Care For Older People Research Articles

Production of research in Southern Africa from a political ethics of care perspective: a scoping review and reflection

In this article, we present a scoping review of the evidence and discussions in the extant literature on long-term care for older people in Southern Africa, focusing particularly on patterns of knowledge production in the region. Findings indicate that while the number of publications has increased over recent years, empirical research in countries outside of South Africa is extremely sparse and underfunded, and there is no clear research agenda. Drawing on a political ethics of care perspective, we reflect on the lack of attention to issues of care and the positioning of care for older people within societies in the region.

Factors Impacting User Engagement in Reablement: A Qualitative Study of User, Family Member and Practitioners' Views.

The challenges of population aging have fostered the adoption of reablement as a core pillar of older people's care in many developed economies. Aligning with wider literature on the association between "patient" engagement and outcomes, emerging evidence points to the impact user engagement may have on reablement outcomes. To date, existing research on the factors implicated in engagement with reablement is rather limited. To identify and describe factors which impact user engagement in reablement from the perspectives of reablement staff, staff in interfacing services, service users and family members. A total of 78 staff were recruited from five sites across England and Wales. Twelve service users and five family members were recruited from three of these sites. Data were collected via focus groups with staff and interviews with service users and families, and subject to thematic analysis. The data revealed a complex picture of factors potentially impacting user engagement, ranging from user-, family-, and staff-centered factors, the nature of the relationship between staff and users, and aspects of service organization and delivery across referral and intervention pathways. Many are amenable to intervention. As well as offering a more fine-grained understanding of factors reported by previous research, new factors impacting engagement were identified. These included staff morale, equipment provision systems, assessment and reviewing processes, and attention to social reablement needs. Aspects of the wider service context (eg, degree of integration of health and social care) played a role in determining which factors were pertinent. Findings highlight the complexity of factors influencing engagement with reablement, and the need to ensure features of the wider service context (eg delivery models, referral pathways) do not work against securing and sustaining older people's engagement with reablement.

Editorial

Editorial

Perceptions of community leaders about normative understandings of good family care of older people in rural and urban Zambia

Drawing on qualitative interviews and focus groups with 35 community leaders, this article investigates how community leaders understand norms of care for older people in Zambia. I ask what leads older people in Zambia to receive good care from family. The findings show that across both rural and urban settings, respondents related profoundly powerful norms of reciprocity in both family and community care, with older people viewed as reaping what they have sown in terms of religious and economic contributions throughout their lives. The study raises challenging questions from a rights-based perspective as to who is deserving of care.

Institutional care of older people during the COVID-19 epidemic in Croatia

Institutional care of older people during the COVID-19 epidemic in Croatia

Iatrogenic suffering at the end of life: An ethnographic study

Background: Across the developed West, a significant proportion of older people die in hospital It has been argued that an acute hospital setting is not well equipped to support dying well. A palliative approach, which involves recognising and alleviating suffering, might lead to improved quality of care. Yet suffering is an intangible and contested phenomenon and little is known about people’s actual experiences of suffering in this clinical setting. Aim: To examine the context of end-of-life care for older people in an acute hospital setting, particularly focusing on the experience of suffering. Design: An observational study, using an ethnographic approach. Data analysis was inductive and iterative. Reflexive analysis included observations and inferences from a participant-observer perspective. Over a period of 3 months in 2016, 186 h of observations of clinical care were carried out. Settings/participants: The study was carried out on a 30-bedded acute older peoples’ hospital ward in the United Kingdom. Participants included 11 patients and 33 members of staff and visitors. Results: Patient suffering was influenced by a range of factors. Delays in recognising and acknowledging dying often led to treatments that were burdensome or futile, exacerbating patient suffering. This was frequently associated with clinical decision-making that did not take into consideration long term concerns such as prognosis or quality of life. Environmental factors in the physical clinical setting such as noise and smell also exacerbated suffering. Finally, aspects of interpersonal interactions, such as paternalistic attitudes or ineffective communication, affected patient experience. Conclusion: Acute care for older people in hospital was shaped by an overarching ideology of rescue which predicted and dictated the process of care. Suffering was not restricted to the direct experiences of life-limiting illness but was also associated with the experience of receiving care in an acute hospital setting. Avoiding or minimising iatrogenic suffering is an essential component of compassionate care.

Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study

BackgroundStroke may cause debilitating neurological deficiencies that result in motor, sensory, and cognitive deficits and poorer psychosocial functioning. Prior studies have provided some initial evidence for the significant roles of health literacy and poor oral health for old people. However, few studies have focused on the health literacy of individuals who had a stroke; therefore, the relationships between the health literacy and oral health-related quality of life (OHRQoL) among middle-aged and older adults who had a stroke are unknown. We aimed to assess the relationships between stroke prevalence, health literacy status, and OHRQoL in middle-aged and older adults.MethodsWe retrieved the data from The Taiwan Longitudinal Study on Aging, a population-based survey. For each eligible subject, we gathered data in 2015 on age, sex, level of education, marital status, health literacy, the activity daily living (ADL), stroke history and OHRQoL. We evaluated the respondents’ health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. OHRQoL was identified based on the Taiwan version of the Oral Health Impact Profile (OHIP-7T).ResultsThe final study contained 7702 community-based dwelling elderly people (3630 male and 4072 female) were analysis in our study. Stroke history was reported in 4.3% of participants, 25.3% reported low health literacy, and 41.9% had at least one ADL disability. Furthermore, 11.3% of participants had depression, 8.3% had cognitive impairment, and 3.4% had poor OHRQoL. Age, health literacy, ADL disability, stroke history, and depression status were significantly associated with poor OHRQoL after sex and marital status was adjusted. Medium (odds ratio [OR] = 1.784, 95% confidence interval [CI] = 1.177, 2.702) to low health literacy (OR = 2.496, 95% CI = 1.628, 3.828) was significantly associated with poor OHRQoL.ConclusionsBase our study results, people with stroke history had poor OHRQoL. Lower health literacy and ADL disability were associated with worse QHRQoL. Further studies are necessary to define practical strategies for reducing the risk of stroke and oral health with constantly lower health literacy, thereby improving the quality of life and providing health care of older people.

443 Selection of Outcome Measurement Instruments for a Core Outcome Set for trials aimed at improving appropriate polypharmacy in older people in primary care

Abstract Introduction Different outcome measurement instruments (OMIs) have been used to measure similar outcomes in intervention studies focusing on improving appropriate polypharmacy in older people (1). It is crucial to reach consensus on which OMIs should be used for each outcome in a core outcome set (COS) to promote synthesis of trial findings and help identify effective interventions. A polypharmacy COS was previously developed, consisting of seven outcomes, including serious adverse drug reactions (ADRs), medication appropriateness, falls, medication regimen complexity, quality of life, mortality and medication side effects (1). To date, there has been no consensus as to which OMIs should be used for these outcomes. Aim To select OMIs for the seven outcomes in the COS developed to improve appropriate polypharmacy in older people in primary care. Methods This study followed the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) initiative’s guidelines for selecting OMIs for a COS (2), which include finding existing OMIs from a systematic review, conducting a quality assessment of the OMIs, selecting one OMI for each outcome in the COS, and running a Delphi consensus survey (two rounds) on OMIs for each outcome. For the Delphi exercise, researchers focusing on care of older people or clinicians who had experience in prescribing for this population in primary care, together with public advocates for older people were invited by email to participate. Following provision of consent, a questionnaire was developed and distributed by the SoGoSurvey® platform on two occasions. The two rounds were distributed on June 21st 2022 and July 11th 2022, respectively. Each round remained open for 14 days to allow participants to take part in the study. The questionnaire comprised a list of seven OMIs along with their definitions and illustrative examples. Stakeholders were asked to choose one option (‘agree’, ‘disagree’ or ‘unsure’) for every OMI. Response rate and distribution of scores for the seven OMIs were calculated following each round. Consensus for the inclusion of an OMI in the COS was reached if 70% or more participants selected ‘agree’ and 15% or less participants selected ‘disagree’. Results One hundred and eighty-eight emails were sent to relevant stakeholders (176 researchers or clinicians, 12 public representatives) inviting them to take part in the study. Fifty-seven (30.32%) stakeholders (56 researchers and one public representative) agreed to participate. Fifty (87.72%; all participants were researchers or clinicians) completed Rounds 1 and 2 of the Delphi survey. Following Rounds 1 and 2, consensus (≥70% participants agreed) was reached for three OMIs – ‘the number of ADRs’ (98%), ‘the number of deaths’ (76%) and ‘the number of patients who fell’ (70%) – to measure the ‘serious ADRs’, ‘mortality’ and ‘falls’ outcomes, respectively. Consensus was not reached for the remaining four OMIs. Conclusion This study led to the selection of OMIs for outcomes in a COS aimed at improving appropriate polypharmacy in older people. Although this study planned to include public participants, none agreed to participate. Future work should determine the most appropriate OMIs for the other four outcomes in the COS.

