Priorities Of Older People Research Articles

Identification of the needs and priorities of older people and stakeholders in rural and urban areas of Santo Andre, Brazil.

There are few data reporting the needs and priorities of older adults in Brazil. This hampers the development and/or implementation of policies aimed at older adults to help them age well. The aim of this study was to understand areas of importance, priorities, enablers and obstacles to healthy ageing as identified by older adults and key stakeholders in both urban and rural environments. Two locations were selected, one urban and one rural in the municipality of Santo André, in the metropolitan region of São Paulo (SP). Workshops for older adults (>60 y) and stakeholders were conducted separately in each location. The workshops incorporated an iterative process of discussion, prioritisation and ranking of responses, in roundtable groups and in plenary. Areas of commonality and differences between older adult and stakeholder responses were identified by comparing responses between groups as well as mapping obstacles and enablers to healthy ageing identified by older adults, to the priorities identified by stakeholder groups. The socio-ecologic model was used to categorise responses. There were few shared responses between stakeholders and older adults and little overlap between the top ranked responses of urban and rural groups. With respect to areas of importance, both stakeholder groups ranked policies for older people within their top five reponses. Both older adult groups ranked keeping physically and mentally active, and nurturing spirituality. There was a marked lack of congruence between older adults' obstacles and enablers to healthy ageing and stakeholder priorities, in both urban and rural settings. Most responses were located within the Society domain of the socio-ecologic model, although older adults also responded within the Individual/ Relationships domains, particularly in ranking areas of most importance for healthy ageing. Our results highlight substantial differences between older adults and stakeholders with respect to areas of importance, priorities, enablers and obstacles to healthy ageing, and point to the need for more engagement between those in advocacy and policymaking roles and the older people whose needs they serve.

Priorities and barriers for ageing well; results from stakeholder workshops in rural and urban Rwanda.

The National Older Person's Policy of 2021 in Rwanda highlights the need for social protection of older populations. However, there is a lack of local knowledge regarding the priorities and challenges to healthy aging faced by older people and their caregivers. This study aimed to identify and compare the needs and priorities of older people and other stakeholders involved in caring for them in rural and urban areas of Rwanda. The study was conducted in two locations, Kigali (urban) and Burera district (rural). Each site hosted two separate one-day workshops with older people (≥60 years) and stakeholders (all ages). Discussions were held in plenary and roundtable-groups to generate a list of the top 4 prioritized responses on areas of importance, priorities/enablers to be addressed, and obstacles to living a healthy and active life for older people. The research team identified similarities between stakeholder and older people's responses in each area and a socio-ecological model was used to categorize findings. There were substantial differences in responses between rural and urban areas and between older people and stakeholders. For each question posed, in each rural or urban area, there was only agreement between stakeholders and older people for a maximum of one response. Whereas, when comparing responses from the same participant groups in urban or rural settings, there was a maximum agreement of two responses, with two questions having no agreement in responses at all. Responses across all discussion-areas were mostly categorized within the Societal level, with Individual, Relationship, and Environment featuring less frequently. This study highlights the need for contextually curated interventions to address the concerns of older adults and their caregivers in rural and urban settings. An inclusive and multidimensional approach is needed to conquer the barriers that impede healthy aging, with input from various stakeholders.

The role of older patients\u2019 goals in GP decision-making about medicines: a qualitative study

BackgroundTo optimise medication use in older people, it is recommended that clinicians evaluate evidence on potential benefits and harms of medicines in light of the patients’ overall health, values and goals. This suggests general practitioners (GPs) should attempt to facilitate patient involvement in decision-making. In practice this is often challenging. In this qualitative study, we explored GPs’ perspectives on the importance of discussing patients’ goals and preferences, and the role patient preferences play in medicines management and prioritisation.MethodsSemi-structured interviews were conducted with GPs from Australia (n = 32). Participants were purposively sampled to recruit GPs with variation in experience level and geographic location. Transcribed audio-recordings of interviews were coded using Framework Analysis.ResultsThe results showed that most GPs recognised some value in understanding older patients’ goals and preferences regarding their medicines. Most reported some discussions of goals and preferences with patients, but often this was initiated by the patient. Practical barriers were reported such as limited time during busy consultations to discuss issues beyond acute problems. GPs differed on the following main themes: 1) definition and perception of patients’ goals, 2) relationship with the patient, 3) approach to medicines management and prioritisation. We observed that GPs preferred one of three different practice patterns in their approach to patients’ goals in medicines decisions: 1) goals and preferences considered lower priority – ‘Directive’; 2) goals seen as central – ‘Goal-oriented’; 3) goals and preferences considered but not explicitly elicited – ‘Tacit’.ConclusionsThis study explores how GPs differ in their approach to eliciting patients’ goals and preferences, and how these differences are operationalised in the context of older adults taking multiple medicines. Although there are challenges in providing care that aligns with patients’ goals and preferences, this study shows how complex decisions are made between GPs and their older patients in clinical practice. This work may inform future research that investigates how GPs can best incorporate the priorities of older people in decision-making around medicines. Developing practical support strategies may assist clinicians to involve patients in discussions about their medicines.

