Health Care Choices Research Articles

Healthcare Choices and Challenges among Female Inmates in Selected Correctional Facilities in Southwestern Nigeria

The study examined healthcare choices and challenges among female inmates in selected correctional facilities in Nigeria. This is with a view to examining the major healthcare challenges and choices available. The study employed the descriptive research method, the purposive sampling technique was employed in the selection of the correctional facilities, while the proportionate sampling technique was used to select the female respondents, and a 50% proportion was used. While descriptive analysis was used to analyse the primary data, such parameters as frequency, percentage, mean, and inferential (Pearson’s product moments correlation coefficients) were adopted in the analysis of the primary data. The study reveals that there is a positive and significant relationship between available healthcare and female inmates’ reproductive health, as well as a negative and insignificant relationship between major healthcare challenges and female inmates’ health. The study concludes that available healthcare and female inmates’ reproductive health move in the same direction, while major healthcare challenges and female inmates’ reproductive health move in the opposite direction. The study recommends that in order to improve the female inmate’s reproductive health, the available healthcare facilities require improvement, and the identified health challenges should be addressed as public health issues by the medical practitioners. It is also recommended that a large proportion of the health sector budget be directed towards providing qualitative health facilities in the correctional facilities across the nation in order to improve the standards of female inmates’ reproductive health status.

Understanding patients heterogeneity in healthcare travel and hospital choice - A latent class analysis with covariates

Access to health care is key to well-being, and it is increasingly clear that aggregated accessibility analysis is hard to reflect people's actual healthcare behaviour. This paper employs a patient-based healthcare travel survey to obtain a nuanced picture of how healthcare travel varies across patients. The existing literature shows transportation is an essential factor in accessing health care; however, most studies focus on separate healthcare travel mode choices or hospital choices for certain segments of patients, making it difficult to derive clear profiles of patients. Also, the attitudinal factors in healthcare travel have long been neglected. This research explores the joint hospital choice and travel behaviour of patients. We conducted an online survey with patients in Shanghai to identify the heterogeneity in healthcare travel behaviour and hospital choice. A latent class model with covariates is adopted to identify different patient types that exhibited distinct hospital choices and healthcare travel behaviour. Attitudinal factors are included in our model to form clear-separated clusters. Four categories of patients are identified: public transit patients, car-oriented patients, near-hospital patients, and non-downtown hospital patients, which differ in sociodemographic characteristics, healthcare-seeking behaviour, and public transit accessibility. Our research shows that a substantial share of non-downtown hospital patients should not be underestimated in healthcare travel demand analysis. The behaviour of public transit and non-downtown patients requires improvement of quality and public transit accessibility in non-downtown tertiary hospitals. Our study contributes to a better understanding of the market segments of patients and tailored healthcare and transport policies to meet patient healthcare travel demand.

Female Genital Mutilation: A Religio-cultural Sensitive Issue Determining Maternal Healthcare Choices among Somali Women in Dadaab Refugee Camp, Kenya

This paper focuses on Kenya’s development challenges in maternal health care, especially the impact of traditional birth attendants (TBAs) and female genital mutilation (FGM) among the refugees. The study identifies four objectives: to discuss the persistence of FGM among Somali women in Ifo Refugee Camp; to establish the hospital process of providing maternal health care to mothers who have gone through FGM; to find out the level of preparedness of the midwives to handle mothers with religio-cultural concerns such as prayer and non-involvement of male nurses; and how the practice of FGM contributes to the preference of TBA by mothers. This study assumes that midwives’ training may not have effectively addressed FGM, a social-cultural sensitive issue affecting childbirth and care. The specific support of midwives in refugee camps contexts also remains limited. A qualitative research approach was used in the study, involving Snowballing sampling method, in-depth interviews, and focus group discussions (FGDs). These methods brought out pertinent issues that make TBAs the preferential option for some mothers despite the presence of level 4 category hospitals in the refugee camps. In case of birth complications, the mother’s choice for TBA delays the family’s decision to take her to the hospital and for healthcare workers to save mother and child. The shortage of midwives and the presence of male midwives in hospitals make some Somali mothers seek assistance from TBAs. There is a need to contextualize midwifery training by enhancing the curriculum with evidence-based/mother-centered skills.

