Well-being Of Older People Research Articles

Was it worth it? Older adults\u2019 experiences of participating in a population-based cohort study \u2013 a focus group study

BackgroundAt present, we know relatively little about priorities and problems with topics that older adults experience when completing different examinations in longitudinal population-based studies. To examine these topics, research must be adapted to investigate the meanings, motivations, and interpretations of the individual participants themselves. Therefore, the present study aimed to explore older adults’ motives, understandings and experiences regarding participating in the Gothenburg H70 Birth Cohort Studies (the H-70 study).MethodsFocus group discussions were used. A total of thirty-eight persons, 19 women and 19 men participated in nine focus groups. A strategic sampling technique was used to ensure that the focus group participants represented the larger population.ResultsThe results supported the overall theme: “It was well worth the effort,” which summarized how the participants felt about the population health study. The following specific themes were also identified: an intense event, for the benefit of oneself and others, confidence in health research and the researcher, key decisions about test outcomes and the survey raising questions and providing few answers.ConclusionsKnowledge of priorities and problems with topics experienced by older adults completing different examinations when participating in longitudinal population-based studies is crucial for research to improve the health and wellbeing of older people. To date, older people’s involvement in population-based cohort studies has largely been as research subjects. This study is a first step toward the participants taking a more active part by allowing them to share their experiences which can be used to improve the research procedures. This requires the participation of older adults in collaboration with the researchers, to ensure the quality of longitudinal studies of older adults. Therefore, our intention when it comes to future research will be to involve older adults—the target group—in the research procedure.

The UK pensions landscape – A critique of the role of accountants and accounting technologies in the treatment of social and societal risks

The well-being of older people in society depends in part on their having sufficient financial resources to provide for their everyday needs, and to enable them to maintain their health and relationships. Pensions are therefore directly implicated in the well-being of older members of the population and hence are a potential source of significant social and societal risks. This paper critiques the role of accountants and accounting technologies in the treatment of the social and societal risks inherent in the UK occupational pensions’ landscape in relation to four characteristics of pensions’ security, namely that pensions should be predictable, stable, long-lasting and comprehensive. The UK pensions’ landscape has undergone rapid and fundamental change in recent years. A range of examples drawn from state, public and private sector occupational schemes are discussed. Across all sectors, while some people have gained, others have lost valuable pension benefits. In occupational schemes, employer costs have been reduced and pension liabilities have been de-risked, usually involving risk sharing with employees or risk shifting towards employees. The role played by accountants and other business advisers in quantifying, analysing and mitigating this work is critiqued. The rhetoric of de-risking, security and enablement inherent in the various pension changes, where the reality is often different, is examined and implications for social and societal risk explored.

Effects of an Intervention Approach Based on the Meanings of Vocal Behaviours in Older People Living with a Major Neurocognitive Disorder: A Pilot Study

Introduction: Vocal behaviours (VB) are frequent in long-term care facilities (LTCF) and have many negative consequences. Interventions to decrease VB have limited clinical impact. Objective: This pilot study aimed to provide preliminary evidence on the effects of an intervention approach based on the meanings of VB in older people living with a neurocognitive disorder in LTCF. Methods: A mixed methods action research study was used. Fourteen triads (n=43) made up of an older person who manifested VB, a family member, and formal caregivers were included. An approach based on the meanings of VB was implemented in five LTCF. Semi-structured interviews took place with some participants. Tools were used at four-time points to measure five variables: the frequency of VB, the well-being of older people, the perceived disruptiveness of VB, the partnership-based decision-making and the empowerment felt by family and formal caregivers. Results: The approach improved the perception of family and formal caregivers toward older people. This led to habit changes that influenced positively the frequency of VB and the well-being of older people. Formal and family caregivers also perceived VB as less disturbing and felt more empowered relatively to VB. The attitude of formal caregivers toward families evolved positively. No other changes were noted on partnership-based decision-making. Discussion and conclusion: This study indicates the potential of this approach to improve the well-being of older people who manifested VB, their families, and formal caregivers. This approach could be implemented in LTCF, tested and adapted for other behaviours.

Precariously placed: Home, housing and wellbeing for older renters.

