Services For Older Adults Research Articles

A qualitative study of multiple voices to inform aftercare services for older persons following self-harm.

Self-harm and suicide are closely related in older adults, highlighting the opportunity for Aftercare interventions in targeted suicide prevention. The study aims were to explore strengths and shortfalls of current Aftercare services for older adults from the perspective of key stakeholders and researchers; and inform a set of guiding principles for older persons' Aftercare. Semi-structured interviews were undertaken with a convenience sampleof older people with lived experience of self-harm, clinicians and suicide researchers (n=22). Interviews were focussed on current practice (strengths and limitations), potential improvements, and identifying the core components of an acceptable Aftercare model. Interviews were audio-recorded, transcribed and subjected to a reflexive thematic analysis grounded in interpretive description. Current practice strengths included validation, a person-centred approach and optimising aftercare delivery. Limitations included ageism, practical limitations (lack of service awareness, fragmented service provision, barriers to access, and traumatising approaches), and limited services, funding and training. Overarching themes included anti-ageism; anti-stigma; empowerment and agency; conveying hope; patience and pace; accessible; and finding purpose: connections and meaningful activity. Older people who have self-harmed have complex, individualised needs. They sit within intersecting systems traversing healthcare, support services, family, and the social environment. Systemic, coordinated Aftercare founded upon core principles of anti-ageism, anti-stigma, partnership, empowerment, accessibility and provision of connections and meaning are needed.

Experiences of a Novel Integrated Service for Older Adults at Risk of Frailty: A Qualitative Study.

The UK has a significant and growing population of older adults with frailty and complex healthcare needs, necessitating innovative care solutions. This study aimed to explore patients' and carers' experiences of a novel integrated service that was set up to address the increasing healthcare needs of older people living with frailty. A qualitative study that combined free-text survey questions with in-depth interviews. This study is part of a larger non-randomized trial of the service, with evaluation of wellbeing and quality of life at baseline, 2 to 4 weeks, and 10 to 14 weeks. Patients (aged 65 and above) with an electronic Frailty Index in the severe range and their informal family carers participated in this study. Data were collected between April 2019 and March 2020. Free text survey responses and interview data were subjected to reflexive thematic analyses. Four themes were generated: the overall experience of the service; interactions within the service; treatment and interventions; and outcomes due to the service. Most participants wanted further follow-up and more extensive integration with other services. Most participants described their overall experience positively, especially the available time to address their full range of concerns, but opportunities to integrate the service more fully and to extend follow-up remain.

Social Workers’Perceived Importance, Performance, and Needs Analysis of Tasks in Individualized Support Service for Older Adults

Social Workers’Perceived Importance, Performance, and Needs Analysis of Tasks in Individualized Support Service for Older Adults

The Impact of the COVID-19 Pandemic on Health Services for Older Adults in China

The Impact of the COVID-19 Pandemic on Health Services for Older Adults in China

ELECTIONS MATTER: AGING POLITICS AND POLICY IN THE BIDEN ERA

Abstract The 2020 election of Joe Biden to the presidency has shifted the foundations of the American political system after four years of conservative policy leadership. Combined with a slim Democratic majority in Congress, the policies, priorities, and proposals of the Biden administration have important ramifications for all spheres of American life. Nowhere is this clearer than with older Americans who disproportionately supported Donald Trump’s reelection but are among those who benefit most with enactment of the Democratic party agenda. Between 2010 and 2050 the proportion of the U.S. population aged 65 years or older is projected to increase from 13% to 20%. Population aging creates opportunities and challenges for older adults, their families, and society in general. The Biden administration has chosen to meet these challenges, in part, by seeking to expand the social safety net. By contrast, the Trump administration largely supported Republican priorities to draw back on the federal government’s commitment to programs intended to support an aging population. This panel examines aging politics and policy during the first two years of the Biden administration. It reports on older adults’ voting patterns and the role of issue framing in limiting public support for proposals such as Medicare for All. It analyzes provisions in the American Rescue Plan Act and Build Back Better Bill to bolster formal care and services for older adults, as well as federal actions to support family caregivers. Edward Miller serves as panel chair; Janelle Fassi serves as co-chair and Marc Cohen as discussant.

