Care For People Research Articles

Involvement Challenges of Applying Co-Design Methods in Mental Health Care for Older People

Involvement Challenges of Applying Co-Design Methods in Mental Health Care for Older People

Enhancing clinical service design for multimorbidity management: A comprehensive approach to joined-up care for diabetes, chronic kidney disease, and heart failure.

Multimorbidity is becoming the norm rather than the exception, especially among the ageing population and people with lower socio-economic status. In addition to the rising healthcare cost, multimorbidity poses considerable difficulty in the delivery of adequate holistic care for affected patients. This review presents a discussion of the current barriers to delivering holistic care to people with multimorbidity and proposes a model of clinical care for people living with cardiovascular-kidney-metabolic (CKM) syndrome as an exemplar of a multimorbidity cluster. Single organ/disease services may not be able to provide optimum care to people with multimorbidity due to the potential complex interactions between multiple disease symptoms and management. In addition, people with multimorbidity may be required to attend multiple appointments in different healthcare centres. This may negatively impact access to services due to time and financial burden. Other barriers include co-ordinating communication between healthcare professionals and reduced continuity of care. Optimising CKM health requires patient-centred care led by an interdisciplinary care team who ideally should possess CKM competencies utilising a shared care protocol to coordinate evidence-based care and use of telehealth to empower patients. Stakeholders and policymakers need to adapt new policy models to establish and enhance CKM care models by allocating funds and implementing frameworks for educational reforms. A CKM service has the potential to increase the uptake of cardiac and renal protective medications as well as optimising metabolic care, increase capacity in both primary and secondary care, improve quality of life and clinical outcomes, reduce patient inconvenience, and importantly allow rapid translation of advances in cardiorenal metabolic diseases into clinical practice.

Research progress on the effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus

Both periodontitis and diabetes are chronic inflammatory diseases, which are widely prevalent in the world. For more than 50 years, the research on the relationship between periodontitis and type 2 diabetes has been actively carried out. The epidemiological correlation between these diseases has been basically identified, but the impact of periodontal therapy on glycaemic control in patients with type 2 diabetes has been controversial for a long time. Glycaemic control is a key issue in the care of people with diabetes. If the positive effect of periodontal therapy on improving glycemic control in diabetic patients compared with no active treatment can be identified, it will help establish periodontal therapy as an effective auxiliary measure for glycaemic control of diabetes patients, and further confirm the relationship between dental health and systemic diseases. Through reviewing the literature, it has been basically determined that the glycaemic control of diabetes patients can be improved within 6 months after the commencement of non-surgical periodontal therapy. In addition, the guidelines of diabetes and suggestions involved periodontal therapy that are constantly put forward by various countries and health organizations at all levels,while in China with extremely heavy in the burden of diabetes, also should propose the guidelines and suggestions of diabetes in accordance with China's national conditions. Both periodontitis and diabetes are diseases with special emphasis on prevention. To clarify the relationship between periodontitis and diabetes can give enlightenment in preventing the occurrence and development of the two diseases.

The Global Intellectual Disability Nursing Research Collaboratory: Forming an international transformational nursing network.

This paper explains how we created the Global Intellectual Disability Nurse Research Collaboratory (GIDNRC), a transformative network. The GIDNRC aims to make improvements in the understanding, research, policy, clinical care, and support provided to people with an intellectual disability. In 2022, the World Health Organization (WHO) called upon healthcare leaders internationally to take actions to promote more equal healthcare for disabled persons. This paper promotes the GIDNRC as a way for professionals to work together to make more equal healthcare throughout the world for people with intellectual disabilities. We created this paper by reviewing peer-reviewed literature and research, international policies, and nursing networking initiatives. This paper explores current policy, research, and practice issues that formed the basis of beginning the GIDNRC, including how the COVID-19 pandemic changed care. Nurses are over 50% of the world's health workforce. Therefore, they have the potential to make a large impact in making care for people with intellectual disability much more equal than currently exists throughout the world. However, barriers exist. Forming the GIDNRC, as well as using the World Wide Web, offers an opportunity to address barriers to this goal. Nurses can address the needs of people with intellectual disability in their daily nursing practice. The GIDNRC aims to strengthen these clinical skills, understand how care may vary throughout the world, and share knowledge, good practices, and new ways to approach care for people with an intellectual disability worldwide. International nursing policy should actively focus on the needs of people with intellectual disabilities and the role nurses play in addressing these health needs. The GIDNRC may provide an important way to achieve developments in this policy.

