Toward Closed-Domain Conversational Item Listing Assistant for Improvement of Experiences of Older Adults in Customer-to-Customer (C2C) Marketplaces

Engaging in one's neighborhood fosters independence, promotes social connectedness, improves quality of life, and increases life expectancy in older adults. There is a lack of evidence synthesis on immigrant older adults' neighborhood perceptions and experiences, essential for addressing neighborhood-level influences on aging in place. This study systematically synthesizes qualitative evidence on immigrant older adults' perceptions and experiences of their neighborhoods. A comprehensive search was conducted from inception to 5 April 2023, in multiple databases. This review considered studies including immigrant older adults aged ≥60 years, included studies from any country where the neighborhood was the focus, and only considered qualitative data while excluding review studies, theoretical publications, and protocols. Eligible studies were appraised using the JBI critical appraisal checklist for qualitative research. The Joanna Briggs Institute meta-aggregation approach was used to synthesize findings, and the ConQual approach established confidence in the synthesis. A total of 30 studies were included. Most studies were conducted in North America and explored phenomena such as aging in place, social capital, social cohesion, sense of community, and life satisfaction. Key contextual factors were walkable safe access to social spaces, accessible transportation to amenities, social cohesion with neighbors, and pre-migration neighborhood experiences. Immigrant older adults have varied experiences related to their sense of belonging and social cohesion. Factors such as racial discrimination, feeling unsafe, and social isolation contributed to negative perceptions. This review highlights the need for inclusive neighborhoods that align with the needs and values of immigrant older adults aging in place.

Background: Older adults account for 25% of all Emergency Department (ED) attendances and experience high rates of adverse outcomes after being discharged from the ED. Internationally, health policy is promoting Integrated Care for older adults where, ED visits are considered as an integral part of the older adult’s continuum of care. Evidence suggests that by bridging care interventions before and after ED discharge it, can lead to better outcomes for older adults. Currently, it is not known if these bridging care interventions respond to the needs of older adults transitioning from the ED. A comprehensive understanding of older adults’ experiences of transition home from the ED is required. Therefore, a systematic review and synthesis of qualitative studies was completed to describe older adult’s experiences of transition from the ED. Who is it for? Policy Makers, Health Care Professionals, Older Adults, Stakeholder Groups, Non-Profit Organisations, Researchers (Older Adults and Integrated Care). Who did you involve and engage with? The topic was identified as a priority by an Older Person Panel and the study was conceived by an interdisciplinary group of health researchers. Analysis is on-going currently. Preliminary findings of the qualitative synthesis will be shared and identified themes discussed and refined with this Older Person Panel. Further meetings will be convened to discuss key implications of the findings and to develop a lay summary of the findings for dissemination to relevant stakeholders. What did you do? The research question was developed and a protocol for a Qualitative Evidence Synthesis (QES) was registered on PROSPERO. This QES included qualitative studies of older adults (65+) experiences and perspectives of transition from the ED. A full database search was completed using three key search terms: Qualitative Research, ED, and Older Person. 4373 articles were retrieved and 9 articles were included after screening. Included articles were quality assessed using the CASP quality appraisal checklist. Data from the included studies was synthesized using the six-stage approach to meta-ethnography described by Noblit and Hare. Findings and Impact: Key findings/themes of this study include: Fragmented Care when transitioning from the ED, the value of communication, risk of readmission to the ED and symptom management. These findings are relevant for those developing interventions for this population. Learning for International audience: Address ways to improve the delivery of care for the complex needs among older persons when transitioning between Emergency Department and Integrated Care. Assist with the Clinical Pathway Development of older persons between ED and Integrated Care/Community. What are the next steps? A Qualitative Descriptive study using semi structed interviews with older adults to examine their experiences and perspectives of GP Integrated Service i

