Assessing Older Adults' Decision-Making Capacity for Independent Living: Practice Tensions and Complexities

Assessment of older adults' decision-making capacity for independent living: Findings from a nominal group technique meeting in Ireland

INTRODUCTION

Occupational therapists are one of the nominated professions who can assess decision- making capacity in according to recent Irish legislation. However, the process of implementing this legislation into practice remains unclear for therapists. The aim of this study was to form a consensus on recommended procedures for occupational therapists when assessing older adults' decision-making capacity for independent living.

METHODS

A nominal group technique was employed to identify and rank critical dimensions of capacity assessment. Twenty occupational therapists from a range of Irish practice settings participated in a 1-day consensus meeting.

RESULTS

Key triggers indicating the need for capacity assessment related to independent living were risk, reduced insight and conflicting stakeholder perspectives on older person's needs (strong consensus). Capacity assessment should consider observations of function, cognitive assessment, and home-based assessment (strong consensus). Strategies to maximise the older person's participation in the capacity assessment and enable occupational therapists to embed will and preference within the capacity assessment process were identified.

CONCLUSION

Findings represent a hierarchical organisation of key components to be considered in capacity assessment of independent living and highlight the role of occupational therapy in assessing and enhancing older adults' decision-making capacity.

CONSUMER AND COMMUNITY INVOLVEMENT

No consumers/patients of occupational therapists were involved in the study.

PLAIN LANGUAGE SUMMARY

Many older people want to stay in their own homes for as long as they can. Occupational therapists assist the person to make this decision. This study looked at how occupational therapists in Ireland help older people make this decision. Twenty therapists agreed on the best way to check if someone can decide to live independently. Sometimes, tests are needed because of safety risks, confusion, or family disagreements. Therapists watch how people do daily tasks, test their thinking, and check their home to help them decide. The study also suggests ways to make sure older people are included in these decisions.

V. Confirmatory factor analysis of the effect of daily-living on the happiness of community-dwelling older adults in Chile

This study examined the effect of the human-functioning dimension on happiness among community-dwelling older adults (OAs) in Chile. Questionnaires were used for data collection from a sample of 785 OAs of both sexes attending healthcare institutions. Exploratory factor analysis was performed using parallel analysis and oblique rotation. Confirmatory factor analysis and structural equation modeling were conducted using the maximum likelihood and unweighted least squares methods. Goodness-of-fit analyses were performed by considering absolute and respective incremental fit indices. The relationships between the functioning and happiness factors were all significant at the 1% level, indicating that functioning impacts happiness. The ratios of the variances between both constructs were identical to those of the covariances, indicating consistency between the models, with similarities and equalities in the estimation of their parameters. The modeling confirms a direct relationship between activities of daily living functioning and happiness. Given that a lack of functioning significantly affects OAs' happiness and quality of life, this relationship is consistent with the available theory. These findings may contribute to the formulation of social and health policies regarding OAs in Chile and other Latin American countries.

Comparing remote and face-to-face assessments of physical performance in older adults: A reliability study

INTRODUCTION

Older people often experience a decline in their physical performance. Tests have been approved to evaluate this performance in person. Yet, the constraints associated with in-person assessments (e.g. lack of medical facilities, pandemic lockdown, and contagion risk) are making us contemplate setting up assessments remotely.

OBJECTIVES

To determine whether remote physical performance measurements of older adults are reliable and valid compared to face-to-face measurements.

METHODS

Forty-five subjects aged 65 and over completed the normal/fast speed test (NWT/FWT), the unipodal balance test (UBT), the normal/fast timed up and go test (NTUG/FTUG), the 5 and 10 rep sit to stand test (5STS and 10STS), the 30 sec chair stand (30CS), the 2 minute step test (2MST) and the flexibility before standing (SAD) once face-to-face and twice remotely, by two different observers. The intraclass correlation coefficients (ICC), the standard errors of measurement (SEM%) and minimum detectable changes (MDC%) were calculated for both intra- and inter-observer conditions, to assess the relative and the absolute reliability. An ICC value exceeding 0.90 indicates a very high reliability, while an ICC between 0.70 and 0.89 signifies a high reliability. In clinical practice, a SEM % of less than 10% is considered acceptable. A smaller MDC % indicates a measurement that is more sensitive to detecting changes.

RESULTS

Intra-observer relative reliability was very high (ICC>0.9) for the UBT, NWT, NTUG, FTUG, 5STS, 10STS, 30CS and the SAD; and high (ICC>0.7) for the 2MST and FWS. SEM% values ranged from 0% to 24.03% and MDC from 0% to 9.93%. Inter-observer relative reliability was considered very high (ICC>0.9) for all tests. SEM% values ranged from 0% to 17.68% and MDC from 0% to 7.32%.

CONCLUSION

Our findings demonstrate that remote assessments exhibited consistently high to very high levels of intra- and inter-observer relative reliability when compared to face-to-face assessments. Additionally, certain remote evaluations showed acceptable absolute reliability, making them viable alternatives for healthcare professionals when in-person assessments are not feasible in clinical practice.

Provider and facility readiness for age-friendly health services for older adults in primary health care centres in southwest, Nigeria

There is a growing focus on interventions at the health system level to promote healthy aging and provide age-friendly health services (AFHS) in low- and middle-income countries where populations are aging. This study aimed to determine the provider and facility readiness for AFHS. We developed and implemented surveys to collect PHC facility capacity and readiness to deliver AFHS and a KAP survey for facility healthcare workers based on guidelines from the WHO age-friendly tool kit and questionnaires from other studies. Direct observation and structured interviews of facility heads were conducted in a stratified random sample of 15 out of the 57 comprehensive PHC facilities in Lagos, Nigeria. One hundred and twenty providers were conveniently sampled for the KAP survey. Statistical analysis was conducted using STATA version 15 (StataCorp, College Station, Texas, USA). For facility readiness, only 13.3% of PHCs sometimes offered hearing assessment and none of the PHCs offered colorectal cancer assessment. Few (20.0%) facilities offered home services and only 1 (0.7%) had dedicated funding for care of older people. Ramps were at the entrance in 60.0% of facilities and almost half (43.3%) of the PHCs had wheelchair accessible entrances to the public toilets. The majority of HCWs (81.7%) had heard about healthy aging but only 5.0% about AFHS, only 10.8% reported formal training. Around a third knew about specific conditions which affect people as they age, including; depression (37.5%), urinary incontinence (35.0%), and falls/immobility (33.3%). Over half of the providers (54.2%) screened for malnutrition in older patients, 25.8% screened for suspected elder abuse and much less (19.2%) for delirium. This study found some areas of strength but also gaps in facility readiness as well as knowledge and training needed to support AFHS care. We recommend identifying interventions to improve the availability and delivery of care for older adults.