LIFE ON THE STREETS IS HORRIBLE: OLDER RURAL-URBAN MIGRANTS COPE WITH HOMELESSNESS IN ETHIOPIA

Abstract The prevalence of homelessness among older adults in Ethiopia is growing. While prior studies examined the push factors and challenges of homeless elders, little is known about how older people in Sub Saharan Africa cope with homelessness. This study explored the coping strategies of homeless older people in Kobo Town, Ethiopia. Purposive sampling was used to identify 10 homeless older people and four key informants. Study participants were homeless for a year or longer. Thematic analysis was used to analyze the data collected through in-depth interviews. To cope with the challenges faced on the street, homeless older people used various strategies including begging, holy water, drying leftover food, using river water for hygiene and sanitation, sleeping in church compounds, and creating their own social networks. Despite their efforts, the coping strategies used by elders were not sufficient. In the absence of family and government support, study participants relied heavily on begging to meet their survival needs. The findings call attention to the need for a national income support program and other supportive services for older adults. Homelessness is the product of a failing support system. Despite Ethiopia having a Plan of Action for Older Persons and Social Protection Policy for Vulnerable Groups, these policies have not been effectively implemented leaving older adults with no safety net. This study calls for the development of new policies to empower older people in Ethiopia and prevent them from turning to begging as their only recourse.

ASSESSING DEMENTIA CLASSIFICATION IN THE NATIONAL CORE INDICATORS AGING AND DISABILITY SURVEY

Abstract Improving the quality of long-term care services for older adults is a national priority. The National Core Indicators Aging and Disability (NCI-AD) collects data from multiple states to evaluate long-term care recipients’ service satisfaction and needs. Many analysts are interested in exploring the service environments of people living with dementia. However, dementia measurement and reporting varies in NCI-AD between states. Dementia status may be obtained from administrative records or self-reported during the survey. We explored the measurement of dementia in NCI-AD and the implications of relying on administrative or self-reported dementia status. We analyzed NCI-AD data from 2015-2018 representing 24,569 respondents age 65+, of which 5,502 (22.4%) were identified as having dementia. 42.9% of respondents had dementia status determined administratively and 57.1% had it determined during the survey. To assess dementia accuracy by data source, we fit separate LASSO models for both the administrative and survey subpopulations predicting dementia status using demographic and functional predictors. We then used each model to predict dementia status in the subpopulation with discordant dementia data source. Using the administrative model to predict survey reported status resulted in a higher sensitivity than using the survey model to predict administrative status (44.6% vs 32.2%). The diminished predictive accuracy of the survey model suggests administrative records may capture cases of dementia diagnosis that would be missed by self-report. These findings highlight analytical caveats for researchers interested study long-term care quality for people with dementia using NCI-AD, and emphasize the importance of moving towards more standardized dementia reporting.

THE ROLE OF THIRD PLACES IN REDUCING LONELINESS AMONG CAREGIVING SPOUSES

Abstract Loneliness is a public health concern that is associated with poor mental and physical health. Caregiving spouses of community-dwelling older adults often have high levels of caregiving burden, which make them more vulnerable to social isolation and loneliness. There has been a growing interest in third places as mediums for social interaction. Research on third places shows a positive association of greater access to third places with social networks and social health. However, this has not been tested in the context of caregiving. In this paper, we examined the role of various types of third places in reducing loneliness among caregiving spouses. We used the 2006-2016 Health and Retirement Study and the National Neighborhood Data Archive to examine the relationship between the availability of third places per square mile and loneliness. Third places include food outlets (e.g. grocery stores), eating and drinking places (e.g., restaurants, coffee shops), commercial establishments (e.g., department stores), entertainment organizations (e.g., museum), exercise facilities (e.g., fitness), religious organizations (e.g., churches), civic and social organizations (e.g., social clubs), personal care services (e.g., barbershops, beauty salons), and social services for older adults (e.g., senior centers). We found that caregiving spouses living in neighborhoods with greater availability of third places had lower levels of loneliness. We also found gender differences in the association. For instance, greater availability of eating and drinking places was associated with loneliness only among females. Increasing access to places that provide opportunities for social interactions may prevent social isolation and reduce loneliness among caregiving spouses.

Evaluating Interorganizational Collaborations: Lessons Learned from Five California Geriatric Workforce Enhancement Programs.

Five Geriatric Workforce Enhancement Programs (GWEPs) in California, funded for 4 years, worked collaboratively across different organizations to provide education on aging issues and/or training to enhance services for older adults. To investigate characteristics of the collaborations that were associated with perceptions and experiences of success for participating organizations. A survey distributed to 37 organizations participating in 5 GWEPs measured the correlation of resources and dimensions of collaboration with perceived sense of success of the collaborations. Interviews with 30 representatives of the participating organizations collected information about perceived barriers, impact, and satisfaction with the collaborations. Overall perceptions of interorganizational collaboration success were associated with provision of physical resources and four key measures of collaboration (governance, administration, mutuality, and norms/trust). Barriers to success were described in terms of organization functioning and resources. Strong communication appeared as a facilitator of success, and reciprocity was described as a key experience of satisfaction. This study highlights the positive effects of shared goals, the experience of reciprocity, and communication during interorganizational collaborations. It also notes the negative effects of having inadequate resources and organizational dysfunction.

