A systematic review of reasons and risks for acute service use by older adult residents of long-term care

AIMS AND OBJECTIVES

To identify the reasons and/or risk factors for hospital admission and/or emergency department attendance for older (≥60 years) residents of long-term care facilities.

BACKGROUND

Older adults' use of acute services is associated with significant financial and social costs. A global understanding of the reasons for the use of acute services may allow for early identification and intervention, avoid clinical deterioration, reduce the demand for health services and improve quality of life.

DESIGN

Systematic review registered in PROSPERO (CRD42022326964) and reported following PRISMA guidelines.

METHODS

The search strategy was developed in consultation with an academic librarian. The strategy used MeSH terms and relevant keywords. Articles published since 2017 in English were eligible for inclusion. CINAHL, MEDLINE, Scopus and Web of Science Core Collection were searched (11/08/22). Title, abstract, and full texts were screened against the inclusion/exclusion criteria; data extraction was performed two blinded reviewers. Quality of evidence was assessed using the NewCastle Ottawa Scale (NOS).

RESULTS

Thirty-nine articles were eligible and included in this review; included research was assessed as high-quality with a low risk of bias. Hospital admission was reported as most likely to occur during the first year of residence in long-term care. Respiratory and cardiovascular diagnoses were frequently associated with acute services use. Frailty, hypotensive medications, falls and inadequate nutrition were associated with unplanned service use.

CONCLUSIONS

Modifiable risks have been identified that may act as a trigger for assessment and be amenable to early intervention. Coordinated intervention may have significant individual, social and economic benefits.

RELEVANCE TO CLINICAL PRACTICE

This review has identified several modifiable reasons for acute service use by older adults. Early and coordinated intervention may reduce the risk of hospital admission and/or emergency department.

REPORTING METHOD

This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Ageism directed at older nurses in their workplace: A systematic review

AIMS

To identify and synthesise evidence related to ageism in older regulated nurses' practice settings.

DESIGN

A systematic review following Joanna Briggs Institute methodology.

METHODS

The review included empirical studies that involved older nurses as the primary study population and studies that focused on ageism in older nurses' work environments, including strategies or interventions to address ageism within the workplace. Following the initial screening, all relevant studies were critically appraised by two reviewers to ensure they were appropriate to include in the review. A synthesis without meta-analysis reporting (SWiM) guideline was employed in the review.

DATA SOURCES

Medical Literature Analysis and Retrieval Systems Online, Scopus, Psychological Information Database and Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched to identify empirical studies and a range of academic institutional websites were accessed for master's and doctoral dissertations and theses. The search covered the period from January 2022 to May 2022, and only publications in English from 2000 onwards were considered.

RESULTS

Nineteen studies were included, ten qualitative studies, seven quantitative studies and two mixed methods secondary analyses. Our results revealed that negative perceptions and beliefs about older nurses' competencies and skills prevail in their practice settings, which influences older nurses' health and well-being as well as their continuation of practice. Further, older nurses' continuation of practice can be facilitated by having a positive personal outlook on ageing, meaningful relationships in their practice settings and working in an environment that is age-inclusive.

CONCLUSION

To combat ageism in older nurses' practice settings and support their continuation of practice, effective interventions should be organisational-led. The interventions should focus on fostering meaningful relationships between older nurses and their colleagues and managers. Further, healthcare institutions should implement initiatives to promote an age-inclusive work environment that supports an age-diverse nursing workforce.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The review findings offer insights for healthcare managers, policymakers and researchers, emphasising the need for anti-ageism policies in healthcare organisations. According to WHO (2021), educational activities such as role-playing and simulation during in-service training may also be effective interventions. Additionally, incorporating anti-ageism initiatives into staff meetings and mandating anti-ageism training could support the continuation of practice for older nurses while fostering a more age-diverse nursing workforce.

IMPACT

We found evidence on the presence of ageism in older nurses' workplace and the detrimental effects of ageism on older nurses' well-being and continuation of practice. Importantly, we identified a lack of organisational initiatives to address ageism and support older nurses. These findings should encourage healthcare organisations to address ageism in older nurses' practice settings and prompt policymakers to develop age-inclusive policies that support older nurses' continuation of practice.

REPORTING METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-analysis checklists were used to report the screening process.

TRIAL AND PROTOCOL REGISTRATION

The PROSPERO registration number for the review was CRD42022320214 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320214). No Patient or Public Contribution.

The alcohol industry-A commercial determinant of poor health for Rainbow communities

BACKGROUND

Alcohol use is an area of challenge for health promotion internationally. The alcohol industry operates as a key commercial determinant of health in that its actions contribute to alcohol misuse, resulting in a range of health and social harms to individuals, families and communities. Rainbow people (including those who identify as lesbian, gay, bisexual, transgender or gender diverse) are one group experiencing considerable harm from alcohol use.

METHODS

Data from 24 focus groups involving 131 people held in six cities in New Zealand during 2018, were used to explore local understandings of the ways in which the alcohol industry operates as a commercial determinant of health for Rainbow communities. The focus group discussions were analysed thematically.

RESULTS

Three key themes were identified. First, the alcohol industry was identified as present in the 'everyday', through targeted alcohol promotion to Rainbow people, and due to the centrality of bars to their social and cultural landscapes. Second, participants recognised the benefits of alcohol industry support for Rainbow communities. Last, an opposing view was articulated, with the alcohol industry and its commercial activities viewed negatively.

CONCLUSIONS

These findings highlight that alcohol as a commodity and the alcohol industry are successfully and firmly embedded within Rainbow communities. Overall, given alcohol is widely regarded in a positive way, this is likely to create difficulties for health promotion efforts to reduce alcohol related harm in these communities.

