Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults

Exploring Correlates of Resource Insecurity Among Older Black or African Americans with HIV in Ohio

OBJECTIVES

Resource insecurity is a social determinant of health that can impact people with HIV (PWH), in particular older African Americans (AA) or blacks with HIV. The purpose of this study was to identify resource insecurities among older Blacks or AA PWH specifically related to food and housing. Secondary focus was to find associations between resource insecurity and substance use history, stigma, and various forms of discrimination.

METHODS

Eligible participants (N = 52) of this cross-sectional study were 50 years old or older, identified as Black or AA, diagnosed with HIV, and living in Ohio. Food insecurity was assessed using the Household Food Insecurity Access Scale and housing insecurity was defined as not having stable housing. Resource insecurity was categorized into food and housing secure, food or housing insecure, and food and housing insecure.

RESULTS

Almost half (48.1%) of participants reported housing insecurity, with approximately 58.0% experiencing food insecurity, and 38.5% facing both. Current substance use, particularly opiates, showed significant association with resource insecurity (OR = 5.54; 95% CI = 1.91-17.30). Moreover, experiences of everyday (OR = 1.19; 95% CI = 1.10-1.30) or major forms (OR = 1.75; 95% CI = 1.33-2.39) of discrimination, as well as HIV stigma (OR = 1.24; 95% CI = 1.01-1.55), were also linked to increased odds of resource insecurity among participants.

CONCLUSIONS

Findings highlight how social factors contribute to resource insecurity among older AA PWH. Understanding the factors offers insight for targeted intervention in the fight against HIV transmission.

Sex-based factors influencing perceived relocation stress and glycemic control among older adults with diabetes

This study investigated sex differences perceived relocation stress and glycemic control among older adults with type 2 diabetes in long-term care facilities. A cross-sectional correlation design was used to recruit 120 residents during their first year after moving into the facilities in southern Taiwan. The results showed that almost two-thirds of the participants (64.2%) were women. The mean age was 79.62 (SD = 1.71). Older women with diabetes were reported to have significantly lower levels of education and poor glycemic control but higher levels of perceived relocation stress than men; however, functional independence was significantly higher in men. Although perceived relocation stress significantly predicted HbA1c levels in both women and men, length of stay was also significant in predicting HbA1c levels in women. These findings indicate the need for effective physical and psychological measures to improve glycemic control during the first year of stay in long-term care facilities.

Decision Regret and Decision-Making Process among Caregivers of Older Adults Receiving Home Care: A Cross-Sectional Study

OBJECTIVES

Family caregivers of older adults receiving home care often find themselves in situations in which they must make important and difficult decisions, which can cause conflict and regret. To tailor shared decision making in this context, we aimed to identify the most difficult decisions they faced, assess their levels of decision regret, and explore the associated factors.

DESIGN

This study used a cross-sectional design.

SETTING AND PARTICIPANTS

Participants included 165 caregivers of older adults who received home care services in Korea.

METHODS

We identified difficult decisions perceived by family caregivers of older adults and evaluated decision regret using the Decision Regret Scale (DRS), decisional conflict using the Decisional Conflict Scale (DCS), burden of care using the Short Zarit Burden Inventory, and Preference Control Scale (PCS). We then performed descriptive, bivariate, and multivariate linear regression analyses to identify factors predicting decision regret.

RESULTS

The most frequently reported difficult decisions were related to place of living (71.6%), management of health conditions (15.1%), and end-of-life decisions (13.3%). The mean DCS score was 37.09 (12.67), the DRS score was 32.33 (15.91), and the burden score was 21.81 (8.25). Matching decisions with preferences and aligning decision-making roles significantly reduced regret, while decision conflicts increased regret.

CONCLUSIONS AND IMPLICATIONS

The positive associations between decision regret, decision conflict, and the alignment of decision-making roles highlight the intricate dynamics involved in the decision-making process for family caregivers. These findings emphasize the need for tailored interventions that recognize and address the diverse factors influencing caregivers' decision-making experiences. Future research exploring the efficacy of targeted interventions such as decision-support programs or caregiver education initiatives could offer valuable insights into mitigating decision-related challenges and improving the overall well-being of both caregivers and care recipients.

Community-Based Residential Relocation in Middle and Older Age: A United States-China Comparison Study on Its Predictors and Associated Mortality Risk

OBJECTIVES

This study compared the United States and China in examining the predictors of community-based residential relocation and its associated mortality risk.

METHODS

Data from the 2010 to 2018 US Health and Retirement Study and from 2011 to 2018 China Health and Retirement Longitudinal Study were used (NUS = 20,292 and NChina = 11,694). Community-dwelling respondents (aged 50+) reported whether they had relocated and were followed up until 2018. Log-binomial regression and Cox survival analysis were used.

RESULTS

In both countries, younger age, higher education, urban residence, and being a renter were associated with higher likelihood of relocation. Community-based relocation was associated with a lower mortality risk (US: HR = 0.63, 95% CI = 0.57, 0.70; China: HR = 0.40, 95% CI = 0.31, 0.50), and this association was significantly stronger in China compared to the United States.

DISCUSSION

Common predictors of community-based relocation were found in the United States and China. The relocation-related survival advantages may be attributed to a better post-move adaptation and living environment.

Social inequity in ageing in place among older adults in Organisation for Economic Cooperation and Development countries: a mixed studies systematic review

BACKGROUND

Most older adults wish to remain in their homes and communities as they age. Despite this widespread preference, disparities in health outcomes and access to healthcare and social support may create inequities in the ability to age in place. Our objectives were to synthesise evidence of social inequity in ageing in place among older adults using an intersectional lens and to evaluate the methods used to define and measure inequities.

METHODS

We conducted a mixed studies systematic review. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and AgeLine for quantitative or qualitative literature that examined social inequities in ageing in place among adults aged 65 and older in Organisation for Economic Co-operation and Development (OECD) member countries. Results of included studies were synthesised using qualitative content analysis guided by the PROGRESS-Plus framework.

RESULTS

Of 4874 identified records, 55 studies were included. Rural residents, racial/ethnic minorities, immigrants and those with higher socioeconomic position and greater social resources are more likely to age in place. Women and those with higher educational attainment appear less likely to age in place. The influence of socioeconomic position, education and social resources differs by gender and race/ethnicity, indicating intersectional effects across social dimensions.

CONCLUSIONS

Social dimensions influence the ability to age in place in OECD settings, likely due to health inequalities across the lifespan, disparities in access to healthcare and support services, and different preferences regarding ageing in place. Our results can inform the development of policies and programmes to equitably support ageing in place in diverse populations.

'Possibilities and challenges for older couples to continue ageing in place'

Ageing in place is an imminent concern for both older couples and communities. Identifying ways to support ageing in place is required to meet the needs and challenges of older couples and social services systems. Through focus groups with a total of 46 participants and a constant comparative methodology, this study aimed to explore and describe the experiences and reasoning of spousal carers, healthcare professionals, and stakeholders regarding possibilities for older couples to age in place. The findings consisted of one main category, 'Facilitating ageing in place is a win-win situation with challenges' and four interrelated categories, 'Focus on older couples - building relationships and providing adequate services', 'Engaged civil society as a source of care and social inclusion,' 'Motivated professionals with competence and time,' and 'Services working together for a sustainable society,' that present possibilities and challenges for ageing in place. This study suggests that facilitating ageing in place is possible but involves a complex series of challenges that can be linked to different contexts ranging from individuals and couples to civil society, services provided, organisational systems, and existing resources. All these aspects need to be considered and balanced to achieve a situation that contributes to older couples' possibilities to age in place as well as to a sustainable society.

Optimizing Older Adult Mental Health in Support of Healthy Ageing: A Pluralistic Framework to Inform Transformative Change across Community and Healthcare Domains

This paper describes a pluralistic framework to inform transformative change across community and healthcare domains to optimize the mental health of older adults in support of healthy ageing. An extensive review and analysis of the literature informed the creation of a framework that contextualizes the priority areas of the WHO Decade of Health Ageing (ageism, age-friendly environments, long-term care, and integrated care) with respect to older adult mental health. The framework additionally identifies barriers, facilitators, and strategies for action at macro (social/system), meso (services/supports), and micro (older adults) levels of influence. This conceptual (analytical) framework is intended as a tool to inform planning and decision-making across policy, practice, education and training, research, and knowledge mobilization arenas. The framework described in this paper can be used by countries around the globe to build evidence, set priorities, and scale up promising practices (both nationally and sub-nationally) to optimize the mental health and healthy ageing trajectories of older adults as a population.

