Services For Older Adults Research Articles

EHealth in Care Coordination for Older Adults Living at Home: Scoping Review.

The population of older adults is projected to increase, potentially resulting in more older adults living with chronic illnesses or multimorbidity. Living with chronic illnesses increases the need for coordinated health care services. Older adults want to manage their illnesses themselves, and many are positive about using eHealth for care coordination (CC). CC can help older adults navigate the health care system and improve information sharing. This study aimed to map the research literature on eHealth used in CC for older adults living at home. This study assessed CC activities, outcomes, and factors influencing the use of eHealth in CC reported by older adults and health care professionals. We used a scoping review methodology. We searched four databases-MEDLINE, CINAHL, Academic Scoping Premier, and Scopus-from 2009 to 2021 for research articles. We screened 630 records using the inclusion criteria (older adults aged >65 years, primary health care setting, description of an eHealth program or intervention or measure or experiences with the use of eHealth, and inclusion of CC or relevant activities as described in the Care Coordination Atlas). The analysis of the included articles consisted of both a descriptive and thematic analysis. A total of 16 studies were included in this scoping review. Of these 16 studies, 12 (75%) had a quantitative design, and the samples of the included studies varied in size. The categories of eHealth used for CC among older adults living at home were electronic health records and patient portals, telehealth monitoring solutions, and telephone only. The CC activity communication was evident in all studies (16/16, 100%). The results on patient- and system-level outcomes were mixed; however, most studies (7/16, 44%) reported improved mental and physical health and reduced rehospitalization and hospital admission rates. Observing changes in patients' health was a facilitator for health care professionals using eHealth in CC. When using eHealth in CC, available support to the patient, personal continuity, and a sense of security and safety were facilitators for older adults. Individual characteristics and lack of experience, confidence, and knowledge were barriers to older adults' use of eHealth. Health care professionals reported barriers such as increased workload and hampered communication. We mapped the research literature on eHealth-enabled CC for older adults living at home. We did not map the gray literature as we aimed to map the research literature (peer-reviewed research articles published in academic journals). The study results showed that using eHealth to coordinate care for older adults who live at home is promising. To ensure the successful use of eHealth in CC, we recommend customized eHealth-enabled health care services for older adults, including individualized education and support.

An evaluation of community care services for the elderly in Hong Kong

PurposeThis article analyses community care services (CCS) in terms of availability, awareness, accessibility, and acceptance (the Four A’s approach), untangles the deep-seated factors underlying the CCS and provides some short-term, medium-term, and long-term recommendations.Design/methodology/approachA literature review was conducted, including relevant government reports, consultation papers, Legislative Council papers and articles from academic journals from 1980 to the present.FindingsThe Four A’s approach shows that applicants to both centre-based services and home-based services endure lengthy waiting times because of the limited number of CCS. Furthermore, the awareness of day respite services is approximately 50 percent, which lags behind other CCS. Accessibility is contingent on a cross-district day respite service system and a lack of consistency between the quota and the proportion of older adults in the districts. Finally, the level of service provided by CCS is unsatisfactory due to inflexible service provision. Reviewing the brief history of long-term care services (LTC) reveals the deep-seated factors at the core of their heavy reliance on the subvention model, in contrast to the adoption of the ‘mixed economy of care’ by residential care services (RCS). An imbalance in budget allocation to RCS and CCS is also revealed.Originality/valueAlthough the principle of ‘ageing in place’ was introduced in 1977, the institutionalisation rate (6.8 percent) of older adults remains unexpectedly high in Hong Kong, even surpassing its Asian counterparts, whereas the usage rate of CCS hovers around 0.8 percent. Thus, how to implement policy concerning LTC services for older adults must be re-evaluated.

Improving Older Adult Health by Operationalizing State Plans on Aging and Health Improvement.