488 A qualitative study into the barriers and facilitators to effective communication with people with age-related hearing loss in community pharmacy settings

Abstract Introduction One in six adults are affected by hearing loss, and this number increases with age.(1) Inadequate communication is a barrier to the delivery of effective care for people with hearing loss.(2) Communication regarding medicines is particularly relevant to the pharmaceutical care of older people who are more likely to be living with hearing loss, have multiple comorbidities and experience polypharmacy, a risk factor for adverse drug events. This study sought to explore factors that facilitate and impede communication with people with age-related hearing loss (presbycusis) in the community pharmacy, to provide a base upon which to identify solutions/interventions to improve these interactions. Aim To explore the barriers and facilitators to effective communication with people with age-related hearing loss in the community pharmacy setting. Methods This qualitative study consisted of semi-structured interviews with people with age-related hearing loss (presbycusis), older people (>50 years old) without hearing loss, and focus groups and interviews with community pharmacists, conducted between March – June 2022. Participants were recruited purposively via advert and snowballing. Interviews and focus groups were conducted using Microsoft Teams or Zoom; two interviews were held by telephone. Data was analysed using the framework method. Results Sixteen people with age-related hearing loss and three older people without hearing loss took part. Eight community pharmacists took part across two focus groups and one interview. Four main themes were identified. The first was ‘grappling with the environment’. This theme reflects the multitude of environmental barriers to communication and person-centred pharmaceutical care such as heavy workload, time constraints, lack of privacy, noise levels and Covid-19 safety measures on communication. The second was ‘promoting acknowledgment and inclusion of hearing loss in the pharmacy’. This theme captures the perception among patients that their hearing loss is not relevant to the community pharmacy setting and that more could be done to signify that a pharmacy recognises the needs of those with hearing loss. Third, ‘patient perceptions and use of community pharmacy services’. This theme highlights the awareness and perceptions of the role of the pharmacy that is, primarily or exclusively as a place to collect prescriptions and the limited interaction with pharmacy personnel. The final theme was ‘differing perceptions of patients and pharmacists about communication’. This theme articulates the varying patient-provider perceptions about communication and levels of awareness among pharmacists about the key facilitators to communication. Conclusion This study garnered rich insights about the experiences of accessing and providing pharmaceutical care for people with age-related hearing loss within the community pharmacy setting. However, due to the Covid-19 pandemic, data collection was chiefly conducted online and the findings cannot be considered reflective of the experiences of older people facing digital exclusion. There is clearly a need to improve pharmacists’ awareness of, access to and implementation of strategies, adaptations, and assistive technologies to facilitate communication with people with hearing loss. Future research should identify interventions to support the implementation of strategies/adaptations that are tailored to the needs of people with hearing loss and pharmacists in order to engender hearing-friendly community pharmacies.