Federal Data for Conducting Patient-centered Outcomes Research on Economic Outcomes.

Patients are increasingly interested in data on the economic burdens and impacts of health care choices; caregivers, employers, and payers are also interested in these costs. Although there have been various federal investments into patient-centered outcomes research (PCOR), an assessment of the coverage and gaps in federally funded data for PCOR economic evaluations has not been produced to date. To classify relevant categories of PCOR economic costs, to assess current federally funded data for coverage of these categories, and to identify gaps for future research and collection. A targeted internet search was conducted to identify a list of relevant outcomes and data sources. The study team assessed data sources for coverage of economic outcomes. A technical panel and key informant interviews were used for evaluation and feedback. Four types of formal health care sector costs, 3 types of informal health care sector costs, and 10 types of non-health care sector costs were identified as relevant for PCOR economic evaluations. Twenty-nine federally funded data sources were identified. Most contained elements on formal costs. Data on informal costs (eg, transportation) were less common, and non-health care sector costs (eg, productivity) were the least common. Most data sources were annual, cross-sectional, nationally representative individual-level surveys. The existing federal data infrastructure captures many areas of the economic burden of health and health care, but gaps remain. Research from multiple data sources and potential future integrations may offset gaps in individual data sources. Linkages are promising strategies for future research on patient-centered economic outcomes.

Ensemble Siamese Network (ESN) Using ECG Signals for Human Authentication in Smart Healthcare System.

Advancements in digital communications that permit remote patient visits and condition monitoring can be attributed to a revolution in digital healthcare systems. Continuous authentication based on contextual information offers a number of advantages over traditional authentication, including the ability to estimate the likelihood that the users are who they claim to be on an ongoing basis over the course of an entire session, making it a much more effective security measure for proactively regulating authorized access to sensitive data. Current authentication models that rely on machine learning have their shortcomings, such as the difficulty in enrolling new users to the system or model training sensitivity to imbalanced datasets. To address these issues, we propose using ECG signals, which are easily accessible in digital healthcare systems, for authentication through an Ensemble Siamese Network (ESN) that can handle small changes in ECG signals. Adding preprocessing for feature extraction to this model can result in superior results. We trained this model on ECG-ID and PTB benchmark datasets, achieving 93.6% and 96.8% accuracy and 1.76% and 1.69% equal error rates, respectively. The combination of data availability, simplicity, and robustness makes it an ideal choice for smart healthcare and telehealth.

UTILIZATION AND CHOICE OF HEALTH CARE: EMPIRICAL EVIDENCE FROM INDIA

Utilization and choice of health care services are two important decision-making issues once an individual perceives or realizes illness. Identifying and measuring the factors that influence health care utilization and choice are important concern for policy makers, to reduce health system inequality. Both demand and supply side factors influence the above-mentioned choice decisions. However, the nature and severity of illness can also affect the above choice decisions. This study has identified and measured the role of disease specification as an important determinant of choice decision along with its influence on other factors. This study also explored the regional and socio-economic variation of factors which hinder the utilization of government-provided health care services. Analyzing the data of women and child household members, the study found that disease specification affects the choice of health care provider and even influences the role of other important factors.