Older renters may encounter a wide range of challenges and constraints in their experiences of ageing, housing and community life that influence their wellbeing. We employ a two-part conceptualisation of precarity and resilience to investigate how housing-related precarities may impact upon experiences of ageing and home during later life. We draw on narratives collected through in-depth interviews with 13 older renters living in a particularly high-pressure housing market within the greater Auckland area. We ground our analysis in ideas of precarity and resilience evident in participants' experiences of being 'at home' at the scale of both the dwelling and wider community. Results show that experiences of renting and ageing can be complicated and compromised in diverse ways by interrelated aspects of precarity and resilience related to housing, community, health, financial and personal circumstances. Distance or isolation from services and healthcare, tourism-related infrastructural pressures, and community changes can intensify precarious experiences of home, and can have implications for older people's wellbeing, as well as their ongoing opportunities to age well in place. In addition to these potential precarities, older renters appear to draw strength from their familiarity with, attachment to, and enjoyment of, place and community. These responses demonstrate older renters' capacity for resilience to challenge and adversity when ageing in rented places.

Improving the delivery of primary care for older people.

Improving the delivery of primary care for older people.

A randomized controlled trial and pragmatic analysis of the effects of volunteering on the health and well-being of older people.

Volunteering among older people has the potential to deliver health benefits to the individual, along with economic and social benefits to society. However, it is not clear whether healthier people are more likely to engage in volunteering, whether volunteering improves health, or the extent to which the relationship may be reciprocal. There is an identified need for longitudinal work, especially in the form of randomized controlled trials, to establish causality. To assess the effects of commencing volunteering among older non-volunteers utilizing a randomized controlled trial approach involving per-protocol and pragmatic analyses. Of the 445 Australians aged 60 + years who participated in the study, 201 were assigned to an intervention arm that required them to participate in a minimum of 1h/week of formal volunteering in a position of their choice. The remaining participants were assigned to a control condition and asked to continue their lives as usual, but were not discouraged from commencing volunteering. Across the assessed physical, psychological, and social variables, a significant difference in sit-to-stand scores was found in both the per-protocol and pragmatic analyses, and a further significant difference in the fast pace walk was identified in the pragmatic analyses. The results provide some support for policies and programs designed to encourage older people to engage in volunteering to maintain or improve their health. Australian and New Zealand Clinical Trials Registry ACTRN12615000091505.

Driving as a Travel Option for Older Adults: Findings From the Irish Longitudinal Study on Aging.

The role of transport in the health and wellbeing of older people is increasingly recognized: driving is the main form of personal transportation across the adult life-span. Patterns of changed mobility and driving cessation are an important focus of research. We investigated cross-sectional changes in driving as the main form of transportation and the frequency of such driving. The impact of Gender and Marital Status on Driver Status was also examined along with the reasons cited for ceasing driving. The impact that Driver Status had on Quality of Life and Loneliness was also assessed. Questionnaire based data from the Irish longitudinal study on aging (TILDA), a stratified clustered sample of 8163 individuals representative of the community dwelling population aged 50 years and over between 2009 and 2011 were examined. Driving oneself was identified by 76.1% as their most frequently used form of transport. Only for 80+ participants in Rural and Urban non-Dublin was it the second most popular option, being replaced by Being driven by someone else. Less women identified Driving oneself as their most frequently used option and they experienced an almost linear decline in uptake with Age. The uptake reported by men remained high up to 69 and only after this point did it begin to decline. A greater proportion of men were Current drivers with a similar pattern being shown by women in relation to Never drivers. Irrespective of Gender, married participants were more likely to drive. A greater proportion of women cited a reason other than health for giving up driving. Three reasons for giving up were impacted by Age category of which Physical incapacity was not one. Driving status impacted positively on Quality of Life and Loneliness. The results are discussed in light of the advantages to society of older drivers continuing to drive.

Health-related quality of life and well-being in people over 75 years of age with end-stage kidney disease managed with dialysis or comprehensive conservative care: a cross-sectional study in the UK and Australia

ObjectiveTo measure health-related quality of life (HRQoL) and well-being in older people with end-stage kidney disease (ESKD) and to determine the association between treatment type and sociodemographic characteristics on these...