A protocol to evaluate the impact of involvement of older people with dementia and age-related hearing and/or vision impairment in a multi-site European research study

Plain English summaryInvolving older people with dementia in research is increasingly recognised as important to ensure that research is relevant and beneficial for older people with dementia. But researchers need to know how best to involve older people with dementia and to be able to show the benefits of involving older people with dementia in dementia research.This paper describes a research plan to explore the involvement of older people with dementia and age-related hearing and/or vision impairment in a European research project investigating the combined impact of dementia with hearing and/or vision impairment. We set up four Research User Groups (RUGs) of older people with dementia with age-related hearing and/or vision impairment and their carers based in the UK, France, Cyprus and Greece to advise our researchers. We provided training to group members to support their input to the research.We will use a questionnaire and interview people in our RUGs to understand what they thought of the training and their experiences of being part of the RUG. We will also interview researchers to understand if they thought the advice from the groups was useful.This study will help us to understand how to effectively involve older people with dementia and age-related hearing and/or vision impairment in research and what the benefits of involving older people with dementia in research are.BackgroundResearch to prevent and treat dementia is an international priority. Involvement of older people with dementia in the research is important to ensure the relevance and utility of the research outcomes in clinical practice to them. Efforts to involve such people in research are growing due to increased recognition of the usefulness of incorporating the views of older people with dementia into the research process. Research User Groups (RUGs) of older people with dementia and carers for people with dementia were set up in UK (Manchester), France (Nice), Cyprus (Nicosia) and Greece (Athens) to advise on the research. We report a protocol for a study which aims to evaluate i) the perceptions of RUG members of the usefulness of Research Awareness Training that was provided to support their involvement in the research and ii) perceived impacts of the involvement of older people with dementia and age-related hearing and/or vision impairment on research from the point of view of RUG members and researchers.MethodsBoth qualitative and quantitative methods will be used to evaluate the acceptability, appropriateness and satisfaction with Research Awareness Training and the perceived impact of involvement of RUGs on research. Focus groups interviews with RUG members and one to one interviews with both RUG members (n = 24) and researchers (n = 6) will be conducted to understand the perceived impacts of patient and public involvement on research from the point of view of older people with dementia, carers and researchers. Any comparative differences in cultural, attitudinal and environmental differences between RUGs in outcomes of training and impact across the four European sites will be reported.DiscussionThis study is unique in its exploration of the impact of the involvement of older people with dementia and age-related hearing and/or vision impairment in a large multi-site European dementia research study. This work will be crucial in informing understanding of how to effectively involve older people with dementia and age-related hearing and/or vision impairment and carers in dementia research to ensure research addresses the needs and priorities of older people with dementia and age-related hearing and/or vision impairment.

Application of EASY-Care Standard 2010 instrument in a population-based survey in transitional Kosovo.

The aim of this study was to assess the health needs and priorities of older people in Kosovo, the newest state in Europe striving for a functional democracy after the breakdown of former Yugoslavia and the following war in the region. A cross-sectional study was conducted in Kosovo in 2011 including a nationwide representative sample of 1890 individuals aged ≥65 years (949 men, mean age: 73 ± 6 years; 941 women, mean age: 74 ± 7 years; overall response rate: 84%). All individuals were administered the full version of EASY-Care Standard 2010 instrument, inquiring about the need for support in activities of daily living ('independence'), the 'risk of breakdown in care' (leading to emergency admission to hospital) and the 'risk of falls'. The degree of 'independence' was lower, whereas the 'risk of breakdown in care' and the 'risk of falls' were significantly higher in: older women; the oldest individuals (≥85 years); rural residents; participants living alone; those perceiving themselves as poor; participants who could not access medical care; those who perceived their general health status as poor; and older people who reported at least one chronic condition. This is one of the very few reports from Southeast European region informing about the health needs and priorities of older people in a large and representative population-based sample of older men and women. The poor health status of older people, especially evident in the socio-demographic disadvantaged categories, should raise the awareness of policymakers and decision-makers for appropriate health and social care of elderly in Kosovo and in other European countries.