Do Health and Housing Attributes Motivate Residential Moves Among Older Chinese Adults? Evidence From an 8‑Year Follow‑up Study

Background and Objectives

Despite the widespread belief in aging-in-place as the preferred housing arrangement for older adults, they are increasingly embracing moving. The person-environment fit theory explains that environmental changes due to residential moves can pose health risks, discouraging older people from moving. However, it also suggests that moves may be suitable when living conditions no longer meet their physical needs. The correlation between older people's health, housing, and their subsequent moving or staying actions in China remains underexplored.

Research Design and Methods

Using alternative operating variables of key concepts and the China Family Panel Studies 2012-2018 data sets, this study examines the effects of health and housing status on older people's residential moves in China. The study outlines changes in health indicators and housing characteristics during multiple moves, as well as examines the relationship between the health and housing status of older adults and moving over a relatively long period of time using both regression models with lagged explanatory variables and fixed effects binary choice models.

Results

The results reveal that: (1) higher rates of subsequent moves were observed among older adults with better self-rated health, positive self-rated health changes, and no ADL impairment, but no significant associations were found between most health variables and moving; and (2) the correlation between older persons' house ownership/type and their residential moves was significant and consistent over time, steady and lasting.

Discussion and Implications

Potential mechanisms explaining the association between specific housing types and ownership statuses on moving are discussed. The findings encourage a focus on the positive benefits of moving in later life and how to provide additional housing options for older individuals.

Unlocking the potential of smartphone and ambient sensors for ADL detection

The detection of Activities of Daily Living (ADL) holds significant importance in a range of applications, including elderly care and health monitoring. Our research focuses on the relevance of ADL detection in elderly care, highlighting the importance of accurate and unobtrusive monitoring. In this paper, we present a novel approach that that leverages smartphone data as the primary source for detecting ADLs. Additionally, we investigate the possibilities offered by ambient sensors installed in smart home environments to complement the smartphone data and optimize the ADL detection. Our approach uses a Long Short-Term Memory (LSTM) model. One of the key contributions of our work is defining ADL detection as a multilabeling problem, allowing us to detect different activities that occur simultaneously. This is particularly valuable since in real-world scenarios, individuals can perform multiple activities concurrently, such as cooking while watching TV. We also made use of unlabeled data to further enhance the accuracy of our model. Performance is evaluated on a real-world collected dataset, strengthening reliability of our findings. We also made the dataset openly available for further research and analysis. Results show that utilizing smartphone data alone already yields satisfactory results, above 50% true positive rate and balanced accuracy for all activities, providing a convenient and non-intrusive method for ADL detection. However, by incorporating ambient sensors, as an additional data source, one can improve the balanced accuracy of the ADL detection by 7% and 8% of balanced accuracy and true positive rate respectively, on average.

A randomized controlled trial on the effects of decision aids for choosing discharge destinations of older stroke patients

BACKGROUND

In Japanese medical practice, older stroke survivors are overwhelmed with information regarding their discharge locations, creating more decision-making challenges. A randomized controlled trial evaluated the influence of decision aids (DAs) for matching older stroke patients and their families' values concerning decisional conflict and participation in discharge destination decisions.

METHODS

Participants were randomly allocated to intervention and control groups. The intervention spanned two months, from admission to discharge, at which times participants were surveyed. DAs were provided to the intervention group, and brochures to the control group. The primary endpoint was decisional conflict, assessed using the Decisional Conflict Scale (DCS). The secondary endpoint decision-making participation was assessed using the Control Preference Scale (CPS) decision-making roles and a 10-point Visual Analog Scale for participation rate. An independent t-test analyzed decisional conflict scores and participation rates to examine between-group differences. The chi-square independence test evaluated roles in decision-making scores. Post hoc subgroup analyses were performed.

RESULTS

Ninety-nine participants (intervention group n = 51; control group n = 48) were included in the full analysis set, with a dropout rate of 38.4%. No significant group differences were found in decision-making conflict [t (99) = 0.69, p = 0.49, d = 0.14] and roles in decision-making scores [χ2 (5) = 3.65, p = 0.46]. However, a significant group difference was found in the participation rate [t (99) = 2.24, p = 0.03, d = 0.45]. DA tended to reduce uncertainty and promote participation rates, especially in participants living alone and unable to decide their discharge destination.

CONCLUSIONS

The use of DA with older stroke patients did not significantly decrease decisional conflicts. In addition, the participation rate in decision-making increased, but their active role did not. Further studies should be conducted to understand the methods of offering DA, their ideal durations, and identify their beneficiaries.

Ageing in the right place-usability of a web-based housing counselling service

INTRODUCTION

Residential reasoning is a complex process that includes decisions on whether to age in place or to relocate. Ageing in the Right Place (ARP), a web-based housing counselling service was created to support older adults in this process. The study's aim was to evaluate the usability of the ARP as regards content, design, specific functions, and self-administration as a mode of delivery and to lay the ground for further optimisation.

MATERIAL AND METHOD

Nine women and five men (aged 66-82) completed a series of tasks using the ARP. Qualitative and quantitative usability data were collected through online interviews. Data were analysed using qualitative content analysis and descriptive statistics.

RESULTS

Experiences of the specific functions, content, and design of the ARP were described as mainly positive. Additions to the content and optimisation to assist in the general navigation of the website were suggested. The participants disagreed regarding the preferred mode of delivery, which indicates a need for selectable options. A system usability scale median score of 84 indicated acceptable usability.

CONCLUSION

The ARP seems to have acceptable usability, which paves the way for further evaluation.

SIGNIFICANCE

By enabling residential reasoning, older adults are supported to make proactive choices based on informed decisions.

Changes in hospitalisation rates in older people before and after moving to a retirement village

OBJECTIVES

An increasing proportion of older people live in Retirement Villages ('villages'). This population cites support for health-care issues as one reason for relocation to villages. Here, we examine whether relocation to villages is associated with a decline in hospitalisations.

METHODS

Retrospective, before-and-after observational study.

SETTING

Retirement villages, Auckland, New Zealand.

PARTICIPANTS

466 cognitively intact village residents (336 [72%] female); mean (SD) age at moving to village was 73.9 (7.7) years. Segmented linear regression analysis of an interrupted time-series design was used.

MAIN OUTCOME MEASURES

all hospitalisations for 18 months pre- and postrelocation to village.

SECONDARY OUTCOME

acute hospitalisations during the same time periods.

RESULTS

The average hospitalisation rate (per 100 person-years) was 44.9 (95% confidence interval [CI] = 36.3-55.6) 18-10 months before village relocation, 58.9 (95% CI = 48.3-72.0) 9-1 months before moving, 47.9 (95% CI = 38.8-59.1) 1-9 months after moving and 62.4 (95% CI = 51.2-76.0) 10-18 months after moving. Monthly average hospitalisation rate (per 100 person-years) increased before relocation to village by an average of 1.2 (95% CI = 0.01-1.57, p = .04) per month from 18 to 1 month before moving, and there was a change in the level of the monthly average hospitalisation rate immediately after relocation (mean difference [MD] = -18.4 per 100 person-years, 95% CI = -32.8 to -4.1, p = .02). The trend change after village relocation did not differ significantly from that before moving.

CONCLUSIONS

Although we cannot reliably claim causality, relocation to a retirement village is, for older people, associated with a significant but non-sustained reduction in hospitalisation.

Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care

BACKGROUND

Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture.

OBJECTIVE

This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system.

METHODS

This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria.

RESULTS

This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024.

CONCLUSIONS

This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/53150.

