Care For Older Persons Research Articles

Middle Adolescents’ Motivations to Care for Older Persons in an Economically Vulnerable Community

ABSTRACTIn the light of ageing populations and limited resources, care is becoming increasingly important in intergenerational relations. Qualitative research was conducted to investigate the motivations of middle adolescents to care for older persons (people aged 60 years). Data from journal entries and the Mmogo-method® of 15 Setswana-speaking adolescents (aged 12–16 years) from South Africa were obtained and analyzed thematically. We found that middle adolescents were moved to care for older persons by extrinsic motivation and internalized external motivators with varying levels of self-determination with no evidence of intrinsic motivation. The findings indicate, therefore, that the care needs of older persons may be at risk.

Kinship care and older persons: An Islamic perspective

This article explores issues pertinent to culturally sensitive social work and the care of older persons in Muslim communities in the context of population ageing. In particular, it examines kinship care in Islam and its incorporation into institutional social work services as part of multicultural practice with older Muslim clients. The aim of the article is to assess the nature of kinship care systems as informal support networks among Muslim communities and their role in supporting the well-being of older persons in the family. These networks play a pivotal role in Muslim family life and need to be considered in social work policies and practice so that service provision can be consistent with the lived realities of Muslim clients in their diverse environments.

The vulnerability of family caregivers in relation to vulnerability as understood by nurses.

In Finland, the care of older persons is shifting from institutional care to family care. Research shows that family caregivers experience their situation much in the same way as professional nurses. The nurses' experiences have been studied in terms of vulnerability, and the same perspective could deepen our understanding of family caregivers' experiences. The aim of this study was to gain knowledge of the vulnerability of older caregivers taking care of an ageing family member. The research questions were as follows: How do family caregivers experience vulnerability? How do their experiences relate to vulnerability as understood by nurses? The study was done as a secondary analysis of focus group interviews on the experiences and daily life of older family caregivers. Four caregivers had taken part in monthly interviews during a period of 10 months. The interviews were analysed by deductive and inductive content analysis. The results showed that the caregivers saw caregiving as part of being human. They experienced a variety of feelings and moral agony and were harmed physically, mentally and socially. They showed courage, protected themselves and recognised that being a caregiver also was a source of maturing and developing. These results corresponded with the nurses' understanding of vulnerability. Shame, the experience of duty as a burden, worry and loneliness were themes that were found only among the family caregivers. The use of a matrix may have restricted the analysis, but using it in an unconstrained way allowed for new themes to be created. The results indicate a common humanness and vulnerability in professional and family caregiving. They also show that family caregivers need more support both from society and professionals.

Geriatric assessment in daily oncology practice for nurses and allied health care professionals: Opinion paper of the Nursing and Allied Health Interest Group of the International Society of Geriatric Oncology (SIOG).

The management of older persons with cancer has become a major public health concern in developed countries because of the aging of the population and the steady increase in cancer incidence with advancing age. Nurses and allied health care professionals are challenged to address the needs of this growing population. The International Society of Geriatric Oncology (SIOG) Nursing and Allied Health (NAH) Interest Group described key issues that nurses and allied health care professionals face when caring for older persons with cancer. The domains of the Geriatric Assessment (GA) are used as a guiding framework. The following geriatric domains are described: demographic data and social support, functional status, cognition, mental health, nutritional status, fatigue, comorbidities, polypharmacy, and other geriatric syndromes (e.g. falls, delirium). In addition to these geriatric domains, quality of life (QoL) is described based on the overall importance in this particular population. Advice for integration of assessment of these geriatric domains into daily oncology practice is made. Research has mainly focused on the role of treating physicians but the involvement of nurses and allied health care professionals is crucial in the care of older persons with cancer through the GA process. The ability of nurses and allied health care professionals to perform this assessment requires specialized training and education beyond standard oncology knowledge.

Learnt and perceived professional roles of a new type of nurse specialized in Gerontology and Geriatrics, a qualitative study.