Midwife led randomised controlled trials in Australia and New Zealand: A scoping review

BACKGROUND

Midwives are the largest workforce involved in caring for pregnant women and their babies, and are well placed to translate research into practice and ensure midwifery priorities are appropriately targeted in researched. Currently, the number and focus of randomised controlled trials led by midwives in Australia and New Zealand is unknown. The Australasian Nursing and Midwifery Clinical Trials Network was established in 2020 to build nursing and midwifery research capacity. To aid this, scoping reviews of the quality and quantity of nurse and midwife led trials were undertaken.

AIM

To identify midwife led trials conducted between 2000 and 2021 in Australia and New Zealand.

METHODS

This review was informed by the JBI scoping review framework. Medline, Emcare, and Scopus were searched from 2000-August 2021. ANZCTR, NHMRC, MRFF, and HRC (NZ) registries were searched from inception to July 2021.

FINDINGS

Of 26,467 randomised controlled trials registered on the Australian and New Zealand Clinical Trials Registry, 50 midwife led trials, and 35 peer-reviewed publications were identified. Publications were of moderate to high quality with scores limited due to an inability to blind participants or clinicians. Blinding of assessors was included in 19 published trials.

DISCUSSION

Additional support for midwives to design and conduct trials and publish findings is required. Further support is needed to translate registration of trial protocols into peer reviewed publications.

CONCLUSION

These findings will inform the Australasian Nursing and Midwifery Clinical Trials Network plans to promote quality midwife led trials.

Organizational Innovation in Long Term Care Enabled by Collaboration Between Government Agencies: A Critical Realist Case Study

Long term care for older people is a highly regulated sector providing accommodation, health, and social care to vulnerable older adults. Older adults in New Zealand are among the highest users of long term care services globally. Traditionally those requiring specialist care for dementia are housed apart from other residents. In an example of organizational innovation, 1 provider relocated residents to a secure village where residents requiring specialist dementia care would be desegregated. We utilized a critical realist case study to explain the role of intersectoral collaboration among government agencies in supporting the transition while managing risk and ensuring regulatory compliance.

A cross‐sectional description of the health characteristics of cognitively impaired older adults

OBJECTIVES

The analysis presented here describes the care needs of older adults with and without cognitive impairment. To describe the health characteristics of older adults with and without cognitive impairment who receive home care or Aged Residential Care services in New Zealand.

METHODS

A descriptive analysis of the initial interRAI assessment for adults older than 55 years was undertaken. Data were grouped by level of assessed cognitive impairment. The population proportions for each level of the following scales were calculated: Changes in Health, End-stage Disease, Signs, and Symptoms Scale (CHESS), pain, pressure injury risk, Activities of Daily Living (ADL), depression screening, and body mass index (BMI).

RESULTS

The analysis included 93,680 assessments. The mean age was 83 years (SD = 8.7) a positive association was observed between age and cognitive impairment (p < 0.01). People with cognitive impairment were less likely to have been recently hospitalised or to have attended ED (p < 0.01). Significant associations with effect sizes ≥3 were observed for cognitive impairment and ADL (p < 0.01, γ = 0.63), pain (p < 0.01, γ = -0.32), and risk of pressure injury (p < 0.01, Cramer's V = 0.271).

CONCLUSIONS

The results reinforce a need to be alert to the differential care needs of older adults with moderate/severe cognitive impairment. The findings may act as a trigger for practitioners to focus assessment on aspects of care that, due to context, may otherwise be underassessed or untreated.

Interventions addressing functional abilities of older people in rural and remote areas: a scoping review of available evidence based on WHO functional ability domains

Background

The World Health Organization (WHO) encourages healthy ageing strategies to help develop and maintain older people’s functional abilities in five domains: their ability to meet basic needs; learn, grow, and make decisions; be mobile; build and maintain relationships, and contribute to society. This scoping review reports the available evidence-based interventions that have been undertaken with people ≥ 50 years of age in rural and remote areas and the outcomes of those interventions relevant to enhancing functional ability.

Methods

The scoping review was undertaken following the JBI methodology. A literature search was carried out to identify published intervention studies for enhancing functional ability in older people living in rural and remote settings. The databases searched included CINAHL, Scopus, ProQuest Central, PubMed, EBSCOHost, APA PsycInfo, Carin.info, and the European Network for Rural Development Projects and Practice database. Gray literature sources included government reports, websites, policy papers, online newsletters, and studies from a bibliographic hand search of included studies.

Results

Literature published from January 2010 to March 9, 2021 were included for review. A total of 67 studies were identified, including quasi-experimental studies (n = 44), randomized controlled trials (n = 22), and a descriptive study. Five main types of interventions were conducted in rural and remote areas with older people: Community Services, Education and Training, Exercise and Physical Activity, Health Promotion Programmes, and Telehealth. Health Promotion Programmes (n = 28, 41.8%) were the most frequently reported interventions. These focused primarily on improving the ability to meet basic needs. About half (n = 35, 52.2%) of the included studies were linked to the ability to learn, grow, and make decisions, and 40% of studies (n = 27) were relevant to the ability to be mobile. Only a very limited number of intervention studies were geared towards outcomes such as maintaining relationships (n = 6) and contributing to society (n = 3).

Conclusion

Interventions for enhancing functional ability focused primarily on the ability to meet basic needs. We identified the need for health-related interventions in rural and remote areas to consider all five functional ability domains as outcomes, particularly to strengthen the psychosocial wellbeing of older people and enhance their sense of purpose through their contributions to society.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03460-2.

Holding on and letting go: Views about filial piety among adult children living in New Zealand

AIMS AND OBJECTIVES

The study aimed to explore the perspectives of adult children about late-life living and care arrangements for their ageing immigrant parents living in New Zealand.

