Development of a Community-Based Integrated Service Model of Health and Social Care for Older Adults Living Alone

Mobile Application for Digital Health Coaching in the Self-Management of Older Adults with Multiple Chronic Conditions: A Development and Usability Study

OBJECTIVES

This study was conducted to develop a mobile application for digital health coaching to support self-management in older adults with multiple chronic conditions. Additionally, the usability of this application was evaluated.

METHODS

The HAHA2022 mobile application was developed through a multidisciplinary team approach, incorporating digital health coaching strategies targeting community-dwelling older adults with multiple chronic conditions. Usability was assessed with the Korean version of the Mobile Application Rating Scale. The usability tests involved eight expert panel members and 10 older adults (mean age, 74 ± 3 years; 90% women) from one senior welfare center.

RESULTS

HAHA2022 is an Android-based mobile application that is also integrated into wearable devices to track physical activity. It features an age-friendly design and includes five main menus: Home, Action Plan, Education, Health Log, and Community. The average overall usability test scores-covering engagement, functionality, aesthetics, and information-were 4.27 of 5 for the expert panel and 4.53 of 5 for the older adults.

CONCLUSIONS

The HAHA2022 application was developed to improve self-management among communitydwelling older adults with multiple chronic conditions. Usability tests indicate that the application is highly acceptable and feasible for use by this population. Consequently, HAHA2022 is anticipated to be widely implemented. Nonetheless, further research is required to confirm its effectiveness through digital health intervention.

Factors influencing the demands for home and community-based care services among older adults living alone in China

The number of older adults living alone in China is rising sharply. This study aimed to explore the demand for home and community-based care services (HCBS) and related influencing factors of older adults living alone. The data were extracted from the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS). Guided by the Andersen model, binary logistic regressions were used to analyze the influencing factors of HCBS demand from the aspect of predisposing, enabling and need variables. Results show that there were significant differences between urban and rural areas for provision of HCBS. HCBS demand of older adults living alone was influenced by distinct factors including age, residence, income source, economic status, availability of services, loneliness, physical function and number of chronic diseases. Implications for HCBS developments are discussed.

Nurturing the Seeds of Participation: Unveiling the Foundational Path for Understanding Aging in Place Barriers and Facilitators From the Perspective of Older Adults Using Mixed Methods and Translational Science

Participation in society is a cornerstone for quality of life, active aging, and aging in place. While the majority of older adults prefer aging in place, health and financial challenges can hinder this vision. Conducted in suburban South Jersey, this study utilized mixed methods, including surveys and interviews with older adult participants. Surveys indicated that satisfaction with participation in the community is influenced by functional ability, healthcare service availability, and information access. Interviewees identified suggestions to overcome barriers (e.g., improve access to community and address ageism). Combined results provide a theory of change which suggests older adults' empowerment in community participation hinges on home living support, participation options aligning with ability and interest, and accessible information on community events. This person-centered planning approach emphasizes the importance of older adult and stakeholder participation in foundational community planning, offering translational foundational tools for evidence-based strategies to engage them in future community action plans (CAPs).

A Tailored Intervention for Improving Diabetes Self-care Among Adults With Visual Impairment: A Pilot Study

OBJECTIVES

Our aim in this study was to develop and evaluate a tailored intervention for improving diabetes self-care among people with visual impairment (TID-VI) in South Korea.

METHODS

The TID-VI program was designed around the barriers, resources, and perceptual factors to promote diabetes self-care in those with visual impairment (VI). A single-arm pilot study was conducted to evaluate the feasibility and preliminary effects of the intervention. Diabetes self-efficacy, self-care behaviours, depression, health-related quality of life, and clinical outcomes (fasting blood glucose, glycated hemoglobin [A1C], lipids, and blood pressure) were measured before, and up to 2 months after the 12-week intervention.

RESULTS

All 14 participants completed TID-VI. Diabetes self-efficacy, diabetes self-care behaviours, depression, and health-related quality of life showed improvement from baseline that was sustained at 2 months. Although high- and low-density lipoprotein also improved, there were no differences in blood glucose, A1C, total cholesterol, or blood pressure at 2 months.

CONCLUSIONS

A theory-driven, tailored intervention specific to the needs of adults with VI can produce substantial improvements in patient-reported quality of life and health status outcomes, although the benefits are yet to be confirmed in a controlled study.

Analysis of health risk factors for older adults living alone in China and establishment and evaluation of a nomogram prediction model

Objective

To understand the health status of older adults living alone in China and analyze the influencing factors, so as to provide reference for improving the health status of older adults living alone.