The COVID-19 pandemic, a growing aging population, and inconsistent equity in aging have prompted more public health departments and agencies that focus on older adult services to establish partnerships to improve older adult health. To develop a model for strengthening and better aligning public health-aging partnerships, the Association of State and Territorial Health Officials (ASTHO) and Trust for America's Health engaged the Georgia Division of Aging Services (DAS) and Georgia Department of Public Health (DPH) to participate in a pilot project. ASTHO conducted an intensive qualitative analysis of Georgia's State Health Improvement Plan and State Plan on Aging to systematically assess shared priorities and differences. Through facilitated discussions about the results, prioritization, and planning, DAS and DPH developed an action plan with 2 priority areas to collaborate on and further their partnership. This process can be replicated by other jurisdictions seeking to enhance public health-aging collaboration.

Factors influencing implementation of assistive technology services for older adults from the perspectives of Thai occupational therapists: a mixed methods study

Purpose Occupational therapists are crucial in providing assistive technology (AT) services for older adults. However, evidence has shown limited provision of such services in Thailand. This study aimed to investigate the factors that influence the implementation of AT services for older adults from the perspectives of Thai occupational therapists. Methods An explanatory sequential mixed-methods design was guided by the measurement instrument for determinants of innovations and literature review. This study was conducted in two phases: quantitative and qualitative. During the quantitative phase, an adapted version of the Measurement Instrument for Determinants of Innovations was administered to 96 occupational therapists (OTs). A subsample of 5 OTs completed a semi-structured interview during the qualitative phase to explain the findings in the quantitative one. Results Factors were categorized into three sections: personal, organizational and socio-political context levels. At the personal level, integrating knowledge and experience could contribute to awareness and professional competency. Client satisfaction influenced OTs to utilize AT, based on a client centred manner. With coordinator and performance feedback within the organization, OTs indicated that consultants supported them in their decision-making. In contrast, availability of AT for older adults is determined by time and resources. Moreover, at the socio-political context level, legislation and regulations may permit or prohibit accessibility of assistive devices. Conclusion In order to address current challenges, education or training programmes are needed to increase the awareness and competence of OTs. In addition, collaboration with other professionals in community settings is necessary to improve access to AT services. IMPLICATIONS FOR REHABILITATION AT service for older adults is limited by the availability of time and resources. To handle with these challenges, occupational therapists could advocate for village health volunteers to be a part of the AT services for older adults in the community to increase AT accessibility for older adults. Additional education or training programs should be developed to build competencies and increase occupational therapists’ awareness of providing AT services to older adults, as well as to strengthen their roles in AT services. Future research and health policies should focus on access to sufficient funding, and resources for occupational therapists relative to their role in implementing AT services.

Factors associated with access to healthcare services for older adults with limited activities of daily living.

BackgroundLimited studies focused on the situation and related factors of access to healthcare services for older adults with limited activities of daily living (ADL) in China. This study explores factors associated with access to healthcare services of them based on Andersen's healthcare utilization model (namely, need, predisposing, and enabling dimensions).MethodsA total of 3,980 participants aged 65 years and older adults with limited ADL from the latest wave (2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Binary logistic regression was used to explore the influencing factors.ResultsFactors in enabling dimension were associated with access to healthcare services for older adults with limited ADL. Those who lived with better economic status (fair vs poor, OR = 2.98, P < 0.01; rich vs poor, OR = 7.23, P = 0.01), could afford daily life (yes vs no, OR = 2.33, P = 0.03), and lived in the eastern or central region of China (eastern vs western, OR = 2.91, P < 0.01; central vs western, OR = 2.40, P = 0.02) could access to healthcare services more easily. However, factors in predisposing dimension and need dimension showed no statistical significance. Meanwhile, inconvenience in the movement was the major barrier reported by some participants for not going to the hospital when they got sick.ConclusionAccess to healthcare services for older adults with ADL limitation was mainly related to the factors of economic status, affordability for daily life, and living regions in enabling dimension. Strategies focused on health insurance, healthcare system, barrier-free facilities, and social support were proposed to increase the access to healthcare services for participants, which could benefit their health.

Challenges and Visions for the Future Among Paratransit Providers.