Identifying important questions for Cochrane systematic reviews in Eyes and Vision: Report of a priority setting exercise

AbstractIntroductionSystematic reviews are important to inform decision‐making for evidence‐based health care and patient choice. Deciding which reviews should be prioritized is a key issue for decision‐makers and researchers. Cochrane Eyes and Vision conducted a priority setting exercise for systematic reviews in eye health care.MethodsWe established a steering group including practitioners, patient organizations, and researchers. To identify potential systematic review questions, we searched global policy reports, research prioritization exercises, guidelines, systematic review databases, and the Cochrane Library (CENTRAL). We grouped questions into separate condition lists and conducted a two‐round online modified Delphi survey, including a ranking request. Participants in the survey were recruited through social media and the networks of the steering group.ResultsIn Round 1, 343 people ranked one or more of the condition lists. Participants were eye care practitioners (69%), researchers (37%), patients or carers (24%), research providers/funders (5%), or noneye health care practitioners (4%) and from all World Health Organization regions. Two hundred twenty‐six people expressed interest in completing Round 2 and 160 of these (71%) completed the Round 2 survey. Reviews on cataract and refractive error, reviews relevant to children, and reviews on rehabilitation were considered to have an important impact on the magnitude of disease and equity. Narrative comments emphasized the need for reviews on access to eye health care, particularly for underserved groups, including people with intellectual disabilities.ConclusionA global group of stakeholders prioritized questions on the effective and equitable delivery of services for eye health care. When considering the impact of systematic reviews in terms of reducing the burden of eye conditions, equity is clearly an important criterion to consider in priority‐setting exercises.

DATA COLLECTION AND PERFORMANCE EVALUATION OF RUNNING TRAINING SPORT USING DIFFERENT NEURAL NETWORK TECHNIQUES

With the increasing engagement of human beings in the pursuit of healthcare, running as a sport has become a fashionable and healthcare first choice. This research uses artificial intelligence technology to carry out intelligent analysis when conducting running training. Artificial intelligence technology can accurately analyze and predict the application requirements of sports training postures. We proposed an analysis of sports posture and a prediction system, which uses running training data in the form of a heart rate, recorded on a GPS smart sports watch, as well as using the recurrent neural network (RNN), long and short-term memory (LSTM) and the gate recursive unit (GRU). These three types of neural network methods can predict which method is best suited for a road race and can confirm that it will be completed within the scheduled finish time; these models will also perform an intelligent analysis of physical fitness (heart rate, pace) and running technology (cadence, pace). The training and test data are collected from the running training records (running distance, time, heart rate, stride frequency, stride length, pace, calories, altitude and other characteristic values) as input parameters, to test and compare the running completion time trends of the RNN, LSTM and GRU neural network methods in the exercise table, so as to evaluate their predictive abilities. The results show that the GRU method has the best predictive accuracy, and the least accurate is the LSTM method. After the hidden layers are added to the three predictive methods, the RNN is slightly regressive, the LSTM indicates a trend of significant improvement and the GRU exhibits less obvious changes.

Identity change of late-deafened adults after receiving cochlear implants

Purpose The aim of this research was to understand how adults reconceptualise their identity when experiencing hearing loss as an adult, and how their identity might change with a cochlear implant. Materials and methods Using an online survey administered through cochlear implant social media groups, with follow-up semi-structured interviews, participants answered questions about their hearing loss and cochlear implant experiences. Forty-four people answered the survey and 16 participated in an in-depth interview. All were older than 18 years, once had heard, became deafened in adulthood and had at least one cochlear implant. Results The decision to have a cochlear implant often meant acknowledging they were no longer a hearing person. After having an implant four themes emerged. (1) Some participants maintained a hearing identity through hearing loss and after cochlear implantation, while others returned to their hearing identity. (2) Others acknowledged a confused identity, neither deaf nor hearing. In unexpected findings, (3) during the progression of hearing loss, some participants had identified as hearing but could not hear, however after implantation, they became deaf people who could hear. (4) Furthermore, after implantation, some participants identified as disabled when they had not done so when less able to hear. Conclusion Given the prevalence of hearing loss in later life, it is important to understand the way these adults understand their identity through the progression of hearing loss and after becoming cochlear implant recipients. The belief people have of themselves impacts healthcare choices and affects their commitment to ongoing rehabilitation.

The perceived barriers and facilitators for chiropractic care in older adults with low back pain; insights from a qualitative exploration in a dutch context.

