1
|
Gosdin MM, Hoeft T, Henderson S, Wagner J, Hinton L. Missing link: a qualitative analysis of community-based organisations' contributions to partnered collaborative care to treat late-life depression. BMJ Open 2024; 14:e074403. [PMID: 38670617 DOI: 10.1136/bmjopen-2023-074403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE Extending collaborative care, a model integrating mental health services into primary care, to include community-based organisations (CBOs) may improve older patient health outcomes by increasing access to care and addressing patients' social needs; however, little is known about how CBOs contribute to such partnered depression care. We explored how six primary care clinic and CBO partnerships came together to provide late-life depression care through the Care Partners funded in 2014. DESIGN 43 key informant interviews and 15 focus groups were conducted with care managers, administrators and primary care providers partnering to provide late-life depression care. Data were coded and analysed iteratively using qualitative thematic analysis. SETTING Six primary care clinic-CBO sites across California. PARTICIPANTS Care managers, administrators and primary care providers participated in this study. RESULTS Three unique contributions of CBOs to depression care in these clinic-CBO partnerships were identified: (1) CBOs added new services that focus on social needs and enhanced depression care; (2) CBOs strengthened core aspects of collaborative care for depression; (3) CBOs provided new avenues for building connections and trust with underserved patients. CONCLUSIONS CBOs, when partnered with clinics, enhanced both medical and social aspects of depression treatment for older adults. CBOs are well positioned to assist primary care clinics in treating the complex health needs of older adults by providing new and strengthening existing aspects of partnered depression care while building patient trust among culturally diverse populations.
Collapse
Affiliation(s)
- Melissa M Gosdin
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Theresa Hoeft
- Psychiatry & Behavioral Sciences School of Medicine, University of Washington, Seattle, Washington, USA
| | - Stuart Henderson
- Office of Evaluations, UC Davis School of Medicine, Sacramento, California, USA
| | - Jenny Wagner
- Department of Public Health Sciences, University of California Davis, Davis, California, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis, University of California, Davis, Sacramento, CA, USA
| |
Collapse
|
2
|
Alves M, Duque S. Improving the Care of Hip Fracture Patients Through Orthogeriatrics. ACTA MEDICA PORT 2024. [PMID: 38655787 DOI: 10.20344/amp.21169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/11/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Mariana Alves
- Faculdade de Medicina. Universidade de Lisboa. Lisboa; Unidade de Ortogeriatria. Serviço Medicina. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Sofia Duque
- Instituto de Medicina Preventiva e Saúde Pública. Faculdade de Medicina. Universidade de Lisboa. Lisboa; Hospital Cuf Descobertas. Lisboa; Núcleo de Estudos de Geriatria. Sociedade Portuguesa de Medicina Interna. Lisboa. Portugal
| |
Collapse
|
3
|
van den Bulck FAE, Knijff R, Crutzen R, van de Mheen D, Bovens RHLM, Stutterheim SE, Van de Goor I, Rozema AD. Professionals' perspectives on interventions to reduce problematic alcohol use in older adults: a realist evaluation of working elements. BMJ Open 2024; 14:e077851. [PMID: 38626971 PMCID: PMC11029254 DOI: 10.1136/bmjopen-2023-077851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES This study set out to understand how (which elements), in what context and why (which mechanisms) interventions are successful in reducing (problematic) alcohol use among older adults, from the perspective of professionals providing these interventions. DESIGN Guided by a realist evaluation approach, an existing initial programme theory (IPT) on working elements in alcohol interventions was evaluated by conducting semistructured interviews with professionals. SETTING AND PARTICIPANTS These professionals (N=20) provide interventions across several contexts: with or without practitioner involvement; in-person or not and in an individual or group setting. Data were coded and links between contexts, elements, mechanisms and outcomes were sought for to confirm, refute or refine the IPT. RESULTS From the perspective of professionals, there are several general working elements in interventions for older adults: (1) pointing out risks and consequences of drinking behaviour; (2) paying attention to abstinence; (3) promoting contact with peers; (4) providing personalised content and (5) providing support. We also found context-specific working elements: (1) providing personalised conversations and motivational interviewing with practitioners; (2) ensuring safety, trust and a sense of connection and a location nearby home or a location that people are familiar with in person and (3) sharing experiences and tips in group interventions. Furthermore, the mechanisms awareness and accessible and low threshold participation were important contributors to positive intervention outcomes. CONCLUSION In addition to the IPT, our findings emphasise the need for social contact and support, personalised content, and strong relationships (both between client and practitioner, and client and peers) in interventions for older adults.
