Adult Care Research Articles

Growth after pediatric kidney transplantation: a 25-year study in a pediatric kidney transplant center.

Growth failure is one of the major complications of pediatric chronic kidney disease. Even after a kidney transplant (KT), up to 50 % of patients fail to achieve the expected final height. This study aimed to assess longitudinal growth after KT and identify factors influencing it. A retrospective observational study was performed. We reviewed the clinical records of all patients who underwent KT for 25 years in a single center (n=149) and performed telephone interviews. Height-for-age and body mass index (BMI)-for-age were examined at KT, 3months, 6months, 1 year, and 5 years post-transplant and at the transition to adult care. We evaluated target height, disease duration before KT, need and type of dialysis, recombinant human growth hormone pretransplant use, nutritional support, glomerular filtration rate (GFR), and cumulative corticosteroid dose. At transplant, the average height z-score was-1.38, and height z-scores showed catch-up growth at 6months (z-score-1.26, p=0.006), 1 year (z-score-1.15, p<0.001), 5 years after KT (z-score-1.08, p<0.001), and on transition to adult care (z-score-1.22, p=0.012). Regarding BMI z-scores, a significant increase was also detected at all time points (p<0.001). After KT, GFR was significantly associated with height z-score (p=0.006) and BMI z-score (p=0.006). The height in transition to adult care was-1.28 SD compared to the target height. Despite the encouraging results regarding catch-up growth after KT in this cohort, results remain far from optimum, with a lower-than-expected height at the time of transition.

The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study.

The increasing prevalence of Alzheimer disease and Alzheimer disease-related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care. This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers. For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics. Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ≥50 years (25/30, 83%), women (23/30, 77%), White (25/30, 83%), and financially stable (20/30, 67%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90% (27/30) rated the app overall positively. Most of the participants (21/30, 70%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration. The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population.

Who decides ‘what works’, and how does it get implemented? Insights from the UK’s new centre for implementing evidence in adult social care

Who decides ‘what works’, and how does it get implemented? Insights from the UK’s new centre for implementing evidence in adult social care

Strengths-based practice in adult social care: Understanding implementation

Background There has been increasing emphasis towards adopting strengths-based practice (SBP) within adult social care in England. Whilst there is agreement that SBP is the right approach to discharge adult social care duties, there is limited evidence regarding the implementation of SBP. This paper presents findings from the evaluation of the implementation of SBP in fourteen local authorities in one region in England. Methods We employed a mixed methods research design, drawing on data from a scoping review, 36 interviews with practice leaders and two surveys, one with wider adult social care staff and the other, with external organisations like independent care providers and community and voluntary organisations. Our data collection and analysis were guided by two well established implementation theories: the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT). Interviews were analysed deductively, and surveys were analysed descriptively. Results Local authorities are at different stages in their implementation journey. The Care Act 2014 and support for SBP demonstrated by key professional groups were seen as major drivers for implementing SBP. Whilst SBP resonated with the professional principles of social workers and occupational therapists, staff did not always have the confidence and skills to adapt to SBP. Changing paperwork and recording systems, providing training opportunities to develop staff competencies, establishing new care pathways, genuine co-production, and senior management buy-in were key enablers supporting implementation. Conclusions To successfully implement SBP, a whole system approach that meaningfully collaborates with key professionals across sectors is essential. When implemented well, SBP has the potential to empower individuals by focusing on what matters to them.

"An urgent need for transition of care programs for adolescents and young adults with neurogastroenterology and motility disorders".

Transition of Care for Adolescents and Young Adults (AYA) with Neurogastroenterology & Motility (NGM) Disorders.

Corporatisation and financialisation of social reproduction: Care homes and childcare in the United Kingdom

The ownership and financial strategies of companies providing care for children or older people have become an increasingly salient concern, in both research and policy, because of their implications for the quality and availability of care services, as well as working conditions. However, analysis has tended to be sector specific. This article provides the first comparison of ownership, business models and workforces across childcare and adult social care in the United Kingdom. It reveals growing convergence in terms of the dominance of large companies and their financial strategies, which can reward investors while undermining access to care and worsening working conditions for large, low-paid workforces. We conceptualise these developments in terms of corporatisation and the related process of financialisation. They are, we argue, underpinned by the political economy of low wages for care work, which we explain using feminist social reproduction theory – highlighting the devaluation of feminised and racialised caring labour. The article identifies the need for further research to account for differences between the sectors, to map the geographies and political economies of care, and to compare these processes internationally.