Methods

Based on CGSS data from China General Social Survey (2017), the influencing factors of health status of older adults living alone were analyzed by unconditional Logistic regression, and the R software was used to develop a nomogram for predicting the risk of self-assessed unhealthy adverse outcomes.

Results

Gender, annual income, mandarin listening level and participation in medical insurance were the influencing factors of self-rated health of older adults living alone. Age and annual income are the influencing factors of physiological health. Annual income and Internet use were influential factors for mental health. C-Statistic of nomogram prediction model was 0.645. The calibration curve showed that goodness of fit test (χ2 = 58.09, p < 0.001), and the overall prediction ability of the model was good.

Conclusion

The health status of older adults living alone in the home-based older adults care is worrying, and it is affected by various factors. We should pay more attention to older adults living alone, improve the ability of listening and distinguishing mandarin and the use of health information platforms for older adults living alone, and further implement medical insurance policies and health services. Announcing the solution to promote healthy home-based care for older adults living alone.

First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention

BACKGROUND

Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age.

OBJECTIVE

To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process.

METHODS

This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis.

DISCUSSION

Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community.

TRIAL REGISTRATION

NCT05605392.

Factors associated with entry to residential care in frail older inpatients

OBJECTIVE

To examine factors that may influence the risk of discharge to a residential aged care facility (RACF) in a population of frail older inpatients.

METHODS

We analysed data from 5846 inpatients aged over 60 years from 27 hospitals in Queensland, Australia, admitted from independent living and referred for geriatric consultation. Patients underwent an interRAI Acute Care Comprehensive Geriatric Assessment by trained nurses. Frailty was assessed using a 52-item frailty index (FI). Risk/protective factors were determined a priori. Logistic regression assessed the relationship between factors and discharge destination, adjusted for FI, age, sex and hospital. Frailty × risk/protective factor interactions were performed.

RESULTS

Patients had a mean (SD) age of 79.7 (8.2) years and a mean (SD) FI of 0.44 (0.14). Twenty-nine per cent (n = 1678) of patients were discharged to an RACF. Each 0.1 increment in FI increased the risk of discharge to an RACF by 54% (OR 1.54, 95% CI 1.40-1.68, p < 0.01). Being married or in a de facto relationship had protective effects up to an FI of 0.7, whereas behavioural and psychological symptoms of dementia (BPSD) increased the risk of RACF discharge up to an FI of 0.7. Female sex, faecal incontinence and living alone did not influence the relationship between frailty and discharge destination.

CONCLUSIONS

The association between frailty and discharge to RACF has previously been recognised but here we found that risk and protective factors can influence this association. Whether early identification and management of mutable factors can reduce discharge to RACF should be addressed in future studies.

Patient Perspectives of Chronic Disease Management and Unmet Care Needs in South Korea: A Qualitative Study

Understanding and incorporating patients' perspectives are necessary to address the emerging challenge of chronic disease management. Our study examined patients' perceptions and experiences for the current chronic disease management system in South Korea. Focus group interviews were conducted on 23 patients and 11 themes emerged by qualitative content analysis. The participants experienced in terms of provider-patient interaction: doctors only prescribe medicine, doctors who provide conventional advice, doctors who do not respect the patients' opinion, long wait times and inadequate consultations, lack of personalized care, and freedom to select another doctor. They also experienced in their community and health system: struggling alone, commercial media and folk remedies, lack of IT technologies for care, demanding visiting services, and lack of collaboration in the community. We found that patients needed comprehensive and personalized care, respect from providers, and self-management support and collaborated care with the community using information technologies advancement. Our findings suggest that a fundamental change in the South Korean healthcare system paradigm is required for successful chronic care, including payment and healthcare delivery systems.

Leveraging network analysis to determine sex differences in factors associated with frailty among older adults living alone

BACKGROUND

Frailty is a complex geriatric syndrome typically characterized by multiple underlying etiological factors. We determined the contributing factors, by sex, using a network analysis.

METHODS

The study sample consisted of a cross-sectional cohort of community-dwelling older adults aged ≥ 65 years living alone in a Korean city (N = 1,037). Frailty was assessed via the Korean Frailty Index. Participants were assessed for sociodemographic, health-related, mental and cognitive, and social characteristics. Mixed graphical models including all variables were estimated using the R-package mgm discretely by sex. We also used the Walktrap cluster algorithm to identify differences in the network structure in terms of connectivity around frailty between the sex groups for further insights.

