Adult Health Care Research Articles

379P A qualitative study on people with Duchenne muscular dystrophy and caregivers’ experiences during the transition process from pediatric to adult healthcare

379P A qualitative study on people with Duchenne muscular dystrophy and caregivers’ experiences during the transition process from pediatric to adult healthcare

Delays to accessing healthcare for older adults with disabilities in Bengaluru, India: views of healthcare providers and older adults

Introduction A person’s ability to live independently may be limited by physical and cognitive declines associated with ageing, including disabilities that affect mobility and self-care. This study examines the delays to accessing healthcare facilities among older adults who are frail or have disabilities, using the three-delays model. Methods A qualitative study was conducted during March and April 2022 among 21 older adults (aged 60 or above) who were frail or disabled (using assistive devices) in Bengaluru and nine key informants, consisting of geriatricians, physiotherapists, psychologists and NGO workers. Data were analysed using NVivo 12. Results Delays in accessing healthcare for older adults were attributed to multidimensional factors related to the individual (disability; lack of trust in healthcare workers; low/no income), the community and household (neglect/lack of awareness by the family; limited, inaccessible and unaffordable transport modes) and the health system (poor staffing; under-supplied healthcare facilities; waiting times at the hospital). Delays led to complications, hospitalisations and financial burdens for the older adults. The key informant interviews supported these findings. Conclusion This research highlights that it is important to overcome delays in accessing healthcare for older adults to ensure better health and wellbeing among this group. A holistic approach is needed to reach out to individuals, communities and households, and the healthcare system. Providing adequate transport services to hospitals should be planned in conjunction with the health department for timely delivery of care. Providing health insurance for older adults and improving geriatric care would be highly beneficial to improving health outcomes.

Young Adults and Allergic Rhinitis: A Population Often Overlooked but in Need of Targeted Help

Allergic Rhinitis (AR) currently affects 27% of young adults (18–24 years old) in Australia. Although the nature of AR and its management are well-researched in adult and paediatric populations, little is known about young adults. Given the biopsychosocial developmental challenges faced by young adults, this study aims to investigate young adults’ AR management and the source of its influence. A total of 185 young adults with AR in Australia completed an online survey. Seventy-eight percent were female and had a mean age of 21.9 years old. The majority (99%) had moderate to severe symptoms and affected at least one aspect of their quality of life (97%). Despite this, only 11% of participants were using appropriate medications. Parents (50%) were the most common influencer in young adults’ medication use, and general practitioners were most commonly sought for information (63%) and advice (70%). Young adults do not manage their AR with appropriate medications despite consulting healthcare providers, and this was reflected in the heavy burden reported on their quality of life. This study bridges our gap in understanding and shows that young adults lack developmentally appropriate support to equip them with the health literacy skills required to transition into adult healthcare.

Experiences with home monitoring technology in older adults with traumatic brain injury: a qualitative study

BackgroundHome monitoring systems utilising artificial intelligence hold promise for digitally enhanced healthcare in older adults. Their real-world use will depend on acceptability to the end user i.e. older adults and caregivers. We explored the experiences of adults over the age of 60 and their social and care networks with a home monitoring system installed on hospital discharge after sustaining a moderate/severe Traumatic Brain Injury (TBI), a growing public health concern.MethodsA qualitative descriptive approach was taken to explore experiential data from older adults and their caregivers as part of a feasibility study. Semi-structured interviews were conducted with 6 patients and 6 caregivers (N = 12) at 6-month study exit. Data were analysed using Framework analysis. Potential factors affecting acceptability and barriers and facilitators to the use of home monitoring in clinical care and research were examined.ResultsHome monitoring was acceptable to older adults with TBI and their caregivers. Facilitators to the use of home monitoring were perceived need for greater support after hospital discharge, the absence of sound and video recording, and the peace of mind provided to care providers. Potential barriers to adoption were reliability, lack of confidence in technology and uncertainty at how data would be acted upon to improve safety at home.ConclusionsRemote monitoring approaches are likely to be acceptable, especially if patients and caregivers see direct benefit to their care. We identified key barriers and facilitators to the use of home monitoring in older adults who had sustained TBI, which can inform the development of home monitoring for research and clinical use. For sustained use in this demographic the technology should be developed in conjunction with older adults and their social and care networks.