Growing importance of high-volume buprenorphine prescribers in OUD treatment: 2009–2018

BackgroundWe examined the number and characteristics of high-volume buprenorphine prescribers and the nature of their buprenorphine prescribing from 2009 to 2018. MethodsIn this observational cohort study, IQVIA Real World retail pharmacy claims data were used to characterize trends in high-volume buprenorphine prescribers (clinicians with a mean of 30 or more active patients in every month that they were an active prescriber) during 2009–2018. Very high-volume prescribing (mean of 100+ patients per month) was also examined. ResultsOverall, 94,491 clinicians prescribed buprenorphine dispensed during 2009–2018. The proportion of active prescribers meeting high-volume criteria increased from 7.4 % in 2009 to 16.7 % in 2018. High-volume prescribers accounted for 80 % of dispensed buprenorphine prescriptions during 2009–2018; very high-volume prescribers accounted for 26 %. Adult primary care physicians consistently comprised the majority of high-volume prescribers. Addiction specialists were much more likely to be high-volume prescribers compared to other specialties, including psychiatrists and pain specialists. By 2018, the proportion of prescriptions from high-volume prescribers paid by Medicaid had doubled to 40 %, accompanied by a decline in both self-pay and commercial insurance. High-volume prescribers were overwhelmingly concentrated in urban counties with the highest fatal overdose rates. In 2018, the highest density of high-volume prescribers was in New England and the mid-Atlantic region. ConclusionsGrowth in high-volume prescribers outpaced the overall growth in buprenorphine prescribers across 2009–2018. High-volume prescribers play an increasingly central role in providing medication for OUD in the U.S., yet results indicate key regional variation in the availability of high-volume buprenorphine prescribers.

Scaling hypertension treatment in 24 low-income and middle-income countries: economic evaluation of treatment decisions at three blood pressure cut-points

ObjectiveEstimate the incremental costs and benefits of scaling up hypertension care in adults in 24 select countries, using three different systolic blood pressure (SBP) treatment cut-off points—≥140, ≥150 and ≥160 ...

Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders' Perspectives.

Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.

An integrated family approach in the practice of adult and child mental health care.

This paper describes the practice of an integrated family approach to treatment in mental health care in which the focus is on the whole family and treatment is carried out by professionals of adult and child mental health services together. It is presented as an example of a best practice in finding a way to overcome barriers in implementing an integrated family approach in treatment for the benefit of families with a variety of interrelated problems. Even though there is a lot of knowledge about the importance of a family approach in mental health care with specific attention to the patients' parental role, the children, family relationships, and the social economic context, this is worldwide rarely implemented in the practice of mental health care. Barriers to keep the whole family in mind are identified on different levels: organizational policy, interagency collaboration, professionals, and patients themselves. As a solution, a model of an integrated family approach in mental health care is presented: how it is defined; which domains in the family are targeted; which key elements it contains; what the treatment consists of; and which procedures are followed in practice. A case illustrates how this approach might work in practice.

Positive risk-taking within social care for adults with physical disabilities: A review of guidelines in practice in England

Introduction: Despite practice guidelines, professionals do not feel confident in implementing positive risk-taking. This may be due to the guidance provided. Method: A scoping review of current organisational guidance for the professional practice of positive risk-taking within Adult Social Care services for people with a physical disability. Guidelines were obtained from Local Authorities in England in October 2020. The data were extracted using TIDieR to describe positive risk-taking as an intervention. The quality of the guidelines was assessed using AGREE II. Findings: In all, 36 Local Authorities responded out of 106 contacted. A total of 21 documents were included for review. Substantial variability was found in terminology, definitions and risk grading between documents. The greatest consistency was found in how to implement a positive risk-taking intervention. Consistency was also found in the policy that documents cited. There was little reference to evidence to support intervention components. Overall, AGREE II quality scores were low and stakeholder involvement, specifically with regard to the views and preferences of service users, was largely absent. Conclusion: There is a need for a greater consensus to guide the professional practice of positive risk-taking. Determining the extent of current evidence and establishing an evidence base may facilitate more consistent guidelines and support professionals’ confidence in implementing positive risk-taking.