Early Supported Discharge for Older Adults Admitted to Hospital with Medical Complaints: A Qualitative Study Exploring the Views of Stakeholders.

Early supported discharge (ESD) is well established as a model of health service delivery for people with stroke. Emerging evidence indicates that ESD also reduces the length of stay for older medical inpatients. There is a dearth of evidence exploring the views of stakeholders on ESD as a model of care for older medical inpatients. The overall aim of this study is to explore the views and perceptions of older adults, family carers and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints. Purposeful sampling was used to recruit older adults and family carers for interview. For Healthcare Professionals (HCPs), snowball purposeful sampling was used. Phone interviews took place following a semi-structured interview guide. Focus groups were moderated by A-MM. Braun and Clarke's approach to thematic analysis was used. Ethical approval was granted by the HSE Mid-Western Area Regional Ethics Committee in November 2021 (REC Ref. 096/2021). Fifteen HCPs took part across three focus groups, with six older adults and two family members participating in one-to-one interviews. Three themes were identified: 1. Pre-ESD experiences of providing and receiving older adult inpatient care, 2. Navigating discharge procedures from acute hospital services, 3. A vision for more integrated model of care and a medical ESD team. This study provided insight into the current discharge experiences of older adult care in the acute setting, the potential role for ESD in this population and the key factors that would need to be considered for the running of an ESD service for older adults admitted to hospital with medical complaints. This research highlights the barriers and facilitators to ESD for older medical inpatients from the perspectives of key stakeholders. Given the adverse outcomes associated with prolonged hospital stay, these findings will help inform the development of a feasibility trial, examining patient and process outcomes for older adults admitted to hospital with medical complaints who receive an ESD intervention.

Effects of a Structured Multicomponent Physical Exercise Intervention on Quality of Life and Biopsychosocial Health among Chilean Older Adults from the Community with Controlled Multimorbidity: A Pre-Post Design.

Structured multicomponent physical exercise (PE) for older adults, with a combination of strength, aerobic, flexibility, and balance exercises, has been shown to have benefits for physical, cognitive, social, and metabolic functioning, as well as counteracting chronic pathologies and geriatric syndromes. However, little is known about the effect of these interventions in Chilean older adults. Our objective was to determine the effect of a structured multicomponent PE intervention on the quality of life (QoL) and biopsychosocial factors of community-living older adults. We conducted a pre-post intervention without control group, with a face-to-face structured multicomponent PE intervention (cardiovascular, strength/power, flexibility, static and dynamic balance, other psychomotor components, and education), based on FITT-VP principles (frequency, intensity, type, time, volume, and progression of exercise), at moderate intensity, 60 min per session, three times per week, and 12 weeks in duration, among 45 persons with an average age of 70.74 years. Participants were evaluated at the beginning and end of the intervention with different instruments of comprehensive gerontological assessment (CGA). Post intervention, participants (83.70% average attendance) significantly improved scores in QoL, biological and biopsychosocial frailty, sarcopenia, functionality in basic, instrumental, and advanced activities of daily living, dynamic balance, cognitive status and mood, systolic and diastolic blood pressure, weight, body mass index, strength and flexibility clinical tests of lower and upper extremity, aerobic capacity, agility, and tandem balance. The indication and prescription of structured multicomponent PE based on FITT-VP principles, as evaluated with the CGA, improved the QoL and biopsychosocial health of older adults. This intervention could serve as a pilot for RCTs or to improve PE programs or services for older adults under the auspices of existing public policy.

Use of health care services according to functional performance in community-dwelling older adults in Spain. An approach using GAMLSS models.

Functional performance in older adults is a predictor of survival and other health outcomes and its measurement is highly recommended in primary care settings. Functional performance and frailty are closely related concepts, and frailty status is associated with the use of health care services. However, there is insufficient evidence on the utilization of services profile according to the functional performance of older adults. The aim of this study was to assess the relationship between functional performance and the use of a wide range of health services in community-dwelling older adults. Generalized additive models for location, scale and shape were used to study these complex data of services utilization, from primary to hospital care. A total of 749 participants from two Spanish regions were followed up for 2 years. Of those, 276 (37%) presented low functional performance and 473 (63%) normal performance according to the Timed Up and Go test. The results showed that even after adjusting for burden of comorbidity and polypharmacy, participants with low functional performance used primary and secondary care health services more intensively, visited emergency rooms more often, and were hospitalized more frequently and for longer periods of time. A negative binomial distribution and a variant thereof were found to be the best models to describe health service utilization data. In conclusion, functionality should be considered as an important health indicator for tailoring the provision of health services for older adults.