Supportive care decision-making processes of persons with dementia and their caregivers

Little is known about the decision-making processes around seeking more supportive care for dementia. Persons with dementia are often left out of decision-making regarding seeking more supportive care as their dementia progresses. This paper provides a description of findings from the Decision-making in Alzheimer's Research project (DMAR) investigating the process of decision-making about transitions to more supportive care. We conducted 61 qualitative interviews with two stakeholder groups: 24 persons with dementia, and 37 informal caregivers to explore supportive care decisions and associated decision-making factors from the perspectives of persons with dementia and their caregivers. We identified four main decisions that persons with dementia and their informal caregivers played a role in: (1) sharing household responsibilities; (2) limiting routine daily activities; (3) bringing in formal support; and (4) moving to a care facility. Based on our findings we developed a schematized roadmap of decision-making that we used to guide the discussion of our findings. Four crosscutting themes emerged from our analysis: unknowns and uncertainties, maintaining life as you know it, there's no place like home and resource constraints. These results will be incorporated into the development of instruments whose goal is to identify preferences of persons with dementia and their caregivers, in order to include persons with dementia in care decisions even as their dementia progresses.

Developing a comprehensive model of home-based formal care for elderly adults in Iran: A study protocol

BACKGROUND

Due to the increasing Iran's aging population, designing a home care model is necessary. However, the data on designing the home care model for elderly adults among developing countries are limited. This study will be carried out to develop a formal home-based care model for elderly adults in Iran.

METHODS

This multi-method study will include three phases: First, Mixed-methods sequential explanatory study including two steps: One, survey to determine the prevalence of dependence on formal and informal caregivers among people aged ≥ 60 years living in Tabriz metropolis; and two, content analysis approach includes face-to-face, semi-structured interviews with the older adults receiving formal care at home, their caregivers and relevant key informants on the characteristics of care and caregiver, challenges and expectations of standard care. In phase 2, a scoping review will be used to find out the components of home care in other countries, such as care provider organization, caregivers training, and financing. PubMed, Scopus, Web of Science, EMBASE, Google scholar databases and grey literature will be run to retrieve relevant evidence using proper MeSH terms. In phase3, the triangulation method (using the results of the previous phases, reviewing national upstream documents and the focus group discussion) will be done to reach consensus and design the initial model for the Iranian context. In the following, a Delphi study will be conducted on the validation and feasibility of the developed model.

DISCUSSION

The current health infrastructure in Iran is focused on caring for younger people, despite the near future population aging. Most studies have addressed the challenges of geriatric care, but no study has addressed the various dimensions of home care in Iran and how to provide this service to elderly adults. Providing a comprehensive model of home care for the elderly can improve the quality of life and satisfaction of the elderly and their caregivers.

The Role of Individual-Level Socioeconomic Status on Nursing Home Placement Accounting for Neighborhood Characteristics

OBJECTIVE

Independent living is desirable for many older adults. Although several factors such as physical and cognitive functions are important predictors for nursing home placement (NHP), it is also reported that socioeconomic status (SES) affects the risk of NHP. In this study, we aimed to examine whether an individual-level measure of SES is associated with the risk of NHP after accounting for neighborhood characteristics.

DESIGN

A population-based study (Olmsted County, Minnesota, USA).

SETTING AND PARTICIPANTS

Older adults (age 65+ years) with no prior history of NHP.

METHODS

Electronic health records (EHR) were used to identify individuals with any NHP between April 1, 2012 (baseline date) and April 30, 2019. Association between the (HOUsing-based index of SocioEconomic Status (HOUSES) index, an individual-level SES measure based on housing characteristics of current residence, and risk of NHP was tested using random effects Cox proportional hazard model adjusting for area deprivation index (ADI), an aggregated SES measure that captures neighborhood characteristics, and other pertinent confounders such as age and chronic disease burden.

RESULTS

Among 15,031 older adults, 3341 (22.2%) experienced NHP during follow-up period (median: 7.1 years). At baseline date, median age was 73 years old with 55% female persons, 91% non-Hispanic Whites, and median number of chronic conditions of 4. Accounting for pertinent confounders, the HOUSES index was strongly associated with risk of NHP (hazard ratio 1.89; 95% confidence interval 1.66‒2.15 for comparing the lowest vs highest quartiles), which was not influenced by further accounting for ADI.

CONCLUSIONS AND IMPLICATIONS

This study demonstrates that an individual-level SES measure capturing current individual-specific socioeconomic circumstances plays a significant role for predicting NHP independent of neighborhood characteristics where they reside. This study suggests that older adults who are at higher risk of NHP can be identified by utilizing the HOUSES index and potential individual-level intervention strategies can be applied to reduce the risk for those with higher risk.

Integrating shared decision-making, expressing preferences and active participation of older adults in primary care nursing: a systematic review of qualitative studies and qualitative meta-synthesis

OBJECTIVES

To systematically synthesise the results of primary qualitative studies on how community-dwelling older adults experience shared decision-making processes, express preferences and actively participate in care.

DESIGN

Systematic review of qualitative studies and qualitative meta-synthesis.

METHODS

We focused on studies about community-dwelling participants aged ≥65 undergoing a health-disease process circumscribed to a primary healthcare setting, and the central theme should focus on either shared decision-making, expressing preferences or patient participation. We searched the following databases: MEDLINE, CINAHL, Web of Science, Scopus and PsycINFO (time publication frame 2012-2022). We excluded studies in those cases where the qualitative results were not analysed or unrelated to the phenomenon addressed, phenomena were not clear enough to be included or the setting did not occur in the community.

RESULTS

A total of 12 studies were included in this meta-synthesis. We appraised the quality of the selected studies through Critical Appraisal Skills Programme (CASP) Checklist. The metasummary comprised the frequency and intensity of qualitative patterns across the included studies. The meta-synthesis revealed four influential elements in their interaction: recognising personal qualities, facing professional characteristics, experiences of discrimination and a double-edged context.

CONCLUSIONS

The phenomena studied were influenced by how older people approached their role in their binomial relationship with healthcare professionals. Those with a reinforced self-concept were better aware of health-disease-related situations regarding shared decision-making and the importance of being communicatively assertive. Professional characteristics were also crucial in how older people modulated their acting ability through their personality, communication skills and the approach healthcare professionals used towards older adults. Situations of discrimination generated through an imbalance of power inhibited the expression of preferences and hindered the active participation of older people. The context surrounding the participants influenced all these situations, key in tipping the balance between a therapeutic and a harmful side.

PROSPERO REGISTRATION NUMBER

CRD42022363515.

Effectiveness of multimodal intervention for depression, self-esteem, and quality of life among elderly people residing at selected old age homes in Jalandhar, Punjab

BACKGROUND

Depression is the most common mental disorder among old age people residing at old age homes. It is also associated with many physiological and psychological symptoms along with the impaired quality of life and self-esteem. The multimodal intervention, including physical activity, cognitive training, and social activities, has a positive effect on depression and self-esteem. However, only a few studies were conducted in India setup on the older population residing at old age homes. Hence, this study focused on finding the effectiveness of multimodal intervention for depression, quality of life, and self-esteem among elderly people residing at selected old age homes in Jalandhar, Punjab.

MATERIALS AND METHODS

A randomized, controlled trial design was adopted with longitudinal measurement of outcomes for 6 months. An simple random sampling technique was used to recruit 50 subjects to the experimental group and 50 subjects to the control group. Elderly people who are residing at selected old age homes in Jalandhar were selected for the study. The multimodal intervention was administered to the experimental group once weekly eight sessions over eight weeks after the pre-interventional assessment. The data were collected pre-intervention, at one month, three months, and six months after the intervention. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0.

RESULTS

There were no significant differences in demographics between groups at baseline. The mean age of subjects was 64.35 ± 1.32 years in the experimental group and 64.12 ± 1.83 in the control group. The mean duration of stay in old age home was 3.64 ± 1.25 years in the experimental group and 4.05 ± 1.65 in the control group. There were significant multimodal intervention effects on decreasing depression (F = 20.15, P < 0.05, n_p²= 0.092) and increasing self-esteem (F = 84.65, P < 0.001, n_p²= 0.24) and quality of life (F = 62.32, P < 0.001, n_p²= 0.52) over the 6-month interval.

CONCLUSION

This study demonstrated that the multimodal intervention was effective in reducing depression among elderly people residing at selected old age homes. It also shows that self-esteem and quality of life improved significantly after intervention.