Attitudes to inequality: preferences and beliefs

Abstract To understand attitudes to inequality, we need to study people’s fairness preferences and beliefs about the sources of inequality. This article reviews the existing experimental literature on fairness, including our new study ‘Fairness Across the World’ that collected novel data on attitudes to inequality in 60 countries. We establish that people in general are more willing to accept inequalities that reflect differences in performance than inequalities that reflect differences in luck—and that people care more about fairness than efficiency. We also document that people differ in their fairness preferences both within and between countries. Richer countries are more meritocratic, and, correspondingly, richer people are more meritocratic within countries. People also differ in their beliefs about the sources of inequality both between and within countries, and the evidence is consistent with people having a self-serving bias in beliefs.

The Role of the Dentist in Home Care for the Older People: A Narrative Review of the Literature

Objective; This study aimed to discuss the role of dentists in providing home care to older people. Methodology; Studies on the role of the dentist in the oral health of older people living at home were reviewed. The search terms used included: home care, domiciliary care, older people, and oral health. Inclusion criteria comprised articles published in Scielo and Google Scholar databases. The article was categorized to provide a clear exposition of the information. Results; Home Care (HC) in Brazil evolved from an informal practice initiated by sanitary agents in the early 20th century to a structured service with the creation of the Unified Health System (UHS) in 1988. The UHS established programs such as the Family Health Program, which integrated home visits by doctors and nurses, and later incorporated HC in three levels (HC1, HC2, HC3) to address different care complexities. The role of dentists in HC includes promoting oral health, treating urgenties, guiding caregivers, and performing clinical procedures, which are essential for the quality of life of the older people. This approach requires specific handling techniques and professional adaptation, focusing on prevention and less invasive treatments, considering the biopsychosocial health of patients. Conclusion: Home Care Services are crucial, with dentists providing care that includes the prevention and promotion of oral health. HC promotes humanized and comprehensive care, positively impacting the well-being of the older people. Long-term effectiveness depends on prevention, caregiver education, and professional adaptations.

Gendered economic inequalities: a social policy perspective

Abstract This commentary addresses gender inequalities from a social policy perspective. It extends the analysis by Andrew et al. in this collection; focuses on lower incomes and social security; and recognizes both individual financial autonomy and interdependence as central. The commentary discusses labour market issues, including how to improve security and in-work progression for women in particular. Policy proposals are also made to limit the disruptions to women’s working lives by care for elderly or disabled people. More broadly, the commentary argues that a key question for any policy is whether it will help transform gender roles and relationships, to allow both sexes to fulfil their capabilities to the full. In addition, both male disadvantage and inequalities and economic dependence within households require more attention. Impact analysis should therefore explore not only distribution between households at the time but also potential effects on individual women and men over the life course. A balance is needed between moves towards economic independence and recognition of past, and continuing, inequalities. Policies can potentially tackle gender inequalities directly, and norms and values that may affect them indirectly. Proposals are put forward for changes in ‘family policy’, including towards second earners, parental leave and childcare. Finally, the commentary argues that the combination of a focus on autonomy and agency for all with awareness of our interdependence as a society and wider world means that gender issues must be central to the Deaton Review, not just for their own sake but also in a broader context.

Mental health clinical pathways for children and young people with long-term health conditions: A systematic review.

Clinical pathways (CPWs) are structured care plans that set out essential steps in the care of patients with a specific clinical problem. Amidst calls for the prioritisation of integrated mental and physical health care for young people, multidisciplinary CPWs have been proposed as a step towards closer integration. There is very limited evidence around CPWs for young people with mental and physical health needs, necessitating a review of the literature. The aim of this review is to understand how clinical pathways have been used to deliver mental health support to children and young people with long-term physical health conditions and their effectiveness across a range of outcomes. The databases MEDLINE, CENTRAL, PsycINFOand CINAHL were searched from inception to 6September 2023. Keywords linked to children and young people, mental health, long-term physical health conditionsand CPWs were used. Studies using either quantitative or qualitative research designs were included. All studies must have evaluated a CPW to provide mental health support to children and young people (up to 25 years old) with long-term health physical conditions. Both mental and physical health outcomes were considered. Pathways were grouped by integration 'model' as described in the wider literature. The initial search returned 4082 studies after deduplication. A total of eight studies detailing six distinct care pathways (232 participants [170 children and young people; 50 caregivers; 12 healthcare professionals]) met eligibility criteria and were included in the analysis. Four pathways were conducted within an 'integrated model'; two were a combination of 'integrated' and 'colocated'; and none within a 'co-ordinated model'. Only pathways within an integrated model reported quantitative health outcomes, with improvements across a range of mental health measures. One negative physical health outcome was reported from an integrated diabetes pathway, but this should be interpreted with caution. This review identified a range of CPW designs but most fell under an integrated model. The results suggest that calls for integrated mental health pathways in this population may be appropriate;however, conclusions are limited by a paucity of evidence.

