Perspectives Of Older Persons Research Articles

Benefits and barriers associated with the use of smart home health technologies in the care of older persons: a systematic review

BackgroundSmart home health technologies (SHHTs) have been discussed in the frame of caregiving to enable aging-in-place and independence. A systematic review was conducted in accordance with the PRISMA guidelines to gather the up-to-date knowledge on the benefits and barriers of using SHHTs in the care of older persons from the perspective of older persons and their caregivers.MethodsTen electronic databases were reviewed for empirical peer-reviewed literature published from 01.01.2000 to 31.12.2021 in English, German, and French reporting on experimental, qualitative, quantitative, and other empirical study designs were included. Included studies contained user-feedback from older persons over 65 years of age or their caregivers (formal and informal). We used an extraction document to collect relevant data from all included studies and applied narrative synthesis to analyze data related to benefits and barriers of SHHTs.Results163 empirical peer-reviewed articles were included, the majority of those published between 2014 and 2021. Five first-order categories of benefits and five of barriers were found with individual sub-themes. SHHTs could be useful in the care context where continuous monitoring is needed. They improve self-management and independent living of older persons. Barriers currently exist with respect to ease of usability, social acceptance, and cost.ConclusionsSHHTs could be useful in the care context but are not without concerns. Researchers and policy makers can use the information as a starting point to better understand how the roles and outcomes of SHHTs could be improved for the care of older persons, while caregivers of older adults could use our findings to comprehend the scope of SHHTs and to decide when and where such technology could best address their individual family needs. Limitations lie in the possible exclusion of relevant articles published outside the inclusion criteria as well as the fact that due to digital divide, our review represents opinions of those who could and wanted to participate in the included 163 studies.Trial registrationThis review has been registered as PROSPERO CRD42021248543. A protocol was completed in March 2021 with the PRISMA-P guidance. We have extended the review period from 2000 to 2020 since the registration of the protocol to 2000–2021.

‘Ageing with an alcohol problem is not what I envision’: reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems

BackgroundEliciting and understanding older persons’ descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing.MethodsEight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews.ResultsThree themes were identified: “Tipping the balance”, “Staying behind a veil” and “Lifting the vail”. First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery.ConclusionsOlder persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons’ desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.

Integrated care for older persons who live with complex health and social care requirements: a core set of indicators

PurposePerformance measures are an important mediating mechanism that influences the design and delivery of care. Unfortunately, it is still commonly the case that acute care indicators are employed to assess the efficacy of integrated care. This hinders the ability to accurately assess and continuously improve integrated care efforts for priority populations, including older persons who live with complex health and social care requirements. A core set of indicators is needed from which to assess the quality and impact of integrated care on these older persons and care partners.Design/methodology/approachA modified Delphi process was employed that comprised of the following steps: (1) selection of an indicator inventory (2) defining criteria for ranking and achieving consensus, (3) recruiting participants, (4) iterative voting rounds and analysis and (5) selection of a core indicator set.FindingsThe study produced a core set of 16 indicators of integrated care that pertain to older persons who live with health and social care requirements. The set can be applied by health and social care organizations and systems to assess the quality and impact of integrated care for this population across the continuum of care.Research limitations/implicationsAlthough the gap in the availability of relevant indicators was the impetus for the study, this also meant there was a dearth of validated indicators to draw from. There are significant gaps in commonly used data sets with respect to indicators of integrated care as it relates to older persons and care partner.Practical implicationsThe indicator set is intended to follow the older person and care partner throughout their health journey, enabling a whole systems view of their care. The set can be used in full or in part by health and social care systems and organizations across various primary, acute, rehabilitative and community settings for program development and evaluation purposes.Social implicationsThe core set of indicators that emerged out of this study is a first step toward ensuring that older persons who live with complex health and social care requirements and their care partners receive quality integrated care across the continuum of care.Originality/valueThe findings are informed by the perspectives of older persons, care partners and healthcare professionals. Future research is needed to test, validate and potentially expand the indicator set.

Insights into caregivers’ perspectives on abuse of older persons: a qualitative exploratory study in southwest Nigeria

ObjectiveElder abuse perpetration by caregivers is well documented, particularly from the perspectives of older persons who are victims of abuse. However, few studies in Nigeria have examined the caregivers’ viewpoints....

Transitions: Experiences of younger persons recently diagnosed with Alzheimer-type dementia.