To gain insight into a new type of nurse specialized in gerontology and geriatrics, how they find meaning in the care of older persons and how this relates to the seven professional roles derived from the CanMEDS theoretical framework. To promote the quality of care for older persons in the Netherlands, one of the measures taken is the training and deployment of Registered Nurses specialized in Gerontology and Geriatrics. We focus on their professional roles in this study, to gain insight into the extent to which they fulfil their professional standards. A qualitative study, consisting of seven focus group interviews. The study population included 67 Registered Nurses. Data were collected between October 2011-May 2013. Nurses work in all seven CanMEDS roles, but not with all competences associated with these seven roles. The more distant the role is from patient activities, the less frequently competences such as social networks; design; research; innovation of care; legal, financial and organizational frameworks; professional ethics and professional innovation are mentioned. Nurses engage in activities consistent with nursing care for older people; however, despite their training, they are mainly focused on direct-patient care. Their limited awareness of the complete range of professional competences risks the stagnation of their development in professional roles such as health advocate, scholar and professional, which will not lead to an improvement in the care for older persons.

Organizacijos kultūra, tikslai ir vertybės: socialines paslaugas senyvo amžiaus žmonėms teikiančių įstaigų personalo perspektyva

Straipsnyje pristatomas veiklos tyrimas dalyvaujant (angl. participatory action research), kuris buvo atliktas socialinių paslaugų senyvo amžiaus žmonėms įstaigose. Straipsnyje aptariama organizacijų kultūros apibrėžties problematika, organizacijų kultūros tipologijos ir dimensijos bei remiantis empirinio tyrimo rezultatais diskutuojama, kaip organizacijos vadovų ir darbuotojų pasakojimuose apie organizacijos misiją ir tikslus atsiskleidžia tam tikri organizacijos kultūros aspektai bei vertybės. Tyrimo rezultatų analizė leidžia įvardyti moteriškosios ir vyriškosios bei neužtikrintumo vengimo organizacijos kultūrų tipų raišką biudžetinių ir privačių socialines paslaugas senyvo amžiaus žmonėms teikiančių organizacijų vadovų ir darbuotojų pasakojimuose.

Problems experienced by informal caregivers with older care recipients with and without cognitive impairment

ABSTRACTThe care of older persons can have negative impact on the caregiver. The objective of this population-based observational study is to identify problems experienced by informal caregivers, and the extent of related difficulties, in their care of older care-dependent recipients with and without cognitive impairment. Caregivers (n = 2,704) caring for a home-dwelling person aged ≥ 75 years responded to a questionnaire with 23 questions on problems and related difficulties by mail. Prevalence of self-reported problems and related difficulties was calculated. The impact of the problem was estimated by weighing the percentage of problems reported as being difficult against the prevalence of problems. The median number of problems was 12 (range 0–23), with 5 (range 0–23) reported as difficult. Informal caregivers experience a variety of problems, with the impossibility to engage in joint social activities having the highest impact. The impact of problems increased when the care recipient had a cognitive problem.

Care for Older Persons in Cameroon: Alternatives for Social Development

Care increasingly remains a crucial facet in the lives of older persons in Africa including Cameroon. Despite its relevance to social development, providing apposite and effective care services to elderly men and women is still a major challenge in contemporary Cameroon. This is largely due to the weak institutional support system and poverty which estrange the elderly and jeopardizes their wellbeing. Deconstructing the current care system through the redesigning and implementation of age friendly policies will create substantial opportunities that will predispose the old, irrespective of gender to valued choices and quality lives. This paper describes the challenges experienced by the aged and examines the institutional framework for care with alternatives for social development. The study involved 31 elderly and employed an ethnographic survey design with interviews, focus group discussions, participant observation and documentary sources as instruments. Data was analyzed qualitatively and findings show that in as much as organizing the system from a multisectorial approach is imperative, the voices of elderly and the consistent provision of basic needs is also strategic to their social development.