Background Well-documented health benefits are associated with 150 min/week of moderate-to-vigorous physical activity (PA). However, a majority of older adults do not follow this guideline and calls to address this disparity with technology have been made (1). Recommendations from the wider PA literature suggest the incorporation of mobile and wireless technology, i.e. mobile health (mHealth), into PA interventions (2). This study aims to identify and synthesise the evidence base on the experiences of adults using smartphone applications for the promotion of PA. Methods A systematic search of CINAHL, Embase, ERIC, Medline and PsycINFO was conducted in October 2017. Primary qualitative studies with extractable data on the experiences of adults using mHealth for the promotion of PA were included. Data were analysed in NVivo using a meta-ethnographic approach. Results The initial search yielded 4,420 articles. After screening, fifteen articles were included, of which three included young adults, two included young and middle-aged adults, six included middle-aged and older adults and three included young, middle-aged and older adults, while one study did not report age. Because findings were not stratified by age, data were analysed collectively. Our inductive findings included the idea that end-users value the experience of personalisation offered by smartphone applications. Furthermore, mHealth raised awareness of individuals’ PA level, supporting them to strategise ways of incorporating PA into their routines. Finally, negative experiences were not uncommon, though were largely caused by poor design and technical faults (e.g. battery life/ inaccurate data). Conclusion Our review provides evidence of the paucity of studies focused on the experiences of older adults using mHealth for the promotion of PA. Given recommendations for PA interventions to be tailored, particularly across the lifespan (2), and the positive findings noted in the current study, further primary qualitative studies exploring the perspectives of older adults are warranted.

Globally, older adults are undergoing spine surgery for degenerative spine disease at exponential rates. However, little is known about their experiences of living with and having surgery for this debilitating condition. This study investigated older adults' understanding and experiences of living with and having surgery for degenerative spine disease. Qualitative methods, grounded theory, guided the study. Fourteen older adults (≥65 years) were recruited for in-depth interviews at 2 time-points: T1 during hospitalization and T2, 1-3-months postdischarge. A total of 28 interviews were conducted. Consistent with grounded theory, purposive, and theoretical sampling were used. Data analysis included open, axial, and selective coding. A conceptual model was developed illustrating the process older adults with degenerative spine disease experience, trying to get their life back. Three key categories were identified (1) Losing Me, (2) Fixing Me, and (3) Recovering Me. Losing Me was described as a prolonged process of losing functional independence and the ability to socialize. Fixing Me consisted of preparing for surgery and recovery. Recovering Me involved monitoring progression and reclaiming their personhood. Conditions, including setbacks and delays, slowed their trajectory. Throughout, participants continually adjusted expectations. The conceptual model, based on real patient experiences, details how older adults living with and having surgery for degenerative spine disease engage in recovering who they were prior to the onset of symptoms. Our findings provide a framework for understanding a complex, protracted trajectory that involves transitions from health to illness working toward health again.

Background: Occupational therapists in many countries routinely perform predischarge home visits. Although there have been repeated calls to ascertain whether predischarge home visits are clinically and cost effective, there has been a tendency to neglect users' perceptions and experiences of this intervention. Objective: The objective was to conduct a systematic thematic synthesis of older adults' perceptions and experiences of predischarge home visits. Method: The search strategy was an electronic database search. Conference proceedings were hand searched and universities and occupational therapy professional bodies within Europe, Australia and North America were contacted. Results: Forty-four studies were initially identified, of which 13 studies (7 published, 6 unpublished) were selected for detailed screening. Only three qualitative studies met the inclusion criteria and, from this synthesis, two main themes emerged from the data. The first theme was older adults' perceptions of home visits and the second theme was acceptance of occupational therapy. Conclusion: Only a limited body of research has been conducted. This is surprising given the number of predischarge home visits that are performed. This thematic synthesis of qualitative research has highlighted that insufficient attention has been paid to older adults' perceptions of predischarge home visits.

