Perspectives of Caring for Older Persons: A Scoping Review.
Journal of primary care & community health
In this article we explore caring practices for older persons from multiple care perspectives related to organizing home-based care. We employed a scoping review method and searched 5 electronic database using relevant key words and identified 62 articles for codebook thematic analysis. Our analysis identified 6 key themes in older people's care: gender issues; socio-economic status; psychological; cultural issues; elder abuse; and legal, ethical, and human rights concerns. Findings show that despite notable research progress made in recent years on home-based care for older people, research gaps still exist. Researchers and practitioners are encouraged to consider viewing home-based care for older people from multiple perspectives to ensure a holistic understanding of an individual's needs and circumstances and organize care accordingly. Future research and practice should seek to understand the lived experiences of care givers and receivers from multiple care perspectives, to help inform responsive and effective home-based care policies and programs.
10.1177/21501319241296618
Multidisciplinary Inpatient Community Rehabilitation Programmes for Frail Older People: A Scoping Review.
Nursing open
AIM:The aim of this review was to examine the evidence on multidisciplinary inpatient community rehabilitation intervention programmes for frail older people to establish what frailty rehabilitation programmes if any have been described within the literature and to identify gaps in knowledge and outcome measures used. DESIGN:A scoping review was conducted. METHODS:Using the Joanna Briggs Institute approach to scoping reviews, a comprehensive literature search was conducted accessing MEDLINE via PubMed, PsychINFO (via Proquest), CINAHL Complete (via EBSCO) and the Cochrane Library and a limited search of the grey literature was undertaken. RESULTS:Four articles met the inclusion criteria. A heterogenous approach to geriatric rehabilitation was evident across the literature. While the reported rehabilitation interventions were aimed at frail older people, the predominant focus of frailty rehabilitation programmes were on the physical functionality of the older person with an absence or limited measurement of any psychosocial, cognitive or spiritual outcomes or aspects of quality of life. CONCLUSION:This scoping review exposed the paucity of scientific evidence supporting the need for inpatient multidisciplinary rehabilitative programmes for frail older people wishing to remain at home. RELEVANCE TO CLINICAL PRACTICE:Timely access to inpatient integrated frailty rehabilitation programmes can improve the quality of life and reduce the likelihood of hospital admissions for frail older people who wish to remain living in their own homes. With the current dearth of published evidence available, there is a necessity to undertake further research to understand the form, content and best models of delivery for frailty rehabilitative services for clinical, policy and practice purposes. PATIENT OR PUBLIC CONTRIBUTION:There was no patient or public contribution.
10.1002/nop2.70088
Perception of Utility and Efficacy of Implementation of TEC-MED Model of Care for Frail Older People and Their Caregivers: A Qualitative Study.
International journal of older people nursing
INTRODUCTION:The global population is ageing, and healthcare systems continue to adopt outdated social models of ageing that do not respond to older people's needs. The aim of this study was to explore the experiences of participants in the implementation of the Transcultural social-ethical-care (TEC-MED) model for integrated community care. METHODS:A qualitative descriptive research study was conducted. Qualitative data were collected through individual interviews and focus groups with purposive sampling. RESULTS:We gathered experiences from five older people, five informal caregivers, two training agents (nurses), six healthcare professionals and eight stakeholders (senior management of businesses, public administrators, researchers and educators). Four themes were extracted: TEC-MED as a new model of home care, TEC-MED model outcome, key role of training agent and platform and resources. Overall, all the participants were satisfied with the model and various positive outcomes were found. The TEC-MED model of care was inclusive and personalised and bridged the communication and integration gaps between different services for the care of dependent older people and their caregivers in the community. Recommendations were made for improvements to the model. CONCLUSION:New models of care that are inclusive, personalised and integrated are necessary to respond to the multiple needs of the older people. A model that integrates the multiple skills of healthcare professionals is an optimum solution in the care of the older people and their caregivers in Mediterranean countries. Similar research is imperative for other healthcare systems to help them prepare adequately to respond effectively to the needs of present and new generations of older people. IMPLICATIONS FOR PRACTICE:The TEC-MED model presents a promising approach to addressing the complex care needs of older people and their caregivers by fostering inclusivity, personalisation and integration across services. For nursing practice, this model emphasizes the importance of multidisciplinary collaboration and the role of nurses in facilitating the adoption of new care strategies. Implementing such models in everyday practice could improve the quality of care provided to older adults, enhancing communication between healthcare providers and ensuring that care is more aligned with the individual needs of patients. Furthermore, integrating digital platforms and targeted resources, as highlighted in the TEC-MED model, can aid in overcoming existing barriers in healthcare systems, improving the coordination of care at the community level.
