Care For Older Persons Research Articles

Core values and local guarantees of dignity in the care of older persons - Application, obstacles and further actions.

Due to reported shortcomings in elderly care in Sweden, the government has introduced national guidelines to establish core values and guarantees of dignity. With a bottom-up perspective, core values and local guarantees of dignity were developed using an participatory and appreciative action and reflection (PAAR) approach and implemented in municipal elderly care. The aim of this study was to evaluate the core values and local guarantees of dignity applied by the municipal healthcare staff caring for older persons. A cross-sectional descriptive design study using a questionnaire was conducted one year after the implementation of core values and local guarantees of dignity in municipal elderly care. In total, 608 caregivers answered the questionnaire. The results show that the caregivers strived to apply the core values and local guarantees of dignity, but experienced obstacles from the organisation. Proposals were given to facilitate further application of the core values.

Treating Elderly Patients With Muscle-Invasive Bladder Cancer.

Bladder cancer is an extremely common cancer that primarily affects individuals aged >65 years. In caring for patients with bladder cancer, clinicians must also consider care of older persons in general. Management of muscle-invasive bladder cancer (MIBC) involves multidisciplinary treatment planning, because curative-intent therapy includes either surgery or radiation, with consideration of the role of systemic therapy. As clinicians develop a treatment plan, considering a geriatric oncology perspective may enhance patient care and influence outcomes for this large and growing population. Similarly, treatment plan development must also consider aspects unique to an older patient population, such as altered organ function, increased comorbidity, decreased functional reserve, and perhaps altered goals of treatment. Thus a thorough evaluation inclusive of disease assessment and geriatric assessment is essential to care planning. Population-based data show that as patients with MIBC age, use of standard therapies declines. Given the complexities of coordinating a multidisciplinary care plan, as well the complexities of treating a heterogeneous and potentially vulnerable older patient population, clinicians may benefit from upfront assessments to inform and guide the process. This review highlights the unique treatment planning considerations for elderly patients diagnosed with MIBC.

Caring for Balance? Legal Approaches to Those Who Struggle to Juggle Work and Adult Care

The provision of informal (family) care is one of the key work–life balance (WLB) issues to be addressed by social policies. So far, both legislative approaches and legal research have focused mainly on childcare-related issues. This is particularly true for the labour law component of policy measures. Considering current demographic trends, it seems crucial to enhance attention on care for older persons and people with disabilities. This article identifies four basic aims of WLB-enhancing social policies – availability, affordability, discouraging ‘too much’ informal care provision, and countering gender inequality – and explores the strategies developed in different legal systems and at the international level to address them. It then examines the degree to which such strategies exist also for adult care, the extent to which ‘transfers’ of childcare-related approaches are conceivable, and the particularities of adult care that call for new approaches to pursue the same aims. It concludes with a discussion of the most important elements of social policy and labour law approaches to promoting the WLB of workers providing informal care for adults. Work–Life Balance, Family Care, Informal Care, Care Leave, Comparative Law, International Law, Gender Equality, Labour Law, Social Security, Flexible Working Conditions.

Relational care in older persons nursing is not just a consideration but an organisational priority

Commentary on: Bridges J, Flatley M, Meyer J. Older people's and relatives' experiences in acute care settings: systematic review and synthesis of qualitative studies. Int J Nurs Stud 2010;47:89–107. doi:...

Readiness and Challenges of Counsellor in Offering Gerontological Counselling in Malaysia

Malaysia is expected to become an old age nation by 2030. The psychological problem faced by elderly requires counselling intervention. The objective of this study is to explore the readiness of counsellors in dealing with adult and aging as curriculum and to explore the challenges in providing gerontological counselling. The study was used qualitative approach based on case study of 9 informants on purporsive sampling method and conducted within indepth interviews. The findings showed that level of readiness of counsellor is very high and very interested to dealing with aging client. The main challenges of counselor are no public universities offer courses gerontological counselling in Malaysia. The implication of this study involvement of gerontological counsellor through Malaysian Association of counsellor will attract young counsellor interest in the care of older person.

