Experiences Of Older Persons Research Articles

179 Assessing the effectiveness of the Integrated Care Team for Older Persons: a patient satisfaction survey

Abstract Background The Integrated Care Team for Older Persons (ICPOP) commenced operations in June 2022 with a goal of providing quality and person centred care. To assess the effectiveness of the service and enhance the patient experience a patient satisfaction survey was conducted. This qualitative study aimed to evaluate and reflect on the collected data for improving the ICPOP service. Methods The feedback questionnaire was adapted from the ICPOP, Community Healthcare East. It is a seven item questionnaire with an additional section for feedback and suggestion for service development and improvement. This questionnaire was sent to patients discharged from the ICPOP service during the months October 2022 to March 2023 inclusive (n = 30). Completed questionnaires and feedback forms were received and information collated (n = 18). To increase the respondent rate, telephone calls were made resulting in a response rate of 60%. The feedback and suggestion section were analysed using thematic analysis. Results All participants reported a positive experience following ICPOP intervention and would wish to receive input again. 61% rated their overall experience as ‘excellent’, 23% as ‘very good’ and 16% as having had a ‘good’ experience. 94% of respondents agreed that the treatment they received was effective and would recommend to another older person. 78% of respondents also provided written feedback. 12% of the feedback received provided recommendation for communication and integration with home care applications and service development. 66% of the feedback expressed gratitude and appreciation for the Multi-Disciplinary Team (MDT) service. Conclusion Older persons who received input from the Integrated Care Team for Older Persons reported a positive experience and expressed their gratitude for the timely service delivery. Receiving feedback on this new service promotes service development and enables the team to understand the impact and experiences of older persons who received ICPOP intervention and support.

A Descriptive Qualitative Study of Older Persons and Family Experiences with Extreme Weather Conditions in Northern Thailand.

Extreme weather can cause ill health in older persons due to a direct thermal effect on the body's thermoregulation and difficulties in maintaining a healthy lifestyle and accessing the health services they need. To understand experiences in relation to their exposures to extreme weather and how they responded to such weather conditions, including cold snaps, heat and air pollution in northern Thai communities, a descriptive qualitative study was conducted to uncover details and the essence of perspectives and experiences of older persons and family members. Three focus group discussions with 15 older persons and 15 family members occurred in three communities in Chiang Rai, a northern province of Thailand. Thematic analysis was performed. Experiences of older persons and families in relation to extreme weather conditions were described in five themes: local actions against weather changes, the double challenges, awareness and reactions to weather changes, protective and comfortable living environments, and mitigation of the impacts of weather conditions. Seasonal adaptability was key for older persons to stay safe and healthy during extreme weather changes. Heat, cold snaps, and air pollution made health and daily living routine maintenance among older persons challenging, especially among those with declining health. Older persons and families employed predictive and adaptive strategies to avoid and minimise extreme weather impacts and maximise their comfort and optimal living.

An “ultimate partnership”: Older persons’ perspectives on age-stereotypes and intergenerational interaction in co-designing digital technologies

AimThere is often a gap between the ideal of involving older persons iteratively throughout the design process of digital technology, and actual practice. Until now, the lens of ageism has not been applied to address this gap. The goals of this study were: to voice the perspectives and experiences of older persons who participated in co-designing regarding the design process; their perceived role in co-designing and intergenerational interaction with the designers; and apparent manifestations of ageism that potentially influence the design of digital technology. MethodsTwenty-one older persons participated in three focus groups. Five themes were identified using thematic analysis which combined a critical ageism ‘lens’ deductive approach and an inductive approach. ResultsAgeism was experienced by participants in their daily lives and interactions with the designers during the design process. Negative images of ageing were pointed out as a potential influencing factor on design decisions. Nevertheless, positive experiences of inclusive design pointed out the importance of “partnership” in the design process. Participants defined the “ultimate partnership” in co-designing as processes in which they were involved from the beginning, iteratively, in a participatory approach. Such processes were perceived as leading to successful design outcomes, which they would like to use, and reduced intergenerational tension. ConclusionsThis study highlights the potential role of ageism as a detrimental factor in how digital technologies are designed. Viewing older persons as partners in co-designing and aspiring to more inclusive design processes may promote designing technologies that are needed, wanted and used.

Meals on Wheels: Promoting Food and Nutrition Security among Older Persons in Cape Town, South Africa.