Changes in long-term care insurance revenue among service providers during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has impacted peoples’ health-related behaviors, especially those of older adults, who have restricted their activities in order to avoid contact with others. Moreover, the pandemic has caused concerns in long-term care insurance (LTCI) providers regarding management and financial issues. This study aimed to examine the changes in revenues among LTCI service providers in Japan during the pandemic and analyze its impact on different types of services.MethodsIn this study, we used anonymized data from “Kaipoke,” a management support platform for older adult care operators provided by SMS Co., Ltd. Kaipoke provides management support services to more than 27,400 care service offices nationwide and has been introduced in many home-care support offices. The data used in this study were extracted from care plans created by care managers on the Kaipoke platform. To examine the impact of the pandemic, an interrupted time-series analysis was conducted in which the date of the beginning of the pandemic was set as the prior independent variable.ResultsThe participating providers were care management providers (n = 5,767), home-visit care providers (n = 3,506), home-visit nursing providers (n = 971), and adult day care providers (n = 4,650). The results revealed that LTCI revenues decreased significantly for care management providers, home-visit nursing providers, and adult day care providers after the COVID-19 pandemic began. The largest decrease was an average base of USD − 1668.8 in adult day care.ConclusionThe decrease in revenue among adult day care providers was particularly concerning in terms of the sustainability of their business. This decrease in revenue may have made it difficult to retain personnel, and staff may have needed to be laid off as a result. Although this study has limitations, it may provide useful suggestions for countermeasures in such scenarios, in addition to support conducted measures.

Co-production of an intervention facilitating informal caregivers to support adults at risk of suicide and serious self-harm: a brief report

The recovery model in mental healthcare increasingly recognises suicidal behaviour as an interpersonal issue, with caregivers seen as essential in prevention.  In the UK, as in other parts of the world, there is growing consensus in policies, guidelines and academic research towards carer involvement in a person’s mental healthcare, yet inconsistency in practice remain commonplace.&#x0D; In response to the theme of poor family involvement consistently identified in reports into deaths by suicide in Devon (UK), Devon Partnership NHS Trust has developed Stronger Together, a training programme for carers of suicidal adults.  The programme, co-produced with carers and service users, also includes a collaborative learning component with healthcare staff.&#x0D; This report explores the programme's co-production and my personal involvement.  Co-production shaped Stronger Together, aligning it with national policy and research findings.  Its co-delivery and co-learning approach uniquely addresses carers' needs and fosters staff-carer collaboration.  Learning from this initiative could help other mental health trusts foster a culture of carer collaboration, potentially improving patient safety, reducing caregiver burden and enhancing support for patients and families to reduce deaths by suicide.  It also strengthens the case for co-production of training that effectively meets the needs of participants and delivers on its outcomes.

Data science techniques to gain novel insights into quality of care: a scoping review of long-term care for older adults

Background: The increase in powerful computers and technological devices as well as new forms of data analysis such as machine learning have resulted in the widespread availability of data science in healthcare. However, its role in organizations providing long-term care (LTC) for older people LTC for older adults has yet to be systematically synthesized. This analysis provides a state-of-the-art overview of 1) data science techniques that are used with data accumulated in LTC and for what specific purposes and, 2) the results of these techniques in researching the study objectives at hand. Methods: A scoping review based on guidelines of the Joanna Briggs Institute. PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using keywords related to data science techniques and LTC. The screening and selection process was carried out by two authors and was not limited by any research design or publication date. A narrative synthesis was conducted based on the two aims. Results: The search strategy yielded 1,488 studies: 27 studies were included of which the majority were conducted in the US and in a nursing home setting. Text-mining/natural language processing (NLP) and support vector machines (SVMs) were the most deployed methods; accuracy was the most used metric. These techniques were primarily utilized for researching specific adverse outcomes including the identification of risk factors for falls and the prediction of frailty. All studies concluded that these techniques are valuable for their specific purposes. Discussion: This review reveals the limited use of data science techniques on data accumulated in or by LTC facilities. The low number of included articles in this review indicate the need for strategies aimed at the effective utilization of data with data science techniques and evidence of their practical benefits. There is a need for a wider adoption of these techniques in order to exploit data to their full potential and, consequently, improve the quality of care in LTC by making data-informed decisions.

Predictors of fall protection motivation among older adults in rural communities in a middle-income country: A cross-sectional study using the Protection Motivation Theory.