The present study examined paratransit managers' perceptions of a changing transportation market and the resources or supports they might need to adapt to evolving market expectations. Paratransit comprises specialized origin-to-destination transportation, often targeting a transportation-disadvantaged population such as people with disabilities or older adults. Paratransit is often provided by a transit agency, a nongovernmental contractor to the transit agency, or other federally-funded entity. The emergence of transportation network companies (TNCs), which connect drivers with passengers in real-time via online-enabled platforms (e.g., Uber and Lyft), has changed the landscape of demand-responsive transportation, including paratransit. However, the experiences of those close to the operations of paratransit programs have been largely neglected in research on mobility developments. In-depth, semistructured interviews were conducted with 16 managers of paratransit services. The resulting transcripts were coded iteratively with NVivo software, using both inductive and deductive approaches to generate themes. Resulting themes included challenges with insufficient funding, severe driver shortages, and regulatory/policy obstacles, as well as hopes for expansion and modernization of paratransit services. This study's findings advance the literature toward policy and practice solutions that could improve paratransit services for older adults and other transportation-disadvantaged groups.

Social Factors Contributing to Healthcare Service Requirements during the First COVID-19 Lockdown among Older Adults.

This study examined social characteristics and their relations to healthcare service demand among older adults during the first COVID-19 lockdown in 2020. The sample was based on a cohort of 103,955 adults over the age of 65. A general index of needs was composed based on healthcare service use data and was predicted in a multi-nominal logistic regression. The frequency of the total needs significantly (p < 0.000) declined while supportive community services (4.9%, 2.0%), living in a community framework (27.0%, 15.2%), and living in a private residence (29.7%, 20.1%) were significantly associated (p < 0.000) with less frequent needs compared to the complementary groups. Supportive communities turned out to be an extremely important service for older adults. Policy makers should consider expanding supportive community services for older adults, as it was shown to have a positive correlation with lower healthcare service use, which might be an indicator of better overall health.

Older adult Medicaid home and community based services in the American rescue plan: A window of opportunity for nursing

As reported in numerous studies, older adults report the desire to remain at home, expressing their preference to “age in place” and avoid institutionalization. As nurses, we recognize the challenges of attaining this goal given the lack of insurance coverage for routine chronic care at home, shortages of providers, and many older adults’ inability to self-pay for services that would enable them to remain in the community. Recent federal Medicaid policy provides states with funding to address these and other barriers to home-based services for older adults.

Comparison of community health nurses' preventive home visits to older adults in Sweden and Slovenia:

Introduction: Community health nurses contribute significantly to better health, well-being and independence of older adults. The aim of the study is to compare preventive services for older adults in community health care between Sweden and Slovenia.Methods: Literature review and document analysis were used to conduct a qualitative comparative analysis. Literature was retrieved from the MEDLINE, CINAHL and COBIB databases. An analysis of documents such as sectoral legal bases, guidelines and expert recommendations in Slovenia and Sweden was also conducted. The analysis included sources related to preventive services for older adults living at home published between January 2000 and December 2020 in Slovene, English or Swedish.Results: Twenty units of literature were included in the review. Four comparative factors were identified: system and legal basis, organisation and scope, providers, and content. In Slovenia, all older adults are entitled to the same range of preventive services. Compared to Sweden, the organisation of community health care in Slovenia is more centralised, all older adults are entitled to the same scope of preventive health visits, while the level of education and scope of competences of healthcare providers are lower. In both countries, the content of preventive home visits to older adults is similar.Discussion and conclusion: In Slovenia, community health nurses with additional knowledge could prescribe medical devices and medications form a limited list, as well as coordinate care. This would allow them to act more independently in patients' home environment. Further development of more personalised preventive services for older adults depends on research, resource provision and consideration of the organisational culture.

Paid Care Services and Transitioning out of the Community Among Black and White Older Adults With Dementia.