Hearing ability is not a risk factor for admission to aged residential care of older persons in New Zealand

Aged residential care (ARC) admission needs are increasing beyond the available capacity in many countries, including New Zealand. Therefore, identifying modifiable factors which may prevent or delay ARC admissions is of international importance. Hearing impairment is common among older adults and thought to be an important predictor, although the current evidence-base is equivocal. Using the largest national database to date, competing-risk regression analysis was undertaken on 34,277 older adults having standardised home care assessments between 1 July 2012 and 31 May 2014, aged ≥65 years, and still living in the community 30 days after that assessment. Minimal hearing difficulty was reported by 10,125 (29.5%) participants, moderate difficulty by 5,046 (14.7%), severe difficulty/no hearing by 1,334 (3.9%), while 17,769 (51.8%) participants reported adequate hearing. By 30 June 2014, the study end-point, 6,389 (18.6%) participants had an ARC admission while 6,082 (17.7%) had died. In unadjusted competing-risk regression analyses, treating death as a competing event, hearing ability was significantly associated with ARC admission (p < 0.001). However, in adjusted analyses, this relationship was completely confounded by other variables (p = 0.67). This finding implies that screening for hearing loss among community-living older adults is unlikely to impact on ARC admission rates.

Healthcare professionals\u2019 experiences of providing individualized nutritional care for Older People in hospital and home care: a qualitative study

BackgroundRecent studies indicate inadequate nutritional care practices in healthcare institutions and identify several barriers to perform individualized nutritional care to older persons. Organisation of care can become rigid and standardised, thus failing to be respectful of and responsive to each person’s needs and preferences. There is limited research exploring health professionals’ views on how structure of care allows them to individualize nutritional care to older persons. In this study we aim to explore how healthcare professionals’ experience providing individualised nutritional care within the organisational frames of acute geriatric hospital care and home care.MethodsSemi-structured interviews with 23 healthcare professionals from hospital acute geriatric care and home care. Interviews were analyzed using thematic analysis.ResultsTwo main themes and six sub-themes emerged from the material. Theme 1: ‘Meeting patients with complex nutritional problems’ with the sub-themes: ‘It is much more complex than just not eating’ and ‘seeing nutrition as a part of the whole’. Theme 2: ‘The structure of the nutritional care’, with the sub-themes: ‘Nutritional routines: Much ado, but for what?’, ‘lack of time to individualize nutritional care’, ‘lack of interdisciplinary collaboration in nutritional care’ and ‘meeting challenging situations with limited resources in home care’.ConclusionsThe healthcare professionals described having a high focus on and priority of nutritional care when caring for older persons. They did however find it challenging to practice individualized nutritional care due to the complexity of the patients’ nutritional problems and constraints in the way nutritional care was organised. By describing the challenges the healthcare professionals face when trying to individualize the nutritional care, this study may provide important knowledge to health professionals and policy makers on how to decrease the gap between older patients’ preferences for care and nutritional care practice.

AWRAMBA COMMUNITY-BASED CARE FOR ELDERS LACKING FAMILY SUPPORT IN ETHIOPIA

In rural Ethiopia, land fragmentation, poverty, rural-urban migration, and the expansion of market forces are negatively impacting family support for older persons. This study explored an innovative community-based support system that uses its own wealth redistribution mechanism to support congregate residential care for older persons. The Awramba Community in northwest Ethiopia has different social norms and values that make it unique from surrounding communities. To explore this new approach to meeting the needs of rural elders, primary data were obtained from in-depth interviews with 8 elders who reside in the older adult center, 3 focus group discussions, and personal observations. In addition, key informant interviews were conducted with a full-time caregiver, two community leaders, and members of the Older Persons’ Support Committee. Interviews explored the types of services provided to older persons, the interactions of older residents within the community, and the benefits of congregate living. Community members (N=403) must agree to 4 guiding principles relating to gender equality, respecting the rights of children, discouraging dishonesty, lying and stealing, and helping the less fortunate, ill and older persons. The Older Person’s Support Committee is responsible for coordinating the provision of care for the older persons who live in the congregate center. Residing in a common residential home benefited the elders in multiple ways, including opportunities for socialization with peers and access to a full-time caregiver. As traditional family support wanes and the population of elders increases in developing nations, such alternative support strategies are critically needed.