Insights on Poverty-based Inequality in Old-age Mortality in India

BackgroundAs the global population ages, understanding the effect of poverty on old-age mortality becomes increasingly important, especially in India, which is undergoing significant demographic and socio-economic changes. Although previous research has established a link between poverty and mortality, there is a critical need for panel studies to investigate this relationship specifically among older adults. This study addresses this gap by using panel data to examine the association between initial poverty status and subsequent mortality among older adults in India. Additionally, it explores the factors contributing to mortality disparities between poor and non-poor older adults.MethodsWe analyzed panel data from two rounds of the India Human Development Survey. The age-sex standardized old-age mortality rates for poor and non-poor older adults were calculated using direct standardization. Mortality disparities were evaluated through bivariate and proportion tests, as well as multivariable logistic regression analyses. The Fairlie decomposition technique was employed to identify factors contributing to these disparities, with sensitivity analyses performed to ensure the robustness of the findings.ResultsThe age-sex standardized old-age mortality rate for the poor was 31.9 per 100 people, with a 1.15 times higher likelihood of mortality [95% CI: (1.04,1.27)] between round-I to round-II compared to non-poor counterparts. Factors such as household wealth (33.6%), social class (17.1%), education (12%), and occupation (4.3%) were significant indicators of the poverty gap in old-age mortality. Surprisingly, chronic diseases, age, and gender negatively affect mortality disparity, while higher mortality in extended families suggests a weakening traditional support system.ConclusionThe findings underscore the importance of addressing ageist attitudes and enhancing social safety nets and affordable healthcare for older adults, who face higher risks of poverty and premature death. The elevated mortality among those in prolonged poverty cycles highlights the need for policymakers to reconsider universal support policies for older individuals. Specifically, if non-poor older adults have longer lifespans, policies centred solely on poor may not effectively address the needs of all older individuals.

Transition from paediatric to adult health care in Poland – current problems and future challenges. Analysis of issues faced by patients with inborn errors of immunity

The health care system in Poland provides treatment for patients up to 18 years of age in paediatric health care facilities, whereas adult patients are treated in specialist health care facilities for adults. A critical moment for the continuity of permanent treatment for all people with chronic disease is the transition from paediatric care to adult care. Organisational, psychological, and social problems can disrupt this process, posing the risk of health deterioration, and in extreme cases, discontinuation of therapy and premature mortality among young adults. In Poland, there is no universal, coordinated, efficient, and successful model for patient transition. This article highlights potential factors contributing to the lack of fluidity in the transition process and the associated risks. Examples of models ensuring optimal transition of a paediatric patient to adult care are also presented. It seems that creating systematic, uniform patient transfer programmes is the only way to eliminate potential threats. The crucial elements in this process are postulated to include: 1) advance planning of the transition process, 2) efficient transfer of information about the patient’s condition and treatment between paediatric and adult centres, 3) patient awareness of their new role in the decision-making process. The article focus on patients with inborn errors of immunity, highlighting the current experience and potential reasons for failures in the patient transition process.

Landscape of healthcare transition services in Canada: a multi-method environmental scan

BackgroundPoorly supported transitions from pediatric to adult healthcare can lead to negative health outcomes for youth and their families. To better understand the current landscape of healthcare transition care across Canada, the Canadian Health Hub in Transition (the “Transition Hub”, established in 2019) identified a need to: (1) describe programs and services supporting the transition from pediatric to adult healthcare across Canada; and (2) identify strengths, barriers, and gaps affecting the provision of transition services.MethodsOur project included two iterative steps: a national survey followed by a qualitative descriptive study. Service providers were recruited from the Transition Hub and invited to complete the survey and participate in the qualitative study. The survey was used to collect program information (e.g., setting, clinical population, program components), and semi-structured interviews were used to explore providers’ perspectives on strengths, barriers, and gaps in transition services. Qualitative data were analyzed using the Framework Method.ResultsFifty-one surveys were completed, describing 48 programs (22 pediatric, 19 bridging, and 7 adult) across 9 provinces. Almost half of the surveyed programs were in Ontario (44%) and most programs were based in hospital (65%) and outpatient settings (73%). There was wide variation in the ages served, with most programs focused on specific diagnostic groups. Qualitative findings from 23 interviews with service providers were organized into five topics: (1) measuring transition success; (2) program strengths; (3) barriers and gaps; (4) strategies for improvement; and (5) drivers for change.ConclusionsWhile national transition guidelines exist in Canada, there is wide variation in the way young people and their families are supported. A national strategy, backed by local leadership, is essential for instigating system change toward sustainable and universally accessible support for healthcare transition in Canada.