Collapse
Affiliation(s)
- Fieke A E van den Bulck
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Rikste Knijff
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Dike van de Mheen
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Rob H L M Bovens
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
- Positive Lifestyle Foundation, Nijmegen, The Netherlands
| | - Sarah E Stutterheim
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ien Van de Goor
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Andrea D Rozema
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
4
|
Marshall J, Papavasiliou E, Fox C, Hawkes M, Irvine A, Moniz-Cook E, Pick A, Polley MJ, Reeve J, Robinson L, Rook G, Sadler E, Wolverson E, Walker S, Cross JL. Social prescribing for people living with dementia (PLWD) and their carers: what works, for whom, under what circumstances and why - protocol for a complex intervention systematic review. BMJ Open 2024; 14:e080551. [PMID: 38589260 PMCID: PMC11015224 DOI: 10.1136/bmjopen-2023-080551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Dementia is a complex medical condition that poses significant challenges to healthcare systems and support services. People living with dementia (PLWD) and their carers experience complex needs often exacerbated by social isolation and challenges in accessing support. Social prescribing (SP) seeks to enable PLWD and their carers to access community and voluntary sector resources to support them address such needs. Existing research, however, does not describe what SP interventions are currently in place in dementia care. Little is known about the needs these interventions are designed to address, the reasons that lead PLWD and their carers to participate in them, their effectiveness and the extent to which they could increase positive health outcomes if adopted and how. METHODS AND ANALYSIS A complex intervention systematic review of SP for PLWD and/or their carers will be conducted using an iterative logic model approach. Six electronic (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and Cochrane/CENTRAL) and two grey literature databases (EThOS and CORE) were searched for publications between 1 January 2003 and June 2023, supplemented by handsearching of reference lists of included studies. Study selection, data extraction and risk of bias assessment, using Gough's Weight of Evidence Framework, will be independently performed by two reviewers. A narrative approach will be employed to synthesise and report quantitative and qualitative data. Reporting will be informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis Complex Interventions extension statement and checklist. ETHICS AND DISSEMINATION No ethical approval is required due to this systematic review operating only with secondary sources. Findings will be disseminated through peer-reviewed publications, conference presentations and meetings with key stakeholders including healthcare professionals, patient and carer groups, community organisations (eg, the Social Prescribing Network and the Evidence Collaborative at the National Academy for Social Prescribing), policymakers and funding bodies. PROSPERO REGISTRATION NUMBER CRD42023428625.
Collapse
Affiliation(s)
- Jessica Marshall
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | | | | | | | | | - Aimee Pick
- University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | | | | | - Louise Robinson
- Institute for Health and Society, Newcastle University, Newcastle, UK
| | - George Rook
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Euan Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Emma Wolverson
- Faculty of Health Sciences, University of Hull, Hull, UK
| | | | | |
Collapse
|
5
|
Verjans A, Hooley B, Tani K, Mhalu G, Tediosi F. Cross-sectional study of the burden and determinants of non-medical and opportunity costs of accessing chronic disease care in rural Tanzania. BMJ Open 2024; 14:e080466. [PMID: 38553069 PMCID: PMC10982752 DOI: 10.1136/bmjopen-2023-080466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Countries in sub-Saharan Africa are seeking to improve access to healthcare through health insurance. However, patients still bear non-medical costs and opportunity costs in terms of lost work days. The burden of these costs is particularly high for people with chronic diseases (CDs) who require regular healthcare. This study quantified the non-medical and opportunity costs faced by patients with CD in Tanzania and identified factors that drive these costs. METHODS From November 2020 to January 2021, we conducted a cross-sectional patient survey at 35 healthcare facilities in rural Tanzania. Using the human capital approach to value the non-medical cost of seeking healthcare, we employed multilevel linear regression to analyse the impact of CDs and health insurance on non-medical costs and negative binomial regression to investigate the factors associated with opportunity costs of illness among patients with CDs. RESULTS Among 1748 patients surveyed, 534 had at least one CD, 20% of which had comorbidities. Patients with CDs incurred significantly higher non-medical costs than other patients, with an average of US$2.79 (SD: 3.36) compared with US$2.03 (SD: 2.82). In addition, they incur a monthly illness-related opportunity cost of US$10.19 (US$0-59.34). Factors associated with higher non-medical costs included multimorbidities, hypertension, health insurance and seeking care at hospitals rather than other facilities. Patients seeking hypertension care at hospitals experienced 35% higher costs compared with those visiting other facilities. Additionally, patients with comorbidities, older age, less education and those requiring medication more frequently lost workdays. CONCLUSION Outpatient care in Tanzania imposes considerable non-medical costs, particularly for people with CDs, besides illness-related opportunity costs. Despite having health insurance, patients with CDs who seek outpatient care in hospitals face higher financial burdens than other patients. Policies to improve the availability and quality of CD care in dispensaries and health centres could reduce these costs.
Collapse
Affiliation(s)
- Anna Verjans
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Brady Hooley
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Kassimu Tani
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Grace Mhalu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
6
|
Zhu R, Hou W, Wang L, Zhang C, Guo X, Luo D, Wang F. Willingness to purchase institutionalised elderly services and influencing factors among Chinese older adults: a nationwide cross-sectional study. BMJ Open 2024; 14:e082548. [PMID: 38471688 DOI: 10.1136/bmjopen-2023-082548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES In view of the serious ageing of China's population and the low desire of elderly people to purchase institutionalised elderly care services, we explored the willingness of Chinese elderly people to purchase institutionalised elderly care services and its influencing factors. DESIGN This was a cross-sectional study. Three multivariate logistic regression analysis models of the willingness of elderly people to purchase institutionalised elderly care services were established (model 1: 'reluctance - willingness'; model 2: 'reluctance - hesitation'; and model 3: 'hesitation - willingness') to explore the factors that influence elderly people's willingness to purchase institutionalised elderly care services. SETTING This study was based on the 2022 Psychology and Behaviour Investigation of Chinese Residents database. PARTICIPANTS Research data from 4123 older adults who met the requirements of this study were screened from the database. RESULTS Of the 4123 respondents, roughly equal numbers had negative and positive attitudes towards purchasing institutionalised senior care services (1125, 27.3% vs 1079, 26.2%, respectively), and 1919 (46.5%) had hesitant attitudes. The analysis of model 1 showed that medical insurance participation, the number of children and siblings, chronic diseases and per capita monthly household income had an influential effect on the willingness of elderly people to purchase institutional care. In model 2, we found that factors such as per capita monthly household income and anxiety led to hesitancy among older adults to purchase institutionalised senior care services. In model 3, we further found that social support and health literacy led to a shift from hesitation to willingness to purchase institutionalised elderly care services. CONCLUSION The number of children, number of siblings, per capita monthly income of the family, medical insurance participation, health status, health literacy and social support were found to be the main factors influencing the purchase of institutionalised care by elderly individuals.