BACKGROUND

Older immigrants' well-being is closely associated with filial relations and is often reliant on families as a main source of social, financial and emotional support. Research among migrant Asian adults has reported mixed findings regarding intergenerational perspectives of filial practices.

DESIGN

Qualitative design using focused ethnographic lens.

METHODS

Semi-structured individual interviews were undertaken with 45 adult children of older immigrants living in New Zealand to explore their views about filial piety. The CoREQ checklist was used in reporting methods and findings.

RESULTS

Two major themes were identified in this study of adult children's view of filial piety and late-life care for their ageing parents. The first theme, 'holding on-reconfiguring values', referred to a process described by the participants as upholding the core values and cultural familial expectations, looking after their ageing parents, yet modifying the ways in which they provide care. The second major theme 'letting go-reconfigured expectations', described participants' views of aged care for themselves, which meant they no longer held traditional values that needed to be enacted by their children.

CONCLUSIONS

Adult children from immigrant families were positioned as intermediaries of these shifting values of their own and within younger generations. The adult children's shift of thinking and acceptance of reconfigured expression of filial duties impact care and living arrangements of older people from immigrant and culturally diverse backgrounds, which also influences health and well-being in later life.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals including nurses working in the ageing and aged care sector need to accommodate the changing generational perspectives about filial piety to cater to the unique late-life care requirements and health needs of older people and their families.

Age-friendly interventions in rural and remote areas: A scoping review

OBJECTIVES

In 2007, the World Health Organization published a guide on age-friendly cities. However, little is known about interventions that have been implemented to promote age-friendly communities in rural and remote areas. This paper presents the findings from a scoping review undertaken to locate available evidence of interventions, strategies, and programs that have been implemented in rural and remote areas to create age-friendly communities.

METHODS

This scoping review used the Joanna Briggs Institute (JBI) methodology.

RESULTS

A total of 219 articles were included in this review. No intervention studies were referred to as 'age-friendly'. However, there were interventions (mostly healthcare-related) that have been implemented in rural and remote areas with older people as participants. There were also non-evaluated community programs that were published in the grey literature. This review identified the common health interventions in older people and the indirect relevance to the WHO age-friendly framework domains in rural and remote contexts.

CONCLUSIONS

The eight age-friendly domains were not explicitly utilised as a guide in the development of interventions for older people in rural and remote settings. Implementation of age-friendly interventions in rural and remote areas requires a multisectoral approach that is tailored to address the specific needs of individual communities. Age-friendly interventions also need to consider socio-ecological factors to adequately and holistically address community needs and ensure long-term sustainability.

Feeling a deep sense of loneliness: Chinese late‐life immigrants in New Zealand

Objectives

To explore Chinese late‐life immigrants' perceptions of loneliness and social isolation.

Methods

A qualitative descriptive methodology underpinned this study. In‐depth individual interviews were conducted in Mandarin with purposively recruited participants. The twenty‐three participants in the study had all emigrated from China, were 65–80 years old on arrival and had lived in New Zealand for between 2.5 and 16 years. An inductive thematic analytic process was undertaken. The COREQ checklist was followed to ensure study rigour.

Results

Three themes, ‘high value placed on meeting family obligations’, ‘feeling a deep sense of imbalanced intergenerational reciprocity’ and ‘moving away from filial expectations’, were identified. Confucianist values of ‘women's domestic duty of caring for grandchildren’, ‘filial piety’, and ‘saving face’ to be accepted and respected by others negatively attributed to participants' understandings and experiences of loneliness. To plan for increasing frailty and to avoid family conflict while ameliorating potential loneliness, some participants reluctantly discarded prior customary filial piety expectations in favour of formal aged care options.

Conclusions

Participants' profound sense of loneliness was seen to be attributed to their deeply rooted cultural values and backgrounds from having lived for a significant period of time in China. Loneliness occurred as a result of the resettlement process in later life. These experiences highlight the importance of using cultural framing that takes into account beliefs and adaptations to host societies anticipated during the process of late‐life immigration.

Barriers to older Pacific peoples&#x2019; participation in the health-care system in Aotearoa New Zealand

Introduction Participation in the health-care system is a key component of healthy ageing strategies. The number of Pacific people aged ≥65 years in Aotearoa New Zealand will increase significantly over the next decade. Addressing the considerable health inequities and unmet need for care Pacific Island people experience when compared to other ethnicities in Aotearoa New Zealand should be a priority. Aim To identify barriers to older Pacific people's participation in the health-care system in Aotearoa New Zealand. Methods A participatory action research design was utilised. In total, 104 Pacific co-researchers contributed to focus groups using Talanoa , a traditional method of conversational dialogue deeply rooted in Pacific Island culture. Data were collected in Pacific Island languages from storytelling and conversations shared within the focus groups. Data were translated into English and analysed using a collaborative approach. Results Three main themes captured older Pacific peoples' barriers to participation in the health-care system: accessing health care; relationships with health-care providers; and understanding the health-care system. Discussion Older Pacific people have the capacity to influence locally driven programmes to be more responsive to their needs and aspirations. Improving older Pacific peoples' participation in health care will require a commitment to partnership and inter-sectoral collaboration identified in recent ageing strategies. The findings will inform local communities, and policy and practice aimed at improving the health and wellbeing of Pacific peoples who are ageing in Aotearoa New Zealand.

Optimising function and well-being in older adults: protocol for an integrated research programme in Aotearoa/New Zealand

BACKGROUND

Maintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanāu (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing.