Understanding care seeking behaviour is vital to enabling access to care. In the context of low back pain (LBP), chiropractors offer services to patients of all ages. Currently, geriatric sub-populations tend to be under-investigated, despite the disproportionate effects of LBP on older adults. In the Netherlands, the chiropractic profession is relatively unknown and therefore, generally speaking, is not considered as the first choice for conservative musculoskeletal primary health care. The aim of this paper was to explore the experiences of older adults with LBP, seeking chiropracic care for the first time, in order to identify perceived barriers and facilitators in this process. Stage 1: Participants 56 years of age and older with chronic LBP who either sought or did not seek chiropractic care were interviewed to provide detailed information on the factors that promoted or impeded care-seeking behaviour. A purposive sampling strategy was used to recruit participants through a network of researchers, chiropractors and other healthcare professionals offering musculoskeletal health care services. Individuals with underlying pathology, previous surgery for LBP, or insufficient mastery of the Dutch language were excluded. Data were collected until saturation was reached and thematically analysed. Stage 2: To further explore the themes, a focus group interview was conducted with a provider stakeholder group consisting of:two physiotherapists, a nurse practitioner, a geriatrician, and a chiropractor. All interviews were conducted online, voice recorded, and transcribed verbatim. We interviewed 11 older adults with low back pain. During this process four themes emerged that captured their perception and experiences in either seeking or dismissing chiropractic care for their LBP; these being 'generic', 'financial', 'expectation', and 'the image of the chiropractor'. The focus group members largely confirmed the identified themes, highlighting a lack of awarenes and accessibility as key barriers to care. On the other hand, whe chiropractior as an alternative care provider, with a focus on manual interventions, was seen as a facilitator. The lack of knowledge about chiropractic care was found to be the most important barrier to seeking care. The most important facilitator was insufficient resolution of their symptoms following previous care, making patients look further for a solution for their problem. These barriers and facilitators seem not to differ greatly from barriers and facilitators found among younger patients with neck pain. Age and health condition may therefore be weak determinants of care. This new information may help us optimize accessibility for older adults to the chiropractor.

Prioritisation of Informed Health Choices (IHC) key concepts to be included in lower secondary school resources: A consensus study.

The Informed Health Choices Key Concepts are principles for thinking critically about healthcare claims and deciding what to do. The Key Concepts provide a framework for designing curricula, learning resources, and evaluation tools. To prioritise which of the 49 Key Concepts to include in resources for lower secondary schools in East Africa. Twelve judges used an iterative process to reach a consensus. The judges were curriculum specialists, teachers, and researchers from Kenya, Uganda, and Rwanda. After familiarising themselves with the concepts, they pilot-tested draft criteria for selecting and ordering the concepts. After agreeing on the criteria, nine judges independently assessed all 49 concepts and reached an initial consensus. We sought feedback on the draft consensus from other stakeholders, including teachers. After considering the feedback, nine judges independently reassessed the prioritised concepts and reached a consensus. The final set of concepts was determined after user-testing prototypes and pilot-testing the resources. The first panel of judges prioritised 29 concepts. Based on feedback from teachers, students, curriculum specialists, and members of the research team, two concepts were dropped. A second panel of nine judges prioritised 17 of the 27 concepts that emerged from the initial prioritisation and feedback. Based on feedback on prototypes of lessons and pilot-testing a set of 10 lessons, we determined that it was possible to introduce nine concepts in 10 single-period (40-minute) lessons. We included eight of the 17 prioritised concepts and one additional concept. Using an iterative process with explicit criteria, we prioritised nine concepts as a starting point for students to learn to think critically about healthcare claims and choices.

