Well-being Of Older People Research Articles

Promoting independence, health and well-being for older people: a feasibility study of computer-aided health and social risk appraisal system in primary care

BackgroundWith population ageing, research is needed into new low-cost, scalable methods of effective promotion of health and wellbeing for older people. We aimed to assess feasibility, reach and costs of implementing a new tailored computer-aided health and social risk appraisal system in primary care.MethodsDesign: Feasibility study.Setting: Five General Practices in London (Ealing) and Hertfordshire, United Kingdom (UK)Participants: Random sample of patients aged 65 + years.Intervention: The Multi-dimensional Risk Appraisal for Older people (MRA-O) system includes: 1) Postal questionnaire including health, lifestyle, social and environmental domains; 2) Software system generating a personalised feedback report with advice on health and wellbeing; 3) Follow-up of people with new concerning or complex needs by GPs or practice nurses.Evaluation: Feasibility of implementation; participant wellbeing, functional ability and quality of life; social needs, health risks, potential lifestyle changes; and costs of implementation.ResultsResponse rates to initial postal invitations were low (526/1550, 34%). Of these, 454/526 (86%) completed MRA-O assessments. Compared to local UK Census data on older people, participants were younger, more were owner-occupiers and fewer were from ethnic minority groups than expected. A range of problems was identified by participants, including pain in last week (269/438, 61.4%), low physical activity (173/453, 38.2%), sedentary lifestyle (174/447, 38.3%), falls (117/439, 26.7%), incontinence (111/441 25.2%), impaired vision 116/451 (25.7%), impaired hearing (145/431, 33.6%), depressed mood (71/451, 15.7%), impaired memory (44/444 9.9%), social isolation (46/449, 10.2%) and loneliness (31/442, 7.0%). Self-rated health was good/excellent in 312/437 (71.4%), and quality of life and well-being were slightly above age-specific population norms. Implementation costs were low. Practices reviewed medical records of 143/454 (31.5%) of participants as a consequence of their responses, and actively followed up 110/454 (24.2%) of their patients.ConclusionsA computer-aided risk appraisal system was feasible for General Practices to implement, yields useful information about health and social problems, and identifies individual needs. Participation rates were however low, particularly for the oldest old, the poorest, and ethnic minority groups, and this type of intervention may increase inequalities in access. Widespread implementation of this approach would require work to address potential inequalities.

Exploring the importance of discretionary mobility in later life

PurposeTravel and mobility for older people has typically focussed on the practical benefits to the individual, for example, in meeting utilitarian needs of shopping, appointments and staying connected to family and friends. However, previous research has hinted that travel for its own sake, to get out and about and feel and experience mobility, may be just as important for older people and is especially missed when individuals give-up driving. The paper aims to discuss these issues.Design/methodology/approachThis paper examines travel for its own sake, usually referred to as discretionary travel, interviewing 20 older people in each of three different contexts: for drivers, for community transport users and for non-drivers who receive lifts from family and friends.FindingsOlder people not only enjoy discretionary travel, but also feel it is beneficial to their health and wellbeing. The car and especially driving, is seen as the best way to fulfil discretionary travel. Community transport users do fulfil discretionary travel needs but these are over formalised and lack spontaneity affecting feelings of control and identity. Receiving lifts from family and friends can often result in older people feeling a burden to the providers of the lifts especially when travel is viewed as discretionary.Practical implicationsMore needs to be done to ensure discretionary travel needs are met for those without cars, highlighting the importance of such travel to community transport providers and helping reduce the feeling of being a burden to family and friends.Originality/valuePolicy, practice and research has tended to focus on transport as a means to an end. However, older people themselves value mobility just as much for its own sake and just to view nature. Such discretionary reasons for mobility are actually very important for health and wellbeing of older people and need more attention.