METHODS

Well-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. The Compression of Functional Decline model (CFD) underpins aspects of the programme. Interventions vary to optimise engagement and include a co-developed whānau (family) centred initiative (Ngā Pou o Rongo), the use of a novel LifeCurve™App to support behavioural change, development of health and social initiatives to support Pacific elders, and the use of a comprehensive oral health and cognitive stimulation programme for cohorts in aged residential care. Running parallel to these interventions is analysis of large data sets from primary care providers and national health databases to understand complex multi-morbidities and identify those at risk of adverse outcomes. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum.

DISCUSSION

AWESSoM delivers a programme of bespoke yet integrated studies. Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age.

TRIAL REGISTRATION

The At-risk cohort study was registered by the Australian New Zealand Clinical Trials registry on 08/12/2021 (Registration number ACTRN 12621001679875 ).

Seeking and maintaining connections: A grounded theory study of maintaining spirituality in residential aged care facilities

BACKGROUND

Moving to a residential aged care facility involves living far from family and a familiar environment, and leaving behind the social support system of relatives, friends, and society. The pressure to find and develop new and meaningful connections in a residential aged care facility can be significant for older adults.

OBJECTIVE

To provide a theoretical explanation of how older adults seek and maintain connections in a residential aged care facility.

METHODS

A grounded theory study was conducted. A total of 17 residents were recruited from two Nepalese residential aged care facilities using theoretical sampling. Face to face in-depth, semi-structured interviews and observation within interviews were conducted. Data analysis included the process of open, axial, selective coding, and constant comparative analysis as per Corbin and Strauss' variant of grounded theory.

RESULTS

This study identified that the process of seeking connections in a residential aged care facility was forward-moving, and involved "identifying sources," "developing connections," and "appraising responses." By seeking connections, residents built new connections. Similarly, the study found that maintaining connections was a continuous process of "sustaining connections with co-residents," "preserving connections with nurses/caregivers," and "continuing connections with inner-self and higher being/s." Maintaining connections led residents to balance shifting connections. Furthermore, it was found that the process of seeking and maintaining connections was conditional on facility arrangement i.e. the way residents were placed, rules, regulations, co-residents' language, gender, religious affiliation, attitudes, the attitudes and practices of nurses/caregivers, decreasing physical abilities of residents, increasing illness of residents, illness or death of co-residents, and retirement or resignation of nurses/caregivers.

CONCLUSION

The current study provides unique insights into the process of seeking and maintaining connections in a residential aged care facility. Facility arrangement, rules, regulations, and caregiving practices should resonate with residents' socio-cultural expectations and spiritual belief system to support their process of seeking and maintaining connections.

IMPLICATIONS FOR PRACTICE

The findings can be beneficial for managers, nurses, caregivers, and spiritual advisors in developing interventions that promote the development of meaningful connections in a residential aged care facility.

Chinese late‐life immigrants’ loneliness and social isolation in host countries: An integrative review

AIMS AND OBJECTIVE

To synthesise current international empirical evidence on loneliness and social isolation in Chinese late-life immigrants.

BACKGROUND

Loneliness causes adverse health consequences in Chinese late-life immigrants leading to increased utilisation of often increasingly limited healthcare resources. However, little is known about how Chinese late-life immigrants perceive and experience loneliness and social isolation in their host countries.

DESIGN

An integrative review methodology.

METHODS

Using a systematic search strategy, Google scholar and databases, such as Scopus, Web of Science, PubMed, CHNAHL, Medline and open access Theses were searched. No limitation was placed on publication date. Peer-reviewed studies published from the database inception to May 6, 2021 in the English language were included. The review process is reported according to PRISMA.

RESULTS

Eight articles met the criteria and were included in this review. Two themes resulting from the data synthesis process were identified. Firstly, 'disrupted social relations after late-life immigration' and secondly 'moving away from filial expectations'.

CONCLUSION

Loneliness and social isolation are commonly experienced by Chinese late-life immigrants when residing in host countries. Understanding and identification of the sources of loneliness and social isolation among late-life immigrants are essential prompts for healthcare professionals, particularly nurses, to engage sensitively with Chinese late-life immigrants. Nurses culturally relevant care delivery in a variety of settings may best serve recipients' social and health related needs.

RELEVANCE TO CLINICAL PRACTICE

This integrated review informs the planning of health and social services for addressing Chinese late-life immigrants' experiences of loneliness and social isolation. Focused attention on cultural responsiveness is an important component of providing quality and safe nursing care. This review of the recent evidence on socially-rooted health concerns affected by both immigration and ageing will help advance nursing practice in providing culturally responsive care interventions.

Making meaning of the new identity-as-resident: A grounded theory study

Residential living has the potential to threaten older adults' established identity. This study utilized grounded theory methodology to explore how older adults make meaning of the new identity-as-resident in a residential aged care facility. Using theoretical sampling, in-depth semi-structured interviews and observation within interviews were conducted with 17 residents from two Nepalese residential aged care facilities. Data analysis involved the process of open, axial, selective coding, and constant comparative analysis as specified by grounded theory methodology. The process that older adults experience in making meaning of their new identity-as-resident involved phases of isolating, exploring, evaluating, and compromising, which led in consequence to internalization of the new identity. Furthermore, it was found that this process depends on the facility structure, rules and regulations, and the attitudes and practices of nurses/caregivers. A focus on these facilitators is crucial for managers and nurses/caregivers working in residential aged care to assist residents in constructing a positive identity-as-resident. The findings can potentially be beneficial for raising awareness, educating nurses/caregivers, developing policies for promoting a positive identity-as-resident in residential aged care facilities worldwide.

