Issues For Older People Research Articles

Falls: A momentary slip and a lifetime of consequences

Falls can cause death, disability, pain and distress. Falls are a major health issue for older people. Each year, 1.57 million older people fall more than three times and 75 000 fracture their hips. As our population ages and frailty levels increase, the rate of hip factures is predicted to double within the next 40 years (National Institute for Health and Clinical Excellence (NICE), 2011a). This article is the first in a series aiming to explore this important health issue and to enable readers to understand why older people are at risk of falls and what can be done to reduce risk factors and enable people to remain healthy and well. This article explains how ageing affects the risk of falls, how falls affect older people and how to identify those at risk of falls.

Living with Ageing and Dying – Palliative and End of Life Care for Older People

Introduction SECTION 1 - WHAT IS DIFFERENT ABOUT DYING IN OLD AGE? 1. International trends in circumstances of death and dying amongst older people 2. The care of older people at the end of life: an historical perspective 3. Anti-ageing and scientific avoidance of death 4. The challenges of health technology for ageing and dying 5. The disadvantaged dying: ageing, ageism and palliative care provision for older people in the UK 6. What do we know about the congruence between what older people prioritise at the end of life and policy and practices? SECTION 2 - WHAT CAN A PUBLIC HEALTH PERSPECTIVE BRING TO IMPROVING THE END OF LIFE EXPERIENCE FOR OLDER PEOPLE? 7. Health promoting palliative care and dying in old age 8. User and community participation at the end of life 9. Advance care planning: international perspectives 10. New public health approaches to address diversity and end-of-life issues for older people? 11. Loss and bereavement in older age: developing community-based bereavement support SECTION 3 - INVOLVING CARERS AT THE END OF LIFE 12. The changing profile of the family caregivers of older people: a European perspective 13. Needs, access and support for older carers 14. Family carers, palliative care and the end-of-life 15. Costs of family caregiving 16. Workforce development: an international perspective on who will provide care SECTION 4 - THE SIGNIFICANCE OF PLACE AT THE END OF LIFE 17. Place matters: an exploration of the role of physical environment in end of life care 18. Improving care for older people living and dying in long term care settings: a whole system approach 19. The development and implementation of evidence based palliative care guidelines for residential care: lessons for other countries 20. Improving environments for care at the end of life in hospitals SECTION 5 - MOVING FORWARD: A DEBATE ABOUT PRIORITIES FOR RESEARCH AND SERVICE DEVELOPMENT 21. End of life care for older people with dementia: Priorities for research and service development 22. Evidence, evidence and evidence: future priorities for research and service development in improving palliative care for older people 23. Priorities for research and service development in primary care to improve end-of-life for older people 24. Priorities for specialist palliative care: an Australian perspective 25. Inter-disciplinary perspectives 26. Workforce capacity issues: a New Zealand perspective

P02-265 - Discrimination of older people in Serbia

Abuse of older people is a single or a repeated act or a failure to act happening in a relationship between two persons based on trust that causes pain or disturbance on the part of the older person. Red Cross of Serbia is the initiator and the founding member of Humanas (the network of 15 civil society organisations dealing with the issues of older people) and is spearheading a campaign of sensitisation of the public in relation to discrimination, neglect and abuse of older people.Humanas has educated volunteers in Elder Abuse and Discrimination prevention.A survey has been done in 8 cities in Serbia polling 250 older people of both sexes, age 65 or above. The survey results demonstrate that 44% of all the polled people are familiar with the existence of abuse. Alarmingly, as high as 32% of older people have been exposed to some form of abuse, with the most frequent form being verbal abuse (11.2%) The polled older people have stressed that they hate being called names, made fun of and called stupid or illiterate, within their families as well as in the general community. As for prevention, 52% of the polled older people think that ‘everybody’, meaning both public and civil sector should play a role in prevention.ConclusionThe problem of abuse of older people has to be approached from a multi-sector and multi-disciplinary perspective. The emphasis should be on new, deeper surveys, education of professionals, family members and other care takers.