Assessing Basic Needs in Frail Older Persons Calls for Aesthetic Nursing Skills – An Ethnographic Approach

Background: Despite research on caring for older persons’ basic needs, a number of hospital admissions occur which had been preventable, given the proper attention to caring for the basic needs. Literature show that caring for the basic needs of frail older persons can be complicated if they are suffering from chronic diseases and complex functional impairments. A starting point for an exploration of this complexity is the identification of frail older persons’ basic needs Aim: To explore the challenges in nursing assessment of basic needs when the older persons’ frailty also implies impressive and expressive difficulties. Method: We used Spradley’s theory of participant observation. Data were collected from three older persons’ individual assessment meeting, followed by individual interviews with the nurse. Field notes and transcribed dialogues from the assessment meetings and interviews were analyzed systematically in four steps. Findings: Very limited input from the frail older persons characterizes the assessment. The nurses gave ample time and listened patiently to the older persons’ voices to understand his or her limited verbal and nonverbal expressions. Using different types of questions, answers, body language and interpretations the nurses ensured that they had heard correctly and understood the older persons’ remarks and answers. This revealed two themes: Patiently eliciting the older person’s voice, and Empathic listening piecing fragments together to form an understanding. Conclusion: When patient age and frailty implies impressive and expressive challenges, the nursing assessment of basic needs requires well developed nursing skills to create a facilitating setting that involves the frail older person. The nurse elicits patiently the older person’s voice, and listens empathically to piece fragments together to form an understanding. Using imagination and improvisation trying out different solutions, the aesthetic nursing skills are seen prominent though related to the empiric-, ethic-, and personalskills. This enabled the nurses in enhancing the frail older persons’ participation and helped to maintain dignity despite impairment and limited input.

Caregivers of older persons with multiple sclerosis: determinants of health-related quality of life.

This study was conducted to determine which factors (clinical and demographic) are associated with mental and physical health-related quality of life (HRQOL) for caregivers of older persons with multiple sclerosis (MS). The Andersen's Healthcare Utilization Model guided this study. Knowledge of identified predictors of HRQOL may prompt nurses who care for persons with MS to address these issues and provide supportive care. A cross-sectional descriptive design was used to examine the relationship between patient with MS and caregiver clinical and demographic factors with caregiver physical and mental HRQOL. Patients with MS aged 60 years or older and their caregivers from four MS centers on Long Island, New York, self-selected into this study (n = 102). A caregiver survey was administered that collected demographic information and included validated questionnaires measuring HRQOL, caregiver burden, and caregiver perception of risk for neuropsychological impairment of patients with MS. Patient surveys collected demographic information and validated questionnaires measuring cognition, depression, and disability. Multivariate linear regression was used to examine patient and caregiver variables to explain caregiver physical and mental HRQOL. The caregivers in this study were older (mean age = 61 years) with existing comorbidities. We found that caregiver mental HRQOL was negatively associated with patient depression and, surprisingly, positively associated with caregiver burden and caregiver comorbidity of heart disease. Caregiver physical HRQOL was negatively associated with caregiver comorbidities of arthritis and diabetes and lower household income. The challenges older caregivers face when caring for older persons with MS have been shown to affect their mental and physical QOL. Nurses who care for older patients with MS will increasingly rely on older caregivers to provide patient-centered interventions. This descriptive study, based on the Anderson theoretical model, provides insight on factors impacting older caregivers' HRQOL. Further research is necessary to elucidate the types of interventions that support them as they care for older patients with MS.

Why geriatric knowledge AND infrastructure should be implemented into the out-patient sector: Findings and innovative interventions from the Hamburg Longitudinal Urban Cohort Ageing Study (LUCAS)

Aim & methods The LUCAS study design (individual trajectories [ Fig. 1 ] since 2000 with embedded RCTs) revealed unexpected findings leading to appropriate preventative interventions (BMBF01ET1002A). Results Geriatric syndromes start with pre-clinical loss of health resources followed by accumulation of risk-factors resulting in frailty as a leading cause of disability and premature death. This process covered at least 1000 days in initially robust community-dwelling older persons. Therefore, simple but highly predictive self-screening tools were developed and implemented in general practices. Then, identified pre-frail persons underwent an extended geriatric-gerontological assessment (instruments to avoid ceiling effects, technical supported gait analyses). We identified underlying causes (i.e. impact disease, post traumatic distress syndrome) of the frailty cascade and derived therapeutic strategies. Conclusion LUCAS showed a population-based approach was effective in selecting different target groups for interventions preventing frailty and functional decline in pre-clinical stages. We conclude that the outpatient sector in many European countries is inadequately prepared to provide comprehensive medical care to older persons. We recommend implementing not only geriatric knowledge but also appropriate infrastructure like outpatient assessment units planned since 2013 by the German Government. We invite the EAMA-Community to participate in further analyses and interpretation of the extensive LUCAS-database.