Built Environment Accessibility and Disability as Predictors of Well-Being among Older Adults: A Norwegian Cross-Sectional Study

Knowledge about the influence environmental factors have on well-being is important to deliver policies supporting healthy ageing and sustainable health equity. An under-researched question is whether and how the built environment plays a role on well-being among older adults with disabilities. This study explores the relationship between built environment accessibility and disability on psychosocial well-being among older adults. Data were used from the Norwegian Counties Public Health Survey collected during February 2021 in Møre and Romsdal county (N = 8274; age = 60-97, mean = 68.6). General linear modelling was performed to examine the relationship and interaction between built environment accessibility (services, transportation, and nature) and disability on psychosocial well-being (quality of life, thriving, loneliness, and psychological distress). Higher levels of disability and poorer accessibility were each significantly related to lower psychosocial well-being across all variables (p < 0.001). Significant interaction effects were observed between disability and built environment accessibility on thriving (F(8, 5936) = 4.97, p < 0.001, η² = 0.006) and psychological distress (F(8, 5957) = 3.09, p = 0.002, η² = 0.004). No significant interaction effects were found for quality of life and loneliness. These findings indicate good built environment accessibility is associated with thriving and reduces psychological distress among older adults with disabilities. This study supports and extends previous findings on the importance of accessible and equipped environments for well-being and may aid policy makers when planning built environments to foster healthy ageing among this population group.

Transitional care decision-making through the eyes of older people and informal caregivers: An in-depth interview-based study

BACKGROUND

Older people with multifaceted care needs often require treatment and complex care across different settings. However, transitional care is often inadequately managed, and older people and their informal caregivers are not always sufficiently heard and/or supported in transitional care decision-making.

OBJECTIVE

To explore older people's and informal caregivers' experiences with, views on, and needs concerning empowerment in transitional care decision-making.

METHODS

A qualitative descriptive study was conducted in the TRANS-SENIOR consortium's collaborative research using semistructured in-depth interviews between October 2020 and June 2021 in Flanders, Belgium. A total of 29 people were interviewed, including 14 older people and 15 informal caregivers who faced a transition from home to another care setting or vice versa. Data were analysed according to the Qualitative Analysis Guide of Leuven.

FINDINGS

Five themes were identified in relation to the participant's experiences, views and needs: involvement in the decision-making process; informal caregivers' burden of responsibility; the importance of information and support; reflections on the decision and influencing factors.

CONCLUSIONS

Overall, older people and informal caregivers wished to be more seen, recognised, informed and proactively supported in transitional care decision-making. However, their preferences for greater involvement in decision-making vary and are affected by several factors that are both intrinsic and extrinsic. Therefore, healthcare systems might seek out age-tuned and person-centred empowerment approaches focusing on older people's and informal caregivers' empowerment. For future studies, we recommend developing specific strategies for such empowerment.

PATIENT OR PUBLIC CONTRIBUTION

Older persons' representatives were involved in designing the TRANS-SENIOR programme of research, including the current study. Healthcare professionals and nursing care directors were involved in the study design and the selection and recruitment of participants.

Household Composition Under Strain: Regional Unemployment Rates and the Older American Housing Decision

This research explored the relationship between regional unemployment rates and the community-based housing configuration of older Americans. The analysis used the American Community Survey from 2006 to 2016 to examine regions experiencing high unemployment for differences in the likelihood of older adults to live alone, with a spouse or partner, or in a multigenerational household. Findings demonstrated that under the strain of higher regional unemployment, older adults were less likely to live alone and more likely to live in a multigenerational household. Additionally, older adults with a difficulty that could signify a need for support were less likely to live with a spouse or partner, while those without a difficulty were more likely to live with a spouse or partner. Recession-related safety-net policy should target supports to community-dwelling older adults, particularly those living alone, those with more support needs, with lower income, and older renters, because their housing arrangements may become vulnerable during regional economic contraction. Implications during COVID-19 are discussed.

Applying to a nursing home is a way to maintain control of life-Experiences from Swedish nursing home applicants

BACKGROUND

Swedish social policy enables ageing in place with support from home-based care services despite high age and/or declining health.

AIM

This study aims to describe the daily life experiences behind the decision to apply for a nursing home placement in older adults ageing in place.

MATERIALS AND METHODS

A qualitative design was chosen, and 11 semi-structured interviews were conducted and analysed using inductive qualitative content analysis.

RESULTS

The participants described a feeling of dependence in which they had to ignore their personal privacy when receiving home-based care. They reached a turning point when ageing in place was, for several reasons, no longer considered an acceptable option. This influenced their choice to apply to a nursing home where they expected that they could maintain control over their lives.

DISCUSSION AND CONCLUSION

The results indicate that when enhancing ageing in place it is important to enable older adults to receive support to maintain autonomy in daily activities and to have the opportunity to age in the right place.

Canadian Older Adults' Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey

BACKGROUND

Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision.

OBJECTIVE

We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention.

METHODS

We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ≥65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA.

RESULTS

Of the 11,972 invited panelists, 1176 (9.82%) met the eligibility criteria, and 1000 (85.03%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8%), White (906/1000, 90.6%), English speakers (629/1000, 62.9%), and lived in Ontario or Quebec (628/1000, 62.8%) and in urban areas (850/1000, 85%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue (β=.30; P<.001), objective eHealth literacy (β=-.06; P=.03), performance expectancy (β=.55; P<.001), social influence (β=.37; P<.001), and facilitating conditions (β=.15; P<.001).

CONCLUSIONS

Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA.

Challenges to Systems of Long-Term Care: Mapping of the Central Concepts from an Umbrella Review

The ageing of the population poses urgent challenges to the health and social protection sectors, including the need for greater adequacy and integration of health care services provided to older people. It is considered necessary and urgent to understand the state-of-the-art of community-based models of care for older people in institutional care and at home. This study aims to map the concepts that politicians and providers need to address through an umbrella review as a review method. Articles describing the structuring aspects of care models appropriate to the needs in long-term care and systematic reviews or meta-analyses targeting people aged 65 years or more were considered. A total of 350 studies met the inclusion criteria and were included in the review. The results identified the need to contribute to effective and more efficient integration and articulation of all the stakeholders, based essentially on professional care at the patient's homes, focused on their needs using the available technologies, empowering patients and families. Eight categories emerged that addressed factors and variables involved in care models for the long-term care needs of institutionalised and home-based older people as a guarantee of accessibility to healthcare and to enhance the well-being and quality of life of patients and family caregivers.

Salient Targets and Fear of Falling Changed the Gait Pattern and Joint Kinematic of Older Adults

BACKGROUND

Fear of falling and environmental barriers in the home are two major factors that cause the incidence of falling. Poor visibility at night is one of the key environmental barriers that contribute to falls among older adult residents. Ensuring their visual perception of the surroundings, therefore, becomes vital to prevent falling injuries. However, there are limited works in the literature investigating the impact of the visibility of the target on older adults' walking destinations and how that impact differs across them with different levels of fear of falling.

OBJECTIVE

The purpose of the study was to examine the effects of target salience on older adults' walking performance and investigate whether older adults with varying levels of fear of falling behave differently.

METHODS

The salient target was constructed with LED strips around the destination of walking. Fifteen older adults (aged 75 years old and above), seven with low fear of falling and eight with high fear of falling, volunteered for the study. Participants walked from the designated origin (i.e., near their beds) to the destination (i.e., near the bathroom entrance), with the target turned on or off around the destination of the walking trials. Spatiotemporal gait variables and lower-body kinematics were recorded by inertial sensors and compared by using analysis of variance methods.

RESULTS

Data from inertial sensors showed that a more salient target at the destination increased older adults' gait speed and improved their walking stability. These changes were accompanied by less hip flexion at heel strikes and toe offs during walking. In addition, older adults with low fear of falling showed more substantial lower-body posture adjustments with the salient target presented in the environment.

CONCLUSIONS

Older adults with a low fear of falling can potentially benefit from a more salient target at their walking destination, whereas those with a high fear of falling were advised to implement a more straightforward falling intervention in their living areas.