Collapse
Affiliation(s)
- Rui Zhu
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Wenjie Hou
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Lingmeng Wang
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Chenchen Zhang
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Xing Guo
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Dan Luo
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Fuzhi Wang
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| |
Collapse
|
7
|
Norstedt I, Thorell K, Halling A. Importance of kidney function, number of chronic conditions and medications for hospitalisation in elderly in Blekinge County, Sweden: a case-control study. BMJ Open 2024; 14:e077421. [PMID: 38443078 DOI: 10.1136/bmjopen-2023-077421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES To study the association between risk for hospitalisation in an elderly population related to renal function, number of chronic diseases and number of prescribed drugs. DESIGN A case-control study. Persons hospitalised were included and their controls were obtained from electronic hospital medical records. If data were lacking on creatinine levels, multiple imputation was used. SETTING Blekinge County in southwestern Sweden. PARTICIPANTS Study of individuals aged 75 years or older in 2013. We identified a total of 2,941 patients with a first hospitalisation. Of these, 81 were excluded, 78 due to incomplete data and 3 because of lack of control persons. Controls were matched to the same sex and birth year, which resulted in 5720 persons. PRIMARY AND SECONDARY OUTCOME MEASURES To analyse the OR for hospitalisation conditional logistic regression was used. RESULTS A total of 695 persons lacked creatinine value. Using imputation values comparing persons with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 with ≥30 univariate analyses showed an increased OR 2.35 (95% CI 1.83 to 3.03). Adjusted analyses demonstrated an OR of 1.90 (95% CI 1.46 to 2.47). Comparing eGFR<45 mL/min/1.73 m2 against ≥45 univariate analyses showed OR 1.38 (95% CI 1.22 to 1.57). Adjusted analyses OR for the same group were 1.17 (95% CI 1.03 to 1.33). In both models, the OR for five or more chronic conditions and five or more medications showed a statistically increased risk for hospitalisation. CONCLUSIONS There is a need for systems using data collected in routine care to follow elderly patients to minimise avoidable hospitalisations that can cause adverse effects. Renal function, number of chronic conditions and medications are factors that are of significant importance. This study demonstrates the complexity of this patient group.
Collapse
Affiliation(s)
- Isabell Norstedt
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmo, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Kristine Thorell
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmo, Sweden
| | - Anders Halling
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmo, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| |
Collapse
|
8
|
Cho E, Han S, Lee JR, Lee H, Oh B. Effects of the COVID-19 Pandemic on the Medical Use of Elderly Patients with Hypertension: A Nationwide Cohort Study in Korea. Korean J Fam Med 2024:kjfm.23.0129. [PMID: 38437823 DOI: 10.4082/kjfm.23.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/03/2023] [Indexed: 03/06/2024] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services, including chronic disease management, for vulnerable groups, such as older individuals with hypertension. This study aimed to evaluate hypertension management in South Korea's elderly population during the pandemic using treatment consistency indices such as the continuity of care (COC), modified, modified continuity index (MMCI), and most frequent provider continuity (MFPC). Methods This study used the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort (K-COV-N cohort) from the National Health Insurance Service between 2017 and 2021. The research included a total of 4,097,299 hypertensive patients aged 65 years or older. We defined 2018 and 2019 as the baseline period before the COVID-19 pandemic and 2020 and 2021 as the COVID-19 period and calculated the indices of medical continuity (number of visits, COC, MMCI, and MFPC) on a yearly basis. Results The number of visits decreased during the COVID-19 period compared to the baseline period (59.64±52.75 vs. 50.49±50.33, P<0.001). However, COC, MMCI, and MFPC were not decreased in the baseline period compared to the COVID-19 period (0.71±0.21 vs. 0.71±0.22, P<0.001; 0.97±0.05 vs. 0.96±0.05, P<0.001; 0.8±0.17 vs. 0.8±0.17, P<0.001, respectively). Conclusion COVID-19 had no significant impact on the continuity of care but affected the frequency of outpatient visits for older patients with hypertension. However, this study highlights the importance of addressing healthcare inequalities, especially in older patients with hypertension, during pandemics and advocates for policy changes to ensure continued care for vulnerable populations.