Geriatric medicine in Costa Rica

Dr Fernando Morales-Martinez spent over 30 years initiating, fostering, and guiding the education of geriatric medicine in Costa Rica as well as Latin America for medical students, residents, fellows, practicing general physicians and the general public. Currently, all medical students (since 1988) and all family residents rotate through a well-established geriatric medicine section. This section has an established medical staff and a geriatric fellowship-training program of 5 years duration that Dr. Morales initiated in 1992. This fellowship training is incorporated into an extended 4-year family medicine program (1987). Training sites are at the National Hospital of Geriatrics and Gerontology in the capitol, San Jose, as well as outlying community clinics and facilities. Dr Morales is both the general director and the academic director of the Department of Medicine at this hospital. EAMA inspires the model of excellence on his academic career ( Table 1 ). Progressive Care Network For Comprehensive Care Of Older Persons In Costa Rica Introduction The increase in the population aged 65 years and over in Costa Rica is a reality that must be considered by the entire society and particularly by the government and its institutions. What is the Care Network? Is defined as: “Is a social structure composed of individuals, families, organized community groups, non-governmental and state institutions, articulated by actions, interests and programs, to ensure the proper care and satisfaction of needs for older people in the country, thereby promoting quality of life in aging”. Beneficiary Profile/As The Network of Care program aims to support the sector of adult population that is in poverty, extreme poverty and social risk. Some Achievements This program runs since 2011, reporting significant achievements for the benefit of the older population. In December 2013, stands out: – the program has attended 8249 older persons at home; – the program was implemented by 50 community networks of care for older people. The flexibility offered by the program, is valued as an important feature, considering that the actors and the communities have very different running condition, as are the needs of the older population.

Normativity under change: Older persons with implantable cardioverter defibrillator.

In modern society, death has become 'forbidden' fed by the medical technology to conquer death. The technological paradigm is challenged by a social-liberal political ideology in postmodern Western societies. The question raised in this study was as follows: Which arguments, attitudes, values and paradoxes between modern and postmodern tendencies concerning treatment and care of older persons with an implantable cardioverter defibrillator appear in the literature? The aim of this study was to describe and interpret how the field of tension concerning older persons with an implantable cardioverter defibrillator - especially end-of-life issues - has been expressed in the literature throughout the last decade. Paul Ricoeur's reflexive interpretive approach was used to extract the meaningful content of the literature involving qualitative, quantitative and normative literature. Analysis and interpretation involved naive reading, structural analysis and critical interpretation. The investigation complied with the principles outlined in the Declaration of Helsinki. The unifying theme was 'Normativity under change'. The sub-themes were 'Death has become legitimate', 'The technological imperative is challenged' and 'Patients and healthcare professionals need to talk about end-of-life issues'. There seems to be a considerable distance between the normative approach of how practice ought to be and findings in empirical studies. Modern as well as postmodern attitudes and perceptions illustrate contradictory tendencies regarding deactivation of the implantable cardioverter defibrillator and replacement of the implantable cardioverter defibrillator in older persons nearing the end of life. The tendencies challenge each other in a struggle to gain position. On the other hand, they can also complement each other because professionalism and health professional expertise cannot stand alone when the patient's life is at stake but must be unfolded in an alliance with the patient who needs to be understood and accepted in his vulnerability.