Health and quality of life among older rural people in Purworejo District, Indonesia

Introduction: Increasing life expectancy and longevity for people in many highly populated low- and middle-income countries has led to an increase in the number of older people. The population aged 60 years and over in Indonesia is projected to increase from 8.4% in 2005 to 25% in 2050. Understanding the determinants of healthy ageing is essential in targeting health-promotion programmes for older people in Indonesia.Objective: To describe patterns of socio-economic and demographic factors associated with health status, and to identify any spatial clustering of poor health among older people in Indonesia.Methods: In 2007, the WHO Study on global AGEing and adult health (SAGE) was conducted among 14,958 people aged 50 years and over in Purworejo District, Central Java, Indonesia. Three outcome measures were used in this analysis: self-reported quality of life (QoL), self-reported functioning and disability, and overall health score calculated from self-reported health over eight health domains. The factors associated with each health outcome were identified using multivariable logistic regression. Purely spatial analysis using Poisson regression was conducted to identify clusters of households with poor health outcomes.Results: Women, older age groups, people not in any marital relationship and low educational and socio-economic levels were associated with poor health outcomes, regardless of the health indices used. Older people with low educational and socio-economic status (SES) had 3.4 times higher odds of being in the worst QoL quintile (OR=3.35; 95% CI=2.73–4.11) as compared to people with high education and high SES. This disadvantaged group also had higher odds of being in the worst functioning and most disabled quintile (OR=1.67; 95% CI=1.35–2.06) and the lowest overall health score quintile (OR=1.66; 95% CI=1.36–2.03). Poor health and QoL are not randomly distributed among the population over 50 years old in Purworejo District, Indonesia. Spatial analysis showed that clusters of households with at least one member being in the worst quintiles of QoL, functioning and health score intersected in the central part of Purworejo District, which is a semi-urban area with more developed economic activities compared with other areas in the district.Conclusion: Being female, old, unmarried and having low educational and socio-economic levels were significantly associated with poor self-reported QoL, health status and disability among older people in Purworejo District. This study showed the existence of geographical pockets of vulnerable older people in Purworejo District, and emphasized the need to take immediate action to address issues of older people's health and QoL.Access the supplementary material to this article: INDEPTH WHO-SAGE questionnaire (including variants of vignettes), a data dictionary and a password-protected dataset (see Supplementary files under Reading Tools online). To obtain a password for the dataset, please send a request with ‘‘SAGE data’’ as its subject, detailing how you propose to use the data, to global.health@epiph.umu.se

Managing Behavior and Emotional Issues in Older People

Managing Behavior and Emotional Issues in Older People

Age, Ethnicity and Equalities: Synthesising Policy and Practice Messages from Two Recent Studies of Elder Abuse in the UK

Two recent studies of elder abuse in the UK are located in current policy contexts of adult safeguarding. After describing the studies, the discussion draws out their central messages and identifies the challenges that the studies present to recent policy debates and innovations. These relate to the need to properly integrate both wider older people's issues and issues of racism and ethnicity within developments in adult safeguarding policy as well as social care services as the personalisation agenda advances.

Le dinamiche del reddito nella terza etŕ

- Later life can be seen as period of income stability compared to other stages of the life course, and a key issue for older people in low income households is that they have limited means of pro-actively improving their financial situation. This article draws on a qualitative longitudinal study which explored how older people experienced changes in their financial circumstances across a two year period. The findings demonstrate that even where people did not feel that their financial circumstances had changed overall, this did not necessarily indicate a steady state. The study explored the interrelationship between changes in income and outgoings, as well as changing needs, and this article provides an insight into how social and personal resources are drawn on to help manage financial change and maintain stability. In doing so, it illustrates the extent of work that can be involved in maintaining a steady state in constrained circumstances.

Mental capacity assessments among general hospital inpatients referred to a specialist liaison psychiatry service for older people

Mental capacity has been little studied among older general hospital inpatients. A retrospective analysis was undertaken of routinely collected data (age, gender, ethnicity, admission diagnosis, psychiatric diagnosis, Mini-mental State Examination score, whether capacity was assessed, the outcome of that assessment, and discharge destination) on referrals to a liaison psychiatry service for older people (2003-2006) from medical and surgical teams at a large London teaching hospital. 1267 patients were referred to the service, of whom 379 (30%) were assessed for capacity. The most common mental capacity issues were placement (303 assessed of whom 54% lacked capacity), treatment (86 assessed, 59% lacking capacity) and finances (70 assessed, 79% lacking capacity). Cognitive impairment, dementia and delirium, rather than mental disorders were associated with incapacity. Those assessed and deemed to lack capacity for placement decisions were twice as likely to be placed in a care home, and four times as likely to be placed in an elderly mentally ill (EMI) facility, independent of dementia diagnosis and cognitive functioning. Referrals to a liaison psychiatry service for older people for assessment of mental capacity are common. The main mental capacity issues in older people were those linked to discharge planning. The relatively high proportion of those found to have capacity when capacity had been queried by referring clinicians attests to the important role of specialist liaison teams, particularly in complex cases, in protecting the autonomy of vulnerable older people, and avoiding institutionalization.