Collapse
Affiliation(s)
- Eunbyul Cho
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sujeong Han
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Ryun Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Family Medicine, Seoul National University of Medicine, Seoul, Korea
| | - Bumjo Oh
- Department of Family Medicine, Seoul National University of Medicine, Seoul, Korea
- Department of Family Medicine, Seoul National University SMG-SNU Boramae Medical Center, Seoul, Korea
| |
Collapse
|
9
|
Badacho AS, Mahomed OH. Lived experiences of people living with HIV and hypertension or diabetes access to care in Ethiopia: a phenomenological study. BMJ Open 2024; 14:e078036. [PMID: 38417958 PMCID: PMC10900422 DOI: 10.1136/bmjopen-2023-078036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND People living with HIV (PLWH) are more likely to develop hypertension and diabetes than people without HIV. Previous studies have shown that HIV stigma, discrimination and exclusion make it difficult for PLWH to access care for hypertension and diabetes. OBJECTIVES This study aimed to explore the lived experiences of PLWH with comorbid hypertension or diabetes to access hypertension and diabetes care in southern Ethiopia. DESIGN We conducted a qualitative study using a semistructured interview guide for an in-depth, in-person interview. SETTINGS From 5 August to 25 September 2022, PLWH with comorbid hypertension or diabetes were purposefully selected from five primary healthcare (PHC) facilities in the Wolaita zone of southern Ethiopia. PARTICIPANTS A total of 14 PLWH with comorbid hypertension or diabetes who were receiving antiretroviral therapy from PHC were interviewed. Among them, 10 were women, and 4 were men. METHODS In-person, in-depth interviews were conducted. Qualitative data analysis software (NVivo V.12) was used to assist with the data organisation, and Colaizzi's (1978) inductive thematic analyses were conducted to explore key concepts. RESULT This study yielded two main themes: Theme 1: barriers to accessing care as individual barriers to access (low awareness of non-communicable diseases, misperceptions, lack of health insurance and cost of treatment); healthcare system barriers (shortage of supplies, drugs and equipment; long wait times; lack of integrated services; absence of routine screening and lack of respect from providers); community barriers (lack of support from families, friends and the community) and stigma and discrimination access to hypertension and diabetes. Theme 2: accessibility facilitators (support from family, friends and organisations; health insurance coverage). CONCLUSION PLWH recommended that access to services can be improved by service integration, awareness-raising activities, no user fee charges for hypertension and diabetes care and routine screening.
Collapse
Affiliation(s)
- Abebe Sorsa Badacho
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Ozayr Haroon Mahomed
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Dasman Diabetes Institute, Kuwait City, Kuwait
| |
Collapse
|
10
|
Zhou Z, Fu J, Shen Z, Qiu Y, Yang J, Chen X, Li Y, Zheng H. Activities of daily living and non-exercise physical activity in older adults: findings from the Chinese Longitudinal Healthy Longevity Survey. BMJ Open 2024; 14:e074573. [PMID: 38388507 PMCID: PMC10884219 DOI: 10.1136/bmjopen-2023-074573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES Studies have shown that good cognitive function can moderate the relationship between non-exercise physical activity (NEPA) and activities of daily living (ADLs) disability to some extent, and this study mainly explores the relationship between ADL and NEPA and cognitive function in Chinese older adults. SETTING AND PARTICIPANTS Data came from a nationally representative sample of 2471 Chinese old adults (aged 65+) from the 2011, 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. PRIMARY AND SECONDARY OUTCOME MEASURES A cross-lagged panel model combined with mediation analysis was used to determine the relationship between ADL and NEPA and the mediating effect of cognitive function on the ascertained ADL-NEPA relationship. RESULTS The more frequently people over the age of 65 in China participate in NEPA, the lower the risk of ADL disability. Cognitive function partially mediated this expected relationship, accounting for 9.09% of the total NEPA effect on ADL. CONCLUSION Participating in more NEPA could reduce the risk of ADL disability, and participating in NEPA may reduce the risk of ADL disability through cognitive function to some extent.
Collapse
Affiliation(s)
- Zhengcheng Zhou
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Jiangxi Medical College,Nanchang University, Nanchang, Jiangxi, China
- The 4th Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jiehui Fu
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Jiangxi Medical College,Nanchang University, Nanchang, Jiangxi, China
| | - Ziyang Shen
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Jiangxi Medical College,Nanchang University, Nanchang, Jiangxi, China
| | - Yuexin Qiu
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Jiangxi Medical College,Nanchang University, Nanchang, Jiangxi, China
| | - Junsai Yang
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Jiangxi Medical College,Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoyun Chen
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Jiangxi Medical College,Nanchang University, Nanchang, Jiangxi, China
| | - Yue Li
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Jiangxi Medical College,Nanchang University, Nanchang, Jiangxi, China
| | - Huilie Zheng
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Jiangxi Medical College,Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|
11
|
Macdonald M, Weeks LE, Langman E, Roach S, MacNeil MX, Caruso J, Tricco AC, Pham B, Straus SE, Mishra S, Isaranuwatchai W, Cormack GV, Grossman MR, Yakubovich AR, Mojbafan A, Ignaczak M, Leid C, Watt J, Stevens S, Khan T, Curran JA, Moody E, Rodrigues R. Recent innovations in long-term care coverage and financing: a rapid scoping review. BMJ Open 2024; 14:e077309. [PMID: 38388500 PMCID: PMC10884182 DOI: 10.1136/bmjopen-2023-077309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES To identify, chart and analyse the literature on recent initiatives to improve long-term care (LTC) coverage, financial protection and financial sustainability for persons aged 60 and older. DESIGN Rapid scoping review. DATA SOURCES Four databases and four sources of grey literature were searched for reports published between 2017 and 2022. After using a supervised machine learning tool to rank titles and abstracts, two reviewers independently screened sources against inclusion criteria. ELIGIBILITY CRITERIA Studies published from 2017-2022 in any language that captured recent LTC initiatives for people aged 60 and older, involved evaluation and directly addressed financing were included. DATA EXTRACTION AND ANALYSIS Data were extracted using a form designed to answer the review questions and analysed using descriptive qualitative content analysis, with data categorised according to a prespecified framework to capture the outcomes of interest. RESULTS Of 24 reports, 22 were published in peer-reviewed journals, and two were grey literature sources. Study designs included quasi-experimental study, policy analysis or comparison, qualitative description, comparative case study, cross-sectional study, systematic literature review, economic evaluation and survey. Studies addressed coverage based on the level of disability, income, rural/urban residence, employment and citizenship. Studies also addressed financial protection, including out-of-pocket (OOP) expenditures, copayments and risk of poverty related to costs of care. The reports addressed challenges to financial sustainability such as lack of service coordination and system integration, insufficient economic development and inadequate funding models. CONCLUSIONS Initiatives where LTC insurance is mandatory and accompanied by commensurate funding are situated to facilitate ageing in place. Efforts to expand population coverage are common across the initiatives, with the potential for wider economic benefits. Initiatives that enable older people to access the services needed while avoiding OOP-induced poverty contribute to improved health and well-being. Preserving health in older people longer may alleviate downstream costs and contribute to financial sustainability.