482 Developing a person-centred deprescribing process in primary care for older people living with frailty

Abstract Introduction Problematic polypharmacy in older people living with frailty can cause harm due to adverse drug events and deprescribing (withdrawing inappropriate medication to manage polypharmacy and improve outcomes (1)) is one solution to mitigate this. Structured Medication Reviews (SMRs) have been commissioned in England to be conducted by Primary Care Network (PCN) pharmacists for which older people living with frailty are a priority group. SMRs are an ideal opportunity to deprescribe for this high-risk population and a person-centred approach is required to ensure deprescribing is safe, effective and acceptable to patients. However, the optimal deprescribing process has not been developed and tested in this context. Aim To develop a person-centred process for deprescribing for older people living with frailty which could potentially be implemented within SMRs in primary care. Methods We conducted qualitative research with older people living with frailty, carers and primary healthcare professionals to identify barriers and facilitators to deprescribing in this context in the North of England (2). We then used these findings and a “trigger film” of patients’ experiences to conduct Experience-based Co-design (EBCD), a multi-event process where older people living with frailty, informal carers and primary healthcare professionals came together to determine the key features of an ideal deprescribing process and identify priorities for a complex intervention to support the process. Following this, we presented the process model for feedback at the training day of a large multi-site primary care practice based (involving pharmacists, GPs and administrative practice staff) in the North of England and subsequently refined the model to integrate within their evolving SMR programme. Results The co-designed deprescribing process consisted of 3 phases: 1. Prior to the SMR consultation which involved case-finding of high-risk patients, case-note review for deprescribing eligibility and clinician planning for the consultation, inviting and preparing the patient for the consultation with written information (including what to expect during the medication review, and questions for patients about their medicines to reflect upon); 2. The consultation which included shared decision-making, agreement of plans to stop medicines, recording of decisions in the electronic health record, providing written information for patients on how to safely stop their medicines, safety netting and signposting to post-deprescribing support; 3. Post-consultation which involved evaluating patient experiences and organising follow-up and further review as needed. Key elements of the optimal process to ensure it was person-centred, were effective written and verbal communication for patients (during the entire process), shared decision-making and tailored support post-consultation. Conclusion We have developed a person-centred process for deprescribing for older people living with frailty and adapted it for implementation within nationally commissioned SMRs in England. Although the model is grounded in the requirements of multiple stakeholders, the final version requires evaluation. The next steps are to design and develop tools which can support our deprescribing process and to undertake feasibility testing in primary care.

Risk factors associated with home care safety for older people with dementia: family caregivers’ perspectives

BackgroundMany older people with dementia currently prefer home care; however, homes are neither professionally designed nor regulated like health care facilities, and home care is more prone to safety incidents. Many studies have examined home care safety for older people with dementia. However, factors contributing to safety incidents in home care have not been adequately considered. This study explored the risk factors for home care safety for older people with dementia based on the perspective of family caregivers.MethodsThis study used a qualitative research approach; a total of 24 family caregivers were interviewed face-to-face and semi-structured from February 2022 to May 2022, and the Colaizzi seven-step phenomenological research method was used to analyze the data and refine the themes.ResultsSafety risks in home care for older people with dementia stem from five areas: poor health of older people with dementia, dementia symptoms, unsafe home environment, the insufficient caring ability of family caregivers, and lack of safety awareness of family caregivers.ConclusionThe risk factors for home care safety for older people with dementia are complex. And as the primary caregivers of older people with dementia, the caregiving ability and safety awareness of family caregivers primarily determine the safety of home care for older people with dementia. Therefore, when addressing home care safety for older people with dementia, the focus should be on providing targeted education programs and support services for family caregivers of older people with dementia.

Together, at a distance: experiences with a novel technology for social contact among older people and their relatives in Norway during the COVID-19 pandemic