Developing a new quality of life instrument with older people for economic evaluation in aged care: study protocol

IntroductionThe ageing of the population represents a significant challenge for aged care in Australia and in many other countries internationally. In an environment of increasing resource constraints, new methods, techniques...

What can nurses do to manage incontinence challenges in end-of-life care?

What can nurses do to manage incontinence challenges in end-of-life care?

How much frailty is important in cardiology?

Prevalence and incidence of cardiovascular diseases increase dramatically with advancing age, and older subjects account for the vast majority of patients seeking care either for acute and chronic cardiovascular disorders. In the same time, availability and improvements in drugs and devices, and innovative techniques in interventional cardiology and heart surgery procedures, increased as well, posing crucial challenges in clinical decision-making mainly in older people. Elderly subjects represent a very heterogeneous population and the interplay between underlying physiological change, chronic disease and multimorbidity can result in health states in older ages that are not fully captured by traditional disease classifications and that are often missing in disease-based assessments of health. Geriatric syndromes have been widely recognized as an essential determinant of health status and well-being of older people, although there is some debate as to what disorders these include. Foremost among the geriatric syndromes is frailty, which can be regarded as a progressive age-related deterioration in physiological systems that results in greater vulnerability to stressors and increased risk of adverse outcomes, including care dependence and death. This complexity of health states in older ages means that disease-based conceptualizations are inadequate proxies for health in an older person. Rather than the presence or absence of disease, the most important consideration for older subjects is likely to be their functioning. The Comprehensive Geriatric Assessment (CGA), which evaluates through the use of standardized scales several domains - including comorbidity, cognitive and mood disorders, functional abilities, nutritional status, sarcopenia and frailty - has been demonstrated to be a much better predictor of survival and other outcomes than the presence of diseases or even the extent of comorbidities. Therefore, physicians should be aware that age by itself is probably not the best criterion to rely on for challenging clinical decision-making in this setting. In this clinical context, it becomes mandatory that, beyond age-based decisions or an "eyeballing" perception of "frailty" or "vulnerability", standardized and valid measures aimed at selecting those patients who may potentially derive the greatest benefit from medical or interventional procedures are made available for daily clinical use.

Improving community support for older people's needs through commissioning third sector services: a qualitative study.

This exploratory study of commissioning third sector services for older people aimed to explore whether service data was fed back to commissioners and whether this could improve intelligence about the population and hence inform future commissioning decisions. Third sector services are provided through charities and non-profit community organizations, and over recent years services have developed that assess and advise people for self-management or provide wellbeing support in the community. Third sector services have an opportunity to reach vulnerable populations and to provide intelligence about them. Some third sector services are state funded (commissioned) in the United Kingdom. While evidence is available about the commissioning of statutory health and social care, as well as private providers, there is limited evidence about how third sector health services are funded. Participants were recruited from commissioner organizations and third sector organizations, both with an interest in supporting the independence, self-management and wellbeing of older people. Organizations were recruited from five purposively selected sites within one region of England (East Midlands). Semi-structured interviews explored the relationships between commissioners and providers and the nature of funding arrangements, including co-production. Interviews also explored collection of data within the service and how data were fed back to commissioners. Focus groups were held with older people with the potential to benefit from wellbeing services. Commissioning arrangements were varied, sometimes complex, and often involved co-production with the third sector. Commissioners valued third sector organizations for their engagement with the local community, value for money, outreach services and ability to provide information about the community. Assessing the needs and outcomes of individuals was integral to delivery of support and advice to older people. Diverse approaches were used to assess an individual's needs and outcomes, although there were concerns that some assessment questionnaires may be too complex for this vulnerable group. Assessment and outcomes data were also used to monitor the service contract and there was potential for the data to be summarized to inform commissioning strategies, but commissioners did not report using assessment data in this way, in practice. While the policy context encouraged partnerships with third sector organizations and their involvement in decision making, the relationship with third sector organizations was not valued within contract arrangements, and may have been made more difficult by the tendering process and the lack of analysis of service data. This exploratory study has demonstrated a diversity of commissioning arrangements for third sector services across one region of England. Most commissioners invited co-production; that is, the commissioners sought input from the third sector while specifying details of the service. Service data, including assessments of needs and outcomes, were reported to commissioners, however commissioners did not appear to use this to full advantage to inform future commissioning decisions. This may indicate a need to improve measurement of needs and outcomes in order to improve the credibility of the commissioning process.