Do You Feel Safe at Home? A Qualitative Study among Home-Dwelling Older Adults with Advanced Incurable Cancer

Many older adults with cancer prefer to live at home, and home treatment and outpatient care have been recommended for such patients. To improve their mental health, it is important to identify the challenges that are faced by home-dwelling older adults with cancer. This study aimed to examine the impact of the home on older adults with advanced cancer who were receiving treatment and follow-up care. In a cross-sectional design with criterion-based sampling, eight qualitative interviews were transcribed and interpreted thematically. We identified three themes of home-safety management: good home-safety management, uncertain home-safety management, and home-safety management collapse. Moreover, we revealed eight sub-themes important to the participants' home-safety experience. Ensuring that older adults feel safe at home will afford them the opportunity to enjoy living at home, which in turn may alleviate their symptom burden and enhance their mental health.

Moving our care home: A qualitative study of the views and experiences of residents, relatives and staff

INTRODUCTION

Involuntary relocation when care homes close can be detrimental to residents' health and well-being and is associated with increased mortality. There is little formal evidence to support whether planning can mitigate the impact of such moves. This study aimed to understand the experiences of a whole care home relocation where staff and residents relocated together using existing published guidance.

METHODS

A longitudinal qualitative research study using individual face-to-face semi-structured interviews was conducted between August 2018 and August 2019. Baseline interviews were conducted 6-8 weeks after relocation with follow-up interviews 10-12 months later. Interviews were recorded, transcribed and analysed using framework analysis.

RESULTS

27 interviews were conducted; 19 baseline interviews (4 residents, 7 family members, 8 staff) and 8 follow-up interviews (2 residents, 2 family members, 4 staff). Participants' feelings about the relocation were mixed: some reported apprehension before the move but others excitement. Residents and families felt variably involved in planning the move, whereas staff expressed lack of involvement. Time, family support and continuity of care helped participants settle in. The new environment shaped participants' experiences and abilities to adjust, especially the lack of a homely feeling with the new home, the larger size and changes in staff organisation and management.

CONCLUSIONS

Despite implementation of existing guidance, relocation was still challenging for residents, staff and family members. Future relocations should increase involvement of staff in the planning and design of the home; offer continuous support to those involved; and ensure continuity of care and management style.

Aspects of cognition that impact aging-in-place and long-term care planning

BACKGROUND

Older adults frequently defer decisions about their aging-in-place/long-term care (AIP-LTC) needs. As a result, when older adults experience worsening Alzheimer's disease, family members/friends become surrogate decision makers. We sought to understand what aspects of cognition impact older adult AIP-LTC planning.

METHODS

As part of the PlanYourLifespan (PYL)-LitCog study, we longitudinally examined AIP-LTC decision-making among a cohort (LitCog) of community-based older adults (65 years and older) recruited from hospital-associated primary care clinics in Chicago, Illinois, with extensive cognitive testing. PlanYourLifespan.org (PYL) is an evidence-based online intervention that facilitates AIP-LTC planning. Subjects underwent baseline testing, received the PYL online intervention, and then were surveyed at 1, 6, and 12 months about AIP-LTC decision-making. Cross-sectional logistic regression analysis was conducted examining cognitive variables that impacted AIP-LTC decision-making.

RESULTS

Of the 293 older adults interviewed (mean age 73.0 years, 40.4% non-White), subjects were more likely to have made AIP-LTC decisions if they had adequate inductive reasoning (ETS letter sets total-OR = 1.14 (95% CI = 1.03-1.27; p < 0.05)) and adequate working memory (size judgment span total-OR = 1.76 (95% CI = 1.13-2.73; p < 0.05)). There were no differences in decision-making observed in verbal abilities, long-term memory, or processing speed. All analyses were adjusted for participant gender, race, age, and decision-making response at baseline.

CONCLUSION

Inductive reasoning and working memory are critical to AIP-LTC decision-making. Screening routinely for these specific cognitive domains is important in targeting and helping older adults prepare in time for their future AIP-LTC needs.

Influence of the Corporate Image of Nursing Homes on the Loyalty of Residents’ Family Members

This study analyzes the influence of the corporate image of nursing homes on the decisions made by family members as to whether their elderly relatives will stay in the same nursing home. An empirical study was conducted considering 566 residents’ family members with the capacity to decide whether said residents will remain in the same nursing home, using a binary regression model with a logistic link function (i.e., logit). For the first time in the nursing home sector, these results show the specific variables of the corporate image that influence family members when deciding whether their elders will stay in the same nursing home. In order of importance, these variables are the level of trust conveyed by the nursing home, the investment made in the facilities, price-quality ratio, emotional connection to the nursing home, and the promotion of the nursing home’s services. The study also highlights the importance of other personal factors in family members’ decisions to keep their elders in the same nursing home, such as the family members’ employment situations (higher loyalty among those employed by third parties) and the determining factors involved in the relative’s choice of nursing home (higher loyalty among those whose choice was mainly based on humane and dignified treatment). This study offers a discussion of the theoretical contributions this research brings to academia as well as managerial implications for the industry. We believe that one future line of research should be continued after the COVID-19 pandemic comes to an end to compare the results and observe whether the most influential variables on family members’ loyalty remain the same as data for this study was collected from November 2019 to February 2020.

Difficult Decisions for Older Canadians Receiving Home Care, and Why They Are So Difficult: A Web-Based Decisional Needs Assessment

Background. Older adults receiving home care services often face decisions related to aging, illness, and loss of autonomy. To inform tailored shared decision making interventions, we assessed their decisional needs by asking about the most common difficult decisions, measured associated decisional conflict, and identified factors associated with it. Methods. In March 2020, we conducted a cross-sectional survey with a pan-Canadian Web-based panel of older adults (≥65 y) receiving home care services. For a difficult decision they had faced in the past year, we evaluated clinically significant decisional conflict (CSDC) using the 16-item Decisional Conflict Scale (score 0–100) with a >37.5 cutoff. To identify factors associated with CSDC, we performed descriptive, bivariable, and multivariable analyses using the stepwise selection method with an assumed entry and exit significance level of 0.15 and 0.20, respectively. Final model selection was based on the Bayesian information criterion. Results. Among 460 participants with an average age of 72.5 y, difficult decisions were, in order of frequency, about housing and safety (57.2%), managing health conditions (21.8%), and end-of-life care (8.3%). CSDC was experienced by 14.6% (95% confidence interval [CI]: 11.5%, 18.1%) of respondents on all decision points. Factors associated with CSDC included household size = 1 (OR [95% CI]: 1.81 [0.99, 3.33]; P = 0.27), household size = 3 (2.66 [0.78, 8.98]; P = 0.83), and household size = 4 (6.91 [2.23, 21.39]; P = 0.014); preferred option not matching the decision made (4.05 [2.05, 7.97]; P < 0.001); passive role in decision making (5.13 [1.78, 14.77]; P = 0.002); and lower quality of life (0.70 [0.57, 0.87]; P<0.001). Discussion. Some older adults receiving home care services in Canada experience CSDC when facing difficult decisions. Shared decision-making interventions could mitigate associated factors.

Predictors of Decision Regret among Caregivers of Older Canadians Receiving Home Care: A Cross-Sectional Online Survey

Background. In Canada, caregivers of older adults receiving home care face difficult decisions that may lead to decision regret. We assessed difficult decisions and decision regret among caregivers of older adults receiving home care services and factors associated with decision regret. Methods. From March 13 to 30, 2020, at the outbreak of the COVID-19 pandemic, we conducted an online survey with caregivers of older adults receiving home care in the 10 Canadian provinces. We distributed a self-administered questionnaire through Canada’s largest and most representative private online panel. We identified types of difficult health-related decisions faced in the past year and their frequency and evaluated decision regret using the Decision Regret Scale (DRS), scored from 0 to 100. We performed descriptive statistics as well as bivariable and multivariable linear regression to identify factors predicting decision regret. Results. Among 932 participants, the mean age was 42.2 y (SD = 15.6 y), and 58.4% were male. The most frequently reported difficult decisions were regarding housing and safety (75.1%). The mean DRS score was 28.8/100 (SD = 8.6). Factors associated with less decision regret included higher caregiver age, involvement of other family members in the decision-making process, wanting to receive information about the options, and considering organizations interested in the decision topic and health care professionals as trustworthy sources of information (all P < 0.001). Factors associated with more decision regret included mismatch between the caregiver’s preferred option and the decision made, the involvement of spouses in the decision-making process, higher decisional conflict, and higher burden of care (all P < 0.001). Discussion. Decisions about housing and safety were the difficult decisions most frequently encountered by caregivers of older adults in this survey. Our results will inform future decision support interventions.