IMPLEMENTING A NEW MODEL IN PRIMARY CARE FOR OLDER CANADIANS LIVING WITH FRAILTY

Primary care may be the best place within the health system to coordinate care for older persons, but at present, it is poorly equipped to do so. Effective models for complex patients require appropriate targeting, patient/caregiver engagement, and care coordination. A large national project aims to co-design and implement a model in primary care that includes risk-stratification, patient engagement and care coordination techniques for older adults. This presentation focuses on the process of implementation in primary care. Grounded in the Consolidated Framework for Implementation Research, researchers worked with nine primary care sites in three Canadian provinces. Project implementation was completed in two phases. Pre-implementation: Interviews with providers (n=25) and older adults (n=8) were conducted to understand current practices and plan for implementation. Implementation: Researchers worked with sites to train staff and support implementation. Monitoring of the implementation process included Interviews with providers (n=20) and field notes. Data were analyzed using directed coding, following the framework. A number of learnings emerged: buy-in was required from the entire team, teams provided meaningful information to guide implementation, contributing to a sense of ownership, and it was important that intervention components were tailored to the needs at each site. Ongoing and frequent discussions with the team was necessary. Scheduling meetings and training sessions for providers was challenging due to the length of time away from direct patient care. A new primary care model for older adults living with frailty was implemented. Lessons from this project will be used to guide future implementation and spread.

Attributes of person-centred communication: A qualitative exploration of communication with older persons in home health care.

Previous research points to challenges related to the home healthcare of older persons and to the complexity of communication. Although person-centred care has been advocated widely, there remains a need for in-depth knowledge on how to enable person-centred and supportive communication in the care of older persons. The aim of this study was to explore attributes of person-centred communication between nurses and older persons being cared for in their home. A descriptive study with a qualitative approach was conducted. A data set from the COMHOME-study consisting of 77 audio-recorded home healthcare visits between registered nurses and older persons was analysed with a method for qualitative thematic analysis. The findings indicate that the attributes of person-centred communication comprise recognising, inviting and involving older persons. To facilitate this form of communication, attentiveness and responsiveness on the part of RNs seemed significant. Person-centred communication was facilitated when the RNs used verbal expressions to emphasise and acknowledge the older persons' views and were attentive to their emotions and expressions. The nurses' attentiveness and responsiveness seems important for person-centred communication with older persons. Communication skills are needed to recognise, invite and involve older persons in their care and to support their health and well-being. Implication for practice The importance of communication which facilitate a person-centred approach by nurses should be acknowledged when caring for older persons and included in education and training.

Home care services for older persons. The views of older persons and family members: A realistic evaluation.

The aim of the present study was to evaluate client-centred care in older persons' home care services from the perspective of older persons and family members. The following research questions were addressed: How do home care older persons and family members perceive client-centered care in their home care services? What kind of social mechanisms are realized when home care services are implemented? Several older persons are dependent on home care services for their continued living at home. The fundamental value and best practice of home care is the client-centred care in services. The research method was realistic evaluation. Six families with six older person clients of home care and seven family members were interviewed. In the present study, the interview contained three themes (1) content and services of the home care, (2) activities and practices of the home care and (3) development of client centredness in home care. Research data were analysed with deductive content analysis. Home care service should be based on analysis of older person's individual life situation. Social mechanisms such as interaction, participation, trust and adaptation are realised in implementation of home care services. The most significant outcomes of client-centred service were timely availability of services, safe care relationship and continuity of care, ability to influence on own services and appropriate price of services. Significant factors in quality of service were unhurriedness, kindness and competence of professionals. Social mechanisms, such as participation, trust, adaptation and interaction, should be taken in account in care relationship in home care. Client centredness and methods for evaluating it should be defined in practical work. Client-centeredness competence should also be included in all stages of professional education of home care.

The development of Nursing Quality Care Process Metrics and Indicators for use in Older Persons Care Settings: A Delphi-Consensus Study.

