English language proficiency and hospital admissions via the emergency department by aged care residents in Australia: A mixed-methods investigation

Residents of Residential Age Care Facilities (RACFs) have particularly high rates of Emergency Department (ED) visits, with up to 55% being potentially avoidable (e.g. not resulting in a hospital admission). This is concerning as ED visits by RACF residents are associated with negative outcomes including longer hospital stays, iatrogenic illness, complications and mortality. Limited English proficiency (LEP) has significant negative impacts on the healthcare quality and outcomes for older people but has not been studied as a factor in ED visits from RACFs. This study aimed to examine if RACF residents with LEP have a lower rate of hospital admission via the ED compared to non-LEP controls and identify any associated factors. We hypothesised that LEP-related communication difficulties would reduce the ability to manage minor health issues in the RACF, leading to a lower proportion of LEP ED transfers being admitted. We used a parallel mixed-methods design, comprising a quantitative matched cohort study of ED visit data from two Local Hospital Networks (LHNs) in South-East Melbourne, Australia and secondary thematic analysis of 25 interviews with LEP residents, family carers and staff from two RACFs in the same region. We found no differences in the proportion of hospital ED transfers that led to admission (LHN1, 87.1% LEP, 85.6% non-LEP controls, p = 0.57; LHN2, 76.0% LEP, 76.9% non-LEP controls, p = 0.41) and no direct qualitative evidence suggesting that resident LEP affected decisions to transfer residents to ED, despite communication difficulties being reported during the transfer process. These results may be due to the high level of family carer involvement in residents' care identified in the qualitative study. However, additional research using different measures of LEP is recommended to further explore a broader range of cultural and linguistic factors in both rates of ED presentations and the decision-making processes underpinning resident transfers to ED.

Working conditions in the long-term care sector: A comparative study of migrant and native workers in Austria and Sweden

Increased demand for long-term care (LTC) services alongside precarious working conditions has resulted in labour shortages in the LTC sector, which has led to an increasing share of workers of migrant origin filling these jobs. Previous research on migrant care workers has also highlighted the seeming gap in working conditions relative to native workers. However, lack of disaggregated data on migrant and native care workers, alongside single-case studies, may have concealed potential disadvantages faced by certain groups and insufficiently accounted for differences in migration regimes and organisation of LTC sectors. To address these gaps, we carried out a comparative study on various working conditions of migrant and native LTC workers in Austria and Sweden. Using the international Nordcare survey on care sector working conditions, carried out in Austria in 2017 (n = 792) and in Sweden in 2015 (n = 708), we employed t-tests and multivariate logistic regressions to compare the working conditions of migrant and native carers in home and residential care in each country. We found that worse working conditions in Sweden compared to Austria may be explained by differences in training requirements of the LTC workforce and the relatively large for-profit private sector. Country of origin also plays a paramount role in the differences in working conditions experienced by migrants compared to native care workers, with non-European migrants being more likely to face a number of precarious working conditions. Our findings highlight the need to continue addressing precarious working conditions across the sector, particularly during the COVID-19 pandemic where poor working conditions have been linked to increased COVID-related deaths in nursing homes. Our findings also emphasise the importance of policies that consider the various challenges experienced by different migrant groups in the LTC sector, who may particularly be at risk of presenteeism during the COVID-19 pandemic.

Self-managing physical and mental health: A qualitative study on older adults' views and support needs in the Netherlands

To help older adults stay healthy and independent, different stakeholders have developed self-management programmes that aim to support older adults in maintaining or improving physical and mental health. These programmes do not always match older adults' needs and preferences. The aim of this study was to gain insight into independently living older adults' views and support needs in self-managing physical and mental health. A qualitative study was performed to collect data. Sixteen independently living older adults from the eastern part of the Netherlands were recruited through purposive sampling. The interviews were audiotaped, transcribed verbatim and subjected to thematic analysis. The results demonstrate that older adults who live independently believe that maintaining physical and mental health is an important pre-condition for remaining independent and living a meaningful life. They are positive about their health, tend to keep on going with an optimistic attitude and choose activities that suit them regarding type and intensity. The older adults believe deterioration is a normal part of getting older. They focus on preservation and adapt to their natural decline. However, some older adults struggle with their deterioration but prefer self-management rather than seeking professional support. To reach the target group, it has been suggested that nurses and other healthcare professionals tailor their support to the way older adults view and manage the maintenance of both physical and mental health.