Does Adding Training in Shared Decision Making for Home Care Teams to Providing Decision Guides Better Engage Frail Elders and Caregivers in Housing Decisions? :A Stepped-Wedge Cluster Randomized Trial

Background

Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams.

Objective

We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making.

Methods

We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis.

Results

A total of 311 frail older adults were included in the analysis, including 208 (66.9%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3% (95% CI –5.8% to 12.4%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1% (95% CI -11.2% to 23.4%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults’ perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI −0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI −16.5% to 1.6%, P=.10).

Conclusions

Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making.

Trial Registration

ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525

Development and validation of a Perceived Relocation Stress Scale for older individuals transferred to long-term care facilities in Taiwan

BACKGROUND

The aim of the current study was to develop and validate a Perceived Relocation Stress Scale.

METHODS

A cross-sectional research design was used. A total of 175 older adults residing in long-term care facilities in Southern Taiwan for at least 1 y were recruited. An exploratory factor analysis was performed to examine item convergent and discriminant validity. Concurrent validity was checked using the Depression Anxiety and Stress scale. The reliability was analyzed using Cronbach's alpha and intraclass correlation coefficients.

RESULTS

The face and content validity of the scale were verified by adequately measuring the scale items. Factor analysis consisted of four components (challenge/chance, positive appraisal, threat, loss), with a total variance of 67.35%. The content validity was determined by an expert panel to systematically examine the relevance of all items. The results of item convergent and discriminant validity supported the constructs of the scale. The alpha coefficient for the overall scale was .958, indicating good internal consistency reliability.

CONCLUSIONS

The Perceived Relocation Stress Scale is a reliable and valid measurement to assess the stress perceived by older individuals being transferred to a long-term care facility.

Home care providers' perceptions of shared decision-making with older clients (and their caregivers): A cross-sectional study

Interprofessional care teams can play a key role in supporting older adults (and caregivers) in making informed health decisions, yet shared decision making is not widely practiced in home care. Based on an earlier needs assessment with older adults (and caregivers) with home care experience, we aimed to explore the perceptions of home care teams on the decisions facing their clients and their perceived involvement in shared decision making. A cross-sectional study was conducted with 614 home care providers (nurses, personal support workers, rehabilitation professionals) in three Canadian provinces (Quebec, Ontario, and Alberta). Home care providers considered the decision "to stay at home or move" as the most difficult for older adults. Those most frequently involved in decision making with older adults were family members and least involved were physicians. Although all home care providers reported high levels of shared decision-making, we detected an effect of respondent's discipline on self-perceived shared decision-making; nurses and rehabilitation professionals reported significantly higher levels of shared decision making than personal support workers. A more tailored approach is required to support shared decision making in interprofessional care teams.

The role of the district nurse in screening and assessment for frailty

An ageing population is leading to greater demands on healthcare services; investments are being made to allow complex care to be given in patient's homes by community care staff, as highlighted in the NHS Long Term Plan (2019). Frailty is often identified in secondary care when acute crisis is hit; frailty does not suddenly occur and will happen over time. This article aims to explore community screening, the assessment processes of frailty and the role the district nurse has. It also addresses how working collaboratively with the wider multidisciplinary team to earlier identify service users with frailty can assist in improving patient outcomes by empowering and supporting service users to remain at home. Recognising continual improvement to service users' care and changes in practice should be considered and disseminated. based upon best available evidence.

A vulnerable residential environment is associated with higher risk of mortality and early transition to permanent residential aged care for community dwelling older South Australians

OBJECTIVES

This study examined the impact of the residential environment, measured by the Healthy Ageing/Vulnerable ENvironment (HAVEN) Index, on risk of mortality or entry into Permanent Residential Aged Care (PRAC).

DESIGN

A retrospective cohort study using data from the Registry of Senior Australians (ROSA) was conducted. HAVEN Index values were matched to the ROSA by residential postcode.

STUDY SETTING AND PARTICIPANTS

Older individuals living in metropolitan Adelaide and receiving their first eligibility assessment for aged care services between 2014 and 2016 (N = 16,944).

MAIN OUTCOME MEASURE

Time to death and entry into PRAC were the main outcomes.

RESULTS

A higher HAVEN Index value, which represents a favourable residential environment, was associated with a lower risk of mortality and delayed entry to PRAC. For every 0.1 unit increase in HAVEN Index value, the risk of mortality is 3% lower (adjusted hazard ratio [HR], 95% confidence interval [CI] = 0.97, 0.96-0.99) and the risk of entry to PRAC is 5% lower (adjusted subdistribution HR, 95%CI = 0.95, 0.94-0.97) in the first 2 years following aged care assessment. After 2 years, the HAVEN Index was not associated with the risk of transition to PRAC.

CONCLUSION

Place-based health inequalities were identified in Australians seeking aged care services, demonstrating that a better understanding of local neighbourhoods may provide insight into addressing ageing inequalities. Spatial indexes, such as the HAVEN Index, are useful tools to identify areas where populations are more vulnerable to adverse health outcomes, informing responses to prioritise local improvements and health interventions to enable healthy ageing.

People with Parkinson's disease and housing issues: A scoping review

BACKGROUND AND AIMS

There is evidence that housing issues are associated with health outcomes as people age, but little is known in this respect regarding the specific population of people with Parkinson's disease (PD). The objective of this literature review was to identify and analyze the knowledge gap concerning people with PD and housing issues.

METHODS

Applying established guidelines for scoping reviews, a systematic literature search was done in relevant databases applying the following inclusion criteria: empirical studies including human participants with PD, addressing housing in the objective, hypothesis or research questions, and published in English in peer-reviewed journals. Data were analyzed using a framework of domains, factors, and variables influencing housing decisions among older people.

RESULTS

Twelve publications were identified, originating from a few researchers and with very different scopes. While the social dimension was scarcely attended to, the publications addressed all six domains of the analytical framework and 30% of the variables specified therein, but many were only used for descriptive purposes.

CONCLUSION

This scoping review reveals that there is a substantial knowledge gap regarding people with PD and housing issues. The knowledge gap is most evident in the social dimension, while the studies identified provide more information relating to the health dimension than what is the case in research on housing targeting the general aging population. Because society urgently needs evidence to support the development of housing policies and provide suitable housing for this vulnerable population, more research targeting people with PD and housing issues is warranted.

Characteristics of movers and predictors of residential mobility in the Atherosclerosis Risk in Communities (ARIC) cohort

Current efforts to characterize movers and identify predictors of moving have been limited. We used the ARIC cohort to characterize non-movers, short-distance movers, and long-distance movers, and employed best subset algorithms to identify important predictors of moving, including interactions between characteristics. Short- and long-distance movers were notably different from non-movers, and important predictors of moving differed based on the distance of the residential move. Importantly, systematic inclusion of interaction terms enhanced model fit and was substantively meaningful. This work has important implications for epidemiologic studies of contextual exposures and those treating residential mobility as an exposure.

Comparative Analysis of Machine Learning Algorithms for Classification of Environmental Sounds and Fall Detection

In recent years, number of elderly people in population has been increased because of the rapid advancements in the medical field, which make it necessary to take care of old people. Accidental fall incidents are life-threatening and can lead to the death of a person if first aid is not given to the injured person. Immediate response and medical assistance are necessary in case of accidental fall incidents to elderly people. The research community explored various fall detection systems to early detect fall incidents, however, still there exist numerous limitations of the systems such as using expensive sensors, wearable sensors that are hard to wear all the time, camera violates the privacy of person, and computational complexity. In order to address the above-mentioned limitations of the existing systems, we proposed a novel set of integrated features that consist of melcepstral coefficients, gammatone cepstral coefficients, and spectral skewness. We employed a decision tree for the classification performance of both binary problems and multi-class problems. We obtained an accuracy of 91.39%, precision of 96.19%, recall of 91.81%, and F1-score of 93.95%. Moreover, we compared our method with existing state-of-the-art methods and the results of our method are higher than other methods. Experimental results demonstrate that our method is reliable for use in medical centers, nursing houses, old houses, and health care provisions.

