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Karami B, Ostad-Taghizadeh A, Rashidian A, Tajvar M. Developing a Conceptual Framework for an Age-Friendly Health System: A Scoping Review. Int J Health Policy Manag 2023; 12:7342. [PMID: 37579375 PMCID: PMC10461896 DOI: 10.34172/ijhpm.2023.7342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/07/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Population aging is usually associated with increased health care needs. Developing an age-friendly health system with special features, structure, and functions to meet the special needs of older people and improving their health status and quality of life is essential. This study aimed to develop a conceptual framework for an age-friendly health system, which would offer a conceptual basis for providing the best possible care for older people in health system to let them experience a successful, healthy, and active aging. METHODS A scoping review was used to design the conceptual framework based on Arksey and O'Malley's model, including six stages, with the final stage of using expert's opinions to improve and validate the initial framework. The health system model of Van Olmen, was selected as the baseline model for this framework. Then, by reviewing the available evidence, the characteristics of an age-friendly health system were extracted and incorporated in the baseline mode. RESULTS Using the electronic searching, initially 12 316 documents were identified, of which 140 studies were selected and included in this review study. The relevant data were extracted from the 140 studies by two reviewers independently. Most studies were conducted in 2016-2020, and mostly were from United States (33.6%). To have an age-friendly health system, interventions and changes should be performed in functions, components and objectives of health systems. This system aims to provide evidence-based care through trained workforces and involves older people and their families in health policy-makings. Its consequences include better health acre for older people, with fewer healthcare-related harms, greater care satisfaction and increased use of cost-effective health services. CONCLUSION To meet the needs of older people, health systems should make interventions in their functions for better performance. In line with these changes, other parts of society should work in harmony and set the health of older people as a top priority to ensure they can have a successful aging.
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Affiliation(s)
- Badrye Karami
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ostad-Taghizadeh
- Department of Disaster & Emergency Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tajvar
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Menassa M, Stronks K, Khatmi F, Roa Díaz ZM, Espinola OP, Gamba M, Itodo OA, Buttia C, Wehrli F, Minder B, Velarde MR, Franco OH. Concepts and definitions of healthy ageing: a systematic review and synthesis of theoretical models. EClinicalMedicine 2023; 56:101821. [PMID: 36684393 PMCID: PMC9852292 DOI: 10.1016/j.eclinm.2022.101821] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Background Healthy ageing (HA) has been defined using multiple approaches. We aim to produce a comprehensive overview and analysis of the theoretical models underpinning this concept and its associated normative terms and definitions. Methods We conducted a systematic review of peer-reviewed HA models in Embase.com, Medline (Ovid), Cochrane CENTRAL, CINAHL, PsycINFO, and Web of Science until August 2022. Original theoretical papers, concept analyses, and reviews that proposed new models were included. Operational models/definitions, development psychology theories and mechanisms of ageing were excluded. We followed an iterative approach to extract the models' characteristics and thematically analyze them based on the approach of Walker and Avant. The protocol was registered in PROSPERO (CRD42021238796). Findings Out of 10,741 records, we included 59 papers comprising 65 models/definitions, published in English (1960-2022) from 16 countries in Europe, Asia, and America. Human ageing was described using 12 normative terms, mainly (models (%)): successful (34 (52%)), healthy (eight (12%)), well (five (8%)), and active (four (6%)). We identified intrinsic/extrinsic factors interacting throughout the life course, adaptive processes as attributes, and outcomes describing ageing patterns across objective and subjective dimensions (number of models/definitions): cognitive (62), psychological (53), physical (49), social (49), environmental (19), spiritual (16), economic (13), cultural (eight), political (six), and demographic (four) dimensions. Three types of models emerged: health-state outcomes (three), adaptations across the life course (31), or a combination of both (31). Two additional sub-classifications emphasized person-environment congruence and health promotion. Interpretation HA conceptualizations highlight its multidimensionality and complexity that renders a monistic model/definition challenging. It has become evident that life long person-environment interactions, adaptations, environments, and health promotion/empowerment are essential for HA. Our model classification provides a basis for harmonizing terms and dimensions that can guide research and comparisons of empirical findings, and inform social and health policies enabling HA for various populations and contexts. Funding MM, ZMRD, and OI are supported by the European Union's Horizon 2020 Marie Skłodowska-Curie grant No 801076, and MM is also supported by the Swiss National Foundation grant No 189235.