A quantitative comparison between the essential medicines for rheumatic diseases in children and young people in Africa and the WHO model list

BackgroundThe World Health Organisation Essential Medicines List (WHO EML) guides National Essential Medicines Lists and Standard Treatment Guidelines for clearly identified disease priorities especially in low- and middle-income countries. This study compares the degree to which the basket of medicines recommended for rheumatic diseases in children and young people in National Essential Medicines Lists of countries in the WHO Africa region, corresponds to the 2021 WHO EML and WHO EML for children, as a proxy of availability.MethodsAn online search of the WHO medicines and health technology portal, the Health Ministry websites of the 54 African countries, PUBMED and Google Scholar, with search terms for ‘National Essential Medicines List’, AND/OR ‘standard treatment guidelines’ AND/OR ‘Lista Nacional de Medicamentos Essenciais’ AND/ OR ‘Liste Nationale de Medicaments Essentiels’ AND Africa AND/OR < Name of African country > was conducted. The number of medicines on the national lists were compared according to a predefined template of medicines; and the percentage similarity calculated. Descriptive statistics were derived using STATA.ResultsForty-seven countries in the WHO Africa region have developed a National Essential Medicines List. Eleven countries do not have any medicines listed for rheumatic diseases.The majority of countries had less than or equal to 50% similarity with the WHO EML for rheumatic disease in children and young people, median 3 medicines (IQR 1— 4). The most common medicines on the national lists from Africa were methotrexate, sulfasalazine and azathioprine, with etanercept available in 6 countries. Seven countries had only one medicine, acetylsalicylic acid listed in the section ‘Juvenile Joint diseases’.A multiple linear regression model for the predictors of the number of medicines on the national lists established that 20% of the variability was predicted by health expenditure per capita, socio-demographic index and the availability of rheumatology services (adult and/or paediatric) p = 0.006, with socio-demographic index (p = 0.035, 95% CI 0.64—16.16) and the availability of rheumatology services (p = 0.033, 95% CI 0.13 – 2.90) significant.ConclusionFour countries (8.5%) in Africa have updated their National Essential Medicines Lists to reflect adequate care for children and young people with rheumatic diseases. Moving forward, efforts should focus on aligning available medicines with the WHO EML, and strengthening healthcare policy for rheumatology and pharmaceutical services, for affordable access to care and medicines.

'Becoming restrained': Conceptualising restrictive practices in the care of people living with dementia in acute hospital settings.

The use of restrictive practices within health and social care has attracted policy and practice attention, predominantly focusing on children and young people with mental health conditions, learning disabilities and autism. However, despite growing appreciation of the need to improve care quality for people living with dementia (PLWD), the potentially routine use of restrictive practices in their care has received little attention. PLWD are at significant risk of experiencing restrictive practices during unscheduled acute hospital admissions. In everyday routine hospital care of PLWD, concerns about subtle and less visible forms of restrictive practices and their impacts remain. This article draws on Deleuze's concepts of 'assemblage' and 'event' to conceptualise restrictive practices as institutional, interconnection social and political attitudes and organisational cultural practices. We argue that this approach illuminates the diverse ways restrictive practices are used, legitimatised and perpetuated in the care of PLWD. We examine restrictive practices in acute care contexts, understanding their use requires examining the wider socio-political, organisational cultures and professional practice contexts in which clinical practices occurs. Whereas 'events' and 'assemblages' have predominantly been used to examine embodied entanglements in diverse health contexts, examining restrictive practices as a structural assemblage extends the application of this theoretical framework.

Pulmonary rehabilitation in idiopathic pulmonary fibrosis.