Mental healthcare for older adults among countries in World Psychiatric Association Zone 10

Mental healthcare for older adults among countries in World Psychiatric Association Zone 10

Context factors for implementation of clinical recommendations for chronic musculoskeletal pain.

Implementing evidence-informed clinical practice recommendations is important for managing chronic musculoskeletal pain (CMSP) to address the multidimensional impact of the condition. Successful implementation of recommendations requires understanding the multiple context factors that influence CMSP management in different settings. This study aims to explore contextual factors that could influence the implementation of evidence-informed clinical practice recommendations for the primary health care of adults with CMSP. The study focused on the primary health care (PHC) sector in Cape Town, South Africa. A qualitative descriptive study was conducted. A multidisciplinary panel of 13 local health care professionals participated in focused group discussions. The participants considered multimodal clinical recommendations derived from published clinical practice guidelines. In four focus group discussions (three or four members per group), the panel generated and documented context factors that would influence implementing the recommendations in practice. Inductive content analysis was performed to identify categories and themes. The five contextual themes generated indicated health care system organisation, human resource requirements, provider practice patterns, patient empowerment and integration into policy as imperative for the successful implementation of recommendations. There are diverse context factors that could influence the implementation of clinical recommendations for managing CMSP in PHC settings. Identifying these factors as barriers or facilitators is beneficial for developing effective knowledge translation strategies.Contribution:The study findings indicate that an integrated systems approach supported by health care policy and multisectoral collaboration is needed to successfully implement clinical recommendations to address the impact of CMSP.

Kidney diseases in adolescents classified according to nomenclature for kidney function and disease (KDIGO 2019): a cross-sectional study of the regional register 2013-2022 years

Aim. To determine the structure of kidney diseases in 17-year-old adolescents before their transition to the adult healthcare system using the 2019 KDIGO.Methods. This single-center, cross-sectional descriptive study analysed a 10-year regional register of 893 adolescents hospitalized in the V.P. Sitnikova nephrology department at Voronezh Regional Children’s Clinical Hospital between 2013 and 2022. Kidney functions assessed using the CKiDbed (2009) and CKDEPI (2009) equations. Statistical significance was defined as a p<0.05.Results. Over 70% of all hospitalizations were related attributed renal tubulo-interstitial diseases (N10- N16), congenital malformations of the urinary system (Q60-Q64), and glomerular diseases (N00-N08). The distribution of kidney conditions included CKD (36.6%), AKD without AKI (14.9%), AKD combined with CKD (8.5%), AKI (0.4%), AKI combined with CKD (1.3%), and no kidney disease. CKD was more prevalent in males (69.5%, vs 45.3% in females, p<0.001), while AKD was more common in females (38.0% vs 15.1% in males). GFR calculation discrepancies between CKiDbed and CKD-EPI equations led to changes in GFR categories and CKD/AKD stages 55.8% of adolescents, with the largest median discrepancy in males (37 ml/min/1.73 m2).Conclusions. the study classified kidney diseases in 17-year-old, revealing gender differences and highlighting the impact of varying GFR calculation methods of disease staging. The findings emphasized the need for consistent GFR assessment approaches across pediatric and young adult healthcare.

Health-related quality of life in young adults with perinatal HIV after transfer to adult health care in the Netherlands.