Falls part 1: causes and consequences

Falls are a major health issue for older people. Each year 1.57million older people fall more than three times and 70000 fracture their hips. Falls can lead to disability and even death. The National Service Framework for Older People identified falls prevention as a major health priority. This article is the first in a series which will be of particular interest to healthcare assistants studying for NVQ level three or assistant practitioner qualifications. It explains how ageing affects the risk of falls, how falls affect older people and how to identify those at risk of falls.

Falls After Stroke

Falls are an important issue in older people. We aimed to determine the incidence, circumstances, and predictors of falls in patients with recent acute stroke. The Auckland Regional Community Stroke (ARCOS) study was a prospective population-based stroke incidence study conducted in Auckland, New Zealand (NZ) during 2002 to 2003. Among 6-month survivors, the location and consequences of any falls were ascertained by self-report as part of a structured interview. Multivariable logistic regression was used to establish associations between risk factors and "any" and "injurious" falls. Of 1104 stroke survivors who completed an interview, 407 (37%) reported at least 1 fall, 151 (37% of fallers, 14% of stroke survivors) sustained an injury that required medical treatment, and 31 (8% of fallers, 3% of stroke survivors) sustained a fracture. The majority of falls occurred indoors at home. Independent factors associated with falls were depressive symptoms, disability, previous falls, and older age. For injurious falls, the positively associated factors were female sex and NZ/European ethnicity and dependence before the stroke, whereas higher levels of activity and normal cognition were negatively associated factors. Falls are common after stroke, and their predictive factors are similar to those for older people in general. Falls prevention programs require implementation in stroke services.

Knowledge and attitudes of doctors toward the sexuality of older people in Turkey

Few studies have looked at healthcare professionals' knowledge of and attitudes to later life sexuality in both Western and Eastern cultures. Here we examine the attitudes and knowledge of Turkish medical doctors toward sexuality in older people. Eighty-seven doctors, from various specialties, who were directly involved in the care of older people, were contacted by post and asked to complete the Turkish version of the Aging Sexual Knowledge and Attitudes Scale (ASKAS). A majority of physicians indicated that they had limited information and knowledge regarding sexual health issues in older people (69%). Although a small percentage (14.5%) reported that they "always" discuss sexuality and sexual problems with older patients, the majority (69%) indicated that they "sometimes" raise questions about sexuality with these patients. A high percentage (81%) stated that they would be helpful and receptive should an elderly patient initiate a discussion about sexual issues. Most participants (77%) thought that the patient's gender was of no importance when taking a sexual history. Overall, the responses to ASKAS showed that physicians had limited knowledge but their attitude was positive toward sexuality in the elderly. Female physicians had less knowledge than males and had more negative attitudes toward sexuality in this age group. Total and knowledge subscale scores of ASKAS showed that older physicians had more knowledge than younger physicians but similar attitudes. A comparison of the knowledge and attitude scores of psychiatrists, surgeons and non-surgeons showed no significant difference among the three groups. This study identified a low level of awareness of later life sexuality among Turkish medical doctors. These findings identify a need to improve the education and training of doctors at both undergraduate and postgraduate levels to enable them to provide better sexual health care to older people.

Mind your step! A falls prevention programme designed to reduce falls in those over 75 years

Falls among older people cause significant mortality and morbidity, thus presenting a serious issue for older people and health and social care professionals alike. The simple occurrence of a fall conceals the range of physical, psychological, social and environmental factors, which can contribute to this event. Research advocates that professionals should engage with health promotion and develop individualised preventions in order to minimise risk of falling. In this study, a multi‐disciplinary, falls prevention initiative was developed with older people who had recently fallen. The initiative started with a common assessment but was followed by a variable, individualised programme of different interventions. The older people involved were assessed pre‐ and post‐intervention, using a questionnaire checklist, on several different dimensions associated with falling. Outcomes were assessed in terms of reduction in risk and the incidence of falls, both of which were found to be statistically significant in several of the identified dimensions post‐intervention. Consequently, it could be estimated that approximately 44 falls were prevented through this nine‐month initiative. This study would support the integration of this falls prevention initiative into routine community care practice through the existing over‐75 health check and the development of a specialised falls team. Further research would be beneficial to follow up whether the reduction in the incidence of falling is sustained over time. Enhanced participation of user, carer, voluntary and community partners is recommended as this would allow older people themselves to play an active role in improving their own well‐being and that of others.

