Moral Distress as Collective Feeling: Indigenous Care Workers’ Experiences with Indigenous Elderly People in Taiwan

In recent years, the proportion of middle-aged and elderly people in Taiwan has gradually increased and has already surpassed that of advanced countries such as Europe, the United States and Japan, therefore, the health of middle-aged and elderly people is a topic that needs attention. This is because physical deterioration or illness can lead to a decline in quality of life and create a medical burden on the individual and society. This study investigated the common symptoms of sleep apnea in middle-aged and elderly people (over 40 years old), and developed a self-test subjective perception model, using “daytime sleepiness” and “sleep quality” as influencing factors, and “attention” as mediating variables to verify the effect with sleep apnea symptoms. An online electronic questionnaire was conducted and distributed through social media and groups of friends in Taiwan. A total of 541 valid questionnaires were collected and analyzed in three stages: Descriptive Analysis, Measurement Model Validation, and Structural Equation Model. The research processes of the study showed that the sample fitted the normal distribution and the measurement model conformed with convergent reliability and discriminant validity. The research results were found that “sleep quality” had a significant negative effect on sleep apnea symptoms. “Daytime sleepiness” had a positive effect on sleep apnea symptoms. “Daytime sleepiness” had a negative effect on sleep apnea symptoms through the “attention” mediator. Finally, through the questionnaire, we hope to make the middle-aged people aware of themselves, so that they can seek early medical treatment if there are signs and symptoms of sleep apnea symptoms.

To evaluate the prevalence of prehypertension among middle-aged and elderly people in Taiwan and to explore the evolutionary changes of blood pressure in 5-year follow-up period. In 2000, people aged over 40 participating in annual health examinations at local health stations in I-Lan County were invited to join the study. Past medical histories were reviewed, physical examinations and serial laboratory tests were performed for participants. All participants were followed in 2005 by a medical record review, telephone survey or personal visit. Subjects with prehypertension were sorted for further analysis. Overall, 1053 people (mean age=64.4+/-11.4 years, 44.4% males) were enrolled in the primary cohort. The prevalence of hypertension and prehypertension was 40.4% and 35.8%, respectively. In 2005, 677 subjects (mean age: 68.8+/-10.4 years, 42.5% males) were successfully followed, which revealed a significant increase of systolic blood pressure (3.7+/-16.8 mmHg, p<0.001), but not diastolic blood pressure (0.3+/-11.5 mmHg, p=0.758) in prehypertensive subjects; however, both systolic blood pressure (14.3+/-17.4 mmHg, p<0.001) and diastolic blood pressure (7.7+/-13.3 mmHg, p<0.001) were significantly increased among normotensive subjects. The cumulative incidence of prehypertensive subjects becoming hypertensive was 31.3%, and those who became hypertensive were significantly older (65.3+/-8.6 vs. 62.2+/-12.3 years, p=0.024), having higher pulse pressure in 2000 (49.6+/-10.6 vs. 45.1+/-11.6 mmHg, p=0.001), serum total cholesterol (214.3+/-31.7 vs. 204.0+/-37.2 mg/dL, p=0.020) and low-density lipoprotein-cholesterol (141.7+/-29.2 vs. 132.7+/-34.7 mg/dL, p=0.042). The prevalence of prehypertension among older Taiwanese was 35.8% and the 5-year cumulative incidence of hypertension from prehypertension was 31.3%. Older prehypertensive subjects with higher pulse pressure, higher serum total cholesterol and higher low-density lipoprotein-cholesterol were more likely to become hypertensive within 5 years.

To compare a bioelectrical impedance analysis (BIA) prediction equation for estimating skeletal muscle mass (SM) with magnetic resonance imaging (MRI)-measured SM and to investigate the prevalence of sarcopenia in community-dwelling elderly people in Taiwan. Cross-sectional survey. Communities in the district of Zhongzheng, Taipei. Forty-one volunteers (aged 22-90) for BIA equation validation; 302 individuals aged 65 and older and 200 adults aged 18 to 40 for the investigation of the prevalence of sarcopenia. Skeletal muscle mass was estimated using a BIA prediction equation and measured using MRI. No statistical difference between MRI-measured and BIA-derived SM was observed (difference of -0.44 +/- 1.55 kg, P=.08). The prevalence of sarcopenia in was 18.6% in elderly women and 23.6% in elderly men. Estimation of SM using a BIA equation was validated in Taiwanese volunteers. It was confirmed that sarcopenia is an emerging health problem in the aging population in Taiwan.