Perspectives and experiences of community-dwelling older adults who experience falling: A qualitative meta-synthesis

Background: The hospital-to-home transition for older adults with stroke is often fragmented, resulting in hospital readmissions and reduced quality of life, patient satisfaction and safety. There is limited evidence for strategies to improve transitions in care for older adults with stroke and multimorbidity. This study aimed to test, in real-world clinical practice, the effectiveness of the Transitional Care Stroke Intervention (TCSI) versus usual care on health outcomes, patient experience, and health and social service use costs in older adults (> 55 years) with stroke and multimorbidity (> 2 chronic conditions). Methods: This pragmatic randomized controlled trial was conducted among older adults with a stroke and multimorbidity discharged from the hospital to the community using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional team from hospital-based outpatient stroke rehabilitation clinics (Physiotherapist, Occupational Therapist, Speech Language Pathologist, Registered Nurse, and Social Worker). The TCSI is a complex, integrated intervention which includes care coordination/system navigation support, phone/video visits, monthly interprofessional case conferences, and an online resource to support system navigation. Data analysis was performed by intention to treat. The primary outcome was risk of hospital readmission (all-cause) after 6 months. Secondary outcomes were mental and physical functioning, depressive symptoms, stroke self-management, patient experience, number of hospital days and readmissions, number of ED visits, survival rates to first hospital and ED visit, risk of ED visits, and health and social service use costs. Older adults with stroke were engaged as co-investigators and informed the research design, implementation, and evaluation through participation in the Patient Partner Advisory and the TCSI Steering Committees. Results: Ninety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). Most participants were men (60%), with an average of 7 comorbid conditions, and 78% had experienced their first-ever stroke. No significant group differences were seen for the baseline to six-month risk of hospital readmission (all-cause). However, stroke survivors in the intervention group reported higher levels of physical functioning (SF-12 Physical Component Summary Score mean difference: 5.10; 95% CI: 1.58-8.62, p=0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51—11.50, p=0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p=0.005) compared with the usual care group. No significant group differences were seen for the other secondary outcomes. Discussion: The TCSI improved physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs compared to usual care. Conclusion:The results provide evidence for the effectiveness of an integrated intervention to optimize transitional care outcomes for older adults with stroke and multimorbidity receiving outpatient stroke rehabilitation services. Suggestions for future research: Future research is needed to further evaluate this intervention in diverse settings and populations, with a larger sample size and a full economic evaluation.

The global population is aging, and it is becoming increasingly common for older people to suffer from multiple diseases. The development of digital health technologies has assisted the self-management of multimorbid older patients. Currently, there is a lack of qualitative review that synthesizes the needs and experiences of multimorbid older patients using digital health technologies for self-management. To synthesize the needs and experiences of multimorbid older adults using digital health technologies for self-management. The following six electronic databases were searched: PubMed, Embase, Web of Science, Scopus, Cochrane Library, and CINAHL. The search timeframe was from construction to November 4, 2024. Thematic synthesis by Thomas and Harden was used for meta-synthesis. Study selection and data extraction were conducted independently by two researchers, and quality was evaluated using the 10-item Critical Appraisal Skills Programme tool. Ten studies were included. Three themes and seven subthemes were synthesized: (1) different impressions and perceptions, (2) challenges of use, and (3) conveniences and benefits. Older adults with multiple medical conditions have positive or negative impressions and perceptions of digital health technologies and experience multiple challenges in their use (lack of expertise, technical and equipment barriers, need support), while at the same time, digital health technologies offer huge benefits for their self-management (improved communication with healthcare professionals, enhanced self-management skills). This review provides support for healthcare professionals to understand the experiences of multimorbid older adults using digital health technologies for self-management. Healthcare professionals and technology developers should establish collaborative relationships to design comprehensive, usable, and less burdensome digital health technologies for older adults with multiple morbidities. Additionally, comprehensive technical support services should be provided to ensure the effective utilization of these technologies by older adults. PROSPERO number: CRD42024599433.