To develop a suite of nursing quality care process metrics and indicators for older persons care settings in Ireland. Regulatory investigations of health system failures highlight non-adherence to clinical guidelines and standards resulting in deficiencies in nursing care delivery. Limited attention has been paid to measuring nursing care processes particularly in the care of older people. Quality care process metrics can facilitate measurement of nurse-sensitive measures of care. A scoping literature review and modified Delphi-Consensus Technique. A scoping review of literature published between January 2007 - January 2017 was conducted to identify nursing process metrics and indicators. The Delphi Consensus phase incorporated a four-round electronic survey of 404 nurses and a consensus meeting with 13 stakeholders working in Older Persons Care Settings in Ireland. From the review, 33 potential metrics were identified. After all Delphi survey rounds, 20 metrics and 90 associated indicators were selected by the nurses. Following the consensus meeting, 19 metrics and 80 indicators were included in the final suite of nursing quality care process metrics and indicators. Developing this suite of nursing quality care process metrics and indicators for use in older persons care settings provided consensus on what nursing processes should be measured to improve the quality and safety of care delivery. The nursing processes identified, provide a framework for future research and educational programmes in the care of older persons. Although conducted in the Irish healthcare system, there is potential for adoption or adaption in other healthcare settings.

Two revolutions: Digital and demographic

The progressive digitalization of the world has an unprecedented impact on every sphere of our lives. Over the past 20 years, technology has permeated every aspect of modern society, and the use of digital technology, in particular, is becoming an integral part of our everyday lives. Many services and resources are now accessible only through digital means. Robots and artificial intelligence (AI) will also radically transform our lives, including the concept of care of older persons.

Effectiveness of conservative urinary incontinence management among female nursing home residents—A cluster RCT

BackgroundGuideline-compliant conservative management of urinary incontinence (UI) is the first step of the initial management for UI and is recommended for long-term care in older persons. Recent studies have focused on the effects of guideline-compliant UI management. However, most of these studies were tested in another setting than nursing homes and were not focused on conservative management. AimsTo measure the effectiveness of 29 evidence-based nursing recommendations regarding the conservative management of UI in Austrian nursing homes. MethodsThe study is a cluster randomized intervention trial with institution as the unit of randomization. Twelve nursing homes in two Austrian provinces (Styria, Carinthia) were randomly allocated to the intervention group (IG) and control group (CG). Data were collected from participating residents over a three-month period. The intervention consisted of the implementation of recommendations for the conservative management of UI among female nursing home residents. The primary outcome variable was the daily UI experienced by the participating residents. ResultsResidents in the (IG n = 216) had a lower risk (OR = 0.14, p = 0.02) of experiencing daily UI and were less likely to receive absorbent products (OR = 0.01, p = 0.01) than residents in the CG (n = 165). Residents in the IG (OR = 5.16, p = 0.00) were five times more likely to receive recommended interventions (e.g., bladder training) than residents in the CG. ConclusionIntroducing guideline-compliant management into nursing practice can increase the likelihood of evidence-based interventions for the conservative management of UI. The intervention in this study targeted on nurses/nurse managers and can be recommended for the nursing home setting.

Next of kin's perceptions of the meaning of participation in the care of older persons in nursing homes: a phenomenographic study.

BackgroundBeing involved in the care of a loved one is a desire of many next of kin. However, according to several studies of the perceptions of nursing home staff, the involvement of next of kin is not an obvious part of care. To be able to involve next of kin in care at nursing homes, the perceptions of what participation means are an important piece of knowledge. The aim of this study was therefore to describe variations in next of kin's perceptions of the meaning of participation in the care of older persons living in nursing homes.MethodsEighteen next of kin of older persons living in ten nursing homes in Sweden were recruited for interviews. The study design was based on a phenomenographic approach, focusing on the qualitatively different ways in which a person perceives, experiences or conceptualises a phenomenon or certain aspect of reality.ResultsFive categories emerged from analysis of the interviews, representing the next of kin's perceptions of the meaning of participation in the care of older persons in nursing homes: be present; communicate; monitor; do practical tasks; and to represent. The next of kin expressed meanings that belonged to more than one category, and the categories were interdependent.ConclusionsOur results indicate that there are several meanings of next of kin's perceptions of participation at nursing homes. Nursing home staff's knowledge of these perceptions is important to enable next of kin to participate according to their own preferences.

Leadership, Inside and Out: The Tideswell-AGS-ADGAP Emerging Leaders in Aging Program.