The relationship between depressive symptoms and health service utilization for elderly people in Taiwan

Overview of trends in social policy and social services delivery: the development of the British welfare state to be or not to be a Taiwanese welfare state? - lessons from recent experience modernizing social welfare services? - change and continuity in social care and social welfare in Britain the myth and reality of privatizing social welfare services - a case study of Taipei city. Pensions: is it safe enough? - the planning of national pensions insurance in Taiwan thinking the unthinkable? - pensions policy prospects in Britain. Health care: financing health care for middle- to low-income households in Taiwan current themes and issues in Britain's National Health Service. Family and community care and control: a comprehensive policy for the single-parent family family support services - some recent developments the social construction of ageing - elderly women in Taiwan enhancing independence in old age community care for the elderly people in Taiwan - illustion, vision or reality? crime, punishment and community in England and Wales. East-West ideas on welfare and growth: looking East, looking West - trends in Orientalism and occidentalism amongst social scientists elite political-cultural projects, economic growth and the achievement of social welfare in East Africa.

Age and Gender Differences in the Relationship Between Self-rated Health and Mortality Among Middle-aged and Elderly People in Taiwan—Results of a National Cohort Study

Prevalence and Associated Factors of Frailty Among Elderly People in Taiwan

The goal of this study was to explore the concepts of successful ageing held by elderly people in Taiwan. Data were obtained from the Successful Ageing of the Elderly in Taiwan survey of 2004. The sample was drawn from the population aged 65 or more years in one county in Taiwan by probability proportional-to-size sampling. The participants were asked: ‘What do you think are the essential components of an ideal and satisfactory life in old age?’ They were also asked to score the relative importance of 23 ‘successful ageing’ concepts. The replies to the initial open-ended question were grouped in six categories: physical health and independence, economic security, family and social support, engagement with life, spiritual well-being, and environment and social welfare policy. The most highly rated ‘successful ageing’ concepts were physical health, independence, living without chronic disease, living with family, and receiving emotional care. All the responses were subjected to a factor analysis, and five factors accounted for 58.7 per cent of the variance: family and social support, mastery over life, health, enjoyment of life, and autonomy. It is concluded that elderly people in Taiwan most value health and independence, and also place considerable importance on economic security and family support, which they see as inter-related. Many are also concerned about the social environment and social policy, indicating that their awareness of and participation in socio-political debates affects their quality of life.

Oral health is an important element of overall health and quality of life. However, few studies have evaluated the association between quality of life (QOL) and oral function, including tongue and lip movements. This study aimed to investigate the relationship between oral-related QOL and oral function, including tongue and lip movements, in independent elderly people. The participants were 143 community-dwelling elderly people in Taiwan (40 men, 103 women; 76.4 ± 6.4 years). We used the General Oral Health Assessment Index (GOHAI) to evaluate oral-related QOL. The items used to evaluate oral function were as follows: the speed of tongue movement from side to side, maximum tongue pressure, maximum lip pressure, the repeated saliva swallowing test, oral diadochokinesis (speed and dexterity when pronouncing /pa/, /ta/, and /ka/), and masticatory performance. In addition, we surveyed the number of remaining teeth, denture use, and awareness of problems at mealtimes. For the analysis, we compared the GOHAI score for each group, divided by cutoff values. The univariate analysis revealed significant differences in the GOHAI score according to denture use, the number of remaining teeth, the state of occlusal support areas, the speed of tongue movement from side to side, oral diadochokinesis /ta/ and /ka/, and masticatory performance. The logistic regression analysis revealed that oral diadochokinesis /ka/ was a significant explanatory variable for low GOHAI scores (odds ratio = 13.145). Our results imply that lower oral-related QOL was associated with slow motor function at the rear area of the tongue.

This article investigates living arrangement preferences of elderly people in Taiwan, including coresidence with family (their children or spouse), coresidence with spouse only, living alone, and living in an institution. The authors consider the effects of three factors: the elderly persons’ health situation, their family resources, and their social participation, such as community workshops or political activities. Accordingly, the authors propose empirical logit models based on the well-developed discrete choice theory. Empirical results reveal that (1) elderly people with higher socioeconomic status, prefer either independent living arrangements or coresidence with their children, (2) elderly people with more family resources, such as large family size, prefer to coreside with their children, and (3) elderly people with adequate social support and/or contact networks prefer independent living arrangements.