The (cost-) effectiveness of exergaming in people living with dementia and their informal caregivers: protocol for a randomized controlled trial

BackgroundPhysical activity is linked to benefits such as increased physical fitness, cognition, emotional and social functioning, general health and well-being in older people. Some evidence suggests that this also applies to people living with dementia. However, it can be harder for them to perform physical activities, due to several barriers, such as issues with orientation and balance problems. A relatively new type of physical activity called exergaming may help them overcome these barriers. Exergaming is “physical exercise interactively combined with cognitive stimulation in a gaming environment”. The aim of our study is to evaluate the effectiveness and cost-effectiveness of exergaming compared to regular activities in people living with dementia, who attend day-care centres. Additionally, we want to investigate whether the exergaming activity for the person living with dementia, also (indirectly) affects the informal caregiver, as well as which facilitators and barriers to implementation of exergames for this target group exist.MethodsA cluster Randomized Controlled Trial (RCT), with economic and process evaluations alongside will be carried out. In the Netherlands, 24 day-care centres are randomized in the experimental or control group. The study group will consist of 224 dyads (community-dwelling participants with dementia and their informal caregivers), who are interviewed at baseline, and at 3 and 6 months of follow-up. The participant with dementia has to visit the day-care centre for at least two days per week, have a diagnosis of mild to moderate dementia and have an informal caregiver present, who is willing to participate. Societal cost data will be collected during interviews, using healthcare utilization diaries, and from day-care centres. The process evaluation will only involve the experimental group, and will include an online survey, qualitative interviews and focus groups.DiscussionThis study will contribute to the evidence base that more effective exercise among people with dementia will result in positive effects on their wellbeing and quality of life. This will motivate people with dementia to be physically active. We also envision that there might be a positive effect on the burden of care experienced by their informal caregivers.Trial registrationThis trial was registered at the Netherlands Trial Register (NTR) on December 10, 2015 (number: NTR5537), this publication is based on protocol amendment number 01, issue date 28 December 2018. This includes all items from the World Health Organization Trial Registration Data Set [see Additional file 1].

Taking part in activities, an exploration of the role of discretionary travel in older people's wellbeing

IntroductionActivity theory, a construct from social gerontology, provides a framework to bridge the themes of ageing and transport, and thus enable new insights into the role of out-of-home mobility for wellbeing. The theory proposes that undertaking activities (classified as formal, informal and solitary) can generate wellbeing benefits for older people. Transport can be an important enabling mechanism for activity, but such engagement is at risk should access to a car be lost at a time of declining public transport provision in many communities in countries like the UK. MethodAnalysis of survey data collected by the ‘Grey and Pleasant Land?’ study of UK rural citizens aged sixty and above (N = 920), which explores activity participation for groups with and without car access. As well as descriptive analysis of the data, a series of binary logistic regression models facilitate exploration of relationships between mobility and activity, and then activity and wellbeing. ResultsThose with car access are up to three times more likely to participate in formal activity (OR 3.228; CI 1.656, 6.293). More surprisingly, there are higher levels of informal activity for those without car access (65% of this group engage in activity with friends’ weekly compared to only 51% of those with car access). The wellbeing measures proved less conclusive, although lack of weekly activity with friends and family slightly increases the probability of loneliness (OR 1.472; CI .877, 2.470). Age and health are seemingly more important factors. ConclusionsLinks are seen between formal activity and mobility, but less so for informal activity. In both instances, activities are relatively local; suggesting endeavours to improve mobility and activity will achieve optimum wellbeing and community cohesion benefits at a local level. Activity theory does appear to offer promise as a way of exploring these issues.