How to … work better with the GP and pharmacy services

Swift access to primary care services is integral to maintaining the health and wellbeing of older people in care. Adrian Ashurst discusses the importance of developing positive relationships with GP and pharmacy services, and describes how this can be achieved

What matters for life satisfaction among the oldest-old? Evidence from China

ObjectiveThe world population is aging rapidly and the well-being of older people is of great interest. Therefore, this study investigates the determinants of life satisfaction among the oldest-old (i.e. individuals aged 80 or over) in China.Materials and methodsWe use the 2011/2012 Chinese Longitudinal Healthy Longevity Survey data (n = 6530) for this paper. Logistic regression is used to analyse the effects of socio-demographic, economic, health, instrumental activities of daily living, family and community factors on life satisfaction and depression among the oldest-old in China.ResultsOur analysis confirms the significance of many factors affecting life satisfaction among the oldest-old in China. Factors that are correlated with life satisfaction include respondent’s sex, education, place of residence, self-rated health status, cognitive ability (using mini mental state examination), regular physical examination, perceived relative economic status, access to social security provisions, commercialized insurances, living arrangements, and number of social services available in the community (p<0.05 for all these variables). Although life satisfaction is negatively associated with instrumental activities of daily living (β = -0.068, 95%CI = -.093—.043), and depression (β = -0.463, 95%CI = -.644—.282), the overall effect of self-rated health status is positive (p<0.001). This confirms the primacy of health as the determinant of well-being among the oldest-old.ConclusionsMajority of the oldest-old in China rated their life satisfaction as good or very good. Our findings show that health and economic status are by far the most significant predictors of life satisfaction. Our finding on the primacy of health and relative income as determinants of well-being among the oldest-old, and the greater influence of self-rated health status over objective health measures is consistent with the findings of many past studies. Our results suggest that efforts should be directed at enhancing family support as well as health and social service provisions in the community to improve life satisfaction of older people.

Mental well-being and independence for older people.

Essential facts The UK population is ageing rapidly, with the number of people aged 65 or above rising by almost half in the past three decades. By 2035, it is estimated that almost one in four people will be aged 65 or more. The Mental Health Foundation says five main factors affect the mental health and well-being of older people: discrimination, participating in meaningful activities, relationships, physical health and poverty.

Identifying and managing influenza in the care home

Influenza, or the flu, can have a significant effect on the health and wellbeing of older people living in care. In this article Debbie Duncan explains how care home staff can be involved in preventing and reducing the impact of the virus

シニア層ユーザーのPC活用が主観的ウェルビーイングとQOLに及ぼす影響

Previous studies have not shown a consistent association between computer use and the well-being of older people. The authors assumed that this absence of a causal relationship might be due to the mediation effects of some psychological factors and the limited use of scales for measuring multi-dimensional aspects of well-being. Therefore, this study examined the impact of computer skills, attitudes toward computers, and self-efficacy on the subjective well-being and quality of life (QOL) of older computer users (over 60 years of age). Four hundred respondents completed an online survey. Path analysis revealed that the acquisition of computer skills led to positive attitudes towards computers and a higher sense of self-efficacy, and in turn, these two factors improved life satisfaction and QOL. This relationship was modulated by gender- and skill-based group differences. These findings have implications for improving QOL factors with computer use, and may be useful for developing an effective instructional design for computer training for older people.

A note on suitable and healthy housing in the Netherlands

Housing is one of the eight domains of the concept of age-friendly cities or environments of the World Health Organization. This concept concentrates mainly on enabling active ageing and tapping the potential that older people represent for humanity. Proper housing is essential for the safety and well-being of older people and there is also a link between appropriate housing and access to community and social services in influencing independence and quality of life of older people. Given the importance of housing for older people, it looks at least a bit awkward that both the Global Age-Watch Index GAWI and Active Ageing Index AAI pay so little attention to the physical aspects of housing. The question emerges which sub-indices can be made available for GAWI and AAI to include suitable and healthy housing. In our contribution we are offering some suggestions.