Reliability and validity of the EASYCare-2010 Standard to assess elderly people in Portuguese Primary Health Care

IntroductionThe EASYCare is a multidimensional assessment tool for older people, which corresponds to the concerns and priorities of older people in relation to their needs, health, and quality of life. The EASYCare instrument has been used in many countries worldwide. Lack of reliability evidence has recently been raised by researchers. This study aimed to test the validity and reliability of the EASYCare-2010 instrument in community-dwelling Portuguese older people attended in Primary Health Care centres. MethodsThe sample for this transversal study (N=244) was collected from Portuguese Primary Health Care Centers. Categorical Principal Component Analysis was used to assess the underlying dimensions of EASYCare-2010. Construct validity was evaluated through correlation with the World Health Organization Quality of Life Assessment Instrument-Short Form. ResultsA two-factor model (labelled “mobility and activities of daily life”, and “general well-being and safety”) was found. The EASYCare-2010 instrument showed acceptable levels for internal consistency (≥0.70). The EASYCare-2010 factors were correlated with measures of quality of life. Results showed that in most polytomous items, some of the more extreme categories were not considered at all or only by a residual number of participants. ConclusionEASY Care -2010 version is a valid and reliable instrument for holistic assessment of the older people attended in Primary Health Care centres in Portugal.

Doorstep: A doorbell security system for the prevention of doorstep crime.

Safety and security rank highly in the priorities of older people on both an individual and policy level. Older people are commonly targeted as victims of doorstep crime, as they can be perceived as being vulnerable. As a result, this can have a major effect on the victim's health and wellbeing. There have been numerous prevention strategies implemented in an attempt to combat and reduce the number of doorstep crimes. There is, however, little information available detailing the effectiveness of these strategies and how they impact on the fear of crime, particularly with repeat victims. There is therefore clear merit in the creation and piloting of a technology based solution to combat doorstep crime. This paper presents a developed solution to provide increased security for older people within their home.

Comparison of the Rowe-Kahn Model of Successful Aging With Self-rated Health and Life Satisfaction: The West of Scotland Twenty-07 Prospective Cohort Study.

Purpose of the Study:With increasing longevity in industrialized populations, there is growing interest in what defines “successful aging” (SA). Various SA measures have been proposed but no consensus has been reached and many have been criticized for not representing the views and priorities of older people. We consider whether the Rowe–Kahn SA model captures older individual’s perceptions of their own health and aging.Methods:Using two cohorts of 886 and 483 men and women from the West of Scotland Twenty-07 Study, aged around 57 and 76, respectively, we explored associations between Rowe–Kahn SA dimensions (absence of disease/disability; good physical/cognitive functioning; good interpersonal/productive social engagement) and four aspects of self-rated health and satisfaction (current general health; health for age; satisfaction with health; satisfaction with life).Results:Respondents’ self-rated health and satisfaction was generally good but few had all six Rowe–Kahn dimensions positive, the conventional definition of SA. All individual positive SA dimensions were associated with better self-rated health and satisfaction. This was consistent across age, gender, manual/nonmanual occupations, and personality. The prevalence of good self-rated health and satisfaction increased with increasing numbers of positive SA dimensions.Implications:The Rowe–Kahn model provides a functional definition of SA. Future work on ageing should include all Rowe–Kahn dimensions and consider SA as a continuum.

Coexisting principles and logics of elder care: Help to self‐help and consumer‐oriented service?

Healthy and active ageing has become an ideal in Western societies. In the Nordic countries, this ideal has been supported through a policy of help to self‐help in elder care since the 1980s. However, reforms inspired by New Public Management (NPM) have introduced a new policy principle of consumer‐oriented service that stresses the wishes and priorities of older people. We have studied how these two principles are applied by care workers in Denmark. Is one principle or logic replacing the other, or do they coexist? Do they create tensions between professional knowledge and the autonomy of older people? Using neo‐institutional theory and feminist care theory, we analysed the articulation of the two policy principles in interviews and their logics in observations in four local authorities. We conclude that help to self‐help is the dominant principle, that it is deeply entrenched in the identity of the professional care worker and that it coexists with consumer‐oriented service and without major tensions in the logics identified in their practices.