Receiving a diagnosis of dementia before the age of 65 has a huge impact on everyday life. Previously, the disease trajectory has mainly been described from the perspective of older persons. However, young persons with dementia are confronted with specific challenges, influencing the type of life-changing events, or 'critical points' that they may experience. The aim of this study was therefore to describe experiences of persons recently being diagnosed with young-onset dementia. In total, 14 participants with dementia due to Alzheimer's disease (10 woman/4 men) with an average age of 59 were included in the study. Interviews were conducted within 2months after receiving the diagnosis and analyzed using qualitative content analysis with an inductive approach, resulting in three categories: (1) A life changing moment, (2) An ongoing process, and (3) Remaining in control. The findings show that receiving such a diagnosis was experienced by participants as a life changing moment, followed by them seeking to come to terms with the diagnosis and reflecting on its meaning, in which various strategies were adopted to remain in control. The current study highlights three critical points considering the diagnosis of young-onset dementia that warrant special attention and provides insight into factors related to delay in healthy transitioning after receiving the diagnosis, as well as factors that may facilitate successful transitions.

Frail community-dwelling older persons’ everyday lives and their experiences of rehabilitation – a qualitative study

Background The number of older persons with frailty is increasing, and rehabilitation to improve the consequences of frailty are important for both the individual and society. However, the perspective of older persons themselves in research and planning of interventions is scarce. Aim The aim of this study was to describe frail older persons’ everyday lives and their experiences and views of rehabilitation. Material and methods Twenty older persons were interviewed, and analyses were performed using a qualitative content analysis method. Results The two main categories were ’Frailty impacts everyday lifé and ’Experiences and perceptions of rehabilitation’. The participants described that they had to adapt their everyday lives in line with their health conditions. They all used strategies and were dependent on support in their activities of daily living. Their social network had decreased. All participants strived to stay active and independent, and wanted rehabilitation and support from professionals, experiencing decreased access to rehabilitation. Conclusions and significance Frail older persons are a vulnerable group who often need support in everyday life. There is room for improvement when it comes to helping frail older persons to stay active and facilitate participation in both individual and group interventions.

Older Persons' Views on Important Values in Swedish Home Care Service: A Semi-Structured Interview Study.

IntroductionKnowledge of older person’s experiences of important values in home care service can facilitate the development and delivery of high-quality services supporting their well-being, dignity and participation in the care provided. To date, few studies have explored older person’s values and experiences of home care services.PurposeThis study aimed to explore values that older person holds regarding home care services and their experiences of how these values manifest in home care service delivery.Participants and MethodsThe study has a qualitative exploratory design. Semi-structured interviews were conducted with 16 older persons aged 74–90 who received home care service. Data were analysed using qualitative content analysis.ResultsTwo themes (each with sub-themes) of values relating to the experience of home care service from the perspective of the 16 older persons were identified: to be supported as an autonomous person and to be supported as a relational being. The participants experience that these two values were only partly manifested in the home care services they received. They also noted that their well-being was negatively affected when staff failed to implement these values. The fundamental values identified in study related to the older person feeling safe, being autonomous, maintaining control and independence, and having relationships. The values constitute help to guide practice from the perspective of older persons who receive home care services.ConclusionThe identified values are primarily interpersonal-level values. However, such values are also of importance for home care service organisations when promoting delivery of person-centred care. Taking such a position implies adopting a relation-oriented rather than a task-oriented approach in providing home care services for older persons.

Elder Financial Abuse Experience: A Qualitative Study from the Perspective of Older Persons in Malaysia

The underreporting incidents of financial exploitation of older persons committed by family members in Malaysia is a genuine concern. This study explores older adults’ experience of financial abuse by family members, the dynamics of their relationship, and how older people respond to this experience in Malaysia. The study was conducted using a phenomenology study design via in-depth interviews of eight older adults who were purposively sampled using snowball sampling. NVivo 12 analysis software was used to perform the thematic analysis. Seven main themes were identified: cultural expectation and tolerance of abuse, negative well-being, family comes first, helplessness, coping strategies, positive reappraisal, and self-reflection. The themes demonstrate the interactions among the components of experiences of older adults coping with financial abuse by family members and how they chose to respond. The results reveal the inadequacy of protections available to older adults in Malaysia in the reporting process, laws, and policy. These results suggest for authorities to consider dilemmas faced by older victims of financial abuse, especially with regard to underreporting. A clearer understanding of social realities will help improve social and legal protection frameworks for victims of financial abuse involving family members in Malaysia.

Older Persons and Nursing Staff's Perspectives on Continence Care in Rehabilitation: A Qualitative Study.