Food insecurity (FI) prevails in Sub-Saharan Africa. Yet, in South Africa, although many people, including the elderly, are vulnerable to FI, little is known about the experiences of older persons (OPs) with FI and the interventions thereof. In South Africa, Meals on Wheels Community Service (MOWCS) provides readymade home meal deliveries for OPs through 209 branches across the country. Therefore, this study investigated MOWCS' role in the promotion of food security among the OPs at the Brooklyn branch, Cape Town. The study was grounded within the food security framework and focused on the availability, accessibility, utilization, and stability of food at Brooklyn MOWCS. Using qualitative research methods, 10 semi-structured interviews and one focus group discussion (N = 5) were conducted with Brooklyn MOWCS beneficiaries, in addition to three key personnel interviews conducted with staff. Data were analysed using Open Code 4.03. The findings showed Brooklyn MOWCS as a stable source of affordable and nutritious meals to OPs. The portion size satisfied hunger; occasionally, one portion sufficed for two meals. Respondents admitted the meal ingredients represented various food groups and rated them as "healthy". However, some financial challenges hindered the extension of MOWCS services to the wider community. For instance, they only had three paid employees and were overcrowded within church premises. Findings also showed race and gender disparity among respondents; 90% were White and 10% were of Mixed Ancestry, with no Black or Asian OPs represented, and only 10% were male. These outcomes are typical of the current ethnic profile of the overall Brooklyn MOWCS beneficiaries in SA. This calls, therefore, for such interventions to be extended to all South African demographic groups as an initiative to alleviate food and nutrition insecurity among all OPs.

Pandemic Stories: The Voices of Older Adults.

To document the reactions and experiences of older persons during the COVID-19 pandemic, we have conducted a qualitative study of 25 older adults (50 years of age and older) throughout the pandemic, using serial interviewing methods. This analysis reports on the data collected from the first two rounds of interviews - one conducted in the summer of 2020 and one conducted in the fall of 2020. Our thematic analysis found eight major themes: thoughts on the dangers of the pandemic, how the virus has changed daily life (including social life), health care during COVID (being a caregiver, losing a loved one, seeking health care), missing spontaneity and dealing with existential dread, the growing frustration, seeking connection through civic participation, adaptation and resilience, and the social ills that the pandemic has revealed. These stories describe both loneliness and connection, hope coupled with disappointment, but overwhelmingly, an insight into what the pandemic has shown us about the social ills that it has revealed.

Living Out a Life's Meaning.

The literature on aging has grown exponentially in recent years, accompanied by a slew of reports providing data detailing progress, challenges, and opportunities in caring for the aging. Yet such reports too often omit the lived experience of older persons and in-depth discussion of the particular challenges and opportunities that arise within what Janelle S. Taylor calls "moral laboratories." The Evening of Life: The Challenges of Aging and Dying Well, a volume edited by Joseph E. Davis and Paul Scherz and to which Taylor is a contributor, helps fill this gap. With expert analyses from social scientists, philosophers, and health care professionals, the book contains evocative stories that facilitate reflection on the complexity, ambiguity, and diversity of being in later years.

Using a Mobile Application for Health Communication to Facilitate a Sense of Coherence: Experiences of Older Persons with Cognitive Impairment.

The increasing use of technology by older persons and their preferences for living at home and being independent have created an avenue for self-care and care delivery using mobile technologies and health communication. This study aimed to explain how older persons with cognitive impairment experienced technology-based health communication through the use of a mobile application to facilitate a sense of coherence. Individual, semi-structured interviews with 16 participants in the SMART4MD project were conducted. The interviews were transcribed then coded deductively and thematically, creating themes that corresponded to the central components of the sense of coherence model: comprehensibility, manageability, and meaningfulness. The findings produced an overall theme: a challenging technology that can provide support, based on the three identified themes: making sense of mobile technologies, mastering mobile technologies, and the potential added value to use mobile technologies. The participants’ experiences were influenced by their previous use and expectations for the application. Personal support, cognitive and physical ability, and different sources for information impacted use. The participants experienced that using the application created an ambiguity to be challenging and have possible benefits. The study suggests that the sense of coherence model may be used as a method to understand the use of technology by older populations.

(Dis)Connecting Through COVID-19: Experiences of Older Persons in the Context of a Volunteer-Client Relationship.