Collapse
Affiliation(s)
- Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Erin Langman
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheri Roach
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Morgan X MacNeil
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie Caruso
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea C Tricco
- St. Michael's Hospital Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Epidemiology Division, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ba' Pham
- University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- St. Michael's Hospital Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sujata Mishra
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Mueang Nonthaburi, Nonthaburi, Thailand
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gordon V Cormack
- David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Maura R Grossman
- David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | - Alexa R Yakubovich
- St. Michael's Hospital Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Affiliate Scientist, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Arezoo Mojbafan
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa Ignaczak
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Caron Leid
- SPOR Evidence Alliance, Toronto, Ontario, Canada
| | | | - Susan Stevens
- Senior Director Continuing Care, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Tayaba Khan
- SPOR Evidence Alliance, Toronto, Ontario, Canada
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ricardo Rodrigues
- ISEG Lisbon School of Economics and Management, Universidade de Lisboa, Lisboa, Portugal
| |
Collapse
|
12
|
Kafczyk T, Hämel K. Challenges and opportunities in strengthening primary mental healthcare for older people in India: a qualitative stakeholder analysis. BMC Health Serv Res 2024; 24:206. [PMID: 38360656 PMCID: PMC10870524 DOI: 10.1186/s12913-024-10622-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/21/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Primary mental healthcare (PMHC) allows for complex mental health issues in old age to be addressed. India has sought to improve PMHC through legislation, strategies and programmes. This study analyses the challenges and opportunities involved in strengthening PMHC for older persons in India from the perspectives of key stakeholders. METHODS Semistructured interviews were conducted with 14 stakeholders selected from the PMHC system in India and analysed using thematic analysis. First, the analysis was organizationally structured in accordance with the six WHO mental health system domains: (1) policy and legislative framework, (2) mental health services, (3) mental health in primary care, (4) human resources, (5) public information and links to other sectors, and (6) monitoring and research. Second, for each building block, challenges and opportunities were derived using inductive coding. RESULTS This study highlights the numerous challenges that may be encountered when attempting to strengthen age-inclusive PMHC. Among these challenges are poor public governance, a lack of awareness and knowledge among policy-makers and other stakeholders, and existing policies that make unrealistic promises to weak primary healthcare (PHC) structures with an excessive focus on medicalizing mental health problems. Thus, the mental health system often fails to reach vulnerable older people through PHC. Established approaches to comprehensive, family- and community-oriented PHC support attempts to strengthen intersectoral approaches to PMHC that emphasize mental health promotion in old age. Targeting the PHC workforce through age-inclusive mental health education is considered particularly necessary. Experts further argue that adequate monitoring structures and public spending for mental health must be improved. CONCLUSIONS In this study, we aim to elaborate on the mental healthcare developments that may serve to achieve equity in access to mental healthcare in India. Coordinated and collaborative efforts by public and private stakeholders involved in the care of older persons, both with and without lived mental health experiences, as well as their families and communities, are necessary to bring the vision of those policies for PMHC to fruition. The findings presented in this study can also inform future research, policies and practice in other low- and middle-income countries.
Collapse
Affiliation(s)
- Tom Kafczyk
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Universitaetsstrasse 25, 33651, Bielefeld, Germany.