this study sought to systematically review and synthesize qualitative data to explore older adult exergame experiences and perceptions. a comprehensive search was conducted in seven databases from the earliest available date to May 2022. All qualitative and mixed-method studies available in English and explored exergame experiences in older adults were included. Tools from the Joanna Briggs Institute were used for data extraction and synthesis. Data were extracted using the Capability, Opportunity and Motivation Model of Behaviour (COM-B model) as a guide, and a pragmatic meta-aggregative approach was applied to synthesize the findings. this systematic review identified 128 findings and aggregated 9 categories from the 10 qualitative research articles included, and three synthesized findings were: older adult capability, opportunities in the exergaming program and motivation in the exergaming program. Capability consisted of attitude toward exergames, age- or health-related impairments and exergame knowledge and skills. Opportunities included older adult-friendly exergame design and social influence. Motivation included self-efficacy, support, instruction and feedback, health benefits, as well as unpleasant exergaming experiences. it is crucial to tailor the exergaming program to suit the older population. We identified barriers and facilitators of implementing exergaming in older adults and found most barriers are surmountable. The results of the current systematic review could provide evidence for the design and implementation of exergaming programs among older adults. The ConQual score of the synthesized findings was assessed as low. Dependability and credibility should be accounted for in future studies to increase confidence.

Older adults with frailty and kidney failure face higher waitlist mortality and are more likely to be listed as inactive on the kidney transplant (KT) wait list. Photovoice is a qualitative participatory research method where participants use photographs to represent their environment, needs and experiences. It offers unique insight into the lived environment and experience of patients and may offer direction in how to improve functional independence, symptom burden, and kidney transplant outcomes in adults with frailty. This photovoice study was embedded within a larger intervention adaptation project. Participants with pre-frailty or frailty awaiting a KT or recently post-transplant took photos with Polaroid cameras and wrote short descriptions for 11 prompts. Each participant completed a semi-structured interview wherein their photos were discussed. The team coded and discussed photos and interviews to determine overarching themes and implications. Focus groups were used to triangulate visual data findings. Sixteen participants completed both the photovoice and interview. Participants were a mean age of 60.5 years, 31.2% female, 43.4% self-identifying as Black, and 69% were frail. Outcomes were categorized into seven themes: functional space, home safety, medication management, adaptive coping, life changing nature of dialysis, support and communication. Visual data clarified and sometimes changed the interpretations of the text alone. Especially within the themes of home safety and functional space, safety hazards not previously recognized in the literature, like dialysis fluid storage, were identified. Photovoice contextualizes the living conditions and experiences of adults with frailty on the kidney transplant journey and could be a useful tool in geriatric nephrology and transplant. Addressing issues of home storage, organization, and accessibility should be explored as potential intervention targets. Incorporating participant values and goals into care decisions and interventional design should be further explored.

Psychotic-like experiences are subclinical psychotic symptoms that are usually accompanied by sleep problems, negative emotions, and poorer cognitive functioning. However, their night-to-day associations remain understudied in older adults. 72 participants aged 50-79 took part in a home-based sleep study. After an intelligence test, they reported their sleep quality, dream and morning emotions, psychotic-like experiences, and subjective cognitive failures for 7 days, in addition to wearing an electroencephalographic headband. Results showed that poorer subjective sleep quality was associated with higher levels of psychotic-like experiences the following day, a relationship mediated by negative morning and dream emotions. Furthermore, higher subjective cognitive failures and lower IQ were related to more psychotic-like experiences. Objective sleep parameters were not linked to next-day psychotic-like experiences. The results demonstrate that negative emotions play a mediating role between poor sleep quality and psychotic-like experiences in older adults. Additionally, improved cognitive performance, both subjective and objective, seems to protect against the occurrence of psychotic-like experiences. The study indicates that sleep, emotions, and cognitive functions are key contributors to daytime psychotic-like experiences in older adults.