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Affiliation(s)
- Marilyne Menassa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Farnaz Khatmi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Community Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Zayne Milena Roa Díaz
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Octavio Pano Espinola
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Magda Gamba
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Oche Adam Itodo
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Chepkoech Buttia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Faina Wehrli
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Minerva Rivas Velarde
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Public Health, Julius Center for Health Science and Primary Care, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
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Rea JNM, Broczek KM, Cevenini E, Celani L, Rea SAJ, Sikora E, Franceschi C, Fortunati V, Rea IM. Insights Into Sibling Relationships and Longevity From Genetics of Healthy Ageing Nonagenarians: The Importance of Optimisation, Resilience and Social Networks. Front Psychol 2022; 13:722286. [PMID: 35602748 PMCID: PMC9121911 DOI: 10.3389/fpsyg.2022.722286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/28/2022] [Indexed: 12/05/2022] Open
Abstract
Understanding how to “Age Longer and Age Well” is a priority for people personally, for populations and for government policy. Approximately ten percent of nonagenarians reach 90 years and beyond in good condition and seem to have a combination of both age-span and health-span. However, the factors which contribute to human longevity remain challenging. Culture is a shared system of learning ideas, feelings, and survival strategies. It has a strong influence on each person’s psychological development, behavior, values and beliefs. Nonagenarians have rich life experiences that can teach us much about aging well; they are rich reservoirs of genetic, lifestyle and psychological information which can help understanding about how to live longer and better. Sibling or trio nonagenarians are important sources of family beliefs and behaviors upon which individual personalities may have been built. Their personal family histories and narratives are powerful tools that help to determine familial traits, beliefs and social behaviors which may help establish factors important in the siblings’ longevity. Using purposefully selected subjects, recruited to the Genetics of Healthy Ageing (GeHA) project in four European countries, this research used the simple life story and qualitative research methods to analyze contrasting and distinctive questions about the interface between the psychological and social worlds as presented in the nonagenarian siblings’ insights about their longevity. Their stories aimed to give better understanding about which psychological aspects of their common life journey and the degree of emotional support in their sibling relationships may have supported their paths to longevity. The most universal finding in each of the four European countries was that nonagenarians demonstrated high positivity, resilience and coping skills and were supported in social networks. Around this theme, nonagenarians reported “being happy,” “always cheerful,” “never melancholy” and having a contentment with a “rich life” and family relationships which fits with accumulating evidence that life satisfaction comes from a perceived self-efficacy and optimism. Most sibling relationships in this study, when analyzed according to the Gold classification, fit the “congenial” or “loyal” relationship type – demonstrating a healthy respect for the others’ opinion without overt dependence, which may help individual coping and survival mechanisms.
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Affiliation(s)
- Jennifer Nicola M. Rea
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | | | - Elisa Cevenini
- CIG-Interdepartmental Centre ‘L. Galvani’, University of Bologna, Bologna, Italy
| | - Laura Celani
- CIG-Interdepartmental Centre ‘L. Galvani’, University of Bologna, Bologna, Italy
| | | | - Ewa Sikora
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Claudio Franceschi
- CIG-Interdepartmental Centre ‘L. Galvani’, University of Bologna, Bologna, Italy
| | - Vita Fortunati
- CIG-Interdepartmental Centre ‘L. Galvani’, University of Bologna, Bologna, Italy
| | - Irene Maeve Rea
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- School of Biomedical Science, Ulster University, Coleraine, United Kingdom
- Belfast Health and Social Care Trust, Belfast, United Kingdom
- *Correspondence: Irene Maeve Rea,
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Canvin K, MacLeod CA, Windle G, Sacker A. Seeking assistance in later life: how do older people evaluate their need for assistance? Age Ageing 2018; 47:466-473. [PMID: 29315385 PMCID: PMC5920341 DOI: 10.1093/ageing/afx189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/12/2017] [Indexed: 11/29/2022] Open
Abstract
Background legislation places an onus on local authorities to be aware of care needs in their locality and to prevent and reduce care and support needs. The existing literature overlooks ostensibly 'healthy' and/or non-users of specific services, non-health services and informal assistance and therefore inadequately explains what happens before or instead of individuals seeking services. We sought to address these gaps by exploring older adults' accounts of seeking assistance in later life. Methods we conducted semi-structured qualitative interviews with 40 adults aged 68-95. We invited participants to discuss any type of support, intervention, or service provision, whether medical, social, family-provided, paid or unpaid. Findings this paper reports older people's accounts of how they evaluated their need for assistance. We found that the people in our sample engaged in a recursive process, evaluating their needs on an issue-by-issue basis. Participants' progression through this process hinged on four factors: their acknowledgement of decline; the perceived impact of decline on their usual activities and independence; their preparedness to be a recipient of assistance; and, the opportunity to assert their need. In lieu of seeking assistance, participants engaged in self-management, but also received unsolicited or emergency assistance. Conclusions older people's adaptations to change and attempts to meet their needs without assistance mean that they do not present to services, limiting the local authority's knowledge of their needs and ability to plan appropriate services. Our findings offer four stages for policymakers, service providers and carers to target to address the uptake of assistance.