Health-related quality of life (HRQoL) in adult people with HIV is lower than that of the general population. Previously, no differences were detected in HRQoL of Dutch children with perinatal HIV (PHIV) compared to norm groups. In this study we compared HRQoL of PHIV young adults (PHIV-YA, aged 18-30) to two norm groups; the healthy Dutch YA population and YA with various chronic conditions. Participants received questionnaires on HRQoL, adherence and demographics. Additional social and healthcare-related variables were collected from patients' medical files. We explored correlations between HRQoL and demographic characteristics. Effect sizes (ES, Hedges' g with confidence intervals) were calculated to quantify the difference between PHIV-YA and norm groups. Of 81 participants, 53 filled out the questionnaires. Compared with the healthy Dutch YA population, PHIV-YA 18-30 had significantly lower HRQoL scores in the school/work subscale. PHIV-YA aged 26-30 had significantly lower total, physical and psychosocial HRQoL scores as well. Participants in the older age category had lower HRQoL scores throughout all subcategories as compared to the younger age group.For PHIV-YA aged 18-25 lower scores on the school/work subscale were correlated with substance use and being born outside the Netherlands. PHIV-YA had low HRQoL scores in school/work functioning compared with the healthy Dutch YA population. The circumstances driving these outcomes are likely to be multi-dimensional, including HIV infection, social background and challenges in growing up with a chronic condition.

A surgical preadmission pharmacist service in a tertiary paediatric hospital: a pilot study

AbstractBackgroundPharmacist surgical preadmission review is common in adult healthcare settings, however there is little evidence of this practice in the paediatric setting. This research describes a pilot surgical preadmission pharmacist service in a paediatric hospital.AimTo evaluate the impact of a surgical preadmission pharmacist service on patient flow and the quality of medication management.MethodA retrospective review (2 months) was conducted to compare an intervention group (1 May 2019–30 June 2019) to historical baseline (1 October 2018–30 November 2018). Children and adolescents (aged 0–18 years) presenting for elective surgery and overnight admission were included. Relevant clinical data and timestamps were extracted from the electronic medical record. Multiple linear regression models were built to examine the difference in outcomes between the control and intervention groups. This project was exempt due to the local policy requirements that constitute research by the Queensland Children's Hospital Human Research Ethics Committee (Reference no: LNR/19/QCHQ/53406). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of an established standard of clinical care and involved the use of existing collections of records that contain only non‐identifiable patient data.ResultsIn total, 135 patients were included in the baseline and 96 patients were included in the intervention group. The intervention group had statistically significant lower time to best possible medication history (BPMH) by 47.57 h (95% confidence interval [CI] −53.25 to −41.89, p < 0.001). Time to prescription of home medications was significantly reduced in the intervention group by 5.26 h (95% CI −10.45 to −0.08, p = 0.05). There was no difference in proportion of patients with home medications omitted (71–62%, p = 0.38) or requiring modification (14–12%, p = 0.58) between the two groups.ConclusionImplementation of a surgical preadmission pharmacist service in our paediatric hospital demonstrated earlier BPMH documentation and prescription of home medications, without negative effects on perioperative patient flow.

Indonesian dentists' views on providing oral health care for older adults

BackgroundWith demographic changes in aging populations, dentists require special care protocols to treat older adults with diverse and complex oral health needs and problems. Knowledge, positive attitudes, and sufficient practice experience are essential components for promptly treating older adults. However, many dentists encounter multiple barriers influencing their willingness to provide care for older adults. This study assessed Indonesian dentists' knowledge, attitudes, and practices (KAP) in providing oral health care (OHC) for older adults, including their willingness and barriers.MethodsA cross‐sectional survey was conducted with 392 dentists employing an online questionnaire between April and June 2022. The respondents' KAP was categorised utilising a modified Blooms' cut‐off point of ≥60%. Data were analysed using descriptive statistics, the x2 test, and logistic regression.ResultsMost dentists demonstrated adequate knowledge (62.2%), a positive attitude (95.4%), sufficient practice experience (91.6%), and a high willingness (98%) to provide OHC services for older adults. However, 91.4% encountered barriers primarily related to interpersonal communication, disease complexity and polypharmacy, and patient functional status. Significant associations were found between dentists' attitudes toward practices and willingness to attend geriatric dentistry training with knowledge.ConclusionImplementation of continuing professional development (CPD) in geriatric dentistry, the inclusion of geriatric dentistry into the undergraduate curriculum, and enhancing clinic accessibility for older adults may improve dentists' preparedness and benefit the future provision of OHC for older adults in Indonesia.