This review synthesizes the expanding evidence for pulmonary rehabilitation that has led to its recommended inclusion in the holistic care of people with idiopathic pulmonary fibrosis (IPF), as well as discussing strategies that may maximize and sustain benefits. Pulmonary rehabilitation is an effective intervention leading to significant improvements in exercise tolerance, symptoms, and quality of life for people with IPF. Improvements in symptoms and quality of life can persist longer term, whereas functional capacity does not; therefore, strategies to preserve functional capacity are an important area of research. Referral early in the disease course is encouraged to promote longer lasting effects. Evidence that high-intensity interval training may optimize benefits of exercise training is emerging. Supplemental oxygen is frequently used to manage exercise-induced desaturation, although its use as an adjunct therapy requires more evidence. Current evidence strongly supports the inclusion of pulmonary rehabilitation in the standard holistic care of IPF, with early participation encouraged. Further research is needed to establish the optimal exercise strategies, modalities and adjunct therapies that enhance outcomes of pulmonary rehabilitation and promote longer lasting effects.

A community-based geriatric interprofessional education experience and its impact on post-graduate collaborative practice

ABSTRACT While a growing body of interprofessional education (IPE) literature demonstrates a positive impact on learner knowledge, there is limited data on its long-term impact on collaborative practice (CP). With the growth of the aging population globally, understanding both the long-term impact on CP and sustainability of community-based geriatric experiential IPE programs are imperative. This study explores the impact of the Interprofessional Geriatric Curriculum (IPGC), a community-based geriatric IPE program, on post-graduate clinical practice among seven health professions. This study utilized a cross-sectional descriptive design, where both qualitative and quantitative data were collected in the same online survey of health professionals’ to measure their perceptions of the impact IPGC has had on their respective clinical practice 1–3 years post-graduation. Forty-six per cent of health profession graduates provided clinical care for people 65 years of age or older; 81% worked in interprofessional teams; 80% reported the IPGC experience significantly impacted their practice (N = 137), and all used validated assessment tools taught in the IPGC program in their practice. Eight themes emerged from the list of what health professionals learned from IPGC that they use regularly in their clinical practice: four themes were interprofessional in nature (i.e. teamwork and team-based care, interprofessional communication, roles/responsibilities, and personal/professional) and four themes related to geriatrics (i.e. aging, screening and assessment, medications, and didactic content). This study is one of the first to describe the sustained influence of a community-based IPE program across multiple health professional disciplines on clinical geriatric practice.

'Sometimes You Have No Choice but to Give Them Medication': Experiences of Nurses Caring for People With Auditory Hallucinations in an Acute Unit.

The aim of this study was to explore psychiatric nurse's experiences of caring for people with auditory hallucinations in an acute unit. A qualitative study was conducted using thematic analysis. The study involved semi-structured interviews with 18 acute unit nurses all of whom provided interventions to patients with auditory hallucinations. Overall, participants identified their role in the management of risk within an acute unit, the importance of their therapeutic role and a perceived over-reliance on medication administration as a primary nursing intervention. These findings thus demonstrate the personal and professional conflict that nurses face when working in an acute unit with patients who experience auditory hallucinations. Nurses are in a prime position to provide effective interventions and assistance for people with auditory hallucinations in an acute unit. The findings of this study indicate that mental health nurses may require additional support and education to provide care in a truly recovery-based manner, with training in specific interventions and engagement skills for people who hear voices. Due to an unpredictable environment and sometimes high-risk workplace, nurses may also benefit from organisational assistance in this area.

Immunotherapy for non-small cell lung cancer in the elderly population: a generic protocol.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effectiveness and safety of immune checkpoint inhibitors (ICI) as monotherapy or in combination compared to standard of care for elderly people (≥ 65 years) with non-small cell lung cancer (NSCLC).

Current practices in the nutrition management of people with amyotrophic lateral sclerosis (ALS): a survey of U.S. ALS care teams

Objective To assess current practices of U.S. professionals providing outpatient ALS nutrition care. Methods A cross-sectional survey assessing nutrition care practices was distributed in February/March 2023 through electronic mailing lists of relevant professional organizations. Results Of the 87 professionals completing the survey, 85.1% were registered dietitians and 50.6% had five or fewer years of experience in ALS care. Many (44.2%) professionals reported receiving no training on the nutrition care of people with ALS (PALS), and 40.2% reported having no other ALS dietitians in their close network. Methods utilized to estimate calorie and protein requirements in PALS varied widely. Although 95.4% of respondents reported that their clinic’s dietitian participates in feeding tube discussions, many practitioners may be waiting until ALS symptoms negatively impact PALS’ breathing, eating, swallowing, or weight to begin discussing feeding tubes. Additionally, few professionals reported institutional practices conducive for refeeding syndrome prevention or monitoring. Conclusions Many professionals providing outpatient nutrition care to PALS possess limited experience, received insufficient training, and are not connected to other ALS dietitians. Specific nutrition care practices, including nutrient need estimation, vary widely among health professionals. Practices surrounding feeding tube discussions and refeeding syndrome may be suboptimal at many institutions. These findings highlight the need for initiatives that educate and connect practitioners providing nutrition care to PALS.