Older persons mental health in rural Australia: testing a model for integration

Introduction and problem: There is significant unmet need for mental health care for older persons in Australia, with those living in rural communities particularly disadvantaged in terms of availability and access to services. Linkages and collaboration between health and social services has been advocated in national policies, though integrated primary mental health care for older people in the Australian context remains problematic. Purpose and theoretical basis: A participatory research project is being undertaken (October 2013-January 2015) to test a network model to plan and manage the development of integrated primary mental health care for older people, with one rural region in South Australia as a case study. The theoretically informed model [1,2] consists of components (linkages and enablers) and processes (facilitated reflective practice) with the aim to optimize problem solving in situ. The testing of the model is to ascertain if the process of facilitated reflection can help participating organizations to improve integration. Method: A mixed methods case study approach included analysis of the policy context and Organizational Network Analysis to determine the structure and function of links between services, and barriers and enablers to effective linkages. Consumers and their carers will also be interviewed to explore client journeys to care. Meetings are being held over the course of the project for stakeholders (champions and managers) from a range of relevant organizations to reflect on the data. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116607– http://www.ijic.org/ Findings and Conclusion: Early results suggest that the reflective process is effective in engaging stakeholders in identifying problems in the network and participating in the development of solutions at the local level. Formalized processes to support integration however are lacking, with a fragmented policy and funding context creating an unsupportive authorizing and resourcing environment. Three levels appear to impact on how the network is functioning: 1. Local level linkages; 2. Management level linkages; 3. Policy and funding. Implications of emerging findings on the development of sustainable integration of services for older people with mental health issues will be discussed.

O3.03: Caring for elderly with multimorbidity: Evaluation of ambulatory geriatric unit (AGU) (the AGe-FIT-study) – a randomized controlled trial

Importance: The care of older persons with multimorbidity is a future challenge for the welfare sector in many countries in terms of organization of care and provision of sufficient health care resources. Objective: To determine whether an alternative with an ambulatory geriatric unit (AGU) additional to usual care based on Comprehensive Geriatric Assessment (CGA) is more effective than usual care (UC) only. Design: Randomized, controlled, assessor blinded, single center trial of community dwelling patients ≥75 years, hospitalized at least three times during the past 12 months, having at least three concomitant diagnoses [intervention (AGU) n = 208, control group (UC) n = 175]. Outcomes: Hospitalizations, mortality, health related quality of life (HRQoL) and costs of care. Results: After 24 months there was no difference in number of hospitalizations (2.1 in AGU versus 2.4 in CG (P = 0.19). However, patients in AGU had less inpatient days (11.1) compared to the UC (15.2) (P = 0.03). Further, the UC had 54% higher mortality rate than the IG (HR = 1.54 (95% CI: 1.01-2.34), P = 0.046). The cost of care was € 19,941 in the AGU and € 17,730 in the UC group. There was no difference in HRQoL between the groups. Conclusion: The superiority of the alternative with AGU in important findings such as decreased inpatient days and mortality, but to slightly higher total cost after 24 months follow up. This finding is important knowledge when organizing the care for the elderly. (Less)

Can therapy dogs evoke awareness of one's past and present life in persons with Alzheimer's disease?

Persons with Alzheimer's disease (AD) sometimes express themselves through behaviours that are difficult to manage for themselves and their caregivers, and to minimise these symptoms alternative methods are recommended. For some time now, animals have been introduced in different ways into the environment of persons with dementia. Animal-Assisted Therapy (AAT) includes prescribed therapy dogs visiting the person with dementia for a specific purpose. This study aims to illuminate the meaning of the lived experience of encounters with a therapy dog for persons with Alzheimer's disease. Video recorded sessions were conducted for each visit of the dog and its handler to a person with AD (10times/person). The observations have a life-world approach and were transcribed and analysed using a phenomenological hermeneutical approach. The result shows a main theme 'Being aware of one's past and present existence', meaning to connect with one's senses and memories and to reflect upon these with the dog. The time spent with the dog shows the person recounting memories and feelings, and enables an opportunity to reach the person on a cognitive level. The present study may contribute to health care research and provide knowledge about the use of trained therapy dogs in the care of older persons with AD in a way that might increase quality of life and well-being in persons with dementia. The study might be useful for caregivers and dog handlers in the care of older persons with dementia.