How Do Health Care, Social Care, and Housing Providers Coordinate Services for Older Adults Aging in Place: A Case Study of the Community Wellness Hub

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

The impact of the first UK COVID-19 lockdown on presentations with psychosis to mental health services for older adults: An electronic health records study in South London.

Social distancing restrictions in the COVID-19 pandemic may have had adverse effects on older adults' mental health. Whereby the impact on mood is well-described, less is known about psychotic symptoms. The aim of this study was to compare characteristics associated with psychotic symptoms during the first UK lockdown and a pre-pandemic comparison period. In this retrospective observational study we analysed anonymised records from patients referred to mental health services for older adults in South London in the 16-week period of the UK lockdown starting in March 2020, and in the comparable pre-pandemic period in 2019. We used logistic regression models to compare the associations of different patient characteristics with increased odds of presenting with any psychotic symptom (defined as hallucinations and/or delusion), hallucinations, or delusions, during lockdown and the corresponding pre-pandemic period. 1991 referrals were identified. There were fewer referrals during lockdown but a higher proportion of presentations with any psychotic symptom (48.7% vs. 42.8%, p=0.018), particularly hallucinations (41.0% vs. 27.8%, p<0.001). Patients of non-White ethnicity (adjusted odds ratio (OR): 1.83; 95% confidence interval (CI): 1.13-2.99) and patients with dementia (adjusted OR: 3.09; 95% CI: 1.91-4.99) were more likely to be referred with psychotic symptoms during lockdown. While a weaker association between dementia and psychotic symptoms was found in the pre-COVID period (adjusted OR: 1.55; 95% CI: 1.19-2.03), interaction terms indicated higher odds of patients of non-White ethnicity or dementia to present with psychosis during the lockdown period. During lockdown, referrals to mental health services for adults decreased, but contained a higher proportion with psychotic symptoms. The stronger association with psychotic symptoms in non-White ethnic groups and patients with dementia during lockdown suggests that barriers in accessing care might have increased during the COVID-19 pandemic.

Connecting the missing link between homecare services and oral healthcare services for older adults living at home

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

216 ENABLING THE DELIRIOUS PATIENT TO REMAIN AT HOME: TWO CASE STUDIES FROM THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE

Abstract Background The EDITH service brings emergency department care to the older adult thus negating the need for hospital presentation. There is an emerging body of literature regarding optimal treatment for patients with delirium suggesting care takes place in a familiar/ home environment. Methods Patient A: an 86 year-old lady with a UTI. She had a CFS:6 and a 4AT:7. She lived with her husband and her daughter who was a nurse lived nearby and provided care. She had a hypoactive delirium presentation. Patient B: an84year old gentleman with a chest infection. He had a CFS:5 and a 4AT:7. He lived with his wife and had a home care package. He had a mixed delirium presentation. Results In both cases, the Occupational Therapist (OT) provided education to the family regarding delirium and the recovery process of same. The OT provided advice regarding modifying and optimising the home environment for the delirious patient. The OT provided advice on the therapeutic use of activity and functional engagement. Medical input involved antibiotics and ensuring adequate nutrition and hydration. Safety netting was completed by onwards referrals to community services (PHN, COT, GP etc) and providing additional EDITH in-person reviews and phone-calls during the period of recovery. Conclusion Delirium type, level of family support and their understanding of delirium may impact on the success of a delirious patient remaining at home. The OT has a specialised role with regards to the treatment and management of the delirious patient. This is an emerging area of practice that OTs can lead as older adult services evolve and there is a move towards caring for patients with delirium within the familiar home environment.

Local government-led care services for older adults using technology in community: Current trends, issues, and implications

Local government-led care services for older adults using technology in community: Current trends, issues, and implications

Moderating effects of supervision on the relationship between job performance and their geriatric social work competency among social workers in the individualized support service for older adults

Moderating effects of supervision on the relationship between job performance and their geriatric social work competency among social workers in the individualized support service for older adults

Evaluating effectiveness of safety and care services for older adults living alone using living lab

Evaluating effectiveness of safety and care services for older adults living alone using living lab

Information technology-supported integrated health service for older adults in long-term care settings: A cluster randomized controlled study

Information technology-supported integrated health service for older adults in long-term care settings: A cluster randomized controlled study