| | - Kerstin Hämel
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Universitaetsstrasse 25, 33651, Bielefeld, Germany
| |
Collapse
|
13
|
Miura H, Goto Y. Overall survival of homebound patients without cancer receiving inpatient respite care in a hospital ward in Japan: a retrospective observational study. BMJ Open 2024; 14:e078871. [PMID: 38346882 PMCID: PMC10862294 DOI: 10.1136/bmjopen-2023-078871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the relationship between the use of inpatient respite care and the overall survival of homebound patients without cancer admitted to a hospital ward in order to assess the potential impact of inpatient respite care on the duration of home care. DESIGN This was a single-centre, hospital ward-based retrospective observational study. SETTING AND PARTICIPANTS From March 2011 to September 2018, 393 cancer-free older patients (median age, 84.0 years; 53.9% women) receiving continuous medical care at home through clinics were enrolled upon admission to a hospital ward. PRIMARY OUTCOME MEASURES Continuous cumulative survival curves were generated using the Kaplan-Meier method for two groups: inpatient respite care users and non-users. Additionally, prognostic factors associated with all-cause mortality were assessed using the Cox proportional hazards model. RESULTS The Kaplan-Meier curves for inpatient respite care users without cancer admitted to the hospital ward demonstrated a longer median survival time than non-users. Subgroup analyses for patients with or without neurological disorders yielded similar results. The HR for inpatient respite care use, after adjusting for age, sex and other confounding variables, was 0.480 (95% CI: 0.328 to 0.703, p<0.001). CONCLUSIONS Homebound patients without cancer receiving inpatient respite care during the study period in Japan demonstrated higher overall survival than those who did not receive respite care. Subgroup analysis of patients with neurological disorders yielded similar results. Further studies are needed to investigate the benefits of inpatient respite care, including the exploration of appropriate methods for its use.
Collapse
Affiliation(s)
- Hisayuki Miura
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Yuko Goto
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| |
Collapse
|
14
|
Schneider C, Nißen M, Kowatsch T, Vinay R. Impact of digital assistive technologies on the quality of life for people with dementia: a scoping review. BMJ Open 2024; 14:e080545. [PMID: 38341210 PMCID: PMC10862336 DOI: 10.1136/bmjopen-2023-080545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Digital assistive technologies (DATs) have emerged as promising tools to support the daily life of people with dementia (PWD). Current research tends to concentrate either on specific categories of DATs or provide a generic view. Therefore, it is of essence to provide a review of different kinds of DATs and how they contribute to improving quality of life (QOL) for PWD. DESIGN Scoping review using the framework proposed by Arksey and O'Malley and recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. DATA SOURCES Cochrane, Embase, PubMed, Scopus and Web of Science (January 2013 to May 2023). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Completed scientific literature with a primary focus on DATs for PWD, perspectives of caregivers, family members or healthcare workers in relation to a PWD, people living in diverse settings and all severities of dementia. DATA EXTRACTION AND SYNTHESIS Screening and data extraction were conducted, followed by quantitative and qualitative analyses using thematic analysis principles and Digital Therapeutics Alliance categories for DAT grouping. RESULTS The literature search identified 6083 records, with 1056 duplicates. After screening, 4560 full texts were excluded, yielding 122 studies of different designs. The DATs were categorised into digital therapeutics (n=109), patient monitoring (n=30), digital diagnostics (n=2), care support (n=2) and health system clinical software (n=1). These categories were identified to impact various aspects of QOL: preserving autonomy, engagement, and social interaction, health monitoring and promotion, improving activities of daily living, improving cognition, maintaining dignity, managing behavioural and psychological symptoms of dementia and safety/surveillance. CONCLUSIONS Various DATs offer extensive support, elevating the QOL of PWD. Digital therapeutics are predominantly used for ageing-in-place and independent living through assistance with daily tasks. Future research should focus on less-represented digital health technology categories, such as care support, health & wellness or software solutions. Observing ongoing DAT developments and their long-term effects on QOL remains essential.
Collapse
Affiliation(s)
- Charlotte Schneider
- Department of Management, Technology and Economics, ETH Zürich, Zurich, Switzerland
| | - Marcia Nißen
- University of St. Gallen, St. Gallen, Switzerland
| | - Tobias Kowatsch
- Department of Management, Technology and Economics, ETH Zürich, Zurich, Switzerland
- Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Rasita Vinay
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
15
|
Miao W, Lu Y, Xv H, Zheng C, Yang W, Qian X, Chen J, Geng G. Study protocol for a prediction model for mild cognitive impairment in older adults with diabetes mellitus and construction of a nurse-led screening system: a prospective observational study. BMJ Open 2024; 14:e075466. [PMID: 38326248 PMCID: PMC10860066 DOI: 10.1136/bmjopen-2023-075466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION With an increasing number of older adults in China, the number of people with cognitive impairment is also increasing. To decrease the risk of dementia, it is necessary to timely detect mild cognitive impairment (MCI), which is the preliminary stage of dementia. The prevalence of MCI is relatively high among older adults with diabetes mellitus (DM); however, no effective screening strategy has been designed for this population. This study will construct a nurse-led screening system to detect MCI in community-dwelling older adults with DM in a timely manner. METHODS AND ANALYSIS A total of 642 participants with DM will be recruited (n=449 for development, n=193 for validation). The participants will be divided into MCI and none-MCI groups. The candidate predictors will include demographic variables, lifestyle factors, history of diseases, physical examinations, laboratory tests and neuropsychological tests. Univariate analysis, least absolute shrinkage and selection operator regression screening, and multivariate logistic regression analysis will be conducted to identify the outcome indicators. Based on the multivariate logistic regression equation, we will develop a traditional model as a comparison criterion for the machine learning models. The Hosmer-Lemeshow goodness-of-fit test and calibration curve will be used to evaluate the calibration. Sensitivity, specificity, area under the curves and clinical decision curve analysis will be performed for all models. We will report the sensitivity, specificity, area under the curve and decision curve analysis of the validation dataset. A prediction model with better performance will be adopted to form the nurse-led screening system. ETHICS AND DISSEMINATION This prospective study has received institutional approval of the Medical Ethics Committee of Qidong Hospital of TCM (QDSZYY-LL-20220621). Study results will be disseminated through conference presentations, Chinese Clinical Trial Registry and publication. TRIAL REGISTRATION NUMBER ChiCTR2200062855.