'The Primacy of 'Home': An exploration of how older adults' transition to life in a care home towards the end of the first year

This grounded theory study sought to explore how older adults' experience the transition from living at home to a care home with a specific focus on the latter part of the first year of the move. The study was carried out within a large Health Trust in the UK between August 2017 and May 2019. Purposive sampling was used in the initial stages of data collection. Thereafter and consistent with grounded theory methodology, theoretical sampling was employed to undertake semi-structured interviews with 17 individuals from eight care homes between 5 and 12 months after the move. This paper reports five key categories which were: (a) The lasting effect of first Impressions 'They helped me make my mind up' (b) On a Journey 'I just take it one day at a time', (c) Staying connected and feeling 'at home' 'You get something good out of it you know…you get hope'. (d) Managing loss and grief 'It was important for me to say cheerio to the house' and (e) Caring relationships 'I didn't realise that I was lonely until I had company'. Together these five categories formed the basis of the core category 'The Primacy of 'Home' which participants identified as a place they would like to feel valued, nurtured and have a sense of belonging. This study identifies that it is important for individual preferences and expectations to be managed from the outset of the move. Individuals and families need to be supported to have honest and caring conversations to promote acceptance and adaptation to living in a care home while continuing to embrace the heart of 'home'. Key recommendations from this study include the need to raise awareness of the significance of the ongoing psychological and emotional well-being needs of older people which should be considered in policy directives and clinical practice.

Where to Retire? Experiences of Older African Immigrants in the United States

Doubling in size since the 1970s, the aging needs of the African immigrant population are not fully understood. This qualitative study examined experiences of aging and retirement planning for African immigrant older adults in the United States (U.S.). Specifically, it explored the factors, processes, and ultimate decision of where these older adults planned to retire. Secondary analysis of semi-structured interviews with 15 older African immigrants in the Baltimore-Washington Metropolitan area was conducted. Data was analyzed using thematic analyses in NVivo. The majority of participants were women, with a mean age of 64. Three overarching themes with ten sub-themes were identified. The themes included: (1) cultural identity, which indicated the participant's comfort with the U.S. society and culture; (2) decision making, meaning factors that impact participants' choice of retirement location; and (3) decision made, meaning the final choice of where participants would like to retire. Age-friendliness for immigrant older adults in the U.S. is complex and it includes traditional domains such as physical and sociocultural environment (e.g., housing, transportation, and income). However, immigrant age-friendliness also needs to include wider contextual aspects such as political climate of their country of origin, immigrant status, family responsibilities, and acculturation in the U.S. More research is needed to better understand and facilitate age-friendly environments and transnational aging of immigrant older adults.

"The Internal Police Officer Has Not Retired but Has Slowed Down": Israeli Women Reframe Their Aging Experiences in the Second Half of Life

Compared with gains, losses have received a substantial amount of research and public attention. The present study aims to shed light on the positive gains associated with older age from the perspective of older women. Five focus groups with 19 Israeli women over the age of 54 were conducted. Trailers of three different films were used to stimulate discussion about old age and aging and allow for reflections on societal norms in light of personal experiences. Focus group interviews were analyzed thematically. Respondents identified four contexts, characterized by reframing their experiences against societal norms. These included gender stereotypes, physical appearance, interpersonal relations, and employment. This study represents an opening to a different discourse around old age, which is characterized by gains and possibilities brought about by changes in reframing one’s experiences, while distancing oneself and exerting free will vis à vis social norms.

Behavioral and Cognitive Problems as Determinants of Malnutrition in Long-Term Care Facilities, a Cross-Sectional and Prospective Study

OBJECTIVES

To investigate the cross-sectional and prospective associations between behavior and cognitive problems and malnutrition in long-term care facilities (LTCF).

DESIGN

Cross-sectional and prospective routine care cohort study.

SETTING

6874 Residents in Dutch LTCFs (period 2005-2020).

PARTICIPANTS

Data were obtained from the InterRAI-LTCF instrument. Cross-sectional analyses on prevalence of malnutrition at admission included 3722 residents. Prospective analyses studied incident malnutrition during stay (total follow-up time 7104 years) and included data of 1826 residents with first measurement on admission ('newly-admitted') and n=3152 with first measurement on average ~1 year after admission ('existing').

MEASUREMENTS

InterRAI scales for communication problems (CS), aggressive behavior (ABS), social engagement (RISE), depressive symptoms (DRS), cognitive performance (CPS) and the total number of behavior and cognitive problems were investigated as independent variables and malnutrition (ESPEN 2015 definition) as dependent variable in regression analyses. Results were stratified for gender and group 'newly-admitted' vs. 'existing'.

RESULTS

On admission, 9.5% of residents was malnourished. In men, low social engagement was associated with prevalence of malnutrition. In women, all behavior and cognitive problems except depression were associated with malnutrition in the unadjusted analyses, but this attenuated in the full model taking all problems into account. The incidence of malnutrition during stay amounted to 8.9%. No significant associations of behavior and cognitive problems with malnutrition incidence were seen in 'newly-admitted' male residents while in 'existing' male residents all determinants were significantly associated. In 'newly-admitted' female residents CS, ABS and CPS, and in 'existing' female residents CS, RISE, ABS and CPS were significantly associated with incident malnutrition. All associations slightly attenuated after adjustment. Malnutrition incidence increased with increasing number of combined behavior and cognitive problems.

CONCLUSION

Residents with behavior and cognitive problems are at an increased risk of being malnourished at admission, or becoming malnourished during stay in a LTCF, especially residents with multiple behavior and cognitive problems.

The Role of Information and Communication Technology (ICT) for Older Adults' Decision-Making Related to Health, and Health and Social Care Services in Daily Life-A Scoping Review

Information and communication technology (ICT) can potentially support older adults in making decisions and increase their involvement in decision-making processes. Although the range of technical products has expanded in various areas of society, knowledge is lacking on the influence that ICT has on older adults' decision-making in everyday situations. Based on the literature, we aimed to provide an overview of the role of ICT in home-dwelling older adults' decision-making in relation to health, and health and social care services. A scoping review of articles published between 2010 and 2020 was undertaken by searching five electronic databases. Finally, 12 articles using qualitative, quantitative, and mixed-method designs were included. The articles were published in journals representing biology and medicine, nursing, informatics, and computer science. A majority of the articles were published in the last five years, and most articles came from European countries. The results are presented in three categories: (i) form and function of ICT for decision-making, (ii) perceived value and effect of ICT for decision-making, and (iii) factors influencing ICT use for decision-making. According to our findings, ICT for decision-making in relation to health, and health and social care services was more implicitly described than explicitly described, and we conclude that more research on this topic is needed. Future research should engage older adults and health professionals in developing technology based on their needs. Further, factors that influence older adults' use of ICT should be evaluated to ensure that it is successfully integrated into their daily lives.

Exploring the Psychometric Properties of the Questionnaire on Family Members Adapting to an Older Adult's Admission to a Nursing Home (CAFIAR-15) in a Colombian Sample

Institutionalization to a nursing home can be one of the most significant and traumatic events in a senior's life, and for their family. For this reason, it is especially important to have validated instruments that evaluate the family member's adaptation to admitting the senior to a nursing home. The study included 139 family members recruited equally in two types of institutions (low-income nursing home (LINH) vs. high-income nursing home (HINH)). A sociodemographic questionnaire with questions to study antecedents and conditions for care and the Questionnaire for Admitting an Older Adult to a Nursing Home (CAFIAR-15) were used. Examining the communalities indicated that four of the five items in factor 3 presented communalities lower than 0.30 and differences in the factorial structure of the CAFIAR-15 were found. There were differences in the antecedents and conditions for care between the relatives of the older adults at LINH and HINH. Cultural differences and differences between LINH and HINH may be the basis for flaws in the conceptual validity of the CAFIAR-15 in the Colombian sample.