To evaluate factors associated with fall protection motivation to engage in fall preventive behaviour among rural community-dwelling older adults aged 55 and above using the protection motivation theory scale. A cross-sectional study. The study was conducted in a healthcare clinic in Malaysia, using multistage random sampling from November 2021 to January 2022. Three hundred seventy-five older adults aged 55 and older were included in the final analysis. There were 31 items in the final PMT scale. The analysis was performed within the whole population and grouped into 'faller' and 'non-faller', employing IBM SPSS version 26.0 for descriptive, independent t-test, chi-square, bivariate correlation and linear regressions. A total of 375 older participants were included in the study. Fallers (n = 82) and non-fallers (n = 293) show statistically significant differences in the characteristics of ethnicity, assistive device users, self-rating of intention and participation in previous fall prevention programmes. The multiple linear regression model revealed fear, coping appraisal and an interaction effect of fear with coping appraisal predicting fall protection motivation among older adults in rural communities. Findings from this study demonstrated that coping appraisal and fear predict the protection motivation of older adults in rural communities. Older adults without a history of falls and attaining higher education had better responses in coping appraisal, contributing to a reduction in perceived rewards and improving protection motivation. Conversely, older adults from lower education backgrounds tend to have higher non-preventive behaviours, leading to a decline in fall protection motivation. These results contribute important information to nurses working with older adults with inadequate health literacy in rural communities, especially when planning and designing fall prevention interventions. The findings would benefit all nurses, healthcare providers, researchers and academicians who provide care for older adults. Participants were briefed about the study, and their consent was obtained. They were only required to answer the questionnaire through interviews. Older individuals aged fifty-five and above in rural communities at the healthcare clinic who could read, write or understand Malay or English were included. Those who were suffering from mental health problems and refused to participate in the study were excluded from the study. Their personal information remained classified and not recorded in the database during the data entry or analysis.

Professional Experiences and Career Trajectories of Mid- to Senior-Career Women Clinician-Scientists

Despite increasing evidence and recognition of persistent gender disparities in academic medicine, qualitative data detailing the association of gender-based experiences with career progression remain sparse, particularly at the mid- to senior-career stage. To investigate the role gender has played in everyday professional experiences of mid- to senior-career women clinician-scientists and their perceptions of gender-related barriers experienced across their careers. In this qualitative study, a total of 60 of 159 invited clinician-scientists who received National Institutes of Health K08 or K23 awards between 2006 and 2009 and responded to a survey in 2021 agreed to participate. Invitees were selected using random, purposive sampling to support sample heterogeneity. Semistructured in-depth interviews were conducted January to May 2022. For this study, interviews from 31 women were analyzed using the framework approach to thematic analysis. Data analyses were performed between August and October 2023. Descriptive themes of participant experiences of gender and gender-based barriers in academic medicine. A total of 31 women clinician-scientists (8 identifying as Asian [25.8%], 14 identifying as White [45.2%], and 9 identifying as members of a minority group underrepresented in medicine [29.0%]; 14 aged 40-49 years [45.2%] and 14 aged 50-59 years [45.2%]) were included. Among them, 17 participants (54.8%) had children who required adult supervision or care, 7 participants (22.6%) had children who did not require supervision or care, and 6 participants (19.4%) did not have children. There were 4 dominant themes identified within participant experiences in academic medicine: the mental burden of gendered expectations at work and home, inequitable treatment of women in bureaucratic processes, subtle and less subtle professional exclusion of women, and value of communities built on shared identities, experiences, and solidarity. This study found that women perceived the institution of academic medicine as a male-centric system misaligned with the needs of women, with associated feelings of exclusion, disillusionment, and loss of trust in their institutions. Findings suggest that the confluence of domestic obligations and unaccommodating institutional environments may make it difficult for women clinician-scientists to achieve established timelines of career progression and productivity; these findings may have long-term implications for the well-being and retention of women in academic medicine.

Parenteral Nutrition in the Critically Ill Adult: A Narrative Review.

Malnutrition in adult intensive care unit patients is associated with poor clinical outcomes. Providing adequate nutritional support to the critically ill adult should be an important goal for the intensivist. This narrative review aims to delineate the role of parenteral nutrition (PN) in meeting nutritional goals. We examined the data regarding the safety and efficacy of PN compared to enteral nutrition. In addition, we describe practical considerations for the use of PN in the ICU including patient nutritional risk stratification, nutrient composition selection for PN, route of PN administration, and biochemical monitoring.

Inequalities in Healthcare Access, Experience and Outcomes in Adults With Inflammatory Bowel Disease: A Scoping Review.