The aim of the study was to understand continence care in geriatric rehabilitation from the perspectives of older persons and nursing staff. This is a qualitative descriptive study. Ten patients and 10 nursing staff participated in semistructured interviews. Observations of care were recorded in field notes. Content analysis was used to develop themes of patient and nursing staff perspectives. Three themes were developed: Perceptions of Assessment, Continence Management, and Rehab: The Repair Shop. Patients had limited insight into continence assessment and management by nursing staff. For older persons, incontinence was embarrassing and created dependence; independence in toileting meant gaining control. Staff viewed continence as an important part of rehabilitation nursing but focused on containment and regular toileting, with patients seeing absorbent pads as commonly suggested. Continence care approaches that engage older persons during rehabilitation are needed. Restoration of continence through patient-centered care is core to older person rehabilitation.

A concept analysis of health communication in a home environment: Perspectives of older persons and their informal caregivers.

Health communication (HC) is a vast research field focusing on changing health behaviours, and rapidly evolving technology is creating different ways and possibilities to reach target groups and audiences. In the context of home care, a deeper understanding of HC is lacking, specifically for older persons with care needs and their informal caregivers. The aim of this concept analysis is to identify and construct the meaning of HC from the perspective of older persons in need of care in the home environment and their informal caregivers. This study utilised Rogers' (2000) Evolutionary Concept Analysis Method (EMCA) to create and construct a meaning of the concept of HC. The EMCA was based on a systematic literature review of scientific articles, using CINAHL, Pubmed and Inspec (2000-2017). A total of 29 articles were retrieved and analysed. The identified attributes of the concept were as follows: resources of the recipient, influence on decisions and advantages of tailored information. HC was described as both contributing to knowledge as well as being overwhelming where habits and resources influenced the use of information. The attributes led to the following descriptive definition of HC: 'Tailored HC, based on needs and resources of the recipient influence care decisions'. The home environment influenced HC by habits and interactions between older persons and their informal caregivers. The home environment influenced HC in terms of social aspects of interactions and habits and between the older person and the informal caregiver. Tailored information with the use of technology contributed to knowledge in care of older persons and their informal caregivers. HC was shown to contribute to improve care for older people in their home environment.

Care Professionals Manage the Future, Frail Older Persons the Past. Explaining Why Frailty Management in Primary Care Doesn't Always Work.

Frailty management focuses on optimizing the physical and psychological functioning of older people with frail health through early risk identification and intervention in primary care. Such care programs demand a joint effort by primary care professionals and older persons, one in which professionals are expected to promote or facilitate self-management practices and older persons are expected to adhere to the professional advice. It is known that patients and professionals hold different perspectives on frailty, but we know little about how this may affect their cooperation in frailty management. In this article, we therefore study how different perspectives of older persons and their primary care professionals play a role frailty management in practice. Nine cases of frailty management were reconstructed through semi-structured interviews with older persons, their family doctor and practice nurse. Drawing from literature on managing complex problems, we analyzed how “factual” and “normative” orientations played a role in their perspectives. We observe that the perspectives of care professionals and older persons on frailty management were substantially different. Both actors “manage” frailty, but they focus on different aspects of frailty and interestingly, care professionals' rationale is future-oriented whereas older person's rationale past-oriented. Primary care professionals employed practices to manage the medical and social factors of frailty in order to prevent future loss. Older persons employed practices to deal with the psychological, emotional and social aspects of the different types of loss they already experienced, in order to reconcile with loss from the past in the present. These findings raise fundamental questions regarding the different perceptions of and priorities around not only care for frail older people in general, but also implied professional-patient relations and the value of a risk-management approach to care for older people with frail health. The distinction between these perspectives could help care professionals to better respond to older patients' preferences and it could empower older persons to voice preferences and priorities that might not fit within the proposed care program.

Older persons and relatives' experience of coordinated care planning via a video meeting.

AimThe study aimed to describe coordinated care planning via a video meeting from the perspective of older persons and their relatives.DesignA qualitative inductive research design was used to describe older persons and relatives’ experience of care planning via video meeting.MethodsEight unstructured interviews were conducted. Purposive sampling resulted in a sample of four older persons and four relatives. The material was analysed by qualitative content analysis.ResultsThe theme being excluded illustrates how the older persons and their relatives experienced care planning via a video meeting as lack of a personal relationship, meaninglessness and lack of participation. The older persons and their relatives had a feeling of being excluded and in an unfamiliar situation. Lack of information about the meeting's structure and content impaired their ability to prepare for it beforehand, which led to uncertainty.

Caring responsibility from the perspectives of older persons whose adult children are their caregivers.