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Tøien M, Bjørk IT, Fagerström L. An exploration of factors associated with older persons' perceptions of the benefits of and satisfaction with a preventive home visit service. Scand J Caring Sci 2017; 32:1093-1107. [PMID: 29250819 DOI: 10.1111/scs.12555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 11/29/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preventive home visits (PHVs) are healthcare services aimed at promoting the health of home-dwelling older people and to support their abilities to live independently. To enhance effectiveness, studies that explore older persons' experiences of PHVs are needed. OBJECTIVE To assess older persons' perceived benefits and opinions of a PHV service and explore associations between perceived benefits from PHV and relevant sociodemographic/health-related factors. THEORY The study was based on a comprehensive understanding of health, as including objective health/disease, subjective health/well-being and coping ability. METHODS A cross-sectional survey was administered during spring 2013 in a Norwegian municipality where nurses had offered annual PHVs to residents aged 75 years and older since 1999. We invited a stratified random sample of 393 PHV users to participate; of these, 161 volunteered. The main outcome variables in the questionnaire were perceived benefits from PHV. Logistic regression models were used to analyse the associations between each benefit and sociodemographic/health-related background variables. RESULTS Approximately 39% of the respondents reported that PHVs added to their feelings of safety; 66% reported support for ability to live at home; 72% reported support for having a good life, 83% were satisfied with the service, and 90% stated that PHVs are important for older people. Each benefit was associated with different sociodemographic/health-related factors. Support for feelings of safety increased with age. More support for living at home was associated with poor physical health and not living alone. Those without children perceived more support for a good life. Satisfaction with PHV increased with increasing scores on the Life Orientation Scale. Persons with poor mental health and those not living alone more often perceived PHV as important. CONCLUSIONS Annual, comprehensive PHVs to a general older population may support older persons' health and independence. Low response rate restricts the possibility to generalise the results.
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Affiliation(s)
- Mette Tøien
- Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway.,Department of Nursing Science, University of Oslo, Oslo, Norway
| | | | - Lisbeth Fagerström
- Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway.,Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
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Morilla-Herrera JC, Morales-Asencio JM, Martín-Santos FJ, Garcia-Mayor S, Rodríguez-Bouza M, González-Posadas F. Effectiveness of advanced practice nursing interventions in older people: protocol for a systematic review and qualitative study. J Adv Nurs 2012; 69:1652-9. [DOI: 10.1111/jan.12030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Juan Carlos Morilla-Herrera
- Director of the Home Nursing Unit and Primary Health Care District of Málaga
- Faculty of Health Sciences; University of Málaga; Spain
| | | | - Francisco Javier Martín-Santos
- Director of the Home Nursing Unit and Primary Health Care District of Málaga
- Faculty of Health Sciences; University of Málaga; Spain
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Abstract
ABSTRACTSocial isolation and loneliness in older adults are growing problems. Empirical research suggests that loneliness can lead to poorer health outcomes including higher mortality rates. Befriending has been shown to decrease loneliness and depression although the exact mechanisms of action are unclear. In this study we aimed to explore experiences and identify key ‘ingredients’ of befriending through interviews conducted with 25 older adults who had used five different befriending services across England. We used Berkman's theoretical model of how individual social networks impact on health to help interpret our data and explore the mechanisms of befriending for older adults. Findings suggest that befriending offers some compensation for loss of elective relationships from older adults’ social networks, providing opportunities for emotional support and reciprocal social exchange through development of safe, confiding relationships. Good conversational skills and empathy were the foundation of successful relationships within which commonalities were then sought. Befrienders broadened befriendees’ perspectives on life (particularly among older adults in residential care). Social engagement was a powerful mechanism of action, particularly in terms of connecting people back into the community, reinforcing meaningful social roles and connecting to a past life that had often been significantly disrupted by loss. Understanding key components and mechanisms of befriending for older adults may facilitate development of more effective and theoretically sound befriending services.