BackgroundThe recognition that people are social beings is fundamental for person-centered care. During the COVID-19 pandemic, the lives of older people were restricted in ways that dramatically reduced their opportunities for face-to-face contact. Limited contact with family members due to social distancing raised concerns about the well-being of older people. In Norway, interactive technologies were therefore introduced to older people to help them maintain social contact while practicing physical distancing.ObjectivesThis study was designed to examine how older people and their relatives experienced the use of technology-mediated communication through KOMP, a tablet-like device for supporting social contact in care facilities and homes during the pandemic.MethodsWe adopted an open phenomenological approach inspired by Kvale and Brinkmann (2009) to explore how the use of KOMP became meaningful during the pandemic. The study was based on individual interviews with 4 residents in care facilities and 13 relatives.ResultsThe lived experiences of using KOMP among older people and their relatives revealed that adopting digital communication helped older people, and their families mitigate social distancing and maintain relationships with each other, despite the restrictions imposed by the government. Virtual involvement through KOMP afforded meaningful interconnections in the social lives of the users and their distant family members, thereby supporting their roles as parents and grandparents despite the distance, and promoting cross-generational connections among family members. Digital meetings also provided opportunities for older people and their relatives to enjoy each other’s presence in favored places, by conveying a homely atmosphere, for instance. These virtual encounters did not rely exclusively on talk as the only means of communication.ConclusionThis study suggests that communicating via KOMP was a meaningful activity for the participants. Technologies for social contact can, to some extent, facilitate person-centered care for older people in care facilities and their private homes, despite circumstances requiring social distancing.

Toward developing care outcome quality indicators for home care for older people: A prospective cohort study in Japan.

Care quality in Japan's long-term care (LTC) agencies, including home care, is the responsibility primarily of individual agencies, and the evaluation of service processes and outcomes is minimal. To describe the development of quality indicators for LTC (QIs-LTC) in Japan. QIs-LTC were developed through literature review and expert panel discussions and then were piloted and used in a 2-year longitudinal survey. The survey (launched in September 2019) targeted older people receiving home care (n = 1450), their family members (n = 880), their professional home care providers (n = 577), and managers of home care agencies (n = 122). Across eight domains (maintaining dignity, minimizing symptoms and disease deterioration, maintaining nutritional status, maintaining bladder/bowel control, encouraging physical activities, experiencing sound sleep, maintaining serenity and contentedness, and maintaining family's well-being), 24 care quality objectives were set with 24 outcome QIs-LTC and 144 process QIs-LTC. In the survey, 84.8% of clients were using home care nursing, 26.3% were living alone, and 39.5% had dementia. In the month preceding the data collection, 13.9% of clients had a new disease or worsening of an existing disease, 8.8% were hospitalized at least once, and 47.9% did not participate in activities of interest. About 20% of clients' families were unable to spend time peacefully, and 52.8% were exhausted from the client's care. The QIs-LTC developed in the current study are generic and client- and family-centered. They encompass objective and subjective information and would facilitate standardized monitoring if adopted and comparison between LTC settings, including home care. In addition, future research directives are outlined. Geriatr Gerontol Int 2023; 23: 383-394.

Evaluation of a co-designed educational e-resource about oral health for community nurses: study protocol

BackgroundOral health is a crucial aspect of health and wellbeing for older people. Poor oral health has been found to significantly increase the risk of chronic health conditions and poor quality of life for older people. Nurses practicing in the community are well-placed to provide oral health care to older people in their own homes, yet there has been little research in this field to develop accessible support for them to do so. Previous literature, reviewed in an earlier phase of this work, revealed that there has, historically, been a paucity of oral health care education for nurses and very few educational resources have been developed in this field.MethodsThis study will evaluate an educational e-resource which has been co-designed by service users, carers and clinicians. In the first phase of research, evidence of promise will be evaluated by analysing quantitative data on community nurses’ oral health attitudes and self-efficacy for oral health assessments of older people. In the second phase of research, facilitators and barriers to community nurses’ provision of oral health care to older people and the acceptability of the educational e-resource will be evaluated.DiscussionThis research will investigate the potential of an educational e-resource to improve community nurses’ capabilities to deliver oral health care to older people in their own homes. This research will inform both future intervention design and understanding of community nurses’ knowledge and attitudes about oral health care. Facilitators and barriers to provision of this care for older people will also be explored.