Falls prevention in practice: guidance and case study

Falls are a major health issue for older people. Each year 1.57 million older people fall more than three times and 70,000 fracture their hips, and injury which frequently leads to disability and even death. The National Service framework for Older People identified falls prevention as a major health priority. This article explains how a community based falls service led by a nurse and physiotherapist identified falls risk factors affecting a housebound 97-year-old lady. Factors identified and treated were poor balance and strength, osteoarthritis of the knees and thumbs, inadequate pain control, uncorrected poor vision, oedema of the legs and feet, unsuitable footwear and an unsuitable walking aid. As a result of the interventions falls risk was reduced and quality of life improved.

Ask the experts

Ask the experts is a forum in which consultant nurses working with older people debate an issue in older people’s care and offer advice. This month, Soline Jerram, consultant nurse: older people and intermediate care, from Windsor, Ascot and Maidenhead PCT, poses questions brought to her by intermediate care staff and informal carers

Knowledge and interest in ageing: a study of final‐year social work students

Objective: To evaluate social work students’ knowledge of older people's issues and their interest in working with older people in the future. Method: Fifty‐five final‐year students completed a questionnaire, including a knowledge/myths instrument and an interest scale. Independent variables included students’ prior contact with older people and exposure to a course on ageing. Results: Students achieved an average 70.4% success rate on the knowledge/myths instrument; no student got all answers correct. Interest levels were moderate with an average score of 5.13 on a 10‐point scale. Prior participation in ageing courses was positively correlated with knowledge of older people's issues and interest in working with older people. Conclusions: Correlations between course attendance and students’ knowledge and interest are in line with international findings. Such courses should challenge common myths associated with ageing and should promote social work with older people as skilled practice within complex health, welfare and family systems.

Food insecurity in community-dwelling older Australians

To identify the extent of food insecurity (defined as running out of food in the last 12 months and being unable to afford to buy more) amongst older Australians, and the characteristics of those who experience this condition. Cross-sectional population survey. Respondents (n = 8,881) were community-dwelling older people (65 years and older) living independently in New South Wales, Australia, randomly sampled to participate in a computer-assisted telephone interview conducted during 1999-2000. The response rate was 71%. Responses to a food insecurity questionnaire item were collected along with sociodemographic information, living arrangements, lifestyle and self-rated health. Univariate analyses and logistic regression modelling of factors for reporting food insecurity were conducted. Approximately one in 50 older people reported experiencing food insecurity in the previous 12 months attributable to inadequate finances. The analyses revealed that those at risk can be identified as more likely to report poorer health, limited financial resources, not owning their own home and living alone. Gender and age differences were also evident. While only a minority of older Australians reported experiencing food insecurity attributable to inadequate finances, such people are at higher risk of malnutrition and associated morbidity. Food insecurity is an important public health and equity issue in older people that can be addressed through implementing appropriate income and social support policies.

Poverty and Hardship among the Aged in Urban China

Abstract China's record in reducing poverty over the last three decades has been impressive, yet few studies have examined the incidence of poverty among older people despite the rapid ageing of the population. This article uses a unique national data set to examine patterns of poverty, deprivation and exclusion among the urban aged population (60 years and over) in 2000. The results point to the importance of poverty as an issue for older people, particularly for women and those who live alone. A number of indicators of hardship are developed in four areas – economic insecurity, housing, health, and social isolation – and the incidence of these is examined, separately and in combination, by living arrangement and gender. Women are shown to experience greater levels of hardship and isolation than men, and to be more likely to experience multiple deprivation across two or more areas. Finally, the overlap between poverty and hardship is examined as a way of validating the poverty estimates and giving them greater credibility. The results indicate that there are strong overlaps, although these differ across the different dimensions of hardship. Access to pension income and concern over the cost of necessary visits to see a doctor emerge as strong predictors of poverty and point to areas where policy change is needed.

Ask the experts Spirituality in care

Ask the Experts is a forum in which nurse consultants working with older people debate an issue in older people’s care and offer advice. This month they consider a question posed by Frances Grant

Ask the experts Non-medical prescribing

Ask the Experts is a forum in which nurse consultants working with older people debate an issue in older people’s care and offer advice. This month they consider a question posed by Wendy Barker

Ask the experts

Ask the Experts is a forum in which nurse consultants working with older people debate an issue in older people’s care and offer advice. This month they consider a question from Lynne Phair about assistive technology