10.1111/opn.12658
Randomized controlled trial parallel-group on optimizing community pharmacist's care for the elderly: The influence of WhatsApp-Email delivered clinical case scenarios.
PloS one
BACKGROUND:Drug-related problems (DRPs) significantly threaten the safety of the elderly. In order to improve pharmacists' ability to minimize these events, novel educational interventions that consider the current challenges in clinical practice are crucial. OBJECTIVES:The primary objective is to assess the impact of two unique educational interventions on pharmacists' ability to identify DRPs. METHOD:A total of 127 community pharmacies in the United Arab Emirates (UAE) were recruited and randomly allocated to one of three arms using a 1:1:1 allocation ratio. While a series of clinical case scenarios (N = 24) related to elderly care were established and validated and sent to pharmacists in Active Group A over a 3-month period, lengthy research articles focused on medication safety in elderly were emailed to pharmacists in Active Group B. The control group pharmacist received no intervention. Then, pharmacists self-reported the number, categories, and severity of DRPs and pharmacist recommendations. RESULTS:The incidence of DRPs identified by pharmacists was 10.8% in Active Group A, 2.0% in the Control Group (p = 0.011), and 3.8% in Active Group B (p = 0.014). A significant difference was observed in the proportion of DRP types between Active Group A and the Control Group. The most common DRPs in Active Group A were avoidable medication (14.7%) and untreated disease (9.2%). Pharmacists in Active Group A (37.2%) and Active Group B (32.3%) most commonly intervened by recommending the cessation of medication, while the most common intervention in the Control Group was recommending a decrease in dose (29.8%). The mean cost reduction per patient was highest in Active Group A (31.3 ±11.8 $), followed by Active Group B (20.8 ±8.6 $) and the Control Group (19.6 ±9.5 $). The mean time needed to resolve a DRP was shortest in Active Group A (7.3 ±3.5 minutes), followed by Active Group B (9.8 ±4.2 minutes) and the Control Group (9.8 ±5.7 minutes). CONCLUSION:Using WhatsApp to deliver clinical scenarios was effective in improving pharmacists' ability to identify and address DRPs in elderly patients, resulting in faster resolution and higher cost savings.
10.1371/journal.pone.0308448
Osteoporosis incidence and its associated factors in the older Korean population: findings from a population-based cohort study.
Archives of osteoporosis
In South Korea, osteoporosis incidence among the elderly was unclear. Our study revealed an incidence of 18.4 per 1000 person-years, with higher rates in females and those with lower education. The findings indicate a need for targeted prevention strategies to guide health policy for improved osteoporosis care for the elderly. BACKGROUND:Although osteoporosis significantly affects morbidity and mortality among the older population in South Korea, the incidence of osteoporosis and its associated factors within this demographic group remains unclear. METHOD:We analyzed data from the Korean National Health Panel Survey, a nationally representative, population-based panel survey covering 2008 to 2018, to compute the incidence of osteoporosis among South Koreans aged 50 and older. Using the stepwise Cox Proportional Hazard model, we then identified and determined the associated factors of osteoporosis. RESULT:Out of the 7304 study participants in our analysis, we identified 792 osteoporosis events, resulting in an overall cumulative incidence rate of 18.4 per 1000 person-years. The incidence of osteoporosis increased steadily with age and was higher among those with lower levels of education. We also found that female study participants were at a statistically significant 7.2-fold higher risk (aHR = 7.2, 95% CI = 5.8-8.8) of developing osteoporosis compared to males. At the same time, those with hyperlipidemia had a statistically significant 1.3-fold increased risk (aHR = 1.3, 95% CI = 1.1-1.4) of developing osteoporosis. CONCLUSION:Our study highlights a significant proportion of the older South Korean population developed osteoporosis, especially among those who are older, females, and who have hyperlipidemia. This indicates the pressing need for the government's and healthcare systems' consideration of osteoporosis diagnosis and prevention strategies to ensure the health and well-being of the older South Korean population.