Individualized counselling for active aging: protocol of a single-blinded, randomized controlled trial among older people (the AGNES intervention study)

BackgroundActive aging has been established as a policy goal for aging societies. We define active aging at the individual level as striving for elements of well-being through activities in relation to a person’s goals, functional capacities and opportunities. Increasing evidence suggests that any meaningful activity is beneficial for different aspects of well-being in older people. The aim of the present randomized controlled trial is to test the feasibility and effectiveness of a one-year community-based intervention on active aging. The AGNES intervention aims at increasing older peoples’ participation in self-selected valued activities.MethodsThe proposed study is a two-arm single-blinded randomized controlled trial. The intervention group receives individually tailored counselling for an active life (one face-to-face session, four phone calls and supportive written material) and the control group written general health information only. Two hundred older adults aged 75- and 80- year old, with intermediate mobility function and without cognitive impairment, living independently in the municipality of Jyväskylä, Finland, are recruited and randomized with a 1:1 allocation to the intervention and control group. Randomization is computer-generated stratified by sex and age. The primary outcome is active aging and secondary outcomes are well-being, depressive symptoms, quality of life, personal goals, mobility and physical activity. Measures are administered at pre-trial, mid-trial (at 6 months) and post-trial (12 months after baseline).DiscussionThe AGNES intervention study will provide new knowledge on the effects of individualized counselling on active aging and the potential of older people to promote their own well-being.Trial registrationThe trial is registered at ISRCTN - ISRCTN16172390: Promoting well-being through active aging.

The effectiveness of a nurse-led short term life review intervention in enhancing the spiritual and psychological well-being of people receiving palliative care: A mixed method study

BackgroundA life review is a promising intervention to enhance spiritual well-being in older people. Conventional life review interventions are lengthy and often led by psychologists. ObjectivesThis is the first randomised controlled trial study to examine the effectiveness and applicability of a nurse-led short term life-review intervention in people with life limiting diseases, the purpose being to enhance their spiritual well-being and lower their anxiety and depression. DesignA sequential mixed method approach, randomised controlled trial and qualitative evaluation, was adopted. The intervention group received the short version life review, and the control group attention placebo. Participants were randomly assigned to either intervention or control groups by computerised randomisation. Both participants and outcome assessors were blinded to the group assignment. SettingsThe study was conducted in three publicly funded regional hospitals in Hong Kong. ParticipantsThe target population were people suffering from life-limiting diseases, and receiving hospitalised, day hospice or outreach home care from the palliative care team. MethodsTwo sets of questionnaires were used: the spiritual sub-scale of the McGill Quality of Life Questionnaire, Hong Kong version and the Hospital Anxiety and Depression Scale, Chinese version. The intervention process was assessed by means of observation log sheets and semi-structured interviews of 12 participants. ResultsA total of 109 participants were recruited (54 in the intervention group, 55 in the control group). The intervention group showed significantly more improvement in spiritual well-being than the control group, with a Cohen’s d-effect size of 0.65. Although there were improvements in both anxiety and depression levels in the intervention group, statistical significance in between-group comparisons was not reached. The process evaluation found that most participants were highly involved (92.6%), interested (77.8%) and participated in the intervention (79.6%). The participants described the intervention process as ‘comfortable’, ‘relaxing’ and ‘interesting’, and felt enlightened, with raised self-awareness, after it. ConclusionThe nurse-led short term life-review intervention demonstrated significant improvement effects in spiritual well-being. Participant feedback on nurses’ performance was positive, finding the intervention acceptable and useful. The setting of the intervention has now been extended from bedside to home. It is recommended to incorporate life review into palliative nursing specialty training, empowering more nurses to deliver the intervention in their daily practice.

Leadership, Inside and Out: The Tideswell-AGS-ADGAP Emerging Leaders in Aging Program.

To optimize health and well-being for all older people, we must collectively develop leaders to pioneer models of care, educate the healthcare workforce, advance research, and engage the community. The Emerging Leaders in Aging (ELIA) program was created to train a multiprofessional cadre of leaders focused on the health and well-being of older people. ELIA uses the social change curricular framework and addresses knowledge of self, community, and engagement with change. Program impact measured included scholar satisfaction, confidence related to curricular domains before and after the program, project progress, and scholar productivity. Four cohorts of 65 scholars in seven health professions from 24 states were selected for the year-long 55-hour program. Overall satisfaction from members of the first three cohorts who have completed the program (n = 46) was 4.86 (scale = 1-5), and scholar confidence increased from 5.8 to 8.0 (scale = 1-9) (p < .001). These scholars reported 85 presentations, 63 publications, and 21 awards subsequent to training. All scholars described the importance of a program focused on early and mid-career leaders in health and aging. The ELIA program leverages longitudinal, distance mentor communities, and project-based learning strategies. It has improved confidence and skills in emerging leaders who commit their efforts toward the care of older persons. Programs like ELIA are critical to preparing a healthcare workforce to optimize care for all as our health needs and expectations change with age. J Am Geriatr Soc 67:437-442, 2019.

