care: A structural equation modelling. Nurs Open 2021; 8:3190-3200. [PMID: 34392605 PMCID: PMC8510720 DOI: 10.1002/nop2.1032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/14/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022] Open
Abstract
Aim To examine how work community factors are related to occupational well‐being and work ability, and how occupational well‐being is related to work ability. Design A cross‐sectional study was conducted among home care workers in one municipality in Finland. Methods A self‐administered survey on work and well‐being was filled out by 167 employees working two shifts in 2019. Structural equation modelling was used to analyse the association between work community factors, occupational well‐being and work ability. Results The only work community factor directly affecting Occupational well‐being was Information and work organization; the effect of the other two factors, Social support and Influence on work shifts, was indirect. All work community factors indirectly affected Work ability. Home care should emphasize information provision and work organization with optimal time use. This requires social support, a well‐functioning work atmosphere and providing employees with opportunities for influence and participation.
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Affiliation(s)
- Anneli Vauhkonen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Terhi Saaranen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kirsi Honkalampi
- School of Educational Sciences and Psychology, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | | | - Saana Kupari
- Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland
| | - Mika P Tarvainen
- Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Finland
| | - Merja Perkiö-Mäkelä
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kimmo Räsänen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tuula Oksanen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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17
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Grønoset Grasmo S, Frostad Liaset I, Redzovic SE. Home health aides' experiences of their occupational health: a qualitative meta-synthesis. Home Health Care Serv Q 2021; 40:148-176. [PMID: 33949920 DOI: 10.1080/01621424.2021.1921650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Home health aides (HHA) have high sickness absence while the need for home care services is rapidly growing. The aim of this study was to derive new conceptual understandings by identifying, describing and interpreting key concepts across qualitative studies on how HHA experience their occupational health related to their working conditions.A qualitative ethnographic meta-synthesis was used as a method to analyze 27 articles included from systematic searches in CINAHL, MEDLINE and PsycINFO.HHA experience physical strenuous work task demands in combination with unfortunate organizational conditions in an uncontrolled and ever-changing psychosocial and physical working environment as the main obstacle to their occupational health, although many positive presence factors with opposite effects were reported.More research is needed to investigate whether physical demanding work tasks can have positive effects on HHA's occupational health by reorganizing their work while preserving patients' empowerment at their home.
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Affiliation(s)
- Sunniva Grønoset Grasmo
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ingeborg Frostad Liaset
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Skender Elez Redzovic
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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18
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Muramatsu N, Yin L, Berbaum ML, Marquez DX, Walton SM, Caceres M, Cruz Madrid KY, Zanoni JP. Protocol for a randomized controlled trial of low-intensity physical activity for frail older adults: Promoting seniors' health with home care aides (Pro-Home). Contemp Clin Trials 2021; 104:106362. [PMID: 33737196 DOI: 10.1016/j.cct.2021.106362] [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: 01/10/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
Regular participation in physical activity benefits older adults physically and mentally. However, the availability and assessment of physical activity programs that are safe and appropriate for homebound older adults at risk for nursing home admission are limited. Here we describe the protocol for a randomized controlled trial that examines the effectiveness of a gentle physical activity program. Delivered by home care aides who regularly help hard-to-reach older home care clients with housekeeping and routine personal care services in the home, this program is implemented in a real-world context of caregiver-client dyads in a Medicaid-funded home care program. The trial uses a two-group repeated measures design (baseline, Month 4, and Month 8) with 300 pairs of eligible home care clients and their home care aides. The results from this trial could provide evidence and guidelines for a new model of home care, which would facilitate the working together of older home care clients and their home care aides to maintain or improve the functional status of nursing home-eligible older adults.
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Affiliation(s)
- Naoko Muramatsu
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, USA; Institute for Health Research and Policy, University of Illinois Chicago, USA.
| | - Lijuan Yin
- Institute for Health Research and Policy, University of Illinois Chicago, USA
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois Chicago, USA
| | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois Chicago, USA
| | - Surrey M Walton
- Department of Pharmacy Systems Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, USA
| | - Maria Caceres
- Institute for Health Research and Policy, University of Illinois Chicago, USA
| | - Katya Y Cruz Madrid
- Division of Academic Internal Medicine and Geriatrics, University of Illinois Chicago, USA; Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Joseph P Zanoni
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, USA
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McDonald AP, Rizzotti R, Rivera JM, D'Arcy RCN, Park G, Song X. Toward improved homecare of frail older adults: A focus group study synthesizing patient and caregiver perspectives. Aging Med (Milton) 2021; 4:4-11. [PMID: 33738374 PMCID: PMC7954833 DOI: 10.1002/agm2.12144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Adopting a better understanding of how both older adults and health care providers view the community management of frailty is necessary for improving home health, especially facing the coronavirus disease 2019 (COVID-19) pandemic. We conducted a qualitative focus group study to assess how both older adults and health care providers view frailty and virtual health care in home health. METHODS Two focus groups enrolled home-living older adults and health care professionals, respectively (n = 15). Questions targeting the use of virtual / telehealth technologies in-home care for frail older adults were administered at audio-recorded group interviews. Transcribed discussions were coded and analyzed using NVivo software. RESULTS The older adult group emphasized the autonomy related to increasing frailty and social isolation and the need for transparent dissemination of health care planning. They were optimistic about remote technology-based supports and suggested that telehealth / health-monitoring/tracking were in high demand. Health care professionals emphasized the importance of a holistic biopsychosocial approach to frailty management. They highlighted the need for standardized early assessment and management of frailty. CONCLUSIONS The integrated perspectives provided an updated understanding of what older adults and practitioners value in home-living supports. This knowledge is helpful to advancing virtual home care, providing better care for frail individuals with complex health care needs.
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Affiliation(s)
- Andrew P. McDonald
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Joanna M. Rivera
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Ryan C. N. D'Arcy
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of Applied SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Grace Park
- Community Actions and Resources Empowering Seniors (CARES)Fraser HealthSurreyBritish ColumbiaCanada
- Home and Community Care MedicineFraser HealthSurreyBritish ColumbiaCanada
| | - Xiaowei Song
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of ScienceSimon Fraser UniversityBurnabyBritish ColumbiaCanada
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