Professionals' understanding of their responsibilities in the collaboration with family caregivers of older persons with mental health problems in Norway

Research has highlighted the importance of health and social care professionals' collaboration with family caregivers. In the field of mental healthcare, involvement of family members is perceived as beneficial to the recovery process of the care recipient. Furthermore, family care-giving is an essential part of elderly care. It is well documented that family members need support to prevent negative consequences of care-giving. Nevertheless, involvement of and support for family caregivers have not developed into a common practice, and research has identified professional barriers to collaboration with family caregivers in several areas. The aim of this study was to explore professionals' experiences of collaboration with family caregivers of older persons with mental health problems, and how they understood their responsibility towards families. We conducted three focus group interviews with 18 health and social care professionals working in community-based services, in three rural municipalities in Western Norway. The thematic analysis by Braun and Clarke guided the analysis. The findings in relation to the professionals' role and responsibility towards family caregivers are presented in three themes: family caregivers - a resource that needs support; a responsibility with unclear boundaries; and balancing different needs. Professionals recognised family caregivers' need for support and acknowledged the importance of family relationships. However, they experienced dilemmas in performing their dual responsibility of caring for the older care recipient as well as the family member, which they described as having unclear guidelines. They also experienced that they had insufficient knowledge to take on this responsibility. We argue that the exercising of discretion is essential for the professionals' responsibility, and that clarification of their responsibility is needed. We recommend a stronger focus in education on developing competence in the family perspective. Furthermore, the apportionment of professionals' responsibility needs to be formalised, especially when several services are involved in providing care.

Safety risks among frail older people living at home in the Netherlands - A cross-sectional study in a routine primary care sample

Frail older people face a range of problems and risks that could undermine their ability to live safely at home. A comprehensive overview of these risks, from a multidimensional perspective, is currently lacking. This study aims to examine the prevalence of risks in multiple domains of life among frail older people living at home. We used cross-sectional data from 824 people aged 65 years and older, who received a comprehensive geriatric assessment (the interRAI Home Care [interRAI-HC]) between 2014 and 2018, as part of routine care from 25 general practices in the region of West-Friesland, the Netherlands. The interRAI-HC identifies amenable risks related to people's clinical conditions, functioning, lifestyle and behaviour, and social and physical environment. Descriptive statistics were used to examine population characteristics (age, gender, marital status, living arrangements and presence of chronic conditions) and prevalence of risks. Most common risks were related to people's clinical conditions (i.e cardio-respiratory health, urinary incontinence, pain), functioning (i.e. limitations in instrumental activities of daily living and mood) and social environment (i.e. limitations in informal care and social functioning). More than 80% of frail older people faced multiple risks, and often on multiple domains of life simultaneously. People experiencing multiple risks per person, and on multiple domains simultaneously, were more often widowed and living alone. The multidimensional character of risks among frail older people living at home implies that an integrated approach to care, comprising both health and social care, is necessary. Insight in the prevalence of these risks can give direction to care allocation decisions.

Actions to influence the care network of home-dwelling elderly people: A qualitative study

Positive impact of care networks of home-dwelling elderly people may be based on several network mechanisms: navigation to resources, negotiation between participants and contagion of behaviours. Little is known about actions of participants-elderly people, informal caregivers or formal care providers-to activate such mechanisms and generate support. Aim of this study was to identify actions in relation to these network mechanisms. A cross-sectional qualitative study of 48 interviews with home-dwelling elderly people, informal caregivers and formal care providers in the eastern parts of the Netherlands was conducted between March and September 2016. A framework analysis on network mechanisms categorised actions. Actions were reviewed by network party and compared between networks to explore relations between actions and networks. Results showed that participants navigated through existing relations to seek support. Actions on negotiation were aimed at ameliorating existing relations. Few examples and no actions on contagion of behaviours were found. Actions seemed driven by incidents and existing relations. Elderly people rarely initiated actions, informal caregivers felt hampered by their position in the network. Consistent patterns of relations between actions and network characteristics did not emerge. We concluded that the full potential of network-based support of elderly people is probably underused. Particularly promising seem: navigating the neighbourhood for new informal care, using opposite opinions as a catalyst for change and bringing quality of life and dilemma's into dialogue in the network.