Justifications for heavy alcohol use among gender and sexually diverse people

A range of research reports that many gender and sexually diverse people drink alcohol at heavy levels. This study used 24 focus groups to explore shared understandings of alcohol use among gender and sexually diverse people living in New Zealand. An inductive, data-driven thematic analysis was employed to identify explanations for heavy drinking among gender and sexually diverse people. Three key explanations were articulated: alcohol is needed for socialising; drinking helps coping with stress; alcohol and drug treatment services are inadequate. These results demonstrate justifications for heavy drinking in certain contexts. This behaviour runs counter to public health approaches and messages that highlight low-risk levels of drinking or not drinking as desirable. Public health interventions should continue to address alcohol use at a whole population level but should be supplemented by policy and interventions that take into account the sociocultural contexts and structural conditions that encourage drinking among gender and sexually diverse people.

Beginning on an age-friendly journey: Barriers to implementing age-friendly initiatives

Objective

To explore the barriers to communities in New Zealand developing age‐friendly initiatives.

Methods

A qualitative participatory approach underpinned this study. Semi‐structured digitally recorded individual interviews were undertaken with 24 government officials, local government steering group members and community representatives from an urban city, provincial city and a rural district. A general inductive data analytic process was undertaken. The consolidated criteria for reporting qualitative research (COREQ) guidelines were followed to ensure rigour in this study.

Results

(a) Being at the beginning, (b) Minimal diversity and (c) Problems getting started were three key issues identified.

Conclusions

New Zealand is in the early stages of becoming age‐friendly. Findings from this study provide a place‐based New Zealand perspective and have influenced central government social policy and practice development, culminating in resources supporting local government and communities to successfully implement age‐friendly initiatives.

Aging in New Zealand: Ka haere ki te ao pakeketanga

Aotearoa-New Zealand is expecting the number of older adults to double in the next 20 years. Despite publicly funded health and welfare support for older citizens, the aging experience differs across ethnic groups. This creates opportunities and challenges for health and social services to deliver culturally safe and equitable care for all older New Zealanders. Longitudinal and large data sets are pivotal for characterizing the aging experience from birth to advanced age. The New Zealand research funding system responded to predicted demographic changes by increasing funding in order to inform and address key health and well-being issues for older people. In addition, government strategies and policies increasingly focus on social aspects of aging and health inequities and require researchers and organizations to be better connected to end-users. New Zealand needs to continue to fund research that identifies unique and courageous service delivery solutions that result in positive social, financial, psychological, and physical aging for older New Zealanders.

An ethnic interpretation of mental distress from the perspective of Tongan men and community leaders

Tongan people living in New Zealand have a high prevalence of mental illness and low uptake of mental health services. Rates of mental illnesses also differ between those born in Tonga and those born in New Zealand. However, little is known about the personalized and culturally shaped meaning and experience of mental distress in this population. Therefore, this research explored the meaning of mental distress for Tongan men and community leaders living in Auckland, New Zealand. The Tongan cultural framework, talanoa (talking, to tell), enabled a culturally congruent and collective approach to examining mental health-related ideologies and ensuing distress. Two talanoa groups were held (one with men and one with community leaders), with a total of 18 participants. The primary research questions focused on tufunga faka-Tonga (Tongan constructions of mental distress). Four themes emerged: fa'unga (reality), hu'unga (directionality), ta'anga (temporality), and tu'unga (positionality). The analytic lens used to define reality was fa'unga, because this concept encompasses the creation/preservation of sino (body), me'a (thing, something), and mo'oni (truth, real). The findings suggested that it is necessary to incorporate tufunga faka-Tonga into all aspects of service delivery to improve mental health services for the Tongan population. The Tongan community will benefit from increased awareness of tufunga faka-paiōsaikosōsiolo (biopsychosocial constructions of mental distress) and tufunga fepaki mo e fetaulaki he vaha'a 'o e tufunga faka-paiōsaikosōsiolo mo e tufunga faka-Tonga (intersections between biopsychosocial and Tongan constructions of mental distress) to support identification of health risks and health service seeking behaviours.

Comparing and contrasting Tongan youth and service users' interpretations of mental distress

BACKGROUND

In Aotearoa New Zealand (NZ), Pacific people have a higher prevalence of mental illness compared with the general population. Tongan people have high rates of mental illness and tend to not use mental health services. The risk for mental illnesses also differs between those born in Tonga and those born in NZ.

AIM

This study presented the views of New Zealand-dwelling Tongan youth and mental health service users regarding the meaning of mental distress.

METHODS

A Tongan cultural framework "talanoa" was used to inform the approach to the research. The youth talanoa group had seven participants and the service users talanoa group had twelve participants. Braun and Clarke's thematic analysis was used to analyse the data.

RESULTS

Tongan youth and service users constructed mental distress from biopsychosocial perspectives and challenged traditional Tongan perspectives around being possessed by spirits, cursed and disruptions to social and spiritual relationships.

CONCLUSIONS

The youth and service users construct mental distress from a biopsychosocial angle and there is a need for further information about Tongan perspectives of mental distress. This suggests that a biopsychosocial perspective is needed to ensure engagement by Tongan youth and service users in promoting mental health and alleviating distress.

What makes community-based physical activity programs for culturally and linguistically diverse older adults effective? A systematic review

Objective

This integrative review aimed to determine the features of effective physical activity programs for culturally and linguistically diverse (CALD) older adults.

Methods

We searched for relevant articles in MEDLINE, PubMed, Google Scholar, Scopus and CINAHL. Articles were selected for evaluation if they included CALD older adults and implemented physical activity programs with culturally specific design features. Consistent with the Whittemore and Knafl integrative review methodology, we used the Downs and Black Checklist, Mixed Methods Appraisal Tool and the McMaster University appraisal tool for quantitative studies to assess the quality of included articles.