10.1007/s11657-024-01466-4
The Complex Relationship Between Social and Functional Needs in Frail Older Adults.
North Carolina medical journal
Background:There has been a growing interest in integrating social and function-focused care into health care settings. Little is known about what older adults perceive as the needs that impact their lives, and the resources to address patients' social and functional needs often exist outside of traditional health care settings. Methods:Our objective was to understand frail older adults' and community organizations' perspectives on what social and functional needs impact older adults' health, the support they receive, and how organizations and health systems could partner to address these needs. We conducted semi-structured interviews with patients and community-based organizations. Patients were aged 65 years or older, frail (electronic frailty index greater than 0.21), and at an increased geographic risk of unmet social needs (Area Deprivation Index greater than or equal to the 75th percentile). Staff were from organizations that provided social and/or functional resources to older adults. We used an inductive content analysis approach and the constant comparative method to analyze the data and identify themes. Results:We interviewed 23 patients and 28 staff from 22 distinct organizations. We found that social, financial, and functional needs were common and highly intertwined among older adults with frailty, but the support they received at home, from their health care providers, and from community organizations was highly varied. Limitations:Our sample was limited to participants from one county, so the results may not be generalizable to other areas. We only inter-viewed organizations and patients with frailty. Conclusions:Health systems and community organizations have distinct areas of expertise, and purposeful collaboration between them could be important in addressing the needs of frail older adults.
10.18043/001c.121369
The efficacy of training based on the family-centered empowerment model on the mental health of aged women: a stratified randomized controlled trial.
BMC women's health
BACKGROUND:Mental health among older women is substantial due to their longer life expectancy. They are more susceptible to mental disorders like depression and anxiety compared to older men. Additionally, older women fulfill essential family roles and depend on social support for age-related health issues. Family-centered education provides a platform to assist families and foster a collaborative relationship between the patient, family members, and health care providers in end-of-life care. The study aimed to explore how education based on family‑centered empowerment model affects mental health in aged women. METHODS:This randomized controlled trial involved a group of 60 elderly women aged 60 years and older, specifically selected from elderly-friendly health centers in Tabriz-East Azerbaijan, who were randomly assigned to either an intervention or control group with an equal ratio. The intervention group received a family-centered healthy lifestyle intervention weekly for 10 sessions, while the control group received standard care from elderly-friendly centers. The mean score of mental health using a three-part questionnaire of demographic-anthropometric characteristics and a mental health questionnaire (GHQ) were assessed before the intervention, 4 and 8 weeks after the intervention through SPSS/version 13 using, ANCOVA, independent t‑test, and repeated measure analysis at a significant level of p < 0.05. RESULTS:The average age (standard deviation: SD) was 64.0 (3.8) years. The literacy level of the more than half of the participants was primary school. Regarding occupation and marital status, the majority of them were married and housekeeper. Two months after the intervention (end of the intervention), a significant decrease was detected in terms of overall mental health score in the intervention group compared to the control (the adjusted difference was - 5.7 with a 95% CI from - 10.3 to -1.1, and the p-value was 0.015). In the intragroup analysis, two months after the intervention, there was a significant decrease in overall mental health score compared to baseline in the intervention group (the mean change was - 5.4, with a 95% CI from - 9.9 to -0.9, and a p-value of 0.015). Moreover, a significant decrease was indicated in the physical subscale score in the intervention group compared to the control group (the adjusted difference was - 5.7, with a 95% CI from - 10.2 to -1.2, and a p-value of 0.015). There was no significant difference between the two groups in other subscales (p > 0.05). In the intragroup analysis, there was a significant decrease in the physical subscale score (the mean change was - 1.7, with a 95% CI from - 2.9 to -0.2, and a p-value of 0.038) and anxiety symptoms (the mean change was - 1.8, with a 95% CI from - 3.4 to -1.0, and a p-value of 0.033) compared to the baseline in the intervention group. CONCLUSION:An education based on family-centered empowerment model could improve the overall mental health score in elderly women. Hence, it may be recommended to regard this approach as a practicable educational strategy for improving the well-being of the elderly. TRIAL REGISTRATION:Iranian Registry of Clinical Trials; https://irct.behdasht.gov.ir/trial/30535 (IRCT20161126031087N2), registered (03/08/2018).