Paid care provided in the home includes important support services for older adults with dementia such as cleaning and personal care assistance. By reducing unmet needs, these services could delay the transition to residential long-term care, but access may differ across racial groups. This study examined the relationship between paid care and transitioning out of the community among Black and White older adults with dementia. Using data from 303 participants (29.4% Black) with probable dementia in the 2011 National Health and Aging Trends Study, competing risk hazards models estimated the association between receiving paid care at baseline and the probability of transitioning out of the community over 8 years (through 2019). Covariate selection was guided by the Andersen model of health care utilization. Paid care was associated with lower risk of transitioning out of the community (subhazard ratios [SHR] = 0.70, 95% CI [0.50, 0.98]). This effect was similar after controlling for predisposing factors and most prominent after controlling for enabling and need for services factors (SHR = 0.65, 95% CI [0.44, 0.95]). There was no racial difference in the use of paid care despite evidence of greater care needs in Blacks. Furthermore, Black participants were less likely to transition out of the community than Whites. Paid care services may help delay transitions out of the community. Future research should seek to explain racial differences in access to and/or preferences for home-based, community-based, and residential care.

Informal carers' support needs, facilitators and barriers in the transitional care of older adults: A qualitative study.

Inclusion of informal carers in transitional care is challenging because of fast throughput and service fragmentation. This study aimed to understand informal carers' needs during the care transitions of older adults from inpatient care to the community. A qualitative exploratory design was used with mixed-methods data collection. Seventeen semi-structured telephone interviews were conducted with family carers; one focus group was conducted by videoconference with two family carers and three community-based advocacy and aged care providers; and eight semi-structured telephone interviews were undertaken with healthcare practitioners from rehabilitation services. Data were thematically analysed. All carers described the main social challenge that they needed to address in transitional care as 'Needing to sustain family'. Carers reported their social needs across five solutions: 'Partnering with carers', 'Advocating for discharge', 'Accessing streamlined multidisciplinary care', 'Knowing how to care' and 'Accessing follow-up care in the community'. Focus group participants endorsed the findings from the carer interviews and added the theme 'Putting responsibility back onto carers'. All healthcare practitioners described the main social challenge that they needed to address as 'Needing to engage carers'. They reported their social solutions in three themes: 'Communicating with carers', 'Planning with carers' and 'Educating carers'. Findings highlight the importance of reconstructing the meaning of transitional care and relevant outcomes to be inclusive of carers' experiences and their focus on sustaining family. Transitional care that includes carers should commence at the time of hospital admission of the older adult. Future sustainable and high-quality health services for older adults will require transitional care that includes carers and older adults and efficient use of inpatient and community care resources. Healthcare professionals will require education and skills in the provision of transitional care that includes carers. To meet carers' support needs, models of transitional care inclusive of carers and older adults should be developed, implemented and evaluated. This study was conducted with the guidance of a Carer Advisory Group comprising informal carers with experience of care transitions of older adults they support and community-based organizations providing care and advocacy support to informal carers.

Needs Analysis for Non-Face-to-Face Services among Older Adults to Reduce Loneliness.

Background: Considering older adults’ interests and physical abilities, non-face-to-face services precipitated positive acceptance and reduced loneliness. Developing non-face-to-face services designed after investigating older adults’ needs is necessary. Research question: What is the need for non-face-to-face services to reduce loneliness among older adults in the community? Methods: A questionnaire was developed through a content validity evaluation of a group of experts based on a prior systematic review. The survey was administered to 100 community-dwelling older adults between 15 July and 31 August 2021. The need for non-face-to-face services for older adults was analyzed. Results: This study found that non-face-to-face services precipitate positive perceptions and satisfy the needs of older adults in the community. Additionally, the older adults preferred integrated content from non-face-to-face services. Through the analysis of preference differences according to the general characteristics, this study shows the possibility of inducing participation by developing content that attracts older adults’ attention. Conclusion: This study is expected to provide basic data for content development of non-face-to-face services to reduce loneliness among older adults in the community by investigating their needs.

‘Can't always get what you want’: Allocation of community-based services for older adults

BackgroundWhen older adults seek support through formal community-based services, they or their family caregivers have determined a need for assistance with ongoing functional needs. Eligibility for long-term services and supports is often based on clinically evaluated need determined by a professional clinical health assessment. MethodsUsing state agency data, we explored the relationship between clinically evaluated functional needs and the likelihood of receiving services to address specific needs among 1322 adults aged 60+ requesting assistance through Virginia's Area Agencies on Aging in 2014–2015. ResultsMost older adults (77.4%) received at least one service. Older adults who received at least one service tended to have fewer personal activities of daily living needs [t(1298)=2.716, p = 0.007] and instrumental activities of daily living needs [t(1298)=2.900, p = 0.004)] than older adults who did not receive any services. Few clinically evaluated functional needs were significantly associated with the older adults receiving services explicitly aligned with their limitations. ConclusionsFindings raise questions about service allocation and alignment of needs. A large body of research documents how receiving insufficient help is associated with adverse health consequences; it is a serious public health concern for older adults. We recommend aging services organizations assess their approach to service allocation to ensure evaluated need better aligns with service receipt.