Prioritizing supports and services to help older adults age in place: A Delphi study comparing the perspectives of family/friend care partners and healthcare stakeholders

Background

Aging in place (AIP) is a policy strategy designed to help older adults remain in their community. While planners internationally have modified aspects of the older adult care continuum (e.g., home care, assisted living, nursing homes) to facilitate AIP, further improvements to community-based supports and services are also required. This study compared and constrasted the community-based factors (e.g., supports, services and personal strategies or characteristics) that family/friend care partners and healthcare stakeholders (i.e., planners/providers) view as most important to help older adults successfully AIP.

Methods

An initial list of factors shown to influence AIP was created from the academic literature. These factors were used to develop a Delphi survey implemented separately on care partners and healthcare stakeholders. Respondents rated the importance of each factor using a 10-point Likert Scale (1 = not important; 10 = absolutely critical). Consensus in each group was defined when at least 80% of participants scored a factor ≥8 (“very important”), with an interquartile range ≤2. Respondents suggested additional factors during Delphi round one.

Results

Care partners (N = 25) and healthcare stakeholders (N = 36) completed two and three Delphi rounds, respectively. These groups independently agreed that the following 3 (out of 27) factors were very important to help older adults age in place: keeping one’s home safe, maintaining strong inter-personal relationships, and coordinating care across formal providers. While healthcare stakeholders did not reach consensus on other factors, care partners agreed that 7 additional factors (e.g., access to affordable housing, having mental health programs) were important for AIP.

Conclusions

Compared to healthcare stakeholders, care partners felt that more and diverse community-based factors are important to support older adults to successfully AIP. Future research should replicate these findings in other jurisdictions, examine the availability and accessibility of the priority factors, and develop sustainable solutions to enhance their effectiveness.

Leisure sedentary time and physical activity are higher in neighbourhoods with denser greenness and better built environments: An analysis of the Canadian Longitudinal Study on Aging

Associations of environmental variables with physical activity and sedentary time using data from the Canadian Longitudinal Study on Aging, and the Canadian Urban Environment Research Consortium (Canadian Active Living Environments (Can-ALE) dataset, and Normalized Difference Vegetation Index (NDVI, greenness) dataset) were assessed. The main outcome variables were physical activity and sedentary time as measured by a modified version of the Physical Activity for Elderly Scale. The sample consisted of adults aged 45 and older (n = 36,580, mean age 62.6±10.2, 51% female). Adjusted ordinal regression models consistently demonstrated that those residing in neighbourhoods in the highest Can-ALE category (most well-connected built environment) reported more physical activity and sedentary time. For example, males aged 75+ in the highest Can-ALE category had 1.9 times higher odds of reporting more physical activity (OR = 1.9, 95%CI = 1.1-3.4) and 1.8 higher odds of reporting more sedentary time (OR = 1.8, 95%CI = 1.0-3.4). Neighbourhoods with higher greenness scores were also associated with higher odds of reporting more physical activity and sedentary time. It appears that an environment characterized by higher Can-ALE and higher greenness may facilitate physical activity, but it also facilitates more leisure sedentary time in older adults; research using device measured total sedentary time, and consideration of the types of sedentary activities being performed is needed. Novelty: ●Middle-aged and older adults living in neighbourhoods with higher Can-ALE scores and more greenness report more physical activity and leisure sedentary time ●Greenness is important for physical activity and sedentary time in middle-aged adults.

Out-of-pocket expenses related to aging in place for frail older people: a scoping review

Objective:

The objective of this scoping review was to map and describe the available evidence reporting out-of-pocket expenses related to aging in place for older people with frailty and their caregivers.

Introduction:

As the global population ages, there has been increasing attention on supporting older people to live at home in the community as they experience health and functional changes. Older people with frailty often require a variety of supports and services to live in the community, yet the out-of-pockets costs associated with these resources are often not accounted for in health and social care literature.

Inclusion criteria:

Sources that reported on the financial expenses incurred by older people (60 years or older) with frailty living in the community, or on the expenses incurred by their family and friend caregivers, were eligible for inclusion in the review.

Methods:

We searched for published and unpublished (ie, policy papers, theses, and dissertations) studies written in English or French between 2001 and 2019. The following databases were searched: CINAHL, MEDLINE, Scopus, Embase, PsycINFO, Sociological Abstracts, and Public Affairs Index. We also searched for gray literature in a selection of websites and digital repositories. JBI scoping review methodology was used, and we consulted with a patient and family advisory group to support the relevance of the review.

Results:

A total of 42 sources were included in the review, including two policy papers and 40 research papers. The majority of the papers were from the United States (n = 18), with others from Canada (n = 6), the United Kingdom (n = 3), Japan (n = 2), and one each from Australia, Brazil, China, Denmark, Israel, Italy, The Netherlands, Poland, Portugal, Singapore, South Korea, Taiwan, and Turkey. The included research studies used various research designs, including cross-sectional (n = 18), qualitative (n = 15), randomized controlled trials (n = 2), longitudinal (n = 2), cost effectiveness (n = 1), quasi-experimental (n = 1), and mixed methods (n = 1). The included sources used the term “frailty” inconsistently and used various methods to demonstrate frailty. Categories of out-of-pocket expenses found in the literature included home care, medication, cleaning and laundry, food, transportation, medical equipment, respite, assistive devices, home modifications, and insurance. Five sources reported on out-of-pocket expenses associated with people who were frail and had dementia, and seven reported on the out-of-pocket expenses for caregivers of people with frailty. While seven articles reported on specific programs, there was very little consistency in how out-of-pocket expenses were used as outcome measures. Several studies used measures of combined out-of-pocket expenses, but there was no standard approach to reporting aggregate out-of-pocket expenses.

Conclusions:

Contextual factors are important to the experiences of out-of-pocket spending for older people with frailty. There is a need to develop a standardized approach to measuring out-of-pocket expenses in order to support further synthesis of the literature. We suggest a measure of out-of-pocket spending as a percentage of family income. The review supports education for health care providers to assess the out-of-pocket spending of community-dwelling older people with frailty and their caregivers. Health care providers should also be aware of the local policies and resources that are available to help older people with frailty address their out-of-pocket spending.

'Don't forget the mouth!': a process evaluation of a public oral health project in community-dwelling frail older people

BACKGROUND

Older people are encouraged to remain community dwelling, even when they become care-dependent. Not every dental practice is prepared or able to provide care to community-dwelling frail older people, while their ability to maintain oral health and to visit a dentist is decreasing, amongst others due to multiple chronic diseases and/or mobility problems. The public oral health project 'Don't forget the mouth! (DFTM!) aimed to improve the oral health of this population, by means of early recognition of decreased oral health as well as by establishing interprofessional care. A process evaluation was designed to scientifically evaluate the implementation of this project.

METHODS

The project was implemented in 14 towns in The Netherlands. In each town, health care professionals from a general practice, a dental practice, and a homecare organization participated. The process evaluation framework focused on fidelity, dose, adaptation, and reach. Each of the items were examined on levels of implementation: macro-level, meso-level, and micro-level. Mixed methods (i.e., quantitative and qualitative methods) were used for data collection.

RESULTS

The experiences of 50 health care professionals were evaluated with questionnaires, 22 semi-structured interviews were conducted, and the oral health of 407 community-dwelling frail older people was assessed. On each level of implementation, oral health care was integrated in the daily routine. On macro-level, education was planned (dose, adaption), and dental practices organized home visits (adaption). On meso-level, health care professionals attended meetings of the project (fidelity), worked interprofessionally, and used a screening-referral tool of the project DFTM! in daily practice (dose, adaption, reach). On micro-level, the frail older people participated in the screening of oral health (fidelity, dose), had their daily oral hygiene care observed (adaption) and supported if necessary, and some had themselves referred to a dental practice (reach). The semi-structured interviews also showed that the project increased the oral health awareness amongst health care professionals.

CONCLUSIONS

The project DFTM! was, in general, implemented and delivered as planned. Factors that contributed positively to the implementation were identified. With large-scale implementation, attention is needed regarding the poor accessibility of the oral health care professional, financial issues, and increased work pressure. Trial registration The Netherlands Trial Register NTR6159, registration done on December 13th 2016. URL: https://www.trialregister.nl/trial/6028.