Guideline summary: assessment, diagnosis, care and support for people with dementia and their carers [Scottish Intercollegiate Guidelines Network SIGN Guideline 168

The Scottish Intercollegiate Guidelines Network (SIGN) have recently published their guideline SIGN168 on 'Assessment, Diagnosis, Care, and Support for People with Dementia and their Carers'. The guideline makes evidence-based recommendations for best practice in the assessment, care and support of adults living with dementia. Topics featured in this guideline are limited to those prioritised by stakeholders, especially people with lived and living experience, and those not well covered under pre-existing guidance. We summarise the guideline recommendations related to identification and diagnosis of dementia, investigative procedures, postdiagnostic support living with dementia, including non-pharmacological approaches for distressed behaviours, using technology to support people with dementia, grief and dementia and changing needs of people with dementia. The guideline content is summarised as officially published, with additional commentary in the final section.

Geragogic support for status passages in old age : Challenge and opportunity of anew care for older people

With the continuous increase in the average age, the temporal perspective for the phase of old age is also significantly expanding. This results in an individual need for reorientation for the aging person with respect to ameaningful shaping of this long period of time, which as aprogressive process leads to the end of life. In the context of the status passages to the third, fourth and fifth ages, there is aspecial relevance for this; however, the so-called care for older people (§71 Social Security Code, SGBXII) has so far largely ignored these important aspects. Rethinking in aneeds-oriented way, the facilitation of the necessary reorientation of life in old age through learning and education must therefore be given greater consideration. The article gives anecessary update of the existing care for older persons, which takes greater account of aneeds-oriented design of asociety of long life. Furthermore, the role and significance of the necessary educational processes in the sense of geragogy are outlined and also how they can contribute to successful aging. With reference to current research work and publications on the topic, the possibilities of geragogic support as achallenge and opportunity for new care for older persons are worked out. The learning and educational processes of the aging person can be aimed at various concerns, if nothing else differentiated according to the challenges associated with the social age categories, i.e., the third, fourth or fifth age; however, learning and educational processes also address very different dimensions, each focusing on the question of how older people can tackle and cope with such necessary adaptation and change processes.

Supporting nutritional intake in patients with dementia: strategies for healthcare services

Beth Goss‑Hill and Marie Mumby explore how healthcare services can address barriers to nutritional intake and facilitate holistic, person‑centred care for people with dementia and their caregivers, helping them to stay well for longer.

New horizons in clinical practice guidelines for use with older people.

Globally, more people are living into advanced old age, with age-associated frailty, disability and multimorbidity. Achieving equity for all ages necessitates adapting healthcare systems. Clinical practice guidelines (CPGs) have an important place in adapting evidence-based medicine and clinical care to reflect these changing needs. CPGs can facilitate better and more systematic care for older people. But they can also present a challenge to patient-centred care and shared decision-making when clinical and/or socioeconomic heterogeneity or personal priorities are not reflected in recommendations or in their application. Indeed, evidence is often lacking to enable this variability to be reflected in guidance. Evidence is more likely to be lacking about some sections of the population. Many older adults are at the intersection of many factors associated with exclusion from traditional clinical evidence sources with higher incidence of multimorbidity and disability compounded by poorer healthcare access and ultimately worse outcomes. We describe these challenges and illustrate how they can adversely affect CPG scope, the evidence available and its summation, the content of CPG recommendations and their patient-centred implementation. In all of this, we take older adults as our focus, but much of what we say will be applicable to other marginalised groups. Then, using the established process of formulating a CPG as a framework, we consider how these challenges can be mitigated, with particular attention to applicability and implementation. We consider why CPG recommendations on the same clinical areas may be inconsistent and describe approaches to ensuring that CPGs remain up to date.

Updates in the Management of HIV During Pregnancy.

Human immunodeficiency virus in pregnant people remains a significant public health issue worldwide. The rate of perinatal transmission is 15% to 40% but can be decreased to less than 1% with appropriate antenatal management. Previous recommendations included a protease inhibitor-based antiretroviral therapy, infant prophylaxis, performance of cesarean section for uncontrolled viremia, and the use of formula for infant feeding. However, recent updates include first line of integrase inhibitor-based regimens and supporting parental choices for safe lactation. In this review, we summarize and provide updated recommendations for the care of people living with human immunodeficiency virus during pregnancy.