Care Workers and Managers’ Experiences of Implementing Infection Control Guidance in an Epidemic Context: A Qualitative Study in the South East of England, during the COVID-19 Prevaccination Era

The national response to COVID-19 has had a severe impact on adult social care settings, with high mortality amongst people receiving and providing care in England. Care workers had to rapidly adapt to new infection control measures to protect themselves, their colleagues, and the people receiving care. Infection control in residential and domiciliary care is always complex, but COVID-19 infection control measures impacted exceptionally on care workers’ working and everyday lives. We undertook qualitative interviews with care workers and managers (n = 10) in residential and domiciliary care for older people in the Southeast England during the first wave of the pandemic to understand their experiences, solutions, and concerns to implement guidance in practice. Data were analysed using framework analysis, and the following eight themes were identified: (1) Increasing visibility and support for the sector; (2) the impact of negative messaging about the sector; (3) feelings of isolation; (4) accessibility and usability of guidance; (5) social care staff as agents in producing and sharing good practice; (6) managing expectations and the impact of conflicting messages in the media; (7) improving communication with hospitals; and (8) problems in the early pandemic. The findings reveal widespread concerns for the marginalisation of the sector in the policy response and the inadequacy of infection control guidance. Guidance would benefit from a better understanding of domiciliary and residential care settings. This might involve the following steps: (a) coproduction of guidance with adult social care stakeholders, including those in direct-care roles and (b) a shift away from a clinical model of infection control towards a more flexible approach that attends to the inherent variability of care settings.

Time and space in the care of older people. Ageing in place and the built environment

Time and space significantly affect the autonomy and the care needs of people. In recent years, many countries have adopted an ageing in place strategy, which requires, however, an age-friendly built environment and a dedicated care system. This paper addresses the conditioning role of the built environment on the life of frail older people ageing alone at home. After a brief review of the debate, findings from the IN-AGE research carried out in three regions of Italy are presented, to conclude with some policy suggestions.

QUALITY OF LIFE OF OLDER PEOPLE RESIDING IN A RURAL COMMUNITY AT BANKE DISTRICT, NEPAL

Background: The quality of life of older people reflects their health status and well-being and is an important area of concern for those involved in the care of older people. The objective of the study was to assess the quality of life of older people residing in a rural community at Banke district, Nepal. Methods: A cross-sectional study was conducted among 368 older people aged 60 years and above in ward number-3 (Karmona, Radhaypur, and Indrapur) of Janaki rural municipality of Banke district. Purposive sampling technique was used to recruit participants. Data were collected through face-to-face interviews using World Health Organization Quality of Life Scale- BREF. T-test and ANOVA test were used to compare the mean scores of different variables and domains of quality of life. The significance level was set at p <0.05. Results: The mean score and standard deviation of total quality of life were 72.97±6.91. The mean quality of life score was lowest in the psychological domain (63.39±7.11) compared to environment (71.56±7.40), social (77.68±10.49), and physical domains (79.24±12.39). A statistically significant difference was observed on total quality of life scores between age groups (p=.001), sex (p=0.047), marital status (p=.001), occupation (p=.004), educational status (p=.001), living status (p=.007), source of livelihood (p=0.001), and physical health problems (p=.001) of older people. Conclusions: In older people, the psychological domain of quality of life necessitates particular attention along with their environment, social, and physical health.

Integrating health promotion with and for older people - eHealth (IHOPe) – evaluating remote integrated person-centred care