RESULTS

In both the networks for males and females, frailty correlated most strongly with nutritional status, presence of complex chronic disease, and self-efficacy, and exhibited proximity to decreased sleep quality and loneliness. However, frailty showed an association with suicidal ideation and the number of falls per year only in males, whereas it showed an association with functional disabilities only in females. The overall network connectivity around frailty was stronger with dense interactions (more edges) in the network for females than for males.

CONCLUSIONS

The results signify the need for sex-group customized multi-domain assessments and interventions for the prevention and improvement of frailty among community-dwelling older adults.

Use of Exploratory Graph Analysis in Inspecting the Dimensionality of the Revised University of California Los Angeles (R-UCLA) Loneliness Scale Among Older Adults

Exploratory graph analysis (EGA) based on network theory has been introduced as a highly reliable and effective method to assess scales' dimensionality. We estimated the dimensional network structure of the Revised University of California Los Angeles Loneliness Scale using EGA among a cross-sectional cohort of Korean older adults living alone (N = 1,041). We also evaluated the stability of estimates using a bootstrap version of EGA (bootEGA) and verified the overall fit structure using confirmatory factor analysis (CFA). EGA revealed a two-dimensional structure of the scale initially. The bootEGA result revealed that Item 4 ("I do not feel alone") did not sufficiently load on any dimension, and Item 20 ("There are people I can turn to") was replicated in two or more dimensions. Removing these items resulted in better stability of the dimensions, leading to excellent structural consistency. CFA confirmed a satisfactory fit of the improved structure. [Research in Gerontological Nursing, 16(1), 15-20.].

Effect of the Use of Home and Community Care Services on the Multidimensional Health of Older Adults

Home and community care is an important way to actively respond to population aging and to promote healthy aging. This study aims to estimate the effect of using home and community care services on the multidimensional health of older adults. We used data from the China Health and Retirement Longitudinal Study conducted in 2018 and relied mainly on the propensity score matching method for data analysis. The results showed that using home and community care increased the probability of maintaining and improving physical health by 2.9%, decreased the score of depression by 0.471, and improved the score of cognitive function by 0.704. Using home and community care also increased the probability of actively participating in life by 4.1% and elevated the score of life satisfaction by 0.088. The heterogeneity analysis showed that the use of home and community care had a significant effect on promoting all health indicators in rural older adults and a more obvious promoting effect on the social adaptation of urban older adults. Using home and community care significantly promoted the multidimensional health of people aged 60 to 79 years but had no impact among people aged ≥ 80 years. The use of home and community care significantly improved all health indicators in non-disabled older adults. Whereas, it only improved the levels of cognitive function and life satisfaction in disabled older people. Using this form of care significantly improved all health indicators in those with low socio-economic status, but it only had a partial positive effect on the multidimensional health of those with high socio-economic status. Our results are of importance to the government as they may be used to further improve the quality of home and community care services for the targeted older population.

Impact of COVID-19 on the social relationships and mental health of older adults living alone: A two-year prospective cohort study

Background

Owing to the COVID-19 outbreak, older adults living alone, who can only connect socially outside their homes, are at risk of social isolation and poor mental health. This study aimed to identify the changes, before and after COVID-19, by sex and age, in social relationships (social activity, social network, and social support) and mental health (depression and suicide ideation) among older adults living alone.

Methods

This is a prospective cohort study of community-dwelling older adults who were at least 65 years old and living alone in South Korea. The study was conducted during 2018–2020 with 2,291 participants (795, 771, and 725 for the 1st to 3rd waves, respectively). The data were collected via face-to-face interviews. A generalized linear mixed modeling framework was used to test for changes over three years.

Results

Social activity was reduced after the COVID-19, with an interaction effect of sex: older women (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.15–0.23; p < .001) showed greater reduction than older men (OR, 0.50; 95% CI, 0.34–0.75; p < .001). Interaction with neighbors also reduced after the pandemic, but there was no significant evidence of interaction effects. Interaction with family members increased in both sexes during the pandemic, with the interaction effect of sex: older women (OR, 1.40; 95% CI, 1.11–1.76; p = .004) showed greater increase than men (OR, 1.55; 95% CI, 1.13–2.14; p = .007). Social support increased in both sexes during the pandemic, but there was no significant evidence of interaction effects. Depression and suicide ideation showed no significant differences before and after the pandemic.

Conclusions

The findings provide health administrators and health providers with explorative insights into the impact of the COVID-19 on social relationships and mental health among older adults living alone and can guide further studies of interventions considering specific properties of social relationships.