To optimize health and well-being for all older people, we must collectively develop leaders to pioneer models of care, educate the healthcare workforce, advance research, and engage the community. The Emerging Leaders in Aging (ELIA) program was created to train a multiprofessional cadre of leaders focused on the health and well-being of older people. ELIA uses the social change curricular framework and addresses knowledge of self, community, and engagement with change. Program impact measured included scholar satisfaction, confidence related to curricular domains before and after the program, project progress, and scholar productivity. Four cohorts of 65 scholars in seven health professions from 24 states were selected for the year-long 55-hour program. Overall satisfaction from members of the first three cohorts who have completed the program (n = 46) was 4.86 (scale = 1-5), and scholar confidence increased from 5.8 to 8.0 (scale = 1-9) (p < .001). These scholars reported 85 presentations, 63 publications, and 21 awards subsequent to training. All scholars described the importance of a program focused on early and mid-career leaders in health and aging. The ELIA program leverages longitudinal, distance mentor communities, and project-based learning strategies. It has improved confidence and skills in emerging leaders who commit their efforts toward the care of older persons. Programs like ELIA are critical to preparing a healthcare workforce to optimize care for all as our health needs and expectations change with age. J Am Geriatr Soc 67:437-442, 2019.

The influence of quality of primary care on productive interactions among community-living frail older persons and their general practitioners and practice nurses

Introduction: The Chronic Care Model CCM identifies important elements of primary healthcare systems that promote high-quality care, foster productive patient-professional interactions and improve patient outcomes. We lack evidence regarding the influence of quality of care on productivity of patient-professional interactions in a population of community-dwelling frail older adults. Exactly these productive interactions are at the heart of patient-centered care and considered essential in improving patient outcomes. The aim of our study was to investigate whether community-living frail older persons’ perspectives on quality of primary care delivery according to elements of the CCM are associated with perceived productivity of interactions with general practitioners GPs and practice nurses. Methods: A longitudinal study was conducted in the Netherlands between 2014 and 2017. The study included 4 GP practices providing usual primary care and 11 GP practices that implemented the proactive, integrated care approach ‘Finding and Follow-up of Frail older persons’ FFF. Interrelated components of the FFF approach e.g. multidisciplinary consultations, proactive case finding are presumed to promote high-quality care delivery and foster productive patient-professional interactions. Our study included 464 independently living frail older adults ≥ 75 years. Perceptions of quality of primary care Patient Assessment of Chronic Illness Care Short version; PACIC-S and productive interactions with the GP and practice nurse relational coproduction instrument were assessed at baseline and 12 months after. Data were analyzed using chi-square tests, t-tests, and multilevel methods. Results: Perceived quality of primary care, productive interaction with the GP and productive interaction with the practice nurse improved over time in both the intervention group and control group. Productive interactions with the GP and practice nurse were significantly influenced by the perceived productive interaction at baseline, the perceived quality of primary care at baseline, and the change in perceived quality of primary care over time. We found no significant differences between the intervention group and control group. Discussion and conclusion: Our study showed that perceived productive patient-professional interactions are associated with the perceived quality of primary care delivery in a sample of frail independently living older persons. Based on the relatively robust and comprehensive primary healthcare system in the Netherlands, the contrast between the FFF approach and care as usual may be too small to detect substantial differences between the groups. Lessons learned: Our study stresses the need to invest in high-quality primary care and interactions among frail older persons and their healthcare professionals. Especially in the care for older persons with often long-term complex healthcare needs and multimorbidity, productive patient-professional interactions seem to be important. Limitations: We limited the selection of professionals to GPs and practice nurses. These professionals are most frequently contacted in general practice in the Netherlands. Moreover, we did not examine whether improvements in quality of care and productive patient-professional interactions resulted in improved patient outcomes, like well-being. Suggestions for future research: Research to examine productive interactions with other professionals, like elderly care physicians, is necessary. Furthermore, the influence of improvements in quality of care and productive patient-professional interactions on patient outcomes should be investigated.