Background: Many elderly people in Taiwan move to institutional care due to disability or insufficient family resources. This study aimed to understand the place identity and life adaptation of institutional residents and their influencing factors, and to explore the correlation between these two. Methods: This study adopted a cross-sectional survey method. A total of 120 cases were collected with structured questionnaires, and SPSS 22.0 software package was used for statistical analysis. Results: The place identity was the highest in the sense of belonging, while the sense of participation was the worst; adaptation to life was the best in terms of care management, and the worst in terms of adaptation to life and assistive devices. The length of stay in the institution, daily activities, and the number of chronic diseases were significantly different from place identity, and the number of chronic diseases was significantly different from life adaptation. Conclusions: The results of this study can be used as a reference for institutions to improve the quality of care. It is suggested that institutions can organize more activities to promote interaction and participation among residents, to strengthen their local identity and life adaptation.

Taiwan is facing a rapid change in the composition of its population. As the population ages, a greater demand for long-term care services and, in particular, nursing homes is expected. Before deciding who really needs nursing home care, it is important for policy makers to understand the current pattern of utilisation and what factors are associated with entry. This research assesses the relative importance of predisposing, enabling and need factors that lie behind this. It is based on a survey of elderly people in registered nursing homes, a comparison with a national sample of elderly people in their own homes and interviews with the lucid elderly patients (i.e. could communicate with no problems) and their carers. It was found that nursing home entry was associated with advanced age, gender, educational level and dependency levels of elderly people. After controlling for age, need factors have the greatest impact on admission. Specific medical problems such as cardiovascular, neurological and skeletal muscular diseases were also major contributors. Although most elderly people in Taiwan are cared for in their own homes by their families, under certain circumstances entry to a nursing home seemed inevitable. Decisions about nursing home entry were mainly taken within a family context with adult children being the main players while professionals played a relatively minimal role.

Context: The mental health of staff working in long-term care (LTC) homes is a major concern. Moral distress (and the more severe &lsquo;moral injury&rsquo;) may occur when staff perpetrate, bear witness to, or fail to prevent an activity that is incompatible with their own moral beliefs. The frequency of moral distress and moral injury has increased during the COVID-19 pandemic and may lead to burnout. Objectives: The purpose of this scoping review was to examine interventions to alleviate moral distress and moral injury in LTC staff. Method: Five databases were accessed through the University of Waterloo Library and searched for English research articles published between 2000 and 2023. Search terms included: moral distress, moral injury, PTSD, long-term care, intervention, and treatment. Findings: The initial search revealed 349 articles; 145 duplicates were removed. Thirty-four articles underwent full-text review, three were included. The reference sections of these papers were hand-searched, revealing 61 potential papers; 23 duplicates were removed. Fourteen of these articles underwent full-text review, three were included. Review of the final six papers revealed interventions focussed on resources for LTC staff to address moral distress and reflect on ethical decision-making. Interventions were shown to reduce the impact of moral distress and assist in ethical decision-making. Implications: The scoping review revealed very few existing interventions for moral distress and moral injury in LTC staff. We must act quickly and proactively to address the potential &lsquo;second pandemic&rsquo; of mental health concerns in health human resources, including interventions specific to those working in LTC.

1very insightful and beneficial to my practice. I recently started working in palliative care after 8 years in a medical intensive care unit. In my new role, I’ve become acutely aware of the moral distress that exists throughout my organization, particularly in critical care units. The palliative care team often hears differing opinions from nursing and physician teams regarding patients’ expected prognosis and outcomes. This difference of opinion sends mixed messages to patients and families and indicates the nurse’s opinion is not valued, which can cause moral distress. Measures need to be in place to prevent moral distress. The American Association of Critical-Care Nurses (AACN) issued a position statement on moral distress in 2008 2 and identified several actions for nurses and employers. The identification of moral distress, education, work environment, interdisciplinary collaboration, and support systems can decrease moral distress. Nurse leaders play an integral role in the work environment of individual departments and the hospital. 3 Also, if, as the article noted, 1

Management and leadership of intensive care units for the future.