The coronavirus (COVID-19) pandemic and mandated physical distancing requirements significantly impacted volunteer programs for older persons with many long-standing programs either ceasing altogether or pivoting to connecting through virtual technologies. In this study, we collected qualitative interview data from 23 clients and 33 volunteers to investigate their experiences during the COVID-19 pandemic and the effects on the volunteer-client relationship. Three themes were identified: pandemic emotions, negotiating social interactions, and growing through the COVID-19 pandemic. These findings provide important insights into the experiences of hospice organizations and their volunteers and clients during the COVID 19 pandemic, further highlighting the importance of acknowledging both older persons' vulnerability and their resilience, of building in compassionate community approaches to care, and of finding innovative ways to foster volunteer-client relationships during times when physical visiting is not possible.

Psychosocial variables of the interactive mobile interface for geriatric persons in a Kenyan setting: An exploratory study

We aimed to identify and explore the priority psychosocial considerations for the gerontechnology design for Kenyan geriatrics. Our informants were a convenience sample of eight older adults (female = 4, age range 65 years to 78 years; and males = 4, age range 70 years to 78years) from an assisted living facility. We interviewed them on their regular mobile phone usage to better understand the factors affecting the usage of modern technology by older Kenyan persons. Thematic analysis of the data yielded two themes categorised as physical and psychosocial factors. Physical factors related to usability and user experience of older persons when using mobile phones. Psychosocial factors related to the emotional design experienced by older people when using mobile phones. These findings suggest a need to blend technology-centred and psychosocial factors for interactive mobile interfaces designed for developing country geriatrics.

Improving Communication for Older Adults During Disaster Events

Management of any disaster event (i.e., hurricanes, flooding, wildfires, viral pandemic) is a complicated task. An important and frequently overlooked aspect of efficient disaster response is effective information exchange among emergency managers, aging and social service providers, and those impacted by the disaster. Breakdowns in communication are regularly cited as failures in actual emergency situations. Older adults have unique challenges to effective communication during a disaster event. Further, messaging platforms may be inaccessible to older adults. Given the lack of data collected on the role of effective communication for older adults in a disaster event, we developed this symposium to highlight lessons learned for facilitating disaster communication among older community members and discuss how policy can further disaster communication efforts. The first presentation highlights the advantages of using targeted marketing communication channels to encourage older adults to prepare and recover from a disaster, as well as the value of collaborative partnerships in this communication. The second presentation introduces results from research collected from older adults on their use of social media to stay informed before and after Hurricane Matthew. The third presentation explores whether assisted living communities in Florida’s affected counties evacuated or sheltered in place in the context of emergency management communications concerning evacuation. The fourth presentation highlights the experiences of older persons in Houston’s communication post-Hurricane Harvey from an aging service provider’s perspective. The final presentation discusses disaster literacy and how this model can be used to enhance outcomes at all phases of a disaster. Disasters and Older Adults Interest Group Sponsored Symposium.

Toward a Partnership in the Transition from Home to a Nursing Home: The TRANSCIT Model

The transition from home to a nursing home can be stressful and traumatic for both older persons and informal caregivers and is often associated with negative outcomes. Additionally, transitional care interventions often lack a comprehensive approach, possibly leading to fragmented care. To avoid this fragmentation and to optimize transitional care, a comprehensive and theory-based model is fundamental. It should include the needs of both older persons and informal caregivers. Therefore, this study, conducted within the European TRANS-SENIOR research consortium, proposes a model to optimize the transition from home to a nursing home, based on the experiences of older persons and informal caregivers. These experiences were captured by conducting a literature review with relevant literature retrieved from the databases CINAHL and PubMed. Studies were included if older persons and/or informal caregivers identified the experiences, needs, barriers, or facilitators during the transition from home to a nursing home. Subsequently, the data extracted from the included studies were mapped to the different stages of transition (pre-transition, mid-transition, and post-transition), creating the TRANSCIT-model. Finally, results were discussed with an expert panel, leading to a final proposed TRANSCIT model.The TRANSCIT model identified that older people and informal caregivers expressed an overall need for partnership during the transition from home to a nursing home. Moreover, it identified 4 key components throughout the transition trajectory (ie, pre-, mid-, and post-transition): (1) support, (2) communication, (3) information, and (4) time.The TRANSCIT model could advise policy makers, practitioners, and researchers on the development and evaluation of (future) transitional care interventions. It can be a guideline reckoning the needs of older people and their informal caregivers, emphasizing the need for a partnership, consequently reducing fragmentation in transitional care and optimizing the transition from home to a nursing home.