Rural-Urban Differences in the Associations Between Aging and Disability Services and COVID-19 Vaccination Rates Among Older Adults.

Aging services were poised to play an important role in supporting the COVID-19 vaccination rollout for older adults. In this study, we use ordinary least squares regression models of county-level data (N = 3086) to examine if density of aging and disability services is associated with COVID-19 vaccination rates for older adults in rural and urban areas of the United States. We find that net of compositional characteristics, county-level density of aging and disability services is associated with higher older adult vaccination rates. However, in the rural-urban stratified models, this only remained consistently true for rural counties. Given higher risk of COVID-19 mortality for older adults and larger relative shares of older adults in rural areas, rural counties with low vaccination rates should invest in supporting and/or expanding older adult services to facilitate vaccination.

Emergency provider perspectives on facilitators and barriers to home and community services for older adults with serious life limiting illness: A qualitative study.

BackgroundOlder adults account for a large proportion of emergency department visits, but those with serious life-limiting illness may benefit most from referral to home and community services instead of hospitalization. We aim to document emergency provider perspectives on facilitators and barriers to accessing home and community services for older adults with serious life-limiting illness.MethodsWe conducted interviewer-administered semi-structured interviews with emergency providers from health systems across the United States to obtain provider perspectives on facilitators and barriers to accessing home and community services. We completed qualitative thematic analysis using an iterative process to develop themes and subthemes to summarize provider responses.ResultsWe interviewed 8 emergency nurses and 10 emergency physicians across 11 health systems. Emergency providers were familiar with local home and community services. Facilitators to accessing these services include care management and social workers. Barriers include services that are not accessible full-time to receive referrals, insurance/payment, and the busy nature of the emergency department. The most helpful reported services were hospice, physical therapy, occupational therapy, and visiting nursing services. Home-based palliative care and full-time emergency department-based care management and social work were the services most desired by providers. Providers expressed support for improving access to home and community services in the hopes of decreasing unnecessary emergency visits and inpatient admissions, and to provide patients with greater options for supportive care.ConclusionObtaining the perspective of emergency providers highlights important considerations to accessing HCS for older-adults with serious life-limiting illness from the emergency department. This study provides foundational information for futures studies and initiatives for improving access to home and community services directly from the emergency department.

Predictors of the need for post-discharge transitional care services in older adults: A cross-sectional analysis

Chronic diseases in the growing elderly population lead to repeated hospitalizations and consequent deterioration of older adults' health, highlighting the importance of appropriate post-discharge patient care services during the care transition period from the hospital to their homes or a nursing facility. This study aimed to investigate older adults’ need for transitional care services (TCS) and identify the associated factors. A 1:1 phone survey was conducted on 300 older adults aged ≥65 years who resided in Gangwon Province, Republic of Korea. To identify predictors of older adults’ need for TCS, personal factors (sex, age, education level, residence, economic status), disease-related factors (self-rated health status, noncommunicable diseases and chronic conditions, hospitalization within the last 2 years), and care-related factors (spending time alone during daytime, need assessment of activities of daily living (ADLs), cohabitations) were examined, and the data were analyzed using descriptive statistics and multiple regression analysis. The results indicated that older adults exhibited a high need for TCS, with the greatest need being “information and training on self-management of health after discharge,” “information on social welfare (life support) services available near the patient’s living area,” and “description of the diagnosis, current condition, treatment plan, and outcome at the time of admission.” Additionally, the most common post-discharge difficulties experienced by older adults who had been hospitalized over the last 2 years were “physical discomfort” (3.7) and “psychological discomfort” (3.0). Hierarchical regression analysis revealed that noncommunicable diseases and chronic conditions (among disease-related factors) and need assessment of ADLs (among care-related factors) were identified as predictors of the need for TCS (β=0.206, p&lt;0.001 and β=-0.171, p&lt;0.01, respectively). Based on these results, we proposed the necessity to provide post-discharge TCS for elderly patients, especially older adults with multiple chronic diseases or those with poor ADLs, who should be prioritized for these services.&#x0D;