Tangible and intangible elements of design for well-being in the home

Issue The ISO/IEC Guide 71 states: “It is an important goal for the whole of society that all people, regardless of their age, size or ability, have access to the broadest range of systems”. Considering housing as a system this paper asks if design of Australian housing generally takes the goal mentioned above into account and whether it is a sufficient goal both to address the desire of older Australians to remain living independently as they age and to support their well-being in the home. Approach The architect and author of this paper used ‘an architecture of accommodation’ approach in designing an award-winning house that would support independence of the occupants into old age. This house is used as a case-study to identify both ‘tangible’ and ‘intangible’ elements of the home that are seen to support independence. Further a limited post-occupancy evaluation was carried out as a public litmus test to indicate if the design approach taken was recognized by the general public. Results, discussion and practical implications Both tangible and intangible elements of design contribute to the independence and well-being of older people at home. However, two important guidelines on housing design for older people refer only to tangible elements of design. It is proposed that intangible elements of design, which make older people feel well, encourage self-esteem and support independence, are also critical in providing high quality housing for older people.

“Something to get out of bed for”: creative arts for a happily ageing population

Purpose The purpose of this paper is to relate the growing body of evidence about the impact of creative arts on the health and well-being of older people to the debate about active ageing, prevention and demographic change. Design/methodology/approach It draws on a range of researched examples in order to illustrate the impact of three different art forms – singing, dance and visual arts – on health and well-being. Findings The evidence exists in increasing volume and diversity that creative arts not only improve personal feelings of well-being but also key physiological measures. The arts are increasingly recognised as playing a major potential role in the delivery of health and social care interventions. Greater recognition and action are needed from policy makers, commissioners and care providers in health and social care that the arts are not a marginal and elitist avenue but a mainstream tool supporting older people to remain active, healthy and independent. Importantly, they represent a powerful source of motivation, agency and confidence. Social implications It argues that creative arts should become an integral and more prominent part of ageing policy. The evidence exists in increasing volume and diversity that creative arts not only improve personal feelings of well-being but also key physiological measures. The arts are increasingly recognised as playing a major potential role in the delivery of health and social care interventions. Greater recognition and action are needed from policy makers, commissioners and care providers in health and social care that the arts are not a marginal and elitist avenue but a mainstream tool supporting older people to remain active, healthy and independent. Importantly, they represent a powerful source of motivation, agency and confidence. Originality/value An important research challenge remains, namely to plot cause (arts intervention) and effect (reduced demand on health and care services), if the creative arts are to occupy a central place in commissioning investment at a time of acute financial stringency in the public sector.

Changing the way "we" view and talk about frailty….

This commentary discusses the perception of frailty by different key stakeholders-most notably older people. It considers the need to integrate predominantly medically driven understandings of frailty within a wider conceptual framework. This is imperative if the potential of frailty as a construct, around which the optimisation of health and well-being of older people can take place, is to be realised.

在宅介護支援センター職員の組織間・職種間協働( 高齢者の保健・医療・福祉研究の諸相)

在宅介護支援センター職員の組織間・職種間協働( 高齢者の保健・医療・福祉研究の諸相)

保健・医療・福祉の総合化について( 高齢者の保健・医療・福祉研究の諸相)

保健・医療・福祉の総合化について( 高齢者の保健・医療・福祉研究の諸相)

アメリカ合衆国のジェロントロジー教育( 高齢者の保健・医療・福祉研究の諸相)

アメリカ合衆国のジェロントロジー教育( 高齢者の保健・医療・福祉研究の諸相)

日本とフィンランドの高齢者に関わる国際比較研究の視点と方法( 高齢者の保健・医療・福祉研究の諸相)

日本とフィンランドの高齢者に関わる国際比較研究の視点と方法( 高齢者の保健・医療・福祉研究の諸相)

チームケアにおいて連携を妨げるもの( 高齢者の保健・医療・福祉研究の諸相)

チームケアにおいて連携を妨げるもの( 高齢者の保健・医療・福祉研究の諸相)

Effect of a social intervention of choice vs. control on depressive symptoms, melancholy, feeling of loneliness, and perceived togetherness in older Finnish people: a randomized controlled trial