The Economic Determinants of Mystical Healing: An Empirical Exploration of Danyalism in the Sociocultural Landscape of Gilgit Baltistan

Danyalism, a spiritual healing system prevalent in the Hunza and Nagar valleys of Gilgit Baltistan, represents a syncretic fusion of the mystical and the corporeal. The Danyal, the practitioner at the center of this complex sociocultural system, is imbued with an ethereal connection to the Faerie realm, possessing an authoritative power to remedy sickness through esoteric rites. From an economic perspective, the study also explores the cost-efficiency and accessibility of danyalistic healing, examining how these practices fit within the broader healthcare economy of the region. The empirical exploration undertaken in this study utilized a robust methodological framework, encompassing both survey and case study techniques. A total of 100 female respondents were surveyed for quantitative analysis, selected via snowball sampling, and 4 Danyals were interviewed for qualitative insights, selected through convenient sampling. Employing structured, closed-ended questionnaires and interview guides facilitated the gathering of nuanced qualitative and quantitative data. The results revealed a profound, albeit covert, adherence to danyalistic healing practices among female respondents. Despite existing within a cultural matrix where engaging with a Danyal is stigmatized as a social taboo, a substantial proportion of the population opts for this traditional healing method over conventional medical care, influenced by factors such as affordability and cultural acceptance. The findings illuminate the intricate interplay between belief systems, cultural norms, economic considerations, and health-seeking behaviors in the region, revealing the persistent resonance of danyalistic practices, even in the face of societal prohibition. The economic implications of this study further broaden our understanding of the healthcare choices made by individuals within a specific sociocultural and economic context.

Analysis of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus.

To estimate the prevalence of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus through the diagnostic accuracy of the defining characteristics. A diagnostic accuracy study on the diagnosis of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus was conducted using the latent class analysis model. The sample comprised 180 individuals attending a referral outpatient clinic in Maranhão, Brazil. The data analysis was conducted in the R Core Team software. The prevalence of the nursing diagnosis was 55.23%. The main defining characteristics were expresses desire to enhance health communication with healthcare providers and expresses desire to enhance the understanding of health information to make healthcare choices. All defining characteristics showed significant specificity values. Accurate diagnoses contribute to individualized care plans for patients. The diagnosis Readiness for enhanced health literacy should be considered in implementing care plans, including interventions to reduce complications in the health status of patients with type 2 diabetes mellitus.

Role of Pharmacist in Nutrition Management-The Unexplored Path

Abstract: Public health aims at improving the health and well-being of populations, reducing health inequalities, and ensuring the sustainability of health systems. The prevention of disease is anticipated to be a more cost-effective and long-term method of reducing disease burden. One of the most important strategies for reducing this burden is nutrition management. The problems surrounding nutrition and its management are often multi-dimensional. It demands a trained workforce, forming strong alliances with the same goal, and being able to communicate effectively with all the stakeholders. Fixing the role and responsibility of pharmacists is the logical answer to address India’s multidimensional nutritional challenge now and in the future. One of the critical components in managing acute and chronic diseases and overall public health is nutrition management but it requires knowledge about the importance of a balanced diet, food, and nutrition-related health concerns, drug usage, drug-drug interactions, drug-food interactions, drug-nutrient interactions, food supplements, dietary supplements, nutraceuticals, cost-effective treatments, etc. This article aims to demonstrate pharmacists’ knowledge, attitude, understanding, and professional skills to tackle the issue of nutrition management by assuring cost-effective healthcare choices, offering evidence-based advice on nutritional products and therapies, management of health supplements and nutraceuticals, and advising on drug-drug, drugfood, and drug-nutrient interactions. Keywords: Pharmacist, Nutrition management, Lifestyle diseases, Anatomy and physiology, Nutritional supplements, Nutraceuticals.

A synthesis of qualitative research to understand the complexity behind treatment decision-making for osteoarthritis

ObjectiveOsteoarthritis is the most common joint disease with treatment involving a multidisciplinary approach with pharmacological, physical therapies and surgery as options. Qualitative research can help us to understand the complexity of managing health conditions and this understanding plays a role in good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis, including decision making about joint replacement. MethodsWe comprehensively searched 4 bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10 ​123 titles, 548 abstracts, and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. ResultsWe developed 7 themes: Becoming your own expert can be hard work; Living has become a careful balancing act; Medication is a double-edged sword; I have other things in my life to consider; You have to weigh up the odds of surgery; Surgery is the only effective option; and Surgery will give me a chance to live now. These findings have been drawn into a conceptual model reflecting a complex balancing act with tensions underpinning treatment decision making. ConclusionsOsteoarthritis is framed as a world where patients become their own expert about their management and healthcare choices. Our conceptual model highlights key tensions underpinning treatment decision-making. These findings provide clinicians with insight of the complex nature of these decisions and how they can help patients through shared decision making.