Supporting physical activity in an ageing world: a call for action

Supporting physical activity in an ageing world: a call for action

Substance use treatment services for older adults in five states in the Southern United States: a state-by-state comparison of available treatment services

Objectives: Substance use disorders (SUD) among older adults have become a serious public health concern. The purpose of this study was to assess which states in the Southern U.S. are more responsive to SUD treatment needs of older adults.Methods: This study is a secondary data analysis of the N-SSATS-2019 dataset.Results: There were 1,215 substance treatment facilities in the five states. Kentucky had the highest number of substance use treatment facilities (n = 449, 37%), followed by Georgia (357, 29%), Alabama (153, 13%), Louisiana (146, 12%) and then Mississippi (110, 9%). Out of the 1,215 facilities, only 20% (n = 244) indicated that they had programs specifically tailored for older adults. Kentucky had the largest number of facilities per 1 million older adults while Mississippi had the highest number of facilities per 1 million older adults offering detoxification services. Alabama had the lowest number of services per 1 million adults in all categories examined.Conclusion: Across the U.S., most adults with SUD do not have access to substance use treatment; in the southeastern region of the country, higher rates of poverty, rural geography and stigma, and lack of treatment availability may further complicate individuals’ ability to access substance use-related medical care.

Introducing New Paths towards Public Primary Healthcare Services in Greece: Efforts for Scaling-Up Mental Healthcare Services Addressed to Older Adults.

The exponential growth in the aging population challenges the Primary Care Providers (PCPs) who provide health care services to older adults who are considered highly vulnerable and are in need of specialized healthcare services. The development of new policies and the adoption of appropriate health strategies by PCPs may improve the early detection and prevention of mental disorders in older adults. This reduces both queuing and costs in outpatient clinics while preventing stigma for patients and families. To this end, specialized training for PCPs at the Local Primary Health Care Unit (LPHCU) was provided in order to conduct efficient assessments of older adults (65 and above years old, without previously diagnosed depression or dementia, and willing to participate). The assessment is based on the Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS). Older adults identified with MMSE <20 and GDS >5 were referred to the psychiatric outpatient clinic. The aim of this study is to discuss evidence-informed policymaking in Greece with a focus on advancing mental health practices and scaling up quality primary healthcare services for older adults.

Study on Spatial Distribution Equilibrium of Elderly Care Facilities in Downtown Shanghai.

With the growing challenge of aging populations around the world, the study of the care services for older adults is an essential initiative to accommodate the particular needs of the disadvantaged communities and promote social equity. Based on open-source data and the geographic information system (GIS), this paper quantifies and visualizes the imbalance in the spatial distribution of elderly care facilities in 14,578 neighborhoods in downtown (seven districts) Shanghai, China. Eight types of elderly care facilities were obtained from Shanghai elderly care service platform, divided into two categories according to their service scale. With the introduction of the improved Gaussian 2-step floating catchment area method, the accessibility of two category facilities was calculated. Through the global autocorrelation analysis, it is found that the accessibility of elderly care facilities has the characteristics of spatial agglomeration. Local autocorrelation analysis indicates the cold and hot spots in the accessibility agglomeration state of the two types of facilities, by which we summarized the characteristics of their spatial heterogeneity. It is found that for Category−I, there is a large range of hot spots in Huangpu District. For Category−II, the hot-spot and cold-spot areas show staggered distribution, and the two categories of hot spot distribution show a negative correlation. We conclude that the two categories are not evenly distributed in the urban area, which will lead to the low efficiency of resource allocation of elderly care facilities and have a negative impact on social fairness. This research offers a systematic method to study urban access to care services for older adults as well as a new perspective on improving social fairness.