Results

Seven articles were included in this review. Effective community‐based exercise or physical activity programs for CALD populations commonly featured close‐to‐home delivery, native language instruction and adaptations of culturally familiar activities.

Conclusion

The provision of culturally appropriate community‐based physical activity programs appears to support and encourage engagement among CALD older adults.

Exploring talk about sexuality and living gay social lives among Chinese and South Asian gay and bisexual men in Auckland, New Zealand

Objective: To identify ways Chinese and South Asian gay and bisexual men living in Auckland talk about issues related to sexuality and experiences of living 'gay social lives.' Results will be available to inform health policy and practice.Design: A qualitative design with individual interviews and thematic analysis was used. Semi-structured digitally recorded interviews were undertaken with 27 Chinese and 17 South Asian gay and bisexual men living in Auckland.Results: Four themes in the data related to talk about sexuality and living gay social lives are reported: (a) 'Happy in my skin': Being gay is Ok! (b) 'To come out or not': Managing sexual identity, (c) 'Places to go, people to see': Connecting with others, and (d) 'What's wrong with being Asian': Tolerating discrimination.Conclusion: There are many similarities in the ways these men talked about their identity and sexuality that can be usefully considered by health policy makers and service planners. The concept of gay (and bisexual) sexuality had some salience for the men interviewed, despite the adoption and acknowledgement of same-sex identity being a relatively new phenomenon in some Asian countries. This supports the use of these terms in local health interventions. However, as these men closely managed their gay identity and typically had not disclosed their sexuality to others, including healthcare professionals, interventions to address the skills and comfort of healthcare providers in addressing sexuality in clinical settings appear warranted to facilitate optimal healthcare. These men are not well connected with others and this has implications for HIV health promotion that is based on creating cultural norms among networks to encourage safe sex. Discrimination results in many Chinese and South Asian gay and bisexual men disengaging from connecting with others and should be addressed.

Characteristics of people with pressure ulcers using one year's routinely collected data in a defined diverse community

OBJECTIVE

To determine if meaningful patient characteristics pertaining to pressure ulcers (PU) can be derived from routinely collected community health data.

METHODS

A retrospective cohort analysis of records was carried out. To provide a detailed dataset on PU for the community of interest, demographic, general medical and PU data were extracted from mandatory incident reports and audit of electronic and paper medical records. This study is reported in accordance with the RECORD Guidelines from the Equator Network. Adult patients were enrolled from a district nursing service in the target region (n=1085) during 2015. The target region was based on a geographical region bounded by a single postcode district (target region) consisting of 62,000 people of whom approximately 50,000 were adults, 3000 of whom were aged >75 years.

RESULTS

The total number of recorded PUs was n=137 in 103 individuals. Data from mandatory incident reports was obtainable for nearly all variables. Electronic and paper medical records were less reliable due to missing data.

CONCLUSION

Detailed characteristics of community-dwelling PU patients can be derived from routinely collected data, and provides various forms and levels of information which could feed into different projects. The use of mandatory reporting fields increases the level of reporting and reduces missing data. Data enriched with information from electronic and paper records could inform the addition of variables to mandatory forms to improve characterisation of community dwellers with PUs.

New Zealand nursing students' perceptions of biosciences: A cross-sectional survey of relevance to practice, teaching delivery, self-competence and challenges

BACKGROUND

Bioscience subjects are one of the most discussed nursing curricula contents in terms of the longed known teaching and learning challenges for nursing students. Recent studies examined the specific use of technology as teaching strategies. However, there are still significant gaps around nursing students' perception of biosciences within nursing education and the significance of teaching delivery methods to these perceptions.

OBJECTIVE

The study examined students' overall perception of biosciences within New Zealand undergraduate nursing programmes in terms of relevance to practice, teaching delivery, self-competence and challenges encountered.

METHOD

A descriptive, cross-sectional survey design on perceptions of New Zealand nursing students on biosciences was undertaken.

RESULTS

Five hundred and forty students were included. Fifty-five percent (55%) preferred biosciences papers be taught classroom - based but using a blended learning delivery instead of an exclusively traditional classroom setting (55% vs. 21%). Perception towards the biosciences was positive and the mean perception of older students and those in Year 3 was higher compared to the other students. Overall, students believed biosciences had relevance to the practice of nursing.

CONCLUSION

Positive perceptions of bioscience become more evident when nursing students reach their final year in the nursing programme. The contemporary profile (age) of students studying nursing are sensitive to their preferred teaching delivery. A fully online teaching approach to biosciences for nursing students will most likely require a robust approach and careful decision making for implementation.

Primary care doctor and nurse utilisation rates for billed consultations across the Comprehensive Care Primary Health Organisation

AIM

To examine socio-demographic trends in doctor and nurse utilisation rates for invoiced consultations across Comprehensive Care Primary Health Organisation (PHO).

METHOD

De-identified enrolled patient information and Service Utilisation Reporting data for invoiced consultations were extracted from all general practices for January 2013-December 2016. Utilisation rates were calculated using the number of enrolled patients as the denominator.

RESULTS

Data for 3,657,873 invoiced consultations across 66 general practices were analysed, including 2,941,624 doctor and 716,249 nurse consultations. Average utilisation rates were 3.1 visits per patient year for doctors and 0.7 visits for nurses, with considerable variability between practices. Utilisation rates were higher for females (3.3 visits for doctors; 0.8 for nurses), older adults (5.0-6.9; 1.3-1.6 visits) and patients residing in the most socially deprived quintile (3.3; 1.6 visits). European patients had the highest doctor utilisation rates (3.2 visits), while Māori and Pacific patients had the highest nurse utilisation rates (1.1 and 1.3 visits, respectively).