Inflammatory bowel diseases (IBDs) are incurable diseases that require lifelong access to health services. Accumulating evidence of inequalities in health care access, experience, and outcomes for individuals with IBD is apparent. This review aimed to describe the inequalities in healthcare access, experiences, and outcomes of care for adults with IBD, to identify research gaps, and to identify future research priorities in this area. A scoping review was conducted to retrieve quantitative, qualitative, and mixed methods evidence from 3 databases (EMBASE, Medline, and CINAHL) published between January 1, 2000, and September 27, 2023. Fifty-one studies met the criteria for inclusion. The majority (42 of 51) focused on IBD health outcomes, followed by healthcare access (24 of 51). Significantly fewer investigated patient experiences of IBD healthcare (8 of 51). Most available studies reported on race/ethnic disparities of healthcare (33 of 51), followed by inequalities driven by socioeconomic differences (12 of 51), rurality (7 of 51), gender and sex (3 of 51), age (2 of 51), culture (2 of 51), literacy (1 of 51), and sexuality (1 of 51). Inflammatory bowel disease patients from Black, Asian, and Hispanic ethnic groups had significantly poorer health outcomes. A lack of research was found in the sexual and gender minority community (1 of 51). No research was found to investigate inequalities in IBD patients with learning disabilities or autism. Further research, particularly utilizing qualitative methods, is needed to understand health experiences of underserved patient populations with IBD. Cultural humility in IBD care is required to better serve individuals with IBD of Black and Asian race/ethnicity. The lack of research amongst sexual and gender minority groups with IBD, and with learning disabilities, poses a risk of creating inequalities within inequalities.

Addressing the Transition to Adult Health Care for Adolescents and Young Adults with Pancreatic Disorders.

The transition from pediatric to adult health care is a vulnerable time period for adolescents and young adults (AYA).Guidance on how to effectively implement transition support for AYA with recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) is lacking. To address this gap, we formed a consortium of pancreatic centers that would work in coordination to test interventions to improve the transition for AYA with RAP and CP.We then performed a baseline assessment of consortium resources and patient transition readiness and developed an educational toolkit for AYA with RAP and CP. Results:Our consortium consists of three National Pancreatic Centers of Excellence, each with a multidisciplinary team to work with AYA with RAP and CP.While our patients ages 18 to 23 were generally seen at the pediatric centers, the baseline assessment of transition readiness suggests that our patients may have higher transition readiness scores than other populations.The educational toolkit contains both pancreas-specific and general guidance to support AYA with RAP and CP during their transition, including guidance on nutrition, pain management, and finding an adult gastroenterologist. Conclusions:We have formed a consortium to test interventions to improve the transition to adult health care for AYA with RAP and CP.We have completed a baseline assessment and developed our first intervention: an educational tool kit.Future work planned includes tests of the tool kit and efforts to improve rates of transfer to an adult provider for YA with RAP and CP.

Willingness to work with older adults and related factors in nursing students: a cross-sectional study

ABSTRACT Given the increased demand for health professionals to work with older adults, research on the factors that influence students’ career choices is critical in order to increase the popularity of gerontology. The purpose of this study was to investigate willingness and related factors of undergraduate nursing students to work with older adults. A descriptive and cross-sectional study was conducted with 579 undergraduate nursing students in Turkiye. The data were collected using the descriptive characteristics form, the 12-item expectations regarding aging scale (ERA-12), Kogan’s attitudes toward old people scale (KAOP), and willingness to work with elderly people scale (WEPS). Descriptive statistics and multiple regression were used for data analysis. The WEPS, ERA-12, and KAOP mean score of the students were 68.57 ± 11.54 (range: 20–120), 59.83 ± 15.09 (range: 0–100), and 142.98 ± 18.63 (range: 34–238), respectively. Expectations regarding aging, attitudes toward older adults, prior experience caring for older adults, and completing an elective geriatric nursing course positively predicted the total score of WEPS. These variables accounted for 14% of total variance of WEPS (R2: 0.137, F: 12.995, p < .001). Age, sex, and academic year also positively predicted the total score of WEPS, but it was not statistically significant. The willingness of nursing students to work with older adults was moderate. To enhance nursing students’ willingness to work with older adults, nursing programs should foster a positive attitude toward older adults and expectations regarding aging. Greater willingness of nursing students to care for older adults will eventually improve the quality of care for the geriatric population.