To describe lifeworld insights into the phenomenon of caring responsibility from the perspectives of persons aged 80+years living alone with chronic illness, physical frailty and dependency on adult children. A phenomenological inquiry inspired by Reflective Lifeworld Research. Semi-structured lifeworld interviews with 11 persons aged 80+years were conducted following their discharge. The interviews lasted 35-83min, were audio-recorded and transcribed verbatim. Both interviews and the analysis followed the epistemological and methodological principles of Reflective Lifeworld Research. We identified the essential meaning 'It means everything' and four constituents illuminating different aspects inherent in the complex phenomenon of caring responsibility; 'A life-constraining transition,' 'Trusting the children to fill the gaps and be the glue,' 'Tacit responsibility, agreement and acceptance' and 'Depending on the children and knowing they are burdened by you.' Caring responsibility is based on a trusting relationship and tacit agreements indicating an understanding of interdependence and acceptance of dependence on adult children. However, a paradox appears when older persons express a deep-rooted perception of autonomy and independence as they have difficulties with their growing dependency and feelings of being burdensome. Older persons try to balance the continuum of autonomy, their existential self-image and actual capability. The practical part of caring responsibility seems to dominate and strongly affect the parent-child relationship because the child needs to take care of practical issues related to healthcare management and instrumental activities of daily living, leaving less time for meaningful togetherness. Older persons want their adult children to be involved and acknowledged when planning care and treatment because they often seem to serve as the 'glue' that makes it possible for the parent to remain in his/her own home.

Active ageing in the fourth age: The experiences and perspectives of older persons in long-term care

Abstract Aim: This article reports upon a research study whose aim was to evaluate the running of an active ageing programme for older persons residing in a care home for older persons in Malta. Method: The research study opted for a multi-method research design. The first phase consisted of carrying out observation of the active ageing programme over a two-month period. The second phase was conducting semi-structured interviews with participants and facilitators. Results: First, that for active ageing programme in care homes to be successful the activities must be meaningful to residents. Second, that active ageing programme in care homes has the potential to improve the levels of social and emotional wellbeing, whilst also having benefits for facilitators. Finally, that active ageing programmes include a number of challenges - namely, further training for all staff in gerontological and geragogical principles, overlooking family relatives, and enabling even frail residents to join in the activities. Conclusion. Active ageing policies should go beyond a ‘third age’ lens in their endeavour to improve the quality of life of incoming and current older persons and focus more assiduously on frail and vulnerable elders. The key factor in organising active ageing programmes in a care home that are successful in enabling good quality interaction is the ability of planners to have insight on the subjective world of residents so that they gain the sensitivity and skills to coordinate activities that are meaningful to residents.

"The meal is an activity involving at least two people"-Experiences of meals by older persons in need of elderly care.

AimA shift of focus on older persons’ nutrition has occurred, from focusing on nutrition status to focusing on the whole meal. There is lack of studies on how older persons experience meals. Knowledge is needed to enhance a meal with dignity and pleasure, but also to prevent deterioration in nutrition. The aim was to describe meals from the perspective of older persons in need of elderly care.DesignA descriptive qualitative study.MethodSemi‐structured interviews (N = 18) were conducted and analysed using thematic analyses.ResultThree themes were identified: The meal is an activity which involves at least two persons, The meal relates to habits and traditions and The meal seldom gives possibilities to make individual choices. It was obvious that older persons who live in nursing homes miss the opportunity to decide what to eat, when to eat and with whom to eat. Attention must be paid to listening to older persons to enhance mealtime with dignity and autonomy.

Home care services for older persons. The views of older persons and family members: A realistic evaluation.

The aim of the present study was to evaluate client-centred care in older persons' home care services from the perspective of older persons and family members. The following research questions were addressed: How do home care older persons and family members perceive client-centered care in their home care services? What kind of social mechanisms are realized when home care services are implemented? Several older persons are dependent on home care services for their continued living at home. The fundamental value and best practice of home care is the client-centred care in services. The research method was realistic evaluation. Six families with six older person clients of home care and seven family members were interviewed. In the present study, the interview contained three themes (1) content and services of the home care, (2) activities and practices of the home care and (3) development of client centredness in home care. Research data were analysed with deductive content analysis. Home care service should be based on analysis of older person's individual life situation. Social mechanisms such as interaction, participation, trust and adaptation are realised in implementation of home care services. The most significant outcomes of client-centred service were timely availability of services, safe care relationship and continuity of care, ability to influence on own services and appropriate price of services. Significant factors in quality of service were unhurriedness, kindness and competence of professionals. Social mechanisms, such as participation, trust, adaptation and interaction, should be taken in account in care relationship in home care. Client centredness and methods for evaluating it should be defined in practical work. Client-centeredness competence should also be included in all stages of professional education of home care.

Becoming a guest in your own home: Home care in Sweden from the perspective of older people with multimorbidities.