Nursing issues and concerns in the care of older persons in acute hospital care in the Republic of Ireland: a Delphi study

Having experienced the second highest population increase in the European Union, older people in the Republic of Ireland constitute 14% of the population (Central Statistics Office 2012). Older people, adults aged 65 and older, are at disproportionate risk of becoming seriously ill and requiring hospital care, whether it is in an emergency department, on a medical or surgical ward, or in a critical care unit (Landefeld et al. 2005, p. 111–117). They account for over 40% of the inpatient days in Irish hospitals, amounting to nearly half of hospital expenditures for adults. Nursing holds a prominent position in the delivery of acute care for older people. Mcalfatrick and Keeney (2003, p. 629) advised that nursing research is an essential element of enhancing care and for its successful implementation in practice, ownership and identification must come from clinical nurses. In the absence of knowledge of what the most substantive problems or questions are, nursing research efforts may be directed to areas of least priority. To date, no studies exploring nursing research priorities relating to the care of the older adult in acute hospital care in the Republic of Ireland have been conducted.

Meanings Over Time of Working as a Nurse in Elderly Care

Background: Although registered nurses (RNs) play a central role in the care of older persons, their work in elderly care has historically been described as “low status” in nursing. This is especially problematic due to the global issue of RN turnover, but there is still little evidence of how to change this trend. Better understanding is needed of the reasons why RNs work in elderly care, as well as knowledge of whether these reasons have changed over time.Aim: The aim was to explore the meaning of working in elderly care, over time, from the perspective of RNs.Method: We interviewed thirteen RNs working in nursing homes, six of them in 2000 and the remaining seven in 2012, and analysed the resulting data using Interpretive Description.Results: The results show similarities and differences over time in the RNs’ reasoning about the meaning of their work with older persons, from a focus on obstacles to a view of opportunities.Conclusion: An RN’s intention to continue working in elderly care might be based on their beliefs; their view of older people, and their experiences of being able to influence the care. Managing this knowledge could be an essential factor in reversing the historical trend of RN work in elderly care being seen as low status, and the increasing turnover in such nurses. Our results could stimulate reflection on daily care and beliefs about caring for older persons.

Understanding the Nintendo Wii and Microsoft Kinect consoles in long-term care facilities

In recent years video game consoles, such as the Nintendo Wii™ and the Microsoft Kinect™, have been introduced into residential facilities. This paper presents a review of current studies documenting the benefits and detriments the Wii could have on adults aged 60 years and over in residential facilities, concentrating on the common uses of the Wii in care facilities: maintaining physical fitness, promoting mental well-being, encouraging social interaction and both physical and mental rehabilitation. Furthermore, this paper discusses the potential use of the Microsoft Kinect in care for older persons. The Wii can have a positive impact on the physical and mental health of older adults living in care facilities, but additional work should still be conducted, including assessing the use of games outside of Wii Sports and Wii Fit and possible non-gaming application of the Wii in care for older adults. Results for the Wii display potential for use of the Kinect in care facilities but further exploration is required to assess the potential physical impact and interaction viability.

The tolerability and safety of DPP-4 inhibitors for the treatment of older people with type 2 diabetes mellitus: an observational study

Aims/introduction: Despite type 2 diabetes mellitus being up to five times more prevalent in patients aged ≥65 years compared with patients <65 years of age, this population is surprisingly less well studied. Dipeptidyl peptidase (DPP)-4 inhibitor treatment is an option for this older patient group, but clinical practice data for this drug class are sparse in this population. The study examined the efficacy and tolerability of DPP-4 inhibitors in older patients with type 2 diabetes whilst focusing on particular pertinent aspects relevant to care of older persons. Materials and methods: The medical records of 431 randomly selected patients (median age 74 years) were reviewed and two cohorts (DPP-4-inhibitor-treated and non-DPP-4-inhibitors-treated) were compared. Results: Both groups had a similar duration of diabetes (8 years) and comparable glycated haemoglobin A1C concentrations (7.4% and 7.2%). Hypoglycaemia was less common in the DPP-4 inhibitor group (3%) compared with the medically treated non-DPP-4 inhibitor group (8%), p<0.02. Despite significantly more patients in the non-DPP-4 inhibitor group living in cared accommodation (9% vs. 2%) this group received significantly more insulin (30% vs. 7%). Conclusion: Clinicians need to consider the specific clinical issues relevant to older diabetic patients when taking complex treatment decisions.