Is family relations related to health service utilisation among older immigrants: Evidence from Chinese elderly in the United States

The family is the key for survival and success of the 4.6 million older immigrants in the United States. It is also an overlooked context to understand older immigrants' health service utilisation. Most prior studies on this topic either focus on individual or institutional factors that affect how older immigrants use formal health services. Using data from 2011 Population Study of Chinese Elderly in Chicago (N = 3,159), this study examined potential linkages between family relationships and health service utilisation among US Chinese elderly. Negative binomial and logistic regressions were carried out to investigate whether health service use of these older immigrants are related to positive family relations, negative family relations, and health-related communications among family members. The findings showed that positive spousal or family relations were not associated with either physician visits or hospital stays. However, respondents with more negative family relations had more doctor visits (β = 0.065, p < 0.05) and were marginally more likely to use inpatient services (OR = 1.15, CI: 0.88-1.04, p = 0.08). Respondents who talked to their spouse for medical concerns were less likely to use inpatient services (OR = 0.68, CI: 0.46-0.99, p < 0.05). The findings showed that family relations play a role in Chinese older immigrants' health service use. In addition, family conflict seems to be more influential than close family relations in predicting service use. Practitioners need to thoroughly assess family dynamics to fully understand the resources and barriers for health service utilisation among the older immigrant populations.

The meaning of home for ageing women living alone: An evolutionary concept analysis

The concept of home to women ageing should be visited in the light of ongoing cultural, political, temporal and disciplinary evolutions. In part, to compliment policies increasing focus on supporting older adults to age in place and a growing attention on the home as a place where healthcare is designed and provided. The following concept analysis utilises Rodgers' evolutionary method to inductively analyse literature in order to elicit the meaning and experience of home among older women who are ageing at home. Literature was collected over an 18-month period during 2014-2015 and the sample was made up of 49 articles. The analysis led to the concept of home among women ageing in communities to be defined by four attributes. These attributes are home as (i) a resource, (ii) an attachment, (iii) the precariousness of maintaining and sustaining home and (iv) a cultural expectation. This analysis of the meaning and experience of home among women ageing at home has shed light on the needs for this group of women, while highlighting the need to continue to further clarify and define the concept through research.

Assessment without action; a randomised evaluation of the interRAI home care compared to a national assessment tool on identification of needs and service provision for older people in New Zealand

Comprehensive geriatric assessment (CGA) is considered the cornerstone of good practice, as it identifies need across multiple domains such as social, physical and psychological. The interRAI home care (interRAI-HC), probably the most well-researched and supported community-based CGA has been implemented globally, often at considerable expense. Policy-makers, managers and clinicians anticipate significant gains in health outcomes following such investment; however, the implementation of CGA is often undertaken in the absence of community service development. This study sought to compare the interRAI-HC with an existing CGA [the Support Needs Assessment (SNA)] in community-dwelling older people. A randomised controlled trial was undertaken from January 2006 to January 2007 comparing the interRAI-HC and the SNA in 316 people (65+) referred for assessment of needs with follow-up at 1 and 4 months. Outcomes included health-related quality of life, physical function, social support, cognitive status, mood and health service usage as well as identified need. The study found that significantly more support needs were identified using the interRAI-HC compared to the SNA. More social and carer support were recommended by SNA and more rehabilitation and preventive health screens were recommended by interRAI-HC. Despite these differences, the mean healthcare use was similar at 4 months, although interRAI-HC participants had more Emergency Department presentations and hospital admissions. No statistically significant differences between groups were reported in terms of outcomes. In conclusion, the interRAI-HC was found to identify more unmet support needs than the SNA though resulted in no favourable outcomes for the older person or their carer. The study highlights the need to invest attention around the service context to maximise outcomes based on identified needs.