A Pilot Study of Machine Learning-Based Algorithms to Assist Integrated Care for Older Community-Dwelling Adults

As life expectancy increases, there is a growing consensus on the development of integrated care encompassing the health and daily activities of older adults. In recent years, although the demand for machine learning applications in healthcare has increased, only a few studies have implemented machine learning-based systems in integrated care for older adults owing to the complex needs of older adults and the coarseness of the available data. Our study aims to explore the possibility of implementing machine learning decision-support algorithms in the integrated care of older community-dwelling adults. Our experiment uses secondary data based on the community-based integrated service model. Such data were collected from 511 older adults through 162 assessment items in which tailored services were selected from 18 available services. We implemented four machine learning models: decision tree, random forest, K-nearest neighbors, and multilayer perceptron. The area under the receiver operating characteristic curve results of the four models were decision tree = 0.89, K-nearest neighbors = 0.88, random forest = 0.93, and multilayer perceptron = 0.88. The results suggest that machine learning-based decision-assisting algorithms can improve the quality of tailored services for integrated care with intensive involvement of face-to-face tasks by reducing the simple, repetitive tasks of care managers.

Obstacles to access to community care in urban senior-only households: a qualitative study

Background

The increased number of older adults living alone has created a substantial care need. However, the utilization rate of services and facilities to meet these needs are surprisingly low. Many of older adults experience difficulties accessing these services, although it remains unclear how these obstacles impede access to services. This study explored the obstacles and difficulties experienced by urban older adults in seeking community care.

Methods

A phenomenological study was carried out and participatory observation and in-depth interviews were employed to investigate the process of seeking care of older adults in urban communities. A total of 18 urban community-dwelling older adults aged 75 years and over were included. Data collected were analysed by content analysis.

Results

We identified the pathways by which senior-only households sought community care and encountered obstacles. (1) lack of community care information: older adults did not know where and how to get services, even though the care institutions scattered throughout the community; (2) limited mobility: older adults often suffered from various chronic diseases, which physically hindered their access to care resources; (3) complex process of achieving care: the functional fragmentation and geographical dispersion of care institutions made the care-seeking process challenging and confusing for older adults; (4) incomprehension of needs expression: limited interaction time and communication barriers between staff of institutions and the older adults were the final obstacle. Only by surmounting these obstacles one by one can older adults access the care resources effectively.

Conclusions

When older adults in the community initiated calls for help, they encountered several obstacles. Their physiological and social disadvantages limited their ability to seek care physically. Lack of integration and clear guidance in the process of providing community care exacerbated these difficulties. Reform of care services should focus on the visibility and accessibility of services for older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02816-y.

Identification and Evaluation of Factors Influencing the Quality of Elderly Services Supply Chain Based on DEMATEL-ISM-TOPSIS Method

With the intensification of aging, the importance of the elderly care service supply chain is gradually being recognized by people. A systematic analysis of the quality of elderly care services from the perspective of the supply chain will help provide decision-making reference for improving the quality of elderly care services. The evaluation index system of elderly care services` quality is constructed from the perspective of the integrated SCOR model. The integrated DEMATEL-ISM-TOPSIS method is proposed for evaluation and analysis. The research pointed out the surface and deep influencing factors as well as the weight of each evaluation factor of the elderly care services` quality. The interpretative structure model was constructed to point out the hierarchical relationship and the principal-subordinate logical relationship of each evaluation factor. The weight of the quality factors of elderly care services was obtained, and the applicability of the model and method was verified by an evaluation case of elderly service institutions.

Effectiveness of a community-based integrated service model for older adults living alone: A nonrandomized prospective study

OBJECTIVE

Older adults living alone face physical, emotional, and social health problems, and prefer to age in place (AIP) in their homes. A community-based integrated model for AIP is needed and few studies have identified its impact on older adults living alone.

METHODS

This was a non-randomized prospective study. Participants were 877 community-dwelling older adults living alone, aged above 65 years, in S* city in South Korea. The intervention group (n = 331) received a community-based integrated service (CBIS) model based on AIP for six months from October 2019 to April 2020.

RESULTS

Scores on frailty (β = -0.377, p < .001), loneliness (β = -1.897, p = .018), and health-related quality of life (β = 4.299, p = .021) significantly improved in the intervention group. Among the intervention group, loneliness scores significantly improved among participants aged under 80 years than those aged over 80 years.

CONCLUSION

The CBIS model improved frailty, loneliness, and quality of life in community-dwelling older adults living alone.