Background/Objectives: Boarding refers to the period when patients deemed stable in the emergency department (ED) are temporarily monitored, wait to be admitted, and receive appropriate care. As life expectancy increases, so does the importance of understanding the dynamics and experiences of older adults with frailty in emergency settings. The absence of a care environment tailored to specific needs could diminish the overall quality of care provided, threatening the health and well-being of this population. To our knowledge, how frail older adults experience this has not yet been synthesized in a qualitative systematic review. The aim of this study was to explore the lived experiences of frail older adults during the emergency department (ED) boarding phase Methods: This systematic review was conducted using PubMed, OVID, and Scopus in October 2024. No time restrictions were settled and only articles published in English were included. Following the predefined inclusion criteria, two researchers independently extracted and synthesized the data using the Joanna Briggs Institute (JBI) meta-aggregation methodology and instruments. Results: Seven studies were included. Thirty-one findings were identified and grouped into seven categories and three themes regarding the lived experiences of frail people in ED boarding areas. The themes we identified were discomfort, distress, frustration, the experience of positive/negative attitudes of healthcare providers, and the supportive role of family members during ED LOS (length of stay). Conclusions: Older frail adults experience significant physical and psychological distress during ED boarding. It is necessary to manage their specific needs through targeted actions aimed at improving their overall experience and quality of care in emergency settings.

BackgroundThis study aimed to test, in real-world clinical practice, the effectiveness of a Transitional Care Stroke Intervention (TCSI) compared to usual care on health outcomes, self-management, patient experience, and health and social service use costs in older adults (≥ 55 years) with stroke and multimorbidity (≥ 2 chronic conditions).MethodsThis pragmatic randomized controlled trial (RCT) included older adults discharged from hospital to community with stroke and multimorbidity using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional (IP) team, and included care coordination/system navigation support, phone/video visits, monthly IP team conferences, and an online resource to support system navigation. The primary outcome was risk of hospital readmission (all cause) after six-months. Secondary outcomes included physical and mental functioning, stroke self-management, patient experience, and health and social service use costs. The intention-to-treat principle was used to conduct the primary and secondary analyses.ResultsNinety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). No significant between-group differences were seen for baseline to six-month risk of hospital readmission. Differences favouring the intervention group were seen in the following secondary outcomes: physical functioning (SF-12 PCS mean difference: 5.10; 95% CI: 1.58–8.62, p = 0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51—11.50, p = 0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p = 0.005). No between-group differences were found in total healthcare costs or other secondary outcomes.ConclusionsAlthough participation in the TCSI did not impact hospital readmissions, there were improvements in physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs. Challenges associated with the COVID-19 pandemic, including the shift from in-person to virtual delivery, and re-deployment of interventionists could have influenced the results. A larger pragmatic RCT is needed to determine intervention effectiveness in diverse geographic settings and ethno-cultural populations and examine intervention scalability.Trial registrationClinicalTrials.gov Identifier: NCT04278794. Registered May 2, 2020.

Psychosocial aspects of perception and emotional experience of older adults during the first wave of the Covid-19 pandemic in Slovakia

This study aims to elucidate what volunteering activities mean for older adults in Japan by analyzing their emotions and evaluations from hedonic (e.g., happiness), eudaimonic (e.g., self-growth), and social (e.g., social coherence) well-being. The qualitative research was conducted to describe the subjective experience of older adults' volunteering activities (frailty checkups) in the community-setting. Eight older adults were interviewed about their experiences during these activities. The interview data were analyzed from two assumption frameworks: first, three aspects of well-being, and second, timeframes of well-being, during the activity, medium-term, and long-term. Previous studies have not focused on the polysemy or the timeframe of well-being. Our results showed that hedonic, eudaimonic, and social well-being are not independent, but overlap. Furthermore, even if older adults experience certain emotions at a point of time, they may change in the long term. This implies that it is important to analyze older adults' feelings and experiences from not only one aspect but from different perspectives and measure their feelings not just at a particular moment but in the long term. This is the first empirical study to examine qualitatively the holistic experiences of well-being among older adults who volunteer. We conclude that this study is unique in that it attempted to associate empirically the experiences of older adults during volunteering with their general psychological status of well-being. These findings could help make volunteering activities more meaningful for older adults and create or promote an active community. Geriatr Gerontol Int 2024; 24: 273-278.