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Gutiérrez G, Pérez-Cuevas R, Levy S, Reyes H, Acosta B, Cantón SF, Muñoz O. Strengthening preventive care programs: a permanent challenge for healthcare systems; lessons from PREVENIMSS México. BMC Public Health 2010; 10:417. [PMID: 20626913 PMCID: PMC2916901 DOI: 10.1186/1471-2458-10-417] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 07/14/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2001, the Instituto Mexicano del Seguro Social (IMSS) carried out a major reorganization to provide comprehensive preventive care to reinforce primary care services through the PREVENIMSS program. This program divides the population into programmatic age groups that receive specific preventive services: children (0-9 years), adolescents (10-19 years), men (20-59 years), women (20-59 years) and older adults (> = 60 years). The objective of this paper is to describe the improvement of the PREVENIMSS program in terms of the increase of coverage of preventive actions and the identification of unmet needs of unsolved and emergent health problems. METHODS From 2003 to 2006, four nation-wide cross-sectional probabilistic population based surveys were conducted using a four stage sampling design. Thirty thousand households were visited in each survey. The number of IMSS members interviewed ranged from 79,797 respondents in 2003 to 117,036 respondents in 2006. RESULTS The four surveys showed a substantial increase in coverage indicators for each age group: children, completed schemes of vaccination (> 90%), iron supplementation (17.8% to 65.5%), newborn screening for metabolic disorders (60.3% to 81.6%). Adolescents, measles - rubella vaccine (52.4% to 71.4%), hepatitis vaccine (9.3% to 46.2%), use of condoms (17.9% to 59.9%). Women, measles-rubella vaccine (28.5% to 59-2%), cervical cancer screening (66.7% to 75%), breast cancer screening (> 2.1%). Men, type 2 diabetes screening (38.6% to 57.8%) hypertension screening (48-4% to 64.0%). Older adults, pneumococcal vaccine (13.2% to 24.9%), influenza vaccine (12.6% to 52.9) Regarding the unmet needs, the prevalence of anemia in children was 30% and a growing prevalence of overweight and obesity, type 2 diabetes, and hypertension was found in men, women and older adults. CONCLUSION PREVENIMSS showed an important increase in the coverage of preventive services and stressed the magnitude of the old and new challenges that this healthcare system faces. The unsolved problems such as anemia, and the emerging ones such as overweight, obesity, among others, point out the need to strength preventive care through designing and implementing innovative programs aimed to attain effective coverage for those conditions in which prevention obtains substandard results.
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Affiliation(s)
- Gonzalo Gutiérrez
- Hospital Infantil de México "Federico Gomez". Dr. Márquez 162, Colonia Doctores, México DF., (Postal code 06720), México
| | - Ricardo Pérez-Cuevas
- Hospital Infantil de México "Federico Gomez". Dr. Márquez 162, Colonia Doctores, México DF., (Postal code 06720), México
- Unidad de Investigación Epidemiológica y en Servicios de Salud CMN Siglo XXI, Instituto Mexicano del Seguro Social. Avenida Cuauhtémoc 330, Colonia Doctores, México DF., (Postal code 06720), México
| | - Santiago Levy
- Inter-American Development Bank. Stop B-900, Washington DC., (Postal code 20577), USA
| | - Hortensia Reyes
- Centro de Investigación en Sistemas de Salud. Instituto Nacional de Salud Pública. Avenida Universidad 655, Colonia Santa Maria Ahuacatitlán, Cuernavaca, Morelos, (Postal code 62508), México
| | - Benjamín Acosta
- Unidad de Salud Pública, Instituto Mexicano del Seguro Social. Mier y Pesado 20, Colonia del Valle, Delegación Benito Juarez, México DF., (Postal code 03100), México
| | - Sonia Fernández Cantón
- Subsecretaria de Promoción y Prevención a la Salud. Secretaría de Salud. Francisco P. Miranda 77, Colonia Merced Gómez, Delegación Alvaro Obregón, México DF., (Postal code 01600), México
| | - Onofre Muñoz
- Hospital Infantil de México "Federico Gomez". Dr. Márquez 162, Colonia Doctores, México DF., (Postal code 06720), México
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Borglin G, Jakobsson U, Edberg AK, Hallberg IR. Older people in Sweden with various degrees of present quality of life: their health, social support, everyday activities and sense of coherence. HEALTH & SOCIAL CARE IN THE COMMUNITY 2006; 14:136-46. [PMID: 16460363 DOI: 10.1111/j.1365-2524.2006.00603.