Older Persons' and Their Caregivers' Perspectives and Experiences of Research Participation With Impaired Decision-Making Capacity: A Scoping Review.

Human research ethics statements support the equitable inclusion of diverse groups. Yet older people are underrepresented in clinical research, especially those with impaired decision-making capacity. The aim of this study was to identify the perspectives and experiences of older persons and their caregivers of research participation with impaired decision-making capacity. Scoping review of the literature and online sources in January-February 2019 (updated June 2020) according to Joanna Briggs Institute methodology and PRISMA Extension for Scoping Reviews. English-language peer-reviewed research articles and Australian online narratives were included. Data were tabulated and narratively synthesized. From 4,171 database records and 93 online resources, 22 articles (2000-2019, 82% United States, 16 first authors) and one YouTube webinar (2018) were initially included; updated searches yielded an additional article (2020) and YouTube webinar (2020). Studies were heterogeneous in terminology, methods, and foci, with hypothetical scenarios, quantitative analyses, and examination of proxy consent predominating. Participants (N = 7,331) were older persons (71%), caregivers of older persons with dementia/cognitive impairment (23%), and older persons with dementia/cognitive impairment (6%). Synthesis identified 2 themes: willingness to participate and decision-making approaches. Research participation by older persons with dementia may be optimized through reducing risks and burdens and increasing benefits for participants, greater consumer input into study development, and shared and supported decision-making. Older persons' and caregivers' perspectives and experiences of research participation with impaired decision-making capacity require investigation in a greater range of countries and conditions other than dementia, and dissemination through more varied media.

Exploring the Perspectives of Older People on the Concept of Home

Objectives Continuing to live at home is arguably one of the most important challenges older persons face as they age. The aim of this study was to clarify how older adults conceptualise home through age-related lifestyle changes. Methods Principles from grounded theory were used to examine the perspectives of 21 older adults obtained from three focus group discussions and 10 in-depth semistructured interviews. Results Four major categories were developed: “anchoring self,” “enabling freedom,” “being comfortable,” and “staying in touch.” Discussion. For the participants in this study remaining at home enabled a sense of independence and freedom, self-worth and identity, comfort, and an ongoing active role in the community. However, some aspects of home could be renegotiated despite changes to living location, with new social connections able to be forged and personal comforts being transferrable. This holds important implications for supporting older persons to both sustain living at home and to adjust to changing circumstances, suggesting the importance of drawing on the experiences of older persons themselves in developing strategies to promote successful aging.

The Experiences of Older Persons and Their Adult Children on Maintaining Positive Parent-child Relationships

The incidence of increased life span as well as a lack of care for older persons, gave rise to the South African Older persons Act (Act No 13 of 2006), which provides a clear indication of the expectations of caring for older persons within communities and families. With many older persons relying on the relationships they have with their children in their golden years, to be fulfilling and loving, this study aimed to explore the experiences of older persons and their adult children from a strengths based perspective by focusing on how they maintain positive relationships. This study adopted a qualitative research approach which was exploratory and contextual in nature, applying a narrative strategy of inquiry. Empirical data was collected from two sample sets, using a non-probability purposive sampling method: i) five older persons who were retirees of an automotive company in South Africa and ii) at least one of their adult children. Individual, semi-structured face to face interviews were conducted with both sample sets. Thematic data analysis technique was used to analyse the data collected. This article reports on two themes generated from the findings of the study.

Shareholding Networks for Care in Rural Thailand: Experiences of Older Persons and Their Family Members

Most members of the older population in Thailand live in rural areas while their children live in cities. With the joint family system separated, elderly Thai persons often have to care for themselves, and opportunities for them to get involved in community care remain limited. In response, the aim of this study was to describe older persons’ and their family members’ experiences with shareholding networks for the care of older people in rural Thailand. Paired interviews with five older persons and five of their family members were conducted, and collected data were subjected to content analysis, which yielded results organized around two themes: older persons’ outsider status and disregard for older persons’ individuality. Whereas the theme of outsider status describes shortcomings in healthcare encounters, the theme of disregard for individuality describes the lack of engagement of authorities and caregivers in older persons’ care. In that sense, the concept of participation emerged as a framework for understanding interviewees’ experiences. Given findings from local authorities, older individuals and their family members should engage in dialogue in order to support healthcare based on shared understanding.