Evaluating the Implementation of Integrated Care for Older Persons as a path to Universal Health Care

Implementing integrated care for older persons is a core challenge for a fragmenting health care system with the additional barriers of being two-tiered complex public/private mix with high cost-barriers to accessing care, deeply siloed and fatigued due to economic crisis, budgetary constraint and organisational uncertainty 1. The Irish National Integrated Care Programme for Older Persons NCP OP is working in this difficult context to establish integrated care for older persons. To do this the Programme developed a 10 Step Implementation Framework now in use for two years 2. Equally relevant in the Irish context is a concerted political drive toward Universal Health Care UHC for the first time in the history of the Irish State. UHC aims to ensure timely access to healthcare for all citizens on the basis of medical need rather than ability to pay 3. Through partnership between the ICP OP and UHC researchers at Trinity College Dublin, the 10 Step Framework as implemented is framed as a practical pathway to UHC in fact. Evaluating the utility of the 10 Step Framework and exploring the challenges of implementing it in practice is therefore essential to sustaining current progress towards both integrated care for older persons, and universal health care for the Irish population. Ireland is an outlier as a High Income Country in Europe that does not have UHC 4. The intervention is an online survey evaluation of the 10 Step Framework, and three co-produced case studies with pioneer sites implementing integrated care for older persons. The change theory underpinning the evaluation is both social cognitive and constructionist in seeking to reinforce the learning emerging from using the Framework so that new experiences lead to better understanding and changed practice. This is achieved through identifying the experiences, documenting and feeding them back to stakeholders for further exploration and application in the on-going planning cycle. The intervention is aimed at service providers in the Community Health Organisations CHOs and Acute settings in Ireland who deliver health and social services using the 10 Step Framework. The Framework has been in use for two years and the evaluation which began in December 2017 will run to April 2018. The evaluation informs the implementation of integrated care for older persons, and supports establishment of UHC in Ireland on practical terms as the country seeks to re-imagine health service delivery. Evaluation is critical to the sustainability of new practice; this project identifies lessons for an international audience interested in understanding the links between UHC, Integrated Care for Older Persons, and the challenges of implementing complex service delivery change. Findings will translate through the ICP OP pioneer sites and networks as important insights for on-going planning and service delivery changes. They also inform the national debate on the capacity of the Irish Health System to deliver UHC; a challenge relevant internationally as governments respond to the difficulty of funding and delivering health and social care on a universal basis to older populations with complex needs 5.

To manage a complex dependency: The experience of caregiving after a fall.

To understand the experience of family members of an older relative who has had a fall which required medical attention. There is abundant bibliography in caregiving, but little is known about the problems faced by caregivers and how family members cope when their older relative has a fall. Qualitative study that used a symbolic interactionism perspective. Twenty-two people with older relatives, who had had a fall and contacted health services in Spain, participated in the study. Data were obtained via written accounts, focus groups, and semi-structured interviews between February 2014 - December 2015. Analysis was guided by grounded theory procedures. With the fall, dependency becomes a complex issue for the family. To manage a complex dependency is the core issue that emerges from the data analysis. It depicts family efforts to assist their relative in gaining autonomy after a fall, in the best conditions they can provide. They do this with little guidance and support from healthcare professionals. Guides and protocols for the care of a fragile older person, particularly after a fall, should not only include care but also support to caregivers. Health professionals and especially nurses need to be aware and respond to the family caregivers needs after a fall. To the fall prevention initiatives already in place, it must be added that those who support family members to cope with the care of an older person who has had a fall.

Do health literacy and self-care behaviours affect quality of life in older persons with lung cancer receiving chemotherapy?

This study aimed at identifying the factors associated with health literacy, self-care behaviours, and quality of life among older persons with lung cancer receiving chemotherapy. This was a descriptive study. A total of 80 older persons with lung cancer receiving chemotherapy participated in this study. Data were collected from July 21 to November 3, 2016 in Korea. The Short Form of the Korean Functional Health Literacy Test, the Self-Care Behaviours Scale, and the Functional Assessment of Cancer Therapy Scale-Lung were used to measure functional health literacy, self-care behaviours, and quality of life, respectively. Stepwise multiple regression analyses were conducted to analyse the data. In the each regression model for the general and disease-related quality of life, performance status, self-care behaviours, and prior lines of treatment were identified as a predictor. However, functional health literacy was found to be a predictor only of disease-related quality of life. Among these predictors, self-care behaviours had the greatest impact. Health care providers should be aware of the effects of health literacy and self-care behaviours on health-related quality of life and consider the factors associated with quality of life when they take care of older persons with lung cancer receiving chemotherapy.