Prescription of the Functional Strength Training for Older People: A Brief Review

Aging is associated with a variety of multisystem changes that influence decreased neuromuscular fitness levels. Such losses decrease physiological resilience and increase vulnerability to chronic diseases. As such, treatment strategies are necessary for health promotion and well-being in older people. Seeking to meet this need, functional strength training is an intervention often used to improve muscle strength and morphology. However, evidence-based doseresponse relationships with key physical training variables (e.g. intensity, volume, speed of movement, frequency and adhesion strategies) are unclear in the scientific literature. Thus, the purpose of this update is to provide an overview of current investigations and to suggest recommendations for the application of functional strength training to elderly. Taking into consideration the conditions of analysis, it may be suggested that a properly designed training program for the elderly should include a functional approach, working with two to three sets in one to two exercises per muscle group, reaching intensities of 70%-85% of one repetition maximum in body movements that resemble daily activities, 2 to 3 weekly sessions, including strength exercises performed at maximum concentric speed also with moderate intensities (40%-60% of one repetition maximum) and having as a basic premise neuromuscular adaptations.

Emotional Stability of the Elderly People

Emotions have an influential value in life, control on emotions is essential for prosperous life. A person who fails to control their emotions faces lot of problems in day to day life. Even emotional stability results happy and adjustable life therefore emotional stability is an important aspect of human life. Emotional stability is the process in which the personality is continuously striving for greater sense of emotional health, both intra-physically and intra-personally. Emotionally stable individuals are calm and happy, they are satisfied with their life; they deal with the situation in perfect way and solve their problems easily. As population aging becomes more and more pronounced, the concern for mental health and wellbeing of older people is also increasing. With the unprecedented increase in the number of oldest adults, several studies have paid attention to centenarians and their lives exploring factors related to longevity, such as health, generic influences, general life style etc. However, till date in India, research on aging was primarily confined to socio-demographic profiles, problems of and services to the aged etc. As a result certain issues related to the problems of elderly have received in sufficient and one such area is elderly well-being, self-esteem and mental health. Even speculation about the nature of the problem has been difficult because of invisibility and sensitiveness of the problem. The elderly often experience mental health issues and mental disorders. The present study focuses on the emotional stability of the elderly people. The study is descriptive in nature. 102 elderly people were selected for the study. Purposive sampling method is used for collecting data.

Analysis of indicators of life quality and well-being of people of older age groups in the russian federation

Aim: to study the problems of the elderly population and the directions of optimization of the geriatric care system. Material and methods. The reports of the international study Global Age Watch Index for 2013 and 2015, the data of state statistics on demography for 2013-2017 are analyzed. The levels of demographic aging in federal districts werestudied. Using Microsoft Excel, SPSS, statistical data processing was performed. 210 respondents were interviewed in an equal gender ratio by the method of simple random sampling in Moscow and the Moscow region.Results. Based on the Global Age Watch Index global rating, an analysis was made of indicators of the quality of life and wellbeing of older people living in the Russian Federation. The factors influencing demographic aging are considered and their estimation is made on the basis of the correlation analysis on the example of four federal districts of the country. To study the motivation for the consumption of drugs by persons of older age groups, a sociological survey was conducted. A conceptual model of the geriatric service management system is proposed with the introduction of systemic unity and an integrated approach to solving organizational, financial, and scientific and methodological problems of providing geriatric care.Conclusion. As a result of the analysis, the reasons for the low position of the Russian Federation in the Global Rating of the Global Age Watch Index, including the incomplete medical personnel and the variation in per capita incomes of the population in the regions, are identified. In the course of the sociological survey, the main pharmacotherapeutic groups of drugs purchased by persons of older age groups as well as the level of expenses were identified. In addition, the respondents' opinion was revealed on optimizing the organizational and managerial structure of medical, social and pharmaceutical care, focused on active longevity, the use of the personal potential of the elderly in work activities.