Scoping study of definitions and instruments measuring vulnerability in older adults

Referral to Geriatric Rehabilitation in the Netherlands, an Exploratory Study of Patient Characteristics

PURPOSE

Geriatric rehabilitation is intended for older adults with vulnerability, comorbidity, and acute functional impairments. To explore and evaluate referral criteria, this study followed hospital patients referred for rehabilitation in nursing homes.

DESIGN

Exploratory, retrospective cohort study.

METHODS

Participants were community living before acute hospitalization and referred for geriatric rehabilitation between January 15 and May 15, 2019. Data were collected at hospital admission, hospital discharge, and discharge from rehabilitation-oriented care. Outcome measure was the final discharge destination.

RESULTS

Out of 87 hospital patients referred for rehabilitation (mean age = 76.3 years, SD = 10.7), 73 received rehabilitation-oriented post-acute care and 60 (82.2%) returned home after rehabilitation. Premorbid functional status was regained by 45 (61.6%) participants and mobility by 40 (54.8%). Independent baseline mobility, no complications during post-acute care, fewer cognitive symptoms, and multidomain vulnerability were associated with discharge destination after rehabilitation.

CLINICAL RELEVANCE TO REHABILITATION NURSING

A multidomain assessment can make vulnerability applicable in referral decisions and induce tailored individual rehabilitation programs.

CONCLUSION

This study explored the case-mix characteristics of hospital patients following rehabilitation trajectories. No frailty measures were available; vulnerability was refined into physical, cognitive, and social components. Careful assessment of vulnerability can support personalized referral decision-making.

Heterogeneous effects of socio-economic status on social engagement level among Chinese older adults: evidence from CHARLS 2020

Introduction

Older adults benefit from social connections as it aids in their adjustment to the physical and psychological changes that come with aging, thereby improving their health, well-being, and overall quality of life.

Methods

This study utilizes data from the 2020 China Health and Retirement Longitudinal Study (CHARLS) to investigate the influence of Socio-economic Status (SES) on the social activity levels of older persons and the disparities observed among demographic groups, employing the Heckman two-stage analysis and heterogeneity analysis.

Results

The results indicate that SES has a significant positive impact on the social engagement of older adults, and this effect varies across different older groups, with women, married individuals living with a spouse, urban residents, those aged 70-79, and individuals with average health conditions.

Discussion

To effectively address the social needs of older adults, it is essential to prioritize integrating cohesive structural methods that improve social connections. Establishing solid and sustainable social support mechanisms and meeting the social needs of older adults across various SES and demographic groups are crucial in promoting active and healthy aging.

Methodological quality of 100 recent systematic reviews of health-related outcome measurement instruments: an overview of reviews

PURPOSE

Systematic reviews evaluating and comparing the measurement properties of outcome measurement instruments (OMIs) play an important role in OMI selection. Earlier overviews of review quality (2007, 2014) evidenced substantial concerns with regards to alignment to scientific standards. This overview aimed to investigate whether the quality of recent systematic reviews of OMIs lives up to the current scientific standards.

METHODS

One hundred systematic reviews of OMIs published from June 1, 2021 onwards were randomly selected through a systematic literature search performed on March 17, 2022 in MEDLINE and EMBASE. The quality of systematic reviews was appraised by two independent reviewers. An updated data extraction form was informed by the earlier studies, and results were compared to these earlier studies' findings.

RESULTS

A quarter of the reviews had an unclear research question or aim, and in 22% of the reviews the search strategy did not match the aim. Half of the reviews had an incomprehensive search strategy, because relevant search terms were not included. In 63% of the reviews (compared to 41% in 2014 and 30% in 2007) a risk of bias assessment was conducted. In 73% of the reviews (some) measurement properties were evaluated (58% in 2014 and 55% in 2007). In 60% of the reviews the data were (partly) synthesized (42% in 2014 and 7% in 2007); evaluation of measurement properties and data syntheses was not conducted separately for subscales in the majority. Certainty assessments of the quality of the total body of evidence were conducted in only 33% of reviews (not assessed in 2014 and 2007). The majority (58%) did not make any recommendations on which OMI (not) to use.