Inequity in the utilization of the home and community integrated healthcare and daily care services in older adults with limited mobility in China

BackgroundThis study aimed to analyze the needs and utilization of the home and community integrated healthcare and daily care services (“home and community care services” for short) among older adults in China and to investigate the inequity in services utilization.MethodsCross-sectional data were obtained from the 2018 China Health and Retirement Longitudinal Study. Needs and utilization rates of the home and community care services in older adults of 60 years old and above were analyzed. Binary logistic regression analysis was performed to explore the factors associated with services utilization among older adults with limited mobility. Concentration index, horizontal inequity index, and Theil index were used to analyze inequity in services utilization. Decomposition analyses of inequity indices were conducted to explain the contribution of different factors to the observed inequity.ResultsAbout 32.6% of older adults aged 60 years old and above had limited mobility in China in 2018, but only 18.5% of them used the home and community care services. Among the single service utilization, the highest using rate (15.5%) was from regular physical examination. Limited mobility, age group, income level, region, self-assessed health, and depression were statistically significant factors associated with utilization of any one type of the services. Concentration indices of any one type service utilization and regular physical examination utilization were both above 0.1, and the contribution of income to inequity were both over 60%. Intraregional factor contributed to about 90% inequity of utilizing any one type service, regular physical examination and onsite visit.ConclusionsThis current study showed that older adults with needs of home and community care services underused the services. Pro-rich inequities in services utilization were identified and income was the largest source of inequity. The difference of the home and community care service utilization was great among provinces but minor across regions. Policies to optimize resources allocation related to the home and community care services are needed to better satisfy the needs of older adults with limited mobility, especially in the low-income group and the central region.

The transition from children to young people living with home mechanical ventilation

ABSTRACT Purpose This study aimed to examine how young people living with Home Mechanical Ventilation experience the transition from childhood to young adulthood in relation to everyday life, perceived health and transition into adult professional healthcare. Methods Nine young adults (three females and six males aged 18–31) were interviewed, and data was primary analysed using phenomenological hermeneutics. In the actual study, data was reworked using secondary analysis as described by Beck. Two interviewees were ventilated invasively and six non-invasively, and one was treated with continuous positive airway pressure (CPAP). Results The results are presented in two main categories. First; moving towards adulthood; and second, To handle changes in health and healthcare contacts. The study highlights the importance of ongoing social relations and being part of a socializing and physically active community. The transfer from paediatric to adult healthcare was solid and worked out well but was a process in which the participants struggled to find their own voice. Conclusions The transition into adulthood is a sensitive and challenging time for young people with HMV, but stable, close relationships and a well-organized transfer can enable this group to feel safe and able to find and use their own voice.

Assessing Competencies, Needs, and Satisfaction With the Transition From Pediatric to Adult Health Care in Rheumatology: Development and Validation of the Transition-KompAZ.

J Rheumatol 2024; doi: 10.3899/jrheum.2024-0097 There were incorrect footnotes in Table 2. All instances of footnote "a" in the Possible Score Range column should be an asterisk. The correct footnote should be, "Only participants with ≤ 1 missing or * additional answer category (ie, "does not currently apply to me") per domain are included for the sum score of the corresponding scale." We apologize for this error. This correction applies only to the August 15 2024 First Release. The correct table appears in the print and online issues.

Dementia-focused programs in older adult centers and health care use among individuals with dementia.