Collapse
Affiliation(s)
- Weiwei Miao
- Medical School, Nantong University, Nantong, Jiangsu, China
| | - Yanling Lu
- Qidong Hospital of TCM, Nantong, Jiangsu, China
| | - Honglian Xv
- Nantong Shibei Nursing Home, Nantong, Jiangsu, China
| | - Chen Zheng
- Medical School, Nantong University, Nantong, Jiangsu, China
| | - Wenwen Yang
- Medical School, Nantong University, Nantong, Jiangsu, China
| | - Xiangyun Qian
- Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Jianqun Chen
- Nantong Shibei Nursing Home, Nantong, Jiangsu, China
| | - Guiling Geng
- Medical School, Nantong University, Nantong, Jiangsu, China
| |
Collapse
|
16
|
Rapaport P, Amador S, Adeleke M, Banerjee S, Barber J, Charlesworth G, Clarke C, Connell C, Espie C, Gonzalez L, Horsley R, Hunter R, Kyle SD, Manela M, Morris S, Pikett L, Raczek M, Thornton E, Walker Z, Webster L, Livingston G. Clinical and cost-effectiveness of DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people living with dementia and their carers: a study protocol for a parallel multicentre randomised controlled trial. BMJ Open 2024; 14:e075273. [PMID: 38307536 PMCID: PMC10836385 DOI: 10.1136/bmjopen-2023-075273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/19/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Many people living with dementia experience sleep disturbance and there are no known effective treatments. Non-pharmacological treatment options should be the first-line sleep management. For family carers, relatives' sleep disturbance leads to interruption of their sleep, low mood and breakdown of care. Our team developed and delivered DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives), a multimodal non-pharmacological intervention, showing it to be feasible and acceptable. The aim of this randomised controlled trial is to establish whether DREAMS START is clinically cost-effective in reducing sleep disturbances in people living with dementia living at home compared with usual care. METHODS AND ANALYSIS We will recruit 370 participant dyads (people living with dementia and family carers) from memory services, community mental health teams and the Join Dementia Research Website in England. Those meeting inclusion criteria will be randomised (1:1) either to DREAMS START or to usual treatment. DREAMS START is a six-session (1 hour/session), manualised intervention delivered every 1-2 weeks by supervised, non-clinically trained graduates. Outcomes will be collected at baseline, 4 months and 8 months with the primary outcome being the Sleep Disorders Inventory score at 8 months. Secondary outcomes for the person with dementia (all proxy) include quality of life, daytime sleepiness, neuropsychiatric symptoms and cost-effectiveness. Secondary outcomes for the family carer include quality of life, sleep disturbance, mood, burden and service use and caring/work activity. Analyses will be intention-to-treat and we will conduct a process evaluation. ETHICS AND DISSEMINATION London-Camden & Kings Cross Ethics Committee (20/LO/0894) approved the study. We will disseminate our findings in high-impact peer-reviewed journals and at national and international conferences. This research has the potential to improve sleep and quality of life for people living with dementia and their carers, in a feasible and scalable intervention. TRIAL REGISTRATION NUMBER ISRCTN13072268.
Collapse
Affiliation(s)
- Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Mariam Adeleke
- Department of Statistical Science, University College London, London, UK
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Georgina Charlesworth
- Division of Psychology and Language Sciences, University College London, London, UK
- North East London NHS Foundation Trust, Rainham, UK
| | | | | | - Colin Espie
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Lina Gonzalez
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Monica Manela
- Division of Psychiatry, University College London, London, UK
| | - Sarah Morris
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Liam Pikett
- Division of Psychiatry, University College London, London, UK
| | - Malgorzata Raczek
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Emma Thornton
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, UK
| | - Lucy Webster
- Division of Psychiatry, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| |
Collapse
|
17
|
Shi L, Pang T, Zheng Q, Liu G, Zhang W, Leung W. Utilisation of community healthcare services among older adults with disabilities in Luohu district, Shenzhen: a community-based survey. BMJ Open 2024; 14:e076249. [PMID: 38286707 PMCID: PMC10826561 DOI: 10.1136/bmjopen-2023-076249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/08/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE China faces the challenge of an ageing population with disabilities. Community healthcare centres (CHCs) serve as frontline community healthcare providers for older adults with and without disabilities. Despite their significance, there is a lack of literature examining the utilisation of CHC services among older adults. This study aims to examine and compare the utilisation and satisfaction of CHC healthcare services among older adults with and without disabilities. SETTING Data from the 2019 Community Health Diagnosis Questionnaire, which interviewed 259 older adults residing in the Luohu district of Shenzhen, were used in the current study. PRIMARY OUTCOME MEASURES Participants self-reported outcomes including use of CHCs, use of home health services from CHCs and satisfaction with CHCs. Five different disability types and an integrated disability variable were assessed as independent variables. Linear probability models were used to determine the relationship between disability types and outcome variables. RESULTS Among 259 older adults aged 60 years and older, 70.66% self-identified as having a disability. No statistically significant associations were found between the use of CHCs, the use of home health services from CHCs and satisfaction with CHCs, and disability status. However, older adults with mobility and cognitive disabilities were more likely to receive home health services from CHCs. CONCLUSION Community health promotion policies should be implemented to improve access to health services for older adults with and without disabilities. In addition, CHCs should implement effective health management plans to ensure the health needs of older adults with disabilities.