CONCLUSION

Despite clear improvements in risk of bias assessments, measurement property evaluation and data synthesis, specifying the research question, conducting the search strategy and performing a certainty assessment remain poor. To ensure that systematic reviews of OMIs meet current scientific standards, more consistent conduct and reporting of systematic reviews of OMIs is needed.

Multidimensional vulnerability among older adults in Germany : Social support buffers the negative association with life satisfaction

BACKGROUND

Multidimensional vulnerability among older adults, characterized by low levels of individual resources in different life domains, has been insufficiently studied. This phenomenon is considered to be associated with a marked decrease in overall life satisfaction. Social support is supposed to buffer the negative effect of multidimensional vulnerability on life satisfaction.

METHODS

Analyses are based on the German Health Update dataset (GEDA 2014/2015-EHIS). The analytic sample includes respondents ≥ 65 years (N = 5826). Confirmatory factor analyses were performed to construct a latent variable from the indicators income poverty, activities of daily living (ADL) limitations, multimorbidity, mental problems, and living alone. Multivariate linear regression models estimate the relationship between vulnerability and life satisfaction with a special focus on the interaction between vulnerability and social support.

RESULTS

The analyses supports the multidimensional construct of vulnerability. Social support considerably moderates the negative relationship between vulnerability and life satisfaction. As the degree of vulnerability increases, the influence of social support becomes more pronounced.

CONCLUSION

The assessment of vulnerability as a multidimensional construct helps to depict the life situation of older people in a more differentiated way. Vulnerable older adults with a small or unreliable social network while finding it difficult to access practical help need additional external social support to achieve a high level of life satisfaction.

Spatial and racial covid-19 disparities in U.S. nursing homes

In many parts of the world nursing home residents have experienced a disproportionate risk of exposure to COVID-19 and have died at much higher rates than other groups. There is a critical need to identify the factors driving COVID-19 risk in nursing homes to better understand and address the conditions contributing to their vulnerability during public health crises. This study investigates the characteristics associated with COVID-19 cases and deaths among residents in U.S. nursing homes from 2020 to 2021, with a focus on geospatial and racial inequalities. Using data from the Centers for Medicare and Medicaid Services and LTCFocus, this paper uses zero-inflated negative binomial regression models, Kruskal-Wallis tests, and Local Moran's I to generate statistical and geospatial results. Our analysis reveals that majority Hispanic facilities have alarmingly high COVID-19 cases and deaths, suggesting that these facilities have the greatest need for policy improvements in staffing and financing to reduce racial inequalities in nursing home care. At the same time we also detect COVID-19 hot spots in rural areas with predominately White residents, indicating a need to rethink public messaging strategies in these areas. The top states with COVID-19 hot spots are Kentucky, Pennsylvania, Illinois, and Oklahoma. This research provides new insights into the socio-spatial contexts and inequities that contribute to the vulnerability of nursing home residents during a pandemic.

Vulnerability, ageism, and health: is it helpful to label older adults as a vulnerable group in health care?

Despite the diversity of ageing, society and academics often describe and label older persons as a vulnerable group. As the term vulnerability is frequently interchangeably used with frailty, dependence, or loss of autonomy, a connection between older age and deficits is promoted. Concerning this, the question arises to what extent it may be helpful to refer to older persons as vulnerable specifically in the context of health care. After analyzing different notions of vulnerability, I argue that it is illegitimate to conclude that older age is related to increased vulnerability. Much more, identifying older adults as a vulnerable group is closely related to ageism and can be associated with paternalistic benevolence and a tendency to overprotection, especially within health care. Additionally, even though older adults are more often in situations of increased vulnerability due to their potentially higher need for health care, I argue further that older adults mainly become a vulnerable group due to ageism. In this way, it can be concluded that the vulnerability of older adults does not originate in certain attributes of the group, but arises from a characteristic of society and, in turn, health personnel, namely ageism. Labeling older adults as vulnerable therefore is only helpful, when it is used to raise awareness of the widespread ageism in society, in this context, especially in the setting of health care, and the negative consequences thereof for older adults.