Social patterning of successful aging in two age-cohorts from the West of Scotland born around 1932 and 1952 (the West of Scotland Twenty-07 study)

Background Longevity is increasing in industrialised populations and there is growing interest in what constitutes and determines “successful aging” (SA). Previous work has largely focussed on disease and disability but there is growing awareness that this does not fully reflect the priorities of older people. We have used a broader six-dimensional model of SA and explored how it varies with socioeconomic position (SEP) across the life-course. Methods Analyses are based on two cohorts of 974 and 1,045 men and …

Cultural Frames, Qualities of Life, and the Aging Self

We used the Self-Concept Enhancement Tactician (SCENT) model to explore whether older Norwegians and Canadians would tactically self-enhance on qualities considered significant within their cultures in their self-perceptions of aging. Qualities were measured using the WHOQOL-BREF and WHOQOL-OLD. Self-perceptions of aging were measured by the Attitudes to Aging Questionnaire. The study is a secondary analysis of data collected in a larger study; 393 older Norwegians and 202 older Canadians were included. The Norwegian and Canadian group self-enhanced their perceptions of psychosocial loss based on harmonious social relationships and being part of a larger social group. For self-perceptions of physical change, both groups self-enhanced on being self-sufficient and being part of a larger social group. Our findings suggest that Norwegians and Canadians are not highly individualistic people and also provide evidence of a bicultural self-perception of aging. Nurses should consider how cultural and individual perspectives affect the care priorities of older people.

Discharge‐planning for long‐term care needs: the values and priorities of older people, their younger relatives and health professionals

Discharge-planning decisions about long-term care (LTC) can be difficult and distressing for older people, families and discharge-planning health professionals. Retrospective research suggests that despite good intentions and a shared focus on the best interests of the older person, stakeholders may hold very different values about good outcomes and how to decide them. We aimed to compare the opinions and values of frail elders living at home, younger relatives and health professionals experienced in discharge-planning, prospectively: before, not after, a LTC decision. We interviewed three types of stakeholders (10 older people, 8 relatives and 18 health professionals) using a hypothetical vignette about a frail elder leaving hospital. In a mixed methods design, we quantitatively compared the discharge plans and decision-makers that stakeholders suggested, and qualitatively analysed the 36 interview transcripts for participants' articulation of underlying values during these discussions. Older participants often suggested safe restrictive options (residential care, proxy decision-making) for the hypothetical frail elder, while advocating autonomy for themselves. Younger people generally endorsed autonomous decision-making and less restrictive discharge options especially if the elder was mentally competent, but reported difficult ethical tensions between safety and autonomy. Individual personality and preferences, mental capacity, and the importance of personal care in supporting autonomy were central themes consistent with the Ecological Theory of Aging. Accordingly, discharge planners can usefully articulate the balance of safety and autonomy, conceptualizing home care as maintaining independence rather than accepting dependence. Ethical training should incorporate sophisticated models of practice specifying both psychological and physical safety as components of beneficence. Few elders adopt a consumer approach to LTC: health professionals can encourage mid-life adults to consider later care needs when planning for retirement.

Influence of policies on nursing practice in long‐term care environments for older people

This paper reports a study exploring nurses' awareness of, access to and use of policies within long-term care environments for older people in Scotland. The provision of the highest quality of nursing care for older people with continuing care needs is facilitated through a number of strategic mechanisms. These encompass regulatory systems, national and local policies and care guidance. Failure of practitioners to engage with the 'policy context' may compromise care standards. This was a two-stage investigation. A Delphi approach with 33 panel members was used to generate consensus as to the 10 most important current policies in this area of practice. A postal survey was undertaken with 2072 nurses to identify the practice impact of policies, including the 10 identified items. Identification of the 10 most important policies proved challenging for panel members. Initially they identified 137 policy items, which were reduced after clustering and two further rounds to 10 items (consensus agreement 57%). Completed questionnaires were returned by 986 (48%) nurses. A long list of problems limited access to policy information. Nurses reported little time to keep up to date, compounded by communication inefficiencies and limited access to the internet. Awareness of the 10 selected items ranged from 46 to 83% and clarity of the practice message was high (85-94%); however, the reported influence on practice varied, with 10-26% of respondents indicating no effect. Professional priorities did not coincide with the priorities of older people themselves. Nurses appear bewildered by the number and status of policy items. Current methods to provide nurses with information and keep them up to date were not ideal. Processes need to be developed that will engage nurses in policy and pursue closer alignment with the priorities of older people. Strategies are required to identify key policies and promote their implementation.