Collapse
Affiliation(s)
- Lu Shi
- College of Health, Oregon State University, Corvallis, Oregon, USA
| | | | - Qingming Zheng
- Shenzhen Luohu Disease Prevention and Control Center, Shenzhen, China
| | - Gang Liu
- Shenzhen Luohu Disease Prevention and Control Center, Shenzhen, China
| | - Wei Zhang
- College of Health, Oregon State University, Corvallis, Oregon, USA
| | - Willie Leung
- Health Sciences & Human Performance, The University of Tampa, Tampa, Florida, USA
| |
Collapse
|
18
|
Sato K, Michinobu R, Kusaba T. Perceptions of family medicine among long-term patients of a family medicine clinic in Japan: a mixed-methods study. BMJ Open 2024; 14:e079726. [PMID: 38267246 PMCID: PMC10824025 DOI: 10.1136/bmjopen-2023-079726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVES To examine the perceptions of family medicine among patients attending a family medicine clinic for over 10 years in Japan and explore the unique characteristics of a family medicine which was developed in the local community in northern Japan. DESIGN Explanatory, sequential mixed-method design comprising a survey by questionnaires and semistructured interviews. SETTING The study was conducted at one of the oldest family medicine primary care clinics in Japan. We surveyed and interviewed participants from November 2019 to March 2020. PARTICIPANTS 144 patients who have attended a family medicine clinic since April 2009 completed the questionnaires. Semistructured interviews with nine participants were conducted. RESULTS Among the respondents, 131 (91%) reported having attended a family medicine clinic. In terms of their perceptions of what 'family physicians' do, 42 (35%) stated 'a doctor who treats various diseases with a general view', 34 (29%) stated 'a doctor who treats outpatients and visit patients' houses', and 15 (13%) stated 'a doctor whom one can consult for anything and is familiar with one's family and lifestyle'. The results of the qualitative analysis revealed two themes with regard to patients' perceptions of family medicine: 'seeing the whole person and referring suitably' and 'medical care at home'. Patients' perceptions of family medicine identified in the quantitative study were strongly associated with the characteristics extracted from the qualitative study. CONCLUSION Patients attending the family medicine clinic had clear perceptions of what family physicians do. The two major perceptions of the characteristics of family medicine were identified as 'seeing the whole person and referring suitably' and 'medical care at home'.
Collapse
Affiliation(s)
- Kotaro Sato
- Academic and Research Centre, Hokkaido Centre for Family Medicine, Sapporo, Japan
- Motowanishi Family Clinic, Muroran, Japan
| | - Ryoko Michinobu
- Fukui Prefectural University Faculty of Nursing and Social Welfare Sciences, Graduate School of Nursing and Social Welfare Sciences, Yoshida-gun, Japan
| | | |
Collapse
|
19
|
Weng V, Wiles N, Jenkins D, Amanatidis S, Kidd JC, Walsh JA, Baillie AJ, Naganathan V. The effectiveness of a home-based dietetic intervention for community-dwelling older adults. Australas J Ageing 2024. [PMID: 38217875 DOI: 10.1111/ajag.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES The aim of this study was to describe the characteristics of clients receiving home-based dietetic intervention and to evaluate the effectiveness of these interventions in improving nutritional status, functional status, and quality of life in a culturally and socioeconomically diverse client group. METHODS Participants referred to a home-based dietetic service were recruited to this prospective cohort study. Dietetic interventions were recommended at baseline and reviewed at 3-month follow-up. Assessment of nutritional, functional and quality of life markers was measured using the Mini Nutritional Assessment (MNA), Timed Up and Go (TUG) and EQ-5D-5L, respectively, at baseline and after home-based dietetic intervention. RESULTS Participants (n = 99) were recruited from consecutive referrals. Participant's weight, body mass index (BMI), total daily energy and protein intake, MNA total score, and TUG significantly improved after a 3-month nutrition intervention (effect sizes 0.257, 0.257, 0.580, 0.533, 0.577 and 0.281, respectively). The most common interventions dietitians utilised were nutrition education, use of oral nutritional supplements (ONS) and meal fortification. In total, 339 dietetic interventions were recommended to participants at baseline with 197 (58.11%) implemented at 3 months, with meal planning and referral to other relevant allied health or Commonwealth Home Support Program (CHSP) services the most implemented interventions. CONCLUSIONS Home-based dietetic intervention improves nutritional status, functional status and quality of life in community-dwelling older adults referred for dietetic input. Improvements observed in nutritional and functional status were consistent with benchmarks of change from published literature.
Collapse
Affiliation(s)
- Vicky Weng
- Community Nutrition, Primary and Community Health, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nicole Wiles
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Deanna Jenkins
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sue Amanatidis
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Joanna C Kidd
- Department of Speech Pathology, Campbelltown Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jessica A Walsh
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Andrew J Baillie
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
Karunananthan S, Rahgozar A, Hakimjavadi R, Yan H, Dalsania KA, Bergman H, Ghose B, LaPlante J, McCutcheon T, McIsaac DI, Abbasgholizadeh Rahimi S, Sourial N, Thandi M, Wong ST, Liddy C. Use of Artificial