CONCLUSION

Females, older adults and people residing in socially deprived areas utilise primary care more frequently according to invoiced consultation data. Analysis of all other consultations, including immunisations, Accident Corporation Claims and non-billed services is needed to more accurately capture utilisation rates, particularly for nurses, to better inform national decision-making, workforce planning and funding assumptions.

Older Filipino immigrants' reconfiguration of traditional filial expectations: a focus ethnographic study

BACKGROUND

One of the many socio-cultural issues impacting older immigrants in host countries is the cultural expectations of filial piety from their adult children.

OBJECTIVE

To understand older Filipino immigrants' beliefs and values towards filial expectations.

DESIGN

Focused ethnography.

RESULTS

Two major themes were identified. The first theme 'moving away from filial expectations' drew out older Filipino's changing views of cultural expectations from their adult children. The second theme 'maintaining cultural values through good family relationships' highlighted the importance of acknowledging the cultural values considered to be most important by older Filipinos, which was having harmonious relationships and avoiding family conflict.

CONCLUSION

The reconfigured expectation was salient with participants' who identified 'not being a burden' to their adult children and the ardent desire to maintain positive family relationships. Impact Statement: Nurses need to be aware of changes to our current understanding of filial piety when providing care to older Filipinos.

Accessing rural health services: Results from a qualitative narrative gerontological study

Objective

Explore how older adults’ talk about accessing rural community health services.

Methods

A qualitative narrative gerontological approach explored issues related to accessing health services in their community. Semi‐structured digitally recorded individual interviews were undertaken with 32 community‐dwelling older people aged between 75 and 93 years. A narrative data analytic process was undertaken. The COnsolidated criteria for REporting Qualitative research guidelines were followed to ensure rigour in this study.

Results

Three collective narratives resulted from the data analytic process: (a) “accessing local health services”; (b) “accessing specialist services”; and (c) “accessing emergency services.”

Conclusions

Narrators identified a number of issues related to accessing rural health services. These included long waiting times, lack of continuity in care provision by doctors and difficulties accessing specialist and emergency services. Nurses were frequently cited as a reliable point of contact for these older people. Expansion of nursing roles would enhance the provision of rural health‐care services.

Challenges to the provision of clinical education in nursing

Objective: To outline and discuss the challenges inherent in providing clinical education for undergraduate nursing students.Design: Discussion paper.Discussion: The primary goal of undergraduate nursing education is the preparation of graduates able to function as newly registered nurses in acute hospital, primary care, continuing care and mental health settings. Clinical practice is a critical yet complex and challenging component of students' professional development.Conclusions: It is argued that different models for clinical learning are appropriate for different contexts and stages of student development. Nursing needs, however, to be fully cognisant of the importance of collaborative development underpinned by adequate funding and to be aware of the often invisible impacts of neoliberal policies and priorities on health and education.

What is known about the spirituality in older adults living in residential care facilities? An Integrative review

AIM

To synthesize evidence regarding the spiritual needs and care of older adults living in residential care facilities from the perspectives of older adults and nurses or caregivers.

DESIGN

Integrative review of literature.

DATA SOURCES

Literature search was conducted using CINAHL Plus with Full Text via EBSCO, Scopus, PubMed, PsychInfo, Web of Science, and ProQuest Social Science Databases from March to December 2017.

REVIEW METHODS

This integrative review utilised the Whittemore and Knafl framework and PRISMA in the selection of eligible articles. Quality of the articles was evaluated using the Mixed Method Appraisal Tool.

RESULTS

Seven articles were reviewed and analysed. There is limited evidence \and no agreed definition of spiritual needs and care of older adults living in residential care facilities. Spiritual needs of older adults in residential care facilities is a psycho-social, religious and existential construct. Spiritual care in residential care facilities is linked to information gathering, religious guidance, maintaining family connections, providing companionship, discussing end of life issues, and providing counseling. Older adults highly value the role of nurses and caregivers in fulfilling their spiritual needs and providing spiritual care. However, nurses and caregivers perceived arranging a referral to a religious advisor as the main aspect of spiritual care. Therefore, nurses', caregivers', and older adults' views on spiritual care differed to some extent.

CONCLUSION

The practical aspects of spiritual needs assessment and spiritual care provision requires further investigation, which is essential to improve the effectiveness of service delivery in residential care facilities.

Knowledge of HIV pre-exposure prophylaxis among immigrant Asian gay men living in New Zealand

ABSTRACT INTRODUCTIONHIV pre-exposure prophylaxis (PrEP) is a new bio-medical means of reducing the risk of HIV infection. It’s use by individuals at high risk of HIV acquisition is recommended. AimsThis study identifies the ways immigrant Asian gay men living in New Zealand talk about and understand issues related to PrEP. METHODSA qualitative descriptive methodology was used. Individual interviews were conducted with 18 immigrant Asian gay men who were not users of PrEP. Participants were aged 21 – 36 years and one-third had arrived in New Zealand within 3 years of completing the interview. Data were analysed using thematic analysis. RESULTSThree themes evident across the men’s talk in relation to pre-exposure prophylaxis were identified: ‘I’m not sure what PrEP is’; ‘PrEP is not proven’; and ‘PrEP is for others, not me’. DISCUSSIONPrEP is necessary for working towards the elimination of HIV. To improve uptake among Asian gay men, improved literacy around HIV and pre-exposure prophylaxis is required. This knowledge needs to be improved at both the individual level in primary care services and collectively through health promotion initiatives. These services and health promotion initiatives need to be provided in ways that encourage engagement by Asian gay men.