BackgroundHealthcare and welfare systems worldwide are unprepared to accommodate the growing population of older people. Simultaneously, the cost of reactive care for older people is increasing. However, healthcare systems in many countries are reforming towards integrated and person-centred care with a focus on health promotion and proactive actions. The Integrating Health Promotion with and for Older People – eHealth (IHOPe) project aims to describe and evaluate a person-centred e-support intervention that promotes a sustainable partnership between community-dwelling frail older people and health and social care professionals.MethodsThe IHOPe project is designed as a randomised controlled trial comparing a control group receiving standard care with an intervention group receiving standard care and add-on person-centred care through telephone support and a digital platform. The primary outcome measure is a composite score of changes in general self-efficacy and the need for unscheduled hospital care. The project is conducted in Gothenburg, Sweden. At least 220 participants aged ≥ 75 years will be included after being screened using a frailty instrument. The study design, intervention components, digital platform, and questionnaires were developed in close collaboration with an advisory group of inter-professional researchers, stakeholders, clinicians, and older representatives. Data will mainly be collected through questionnaires at baseline and 3, 6, and 12 months after inclusion in the study. Recruitment is ongoing and should be completed during 2023. Data will be analysed using quantitative and qualitative methods. The evaluation will include effectiveness, process, and health economics. The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (Dnr 2019–05364, Dnr 2020–03550, Dnr 2021–03255).DiscussionThe findings will expand our knowledge of remotely integrated person-centred care for frail older people. Thereby, the IHOPe project is expected to fill highlighted knowledge gaps on intervention evaluations including the triad of person-centred, digital, and integrated care elements, as well as economic evaluations of remote health services for frail older people. The study is ongoing, and the results are not completed but if they turn out to be positive, implementation is not limited to time or location.Trial registrationClinicalTrial.gov: NCT04416815. Registered 07/06/2021.

Effectiveness of auricular acupressure on constipation and related quality of life among the older people in the residential care home: a randomized clinical trial

IntroductionConstipation can be one of the biggest health problems for the older people that has negative effects on their quality of life. Some studies have reported that new non-pharmacological interventions such auricular acupressure have promising results in the management of constipation. This study was performed to investigate the effect of auricular acupressure on constipation and health-related quality of life in the older people living in the residential care home.MethodsSample of this randomized clinical trial consisted of 53 older people with chronic constipation living in a residential care home in the southeast of Iran (Kerman city). The participants were randomly assigned to intervention (n = 27) and control (n = 26) groups. Auricular acupressure was applied to seven auricular acupoints (large intestine, rectum, San Jiao, spleen, lung, sympathetic, and subcortex) using Vaccaria seeds for the intervention group and for the control group, seedless auricular plasters were used at the seven auricular acupoints for 10 days. Data were collected before the intervention, end of the intervention, and 10-day follow-up using demographic and clinical, Patient Assessment of Constipation-Symptom, and Patient Assessment of Constipation-Quality of Life questionnaires. The SPSS-22 software was used for data analysis.ResultsThe difference between groups and times was significant in constipation and related quality of life and scores. The mean score of constipation at the end of intervention was 0.41 less in the intervention group than the control group (P < 0.0001). This mean score, in the intervention group also on the 10-day follow-up was 0.09 less than the control group (P = 0.004), which indicates a decrease in the severity of constipation symptoms. In the intervention group, mean score of quality of life related to constipation at the end of intervention and the 10-day follow-up was 0.56 and 0.19 less than the control group (Decrease in the mean score of quality of life related to constipation indicates an improvement in the quality of life) (P < 0.0001).ConclusionThe results showed the positive effect of auricular acupressure on reducing the severity of constipation symptoms and improving the quality of life in old patients living in the residential care home. This non-pharmaceutical practice can be used by nurses as an inexpensive, safe, acceptable, and non-invasive nursing care for older people with constipation in homes, medical centers, or nursing homes.

Shifting elder-care practices in Chinese middle-class families.

This paper explores how ideas and practices of elder-care may be changing for the new Chinese middle class. This paper draws on in-depth interviews with the members of different generations of ten middle class families in the Chinese city of Tianjin. It explores how increased resources but also increased pressure are affecting the care of older people and the expectations around elder-care. Thematic analysis of transcripts entered into NVIVO revealed three findings. Firstly, that the generation born in the 1950s and 1960s are often negotiating their care responsibilities between their parents and their grandchildren. Secondly, the only viable elder-care solution for many families is to buy in support from an unregulated market-based home care sector. Thirdly driven by an increasingly postmodern culture, filial piety may be changing from a normative expectation to a set of new practices based on familial reciprocity. The paper concludes by reflecting on the issues that will arise from the proposed raising of the retirement age in China, and the increasing geographic dispersal of generations. Flexible working policies as well as investment in a regulated home care sector are recommended as solutions to be explored.