To describe the meaning of the phenomenon home care from the perspective of older persons who live alone with multimorbidity. In line with worldwide changing demographics, conditions for older people in need of home care are changing. In Sweden there is a stay-in-place policy and older people are expected to live and be cared for in their own home as long as possible. Home care, instituted by different laws, is a challenge affecting the older person when the private home becomes a workplace. This study uses a qualitative design with a lifeworld approach. The study having been conducted in Sweden in 2016, the researchers interviewed 12 older persons that live alone and receive home care. Data were analysed using qualitative content analysis. The findings illustrate four sub-themes: adapting to a caring culture, feeling exposed, unable to influence care and forced relations. The overall theme reveals that older people experience a life-changing situation when receiving home care and they become a guest in their own home. Becoming older with increased needs means to disrupt one's life when one's private home becomes a public arena. The gap between an older person's rights by law and the older person's experiences of receiving home care needs to be highlighted to meet the oncoming challenges in providing a home care that includes participation of the older themselves. Only then can care be offered that enables older people to have a sense of control and experience their home as their own. The findings emphasise the need to view older people as being self-determinant and independent. Older people receiving home care need to be seen as individuals, and their entire life situation should be considered by also acknowledging the important role played by relatives and caregivers.

Health and social care planning in collaboration in older persons' homes: the perspectives of older persons, family members and professionals.

Providing health and social care to older persons is challenging, since older persons often have multiple diseases and a complex health situation. Hence many professions and organisations are involved. Lack of interprofessional and interorganisational collaboration leads to fragmented care. Care planning meetings before hospital discharge have long been used to overcome this fragmentation, but meetings conducted at the hospital have limitations in identifying long-term needs at home. A new model for health and social care planning in collaboration (HSCPC) in older persons' homes was introduced in two Swedish municipalities. The aim of this study was to gain a deeper understanding of the HSCPC-meeting from the perspectives of older persons, family members, and professionals. Ten care planning meetings from two municipalities were consecutively included. Interviews in retrospect with ten older persons, eight family members, and ten groups of professionals who had attended the HSCPC-meeting at home were analysed with a hermeneutic approach. Four themes emerged: unspoken agendas and unpreparedness, security and enhanced understanding, asymmetric relationships, and ambiguity about the mission and need for follow-up. The comprehensive interpretation is that the professionals handled the HSCPC-meeting mainly as a routine task, while the older persons and family members viewed it as part of their life course. Older persons are in an inferior institutional, cognitive and existential position. However, meeting together in the home partly reduced their inferior position. Findings from this study provide some general suggestions for how HSCPC-meetings should be designed and developed: attention of power relations, the importance of meeting skills and follow-up.

Older persons' experiences and perspectives of receiving social care: a systematic review of the qualitative literature.

The topic of social care for older people has gained increasing attention from the part of academics, professionals, policy makers and media. However, we know little about this topic from the perspectives of older persons, which hinders future developments in terms of theory, empirical research, professional practice and social policy. This article presents and discusses a systematic review of relevant qualitative research-based evidence on the older persons' experiences and perspectives of receiving social care published between 1990 and September 2014. This review aimed to obtain answers to the following questions: How is the reception of social care experienced by the older persons? What are the negative and positive aspects of these experiences? What are the factors which influence the experiences? The synthesis of the findings of reviewed papers identified six analytical themes: asking for care as a major challenge; ambivalences; (dis)engagement in decisions concerning care; multiple losses as outcomes of receiving social care; multiple strategies to deal with losses originated by the ageing process; and properties of 'good care'. These themes are discussed from the point of view of their implications for theory, care practice and social policy, and future research.

Nurse–patient encounters in the hospital ward, from the perspectives of older persons: an analysis using the Authentic Consciousness Framework

Despite a growing theoretical base to support the development of person-centred practice, the evidence would suggest that this way of working is somewhat elusive in the care of older people. The study aims to explore nurse-older person encounters and relationships within the context of person-centredness. This study involved secondary analysis of interview data originally collected from a commissioned study investigating whole-systems approaches in services for older people. The process of analysis used the Authentic Consciousness Framework. Nurses are often invisible to the patient, unless they are providing care to address a physical need. A sense of rolelessness pervaded the data, when patients were deprived from actively participating in important decisions about their future care. Patients would like nurses to work with them in more transparent ways. Patients are very conscious that nurses are busy and attempt to share the coping with the busy workload by limiting their expectations of the nurse. Person-centred strategies must enhance the capacity of not only older patients and their ability to assert self, but also the capacity of their nurses. Nurses must work to actively recruit the patient in all decision making.