"Engaging in my rural community": perceptions of people aged 85 years and over

PURPOSE

 Globally, numbers of people aged 85 years and over are increasing. Many older people, including those 85 years and over, are ageing in rural areas. For successful ageing in place, physical and social environments must be appropriate. The aim of this study is to understand the influence the physical and social environments have on enabling those aged 85 years and over to remain engaged in a rural community. Method: Utilizing an environmental gerontological approach, semi-structured interviews were undertaken with 15 people who lived independently in a rural community. Following transcription data were analyzed and themes identified. Results: Two themes were identified; "Negotiating the physical environment: 'Getting there and back'" and "Maintaining social networks: 'Places to go, people to see'". The findings provide insight into the importance of driving, parking close to amenities and negotiating the local environment to this group of older people and their ability to engage with their community. All participants agreed social engagement with friends, family or neighbors was important to them. Conclusion: These findings highlight the interconnection between physical and social environments. An enabling physical environment is essential to support social participation of people aged 85 years and over.

Impacts of older people's patient and public involvement in health and social care research: a systematic review

Background

patient and public involvement (PPI) in research has been linked with numerous beneficial impacts, however, evidence for older people's involvement is limited.

Objectives

to evaluate the impacts of involving older people in health and social care research on older co-researchers, academic researchers, and research processes and outcomes. A secondary aim was to explore critical success factors and future considerations for PPI.

Design

systematic review.

Methods

six databases were searched for English language articles published between 2006 and 2017. A supplementary search was conducted. Two authors independently retrieved articles using standardised inclusion criteria and data extraction forms. Articles reporting formal evaluation of older people's involvement were included.

Results

nine articles, all using qualitative methodology, were included. Benefits for older co-researchers included psychological and social benefits, new learning, and activism and career opportunities, while challenging impacts comprised demanding workloads, difficult relationships and dissatisfaction with level of involvement. Benefits for academic researchers entailed new learning and shared workloads; challenges related to demanding workloads and difficult relationships. Both positive and negative effects on research quality and impact were observed. Benefits for participants and the community were demonstrated. Building relationships, facilitating communication and breaking down barriers to participation were identified as critical success factors.

Conclusions

evidence for the impacts of older people's involvement is mixed although benefits appear to outweigh the challenges. Future considerations for PPI include matching older people's skills and motivations to the project and level of involvement, and establishing an iterative research process in which evaluation is embedded.

Late-life living and care arrangements of older Filipino New Zealanders

AIMS AND OBJECTIVES

To explore the living and care arrangement plans of older Filipino immigrants in New Zealand.

BACKGROUND

New Zealand is rapidly becoming the host to an increasing number of ageing Filipino immigrants. Despite this sizeable population growth of ageing Filipinos in New Zealand, still very little is known about this ethnic group's care needs and living arrangement preferences in later life within the New Zealand context.

DESIGN

Qualitative descriptive approach.

METHODS

Data were collected from 15 older Filipinos who participated in face-to-face interviews. Data were analysed using a thematic analytical framework.

RESULTS

Two major themes were identified from the data analysis. The first theme "preferred living and care arrangements" is about older Filipinos' preferred plans for future residence and in receiving care when no longer able to function independently in their own homes. The second theme "negotiating readiness and acceptance" is about hypothetical situations that older Filipinos described and anticipated that will greatly facilitate their readiness and acceptance to living in aged care facilities.

CONCLUSION

The study results have implications for service delivery within the New Zealand residential aged care sector. Due to an increasing number of older Filipino immigrants requiring care, residential aged care facilities must ensure their care models meet the needs of this growing group of older people.

RELEVANCE TO CLINICAL PRACTICE

Nursing staff skill sets in the aged care sector require sensitivity to older immigrants' health needs without compromising cultural beliefs and practices while living in residential aged care facilities.

Moving backwards, moving forward: the experiences of older Filipino migrants adjusting to life in New Zealand

Purpose: To explore the experiences of older Filipino migrants adjusting to living permanently in New Zealand.

Method: The qualitative descriptive approach taken in this study involved 17 individual face-to-face interviews of older Filipino migrants in New Zealand.

Results: Three main themes emerged from the data. The first theme was “moving backwards and moving forward”, which described how these older Filipino migrants adjusted to challenges they experienced with migration. The second theme was “engaging with health services” and presented challenges relating to the New Zealand healthcare system, including a lack of knowledge of the nature of health services, language barriers, and differences in cultural views. The third theme, “new-found home”, highlighted establishing a Filipino identity in New Zealand and adjusting to the challenges of relocation.

Conclusion: Adjustment to life in New Zealand for these older Filipino migrants meant starting over again by building new values through learning the basics and then moving forward from there.

Loneliness in Men 60 Years and Over: The Association With Purpose in Life

Loneliness as a consequence of getting older negatively impacts on the health and well-being of men as they age. Having a purpose in life may mitigate loneliness and therefore positively impact on health and well-being. Limited research into loneliness and purpose in life has been undertaken in older men. This study seeks to understand the relationship between loneliness and purpose in life in a group of older men. Using data from a cross-sectional survey of 614 men aged 60 years and over living in New Zealand, bivariate and multivariate analyses were undertaken to examine the relationship between loneliness and purpose in life using a range of demographic, health, and social connection variables. Bivariate analysis revealed that being unpartnered and having low socioeconomic status, limited social networks, low levels of participation, and mental health issues were associated with loneliness. Multivariate analysis showed that having poor mental health and lower purpose in life were indicators of loneliness. Consequently, improving mental health and purpose in life are likely to reduce loneliness in at-risk older men. As older men are a heterogeneous group from a variety of sociocultural and ethnic backgrounds, a multidimensional approach to any intervention initiatives needs to occur.