Preferences for Health Care and Its Determinants Among Mentally Ill Patients of the West Shoa Zone Community, Oromia, Ethiopia.

Over 9 million people die from mental diseases each year, making them the second highest cause of mortality and the primary cause of disability worldwide. To explore the preferences for health care and its determinants among mentally ill patients in the West Shoa Zone Community in Oromia, Ethiopia, from July 11-September 20, 2022. The preference for health care and its determinants among mentally ill patients in the West Shoa Zone community were explored using an ethnographical study. Purposefully, a total of 16 FGD participants and 10 unstructured interview subjects, who had pertinent experiences and perspectives, were carefully selected from the urban and district levels. Data was collected utilizing two approaches in a triangulated manner and then coded, findings were contextualized, and a thematic plot was developed for thematic analysis. In this study, in response to the questions, three main findings were thematized according to the causes, and six sub-themes were framed under the themes according to the preferences for treatment among mentally ill patients. The themes that emerged from the data were; 1. Supernatural causes, 2. Traditional non-spiritual beliefs and practices; and 3. Medico-surgical problems. The majority of the participants responded that residents preferred religious spiritualists the most (46%), followed by traditional counselors (Wabeka) (19%), traditional spiritualists (15%), institutional care (12%), herbalists (4%), and psychologists (4%). In this study, the most commonly perceived causes of mental illnesses were bad spirits, devilish activity, and engaging in actions that violated social norms and regulations. Religious spiritualists were the study's first choice for mental health care. This study advises collaboration and a shared strategy between health care professionals and traditional and religious stakeholders.

Abstract P373: Health Care Access and Usage Patterns Among Native Americans: The Strong Heart Study

Introduction: Previous research has shown that health care access and usage patterns among Native Americans are often difficult to measure. Hypothesis: We hypothesize that sociodemographic factors such as age, gender, education, and employment influence health care access and usage patterns in Native communities in the Strong Heart Study (SHS). Methods: The SHS is a prospective population-based epidemiological study of cardiovascular disease and its associated risk factors in American Indians (AI). Between 1997 and 1999, surviving participants (N=2,382) of the original cohort were invited to a third exam, in which health care access and usage information were collected, along with other clinical and sociodemographic measurements. Multivariate logistic regression was used to find influencing factors of health care choices. Results: The majority of study participants (79%, 1,877/2,382) reported Indian Health Services (IHS) as their primary source of care, and close to one-third (29%, 689/2,358) reported having no additional coverage. Figure 1 showed travel time, waiting time after arriving at the clinics, and waiting time of a walk-in visit in IHS, tribal health service, and private practice. As participants aging or obtaining more years of education, they were less likely to use public (IHS or tribal) health service vs. private practice with odds ratio (95% confidence interval) 0.97 (0.95-0.99, p<0.01) and 0.89 (0.84-0.93, p<0.01) respectively, adjusting for gender and employment status. Conclusions: SHS participants primarily utilize IHS compared to other health services. Average waiting time is longer for IHS facilities (vs. private practice or tribal health facilities) with 35% (622/1,760) participants waiting for > 60 minutes to be seen in regular appointments, and with 53% (814/1,540) participants waiting for > 60 minutes in a walk-in visit. Age and education influence access to and selection of health care services for AI. This report provides baseline information for future health care access study in SHS.

Influence of Physical Attractiveness and Gender on Patient Preferences in Digital Doctor Consultations: Experimental Study.