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Public health policies in most European countries are concerned with how to keep older people living independently with a qualitatively good life in the community as long as possible. However, knowledge about what may characterise those seemingly 'healthy' older people is sparse. The aim of the study was to investigate the characteristics of a sample of people (75+) reporting various degrees of Quality of Life (QoL) with respect to QoL in different areas, as well as self-rated health, health problems, social support, everyday activities and sense of coherence. A postal questionnaire was sent out in spring 2001 to a randomly selected population-based sample (n= 600) in the southern parts of Sweden. A two-step cluster analysis was performed (n= 385, mean age 84.6, SD = 5.7) with 'present QoL' as clustering attribute. Three groups were disclosed, classified as high, intermediate and low present QoL, of which 33.8% could be regarded being at risk of low QoL. Those with low present QoL (18.4%) were the oldest and most vulnerable, a majority were women with 'poor or bad' self-rated health, high frequencies of health problems, low total QoL, low social support and sense of coherence and less physically active. Those with high present QoL (47.8%) reported more 'excellent or good' self-rated health, physical activity, satisfactory social support and higher sense of coherence and total QoL than the other two groups. Those with intermediate present QoL (33.8%) had more of 'poor or bad' self-rated health, more health problems were less physically active, had lower total QoL and sense of coherence, and less social support than those with high present QoL. The sample seemed to reflect the ageing process in that the respondents were at different stages of ageing. However, the fact that the level of social support, sense of coherence and self-rated health followed the same curve as QoL may indicate that some are more vulnerable to low present QoL given the same health and these should be targeted in preventive programmes since they report low QoL.
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Affiliation(s)
- Gunilla Borglin
- Department of Health Sciences, Faculty of Medicine, Lund University PO Box 157, SE-221 00 Lund, Sweden.
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Henriksen E, Selander G, Rosenqvist U. Can we bridge the gap between goals and practice through a common vision? A study of politicians and managers' understanding of the provisions of elderly care services. Health Policy 2003; 65:129-37. [PMID: 12849912 DOI: 10.1016/s0168-8510(02)00212-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this study was to identify and describe how local politicians and managers experience and understand problems and goals regarding the structures and processes involved in the care of the elderly. Qualitative methodology of a conceptual modelling workshop was used. Participants were health care politicians, local municipal politicians, and executive care managers. The main result was that all participants agreed on four key visions for the health care of the elderly: see the person, see the individual's resources, see the encounter, and see yourself. Other findings indicated that (a) care of older persons was governed by diverse interests, (b) the organisation lacked clear leadership and comprehensive goals, (c) the organisation was fragmented, and (d) there was a lack of skilled staff members to meet patient needs. Older persons were regarded as passive receivers of care or as objects that did not take an active part in health care decisions that affect them.
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Affiliation(s)
- E Henriksen
- Research and Development Unit for Elderly Care, North West Stockholm County Council, Stockholm, Sweden.
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Wistow G. Modernisation, the NHS Plan and healthy communities. JOURNAL OF MANAGEMENT IN MEDICINE 2002; 15:334-51. [PMID: 11765317 DOI: 10.1108/eum0000000006182] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper reviews the NHS Plan from the perspective of the Government's wider programme of "modernising" public services. Although broadly focussed, particularly highlights older people. Two dimensions of modernisation are identified. The NHS Plan is seen to be patient-cited--rather than citizen-centred. Argues further, that, if the economic, social and environmental causes of ill health are to be addressed more generally and if citizens are to be enabled to live in healthy, sustainable communities, planning for health services should logically be subordinate to planning for health. Health improvement plans should, therefore, be integrated within the wider community strategies for which local authorities are to have lead responsibility. Similarly, as ill health is recognised to be an important aspect of poverty, inequality and social exclusion, there is a strong case for the integration of the regional offices of the NHSE within the wider structure of regional governance. Finally, the personal social services should ensure that the values of social work and social care are not displaced by medical and nursing models which, historically, have shown little understanding of community development processes.
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Affiliation(s)
- G Wistow
- Nuffield Institute for Health, University of Leeds, UK
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