There is growing attention to community-based services for preventing adverse health care outcomes among people aging with dementia. We explored whether the availability of dementia-centered programming within older adult centers (ie, senior centers)-specifically, adult day services (ADS), social adult day centers (SADCs), memory cafes, and caregiver support-is associated with reduced hospitalization, emergency room use, and total Medicare costs for community-dwelling individuals ages 75 and older with Alzheimer's disease and related dementias (ADRD), and whether associations differ by the relative size of the local jurisdiction. We used a novel dataset that links Medicare claims data with data from an organizational census of municipally based Massachusetts older adult centers. Living in a community with an older adult center that facilitates access to ADS and/or SADCs was associated with reduced hospital utilization and costs among residents in smaller jurisdictions. We found no evidence for associations concerning memory cafes or support groups. These findings underscore the potential of older adult centers in curbing health care costs and acute care usage among individuals with ADRD, particularly in smaller communities with centers that provide access to ADS.

Promoting successful health care transitions for young people aging out of foster care.

Improving adolescent to adult health care transitions (HCTs) would benefit all young people in the United States but has particular importance for the more than 120,000 adolescents and young adults (AYA) placed in foster care. Leveraging clinical guidelines and evidence-based interventions, HCT efforts inclusive of and specific to AYA placed in foster care can be strengthened through greater collaboration between child welfare, health care, and other AYA-serving systems. This Health Policy Brief advances the importance of structured Health Care Transition services for adolescents and young adults placed in foster care. Additionally, it highlights opportunities for health care providers, youth-serving systems, and health policy stakeholders to collaborate with child-welfare involved young people in order to prioritize evidence-based health care transition interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Bridging health self-efficacy and patient engagement with patient-centered culturally sensitive health care for Black American adults.

This study investigates whether systems-level interventions, specifically patient-centered culturally sensitive health care (PC-CSHC) from healthcare providers, office staff, and the clinic environment, moderate the relationship between health self-efficacy and patient engagement among Black American adults. An online survey was completed by 198 Black American adults. PC-CSHC from healthcare providers, office staff, and the clinic environment did not mitigate the adverse effects of low health self-efficacy on patient engagement. However, PC-CSHC from healthcare providers (b = 0.38) was as significant as health self-efficacy (b = 0.37) in predicting patient engagement, R2 = 0.47, F(9, 177) = 19.61, p < 0.001. Provider-delivered PC-CSHC can enhance patient engagement among Black American adults. This systems-level approach has the potential to reach more patients than intrapersonal interventions alone and alleviates the undue burden placed on Black Americans to leverage intrapersonal strengths in the face of health disparities rooted in structural racism.

Residential mobility for young adults in extended foster care

BackgroundPlacement stability is tied to well-being among children living in foster care, yet residential mobility remains largely unexplored for transition-age youth residing in extended foster care (EFC) between ages 18 and 21. During the time young adults in EFC can remain in foster homes, child welfare agencies offer living arrangements tailored to the transition into adulthood. In supervised independent living placements (SILPs), residents receive monthly stipends to cover their housing expenses and are responsible for covering food, utilities, and other basic needs-related costs. Transitional housing placements (THPs) offer light-touch caregiving during the transition to independence to ensure that residents have their basic needs met. ObjectiveThe current study is the first comprehensive examination of factors associated with residential mobility in a statewide population of young adults residing in EFC. ParticipantsUsing California administrative Child Protective Services records, we identified young adults who turned 18 between 2016 and 2019 and lived in care for at least 1 week (N = 10,517). MethodsNegative binomial regression evaluated the association between residential characteristics and per-year EFC moves. ResultsWe found that young adults had a median number of 1.0 moves during EFC, with a median rate of 0.67 moves per year in EFC (i.e. roughly one move every 18 months). SILPs and THPs were the most common primary residence types among the study population (41.6 % and 26.0 %, respectively). The average duration of stay in EFC was two years, which varied by primary residence type. Regression results showed that predominant residence type in EFC was associated with EFC mobility, with young adults in SILPs being more likely to experience slightly higher mobility than those primarily living in other residence types (0.82 versus 0.75 moves per year in EFC). ConclusionsFindings suggest that housing for EFC residents tends to be long-lasting and relatively stable in California. Modest variations in mobility by residential type and by experiences in foster care before age 18 underscore the importance of integrating housing and psychosocial resources during independent living planning processes. The commonality of out-of-county residence should be considered when determining housing and transportation expenses for residents, given its potential implications for access to medical and behavioral health care, academic institutions, and employment opportunities for young adults receiving EFC services.