The rise of digital health services, particularly digital doctor consultations, has created a new paradigm in health care choice. While patients traditionally rely on digital reviews or referrals to select health care providers, the digital context often lacks such information, leading to reliance on visual cues such as profile pictures. Previous research has explored the impact of physical attractiveness in general service settings but is scant in the context of digital health care. This study aims to fill the research gap by investigating how a health care provider's physical attractiveness influences patient preferences in a digital consultation setting. We also examine the moderating effects of disease severity and the availability of information on health care providers' qualifications. The study uses signal theory and the sexual attribution bias framework to understand these dynamics. Three experimental studies were conducted to examine the influence of health care providers' physical attractiveness and gender on patient preferences in digital consultations. Study 1 (n=282) used a 2×2 between-subjects factorial design, manipulating doctor attractiveness and gender. Study 2 (n=158) focused on women doctors and manipulated disease severity and participant gender. Study 3 (n=150) replicated study 2 but added information about the providers' abilities. This research found that patients tend to choose attractive doctors of the opposite gender but are less likely to choose attractive doctors of the same gender. In addition, our studies revealed that such an effect is more prominent when the disease severity is high. Furthermore, the influence of gender stereotypes is mitigated in both the high and low disease severity conditions when service providers' qualification information is present. This research contributes to the literature on medical information systems research and sheds light on what information should be displayed on digital doctor consultation platforms. To counteract stereotype-based attractiveness biases, health care platforms should consider providing comprehensive qualification information alongside profile pictures.

MAiD for geriatric syndromes: Special considerations.

Medical Assistance in Dying (MAiD) brings unique considerations in the context of geriatric syndromes such as frailty and cognitive or functional impairment. These conditions are associated with complex vulnerability across health and social domains and often do not have predicable trajectories or responses to healthcare interventions. In this paper, we focus on four categories of gaps in care that are particularly relevant for MAiD in geriatric syndromes, namely, inadequacies in access to medical care, appropriate advance care planning, social supports, and funding for supportive care. We conclude by arguing that appropriately situating MAiD in the context of care for older adults requires careful consideration of these gaps in care to enable real, robust, and respectful healthcare choices for people living with geriatric syndromes and approaching end-of-life.

Elderly people’s preferences for healthcare facilities in Shanghai: gender features and influencing factor analysis

BackgroundChina has one of the fastest paces of the growing aging population, High-level policymakers have recently recognized the aging population presents significant challenges to the Chinese healthcare system. In this context, the healthcare-seeking behaviors of the elderly population have become an essential field of study. It is necessary to understand their access to health services and to improve their quality of life, as well as to help policymakers to formulate healthcare policy. The study empirically investigates the factors influencing the elderly population’s healthcare-seeking behaviors in Shanghai, China, especially in choosing the quality of healthcare facilities to visit.MethodsWe designed a cross-sectional study. The data of this study were derived from the “Shanghai elderly medical demand characteristics questionnaire” in the middle of November to early December 2017. A total of 625 individuals were included in the final sample. Logistic regression was adopted to investigate the differences in healthcare-seeking behaviors between elderly people when suffer from mild illness, severe illness and follow-up treatment. Next, the differences in gender were also discussed.ResultsFactors affecting the healthcare-seeking behaviors of the elderly differ in mild illness and severe illness situations. For mild illness, demographic factors (gender and age) and socioeconomic factors (income and employment) play an important role in elderly healthcare choices. Female and older elderlies are more likely to choose local, lower-quality facilities, whereas those with high income and private employment are more likely to choose higher-quality facilities. For severe illness, socioeconomic factors (income and employment) are important. Furthermore, individuals with basic medical insurance are more likely to choose lower-quality facilities.ConclusionThis study has shown that the affordability of public health services should be addressed. Medical policy support may be an important way to reduce the gap in access to medical services. We should pay attention to the gender differences in the elderly’s choice of medical treatment behavior, consider the differences in the needs of male and female elderly. our findings are only for elderly Chinese participants in the greater Shanghai area.