ABSTRACTObjectives: This study examined effects of a social intervention on depressive symptoms, melancholy, loneliness, and perceived togetherness in community-dwelling Finnish older people.Method: Promotion of mental well-being in older people (GoodMood; ISRCTN78426775) was a single-blinded randomized control trial lasting 1.5 years. Two hundred and twenty-three persons aged 75–79 years reporting symptoms of loneliness or melancholy were randomized into intervention and control groups. The intervention group was allowed to choose among supervised exercise, social activity, or personal counseling. Follow-up measurements were conducted at the end of 6-month intervention, and at 3, 6, and 12 months post intervention.Results: Number of depressive symptoms remained unchanged, while loneliness and melancholy decreased in both the intervention and control groups during the study (p < 0.001). Social integration increased in the intervention group but not in controls (p = 0.041). Attachment and guidance increased in both groups (p < 0.001). Conclusion: The intervention did not alleviate depressed mood. Positive changes over time were observed in loneliness, feelings of melancholy, attachment, and guidance but these occurred independently of the intervention. Our secondary analysis suggests that the intervention increased perceived social integration. In sum, the effects of the intervention were moderate only and did not expedite further overcoming depressive mood or loneliness.

Feeling lonely in an unfamiliar place: older people's experiences of life close to death in a nursing home.

The aim of the study was to deepen the understanding of how older persons living in a nursing home experience life close to death. A move to and a life in a nursing home while being close to death is a reality for many older people in Sweden. Being able to express thoughts and feelings about death has been described as both crucial for sustaining personhood as well as for establishing a meaningful existence at the end of life. Important are the experiences of older people living in nursing homes who are approaching death. Six older people were interviewed on one to four occasions. A total of 16 interviews were conducted with the participants. An interpretative approach was chosen. The main interpretation, Feeling lonely in an unfamiliar place, is based on three themes (i) Waiting for death, with the subthemes death as a release and thinking of oneself as dead; (ii) Subordinate oneself to values and norms of the staff, with the subthemes feeling offended and feeling trapped; and (iii) Keep the courage up. The older people's lives were characterised by feelings of aloneness in an unfamiliar place which contributed to a sense of existential loneliness. They experienced few opportunities to discuss their thoughts of life and death, including preparations for passing away. It is of importance for professionals to be able to meet older people as they are and respect them as human beings in their transitions, before, during and after the move to a nursing home. It is important to find ways to support older people's wellbeing and identity near death.

Creativity should not have an upper age limit.

Janet Morrison writing in Nursing Older People says that care home managers should challenge the belief that expectations in later life are low and instead engage older people in creative programmes. The author, CEO at the Baring Foundation, says that story-telling, comedy, and art can enhance self-esteem, confidence and mental wellbeing for older people in the community and in care homes.

Hospital discharge: lost opportunities to promote or maintain older people’s mental health

PurposeThe purpose of this paper is to explore the impact of hospital discharge on the wider wellbeing of older people, drawing out implications this can have on mental health.Design/methodology/approachThis paper is based on research from the Healthwatch England Special Inquiry into hospital discharge. The paper focuses on the experiences of 1,300 older people, with the majority of the research being undertaken by the local Healthwatch network. The 58 local Healthwatch who submitted evidence on the experiences of older people as part of the inquiry were autonomous in how they were able to carry out the research, with results being analysed through use of a qualitative framework.FindingsOlder people often felt they were not ready for discharge due to not feeling involved in planning of their discharge, being discharged without the information they need and having difficulties accessing aftercare support. This paper examines the impact these issues can have on the mental health and wellbeing of older people, their carers and specifically patients with dementia both during and after discharge from hospital. Through examination of these issues the discharge process can be viewed from the perspective of the individual, and start to conceptualise where the hospital discharge process could further support older people’s mental health and wellbeing.Research limitations/implicationsThis paper examines these issues in detail through case studies collected regarding older people, and exposes the impact poor discharge can have on physical and mental wellbeing for older patients. The paper presents a number of issues which have implications for policy and practice in both health and social care, and the integration of the two services.Originality/valueThis is the first Special Inquiry conducted by Healthwatch England in conjunction with the local Healthwatch network and presents a large scale piece of research led by the experiences of older people.