10.1186/s12905-024-03442-z
A qualitative study on the current status and problems of pharmacists in home healthcare from the viewpoint of care managers in medically underpopulated areas in Japan.
Journal of pharmaceutical health care and sciences
BACKGROUND:Unlike in urban areas, community healthcare in medically underpopulated areas in Japan is constantly challenged because of the uncertainty in effectively using the limited resources. However, no study has focused on human resources or identified the actual state of pharmacists' support in the community. Therefore, our study identified the actual status and problems of pharmacists involved in home medical care in medically underpopulated areas and discussed the roles required of pharmacists and specific methods of support. METHODS:The content of semi-structured interviews with care managers involved in home healthcare in Misugi town, Tsu City, between November 10, 2023 and March 13, 2024, was analyzed qualitatively using the grounded theory approach. RESULTS:Five care managers participated in the study. Semi-structured interviews on the actual situation and challenges faced by pharmacists indicated that the following roles were required for pharmacists: as in other regions, it was observed that elderly people with dementia and those living alone managed their medicines, adjusted leftover medicines, collaborated with other professions, bridged with physicians, checked medication status through frequent visits, and adhered to internal medication regimens. Issues related to the characteristics of depopulated areas were identified including human resources, limitations of healthcare resources, economic burden, limits on the number of visits by pharmacists. As a characteristic of communities with no pharmacies and only in-hospital prescribing, pharmacists were expected by care managers to manage the problems caused by in-hospital prescribing. CONCLUSIONS:Our findings suggest that pharmacists should ensure the number of visits and collaborate with attending physicians, visiting nurses, and care managers to conduct drug management for patients with dementia and older adults living alone. Community healthcare specialists and those involved in the healthcare planning system can also utilize these findings while planning home healthcare to those who live in medically underpopulated areas in Japan.
10.1186/s40780-024-00395-1
Enhanced Home Care Interventions for Community Residing Adults Compared With Usual Care on Health and Cost-effectiveness Outcomes: A Systematic Review.
American journal of physical medicine & rehabilitation
ABSTRACT:The need for home care services is expanding around the world with increased attention to the resources required to produce them. To assist decision making, there is a need to assess the cost-effectiveness of alternative programs within home care. Electronic searches were performed in five databases (before February 2020) identifying 3292 potentially relevant studies that assessed new or enhanced home care interventions compared with usual care for adults with an accompanying economic evaluation. From these, 133 articles were selected for full-text screening; 17 met the inclusion criteria and were analyzed. Six main areas of research were identified including the following: alternative nursing care (n = 4), interdisciplinary care coordination (n = 4), fall prevention (n = 4), telemedicine/remote monitoring (n = 2), restorative/reablement care (n = 2), and one multifactorial undernutrition intervention study. Risk of bias was found to be high/weak (n = 7) or have some concerns/moderate (n = 6) rating, in addition to inconsistent reporting of important information required for economic evaluations. Both health and cost outcomes had mixed results. Cost-effective interventions were found in two areas including alternative nursing care and reablement/restorative care. Clinicians and decision makers are encouraged to carefully evaluate the quality of the studies because of issues with risk of bias and incomplete reporting of economic outcomes.
10.1097/PHM.0000000000001734
Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review.
Roberts Shelley,Collins Peter,Rattray Megan
Nutrients
Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.
10.3390/nu13072316