The Right to Health in Old Age: Israeli Professionals' and Older Persons' Perspectives.

To develop a better understanding of the right to health in old age through the personal knowledge and experience of older persons and professionals in Israel. A qualitative research method was adopted based on focus groups. Information was collected through four focus groups with 33 participants. Three main themes emerged: The first focused on the older persons' self-positioning vis-à-vis the health-care system. The second illustrated the verbal means chosen by the participants to situate the health-care system itself. The third elaborated on the institutional and cultural processes involved in upholding health rights in old age. Future discussions regarding conceptualization of the right to health in old age should relate to its human aspects, that is, communication and interaction, and the older person's knowledge, participation, and involvement in shaping the medical services that they receive.

Older persons' experiences of their own decision making about their care: a systematic review of qualitative evidence protocol.

REVIEW QUESTION/OBJECTIVE: The overall objective of this systematic review is to identify and synthesize the best available qualitative evidence of how older persons go about making decisions regarding their own health care. INCLUSION CRITERIA: Types of participants: This review will consider studies that include people 65 years or over who are living in the community. Studies that include participants under 65 years of age will be excluded. Studies focusing on decision making with participants with dementia, who are cognitively impaired; who are undergoing palliative care or who are terminally ill will be excluded. Phenomena of interest: This review will consider studies where the phenomena of interest are the experiences of older people in regards to decision making about their health care. Context: The review will consider studies that investigate the experiences of older persons’ living in community based settings. These settings may include: the older persons’ home, a community living environment and a retirement village setting, but exclude residential aged care facilities.

Promoting sense of security in old-age care

Purpose: The concept of security is related to the experience of health but has ever so often been argued from a risk perspective rather than from a promotional perspective. The experience of older persons’ sense of security in private homes and in nursing homes seems to be missing when it comes to promote aging well throughout the life span. This study aimed to describe and analyze factors related to the sense of security of older persons receiving care in nursing homes in Sweden. Design and Methods: The study was based on a questionnaire from a total of 495 persons aged ≥ 65 in private homes (n = 350) or nursing homes (n = 145) in Sweden. Results: Secure relationships, sense of control, and perceived health were significantly related to the subjects’ sense of security. No significant relationships were found between sense of security and having a personal emergency response alarm. Implications: Experience of sense of security from the older person perspective differs depending on the context. To promote the sense of security within the care of older persons, methods on how to establish secure relations as well as the sense of control and knowledge need to be further tested, developed and analyzed together with older persons.

Will older persons and their clinicians use a shared decision-making instrument?

To examine experiences of older persons and their clinicians with shared decision making (SDM) and their willingness to use an SDM instrument. Qualitative focus group study. Four focus groups of 41 older persons and 2 focus groups of 11 clinicians, purposively sampled to encompass a range of sociodemographic and clinical characteristics. APPROACH AND MAIN RESULTS: Audiotaped responses were transcribed, coded independently, and analyzed by 3 reviewers using the constant comparative method. Patient participants described using informal facilitators of shared decision making and supported use of an SDM instrument to keep "the doctor and patient on the same page." They envisioned the instrument as "part of the medical record" that could be "referenced at home." Clinician participants described the instrument as a "motivational and educational tool" that could "customize care for individual patients." Some clinician and patient participants expressed reluctance given time constraints and unfamiliarity with the process of setting participatory clinical goals. Participants indicated that they would use a shared decision-making instrument in their clinical encounters and attributed multiple functions to the instrument, especially as a tool to facilitate agreement with treatment goals and plans.

Occupational adaptation: the experiences of older persons with physical disabilities.

The purpose of this phenomenological study was to explore the experiences of occupational adaptation among a small number of older Dutch persons with physical disabilities. Occupational adaptation was tentatively defined as overcoming disabling influences on occupational functioning. Eight occupational therapy clients, who were living in the community, were interviewed using an open in-depth interview format. A phenomenological analysis resulted in descriptions of occupational adaptation as a process that required these clients' active engagement. The clients recruited already familiar problem-solving strategies and personal resources as well as resources in their social and physical environments to identify prospects of potential solutions and to create solutions to overcome constraints on occupational functioning. Furthermore, participants strived for finding satisfaction through occupations, a meaning theme which emerged as the object of occupational adaptation. Satisfaction through occupations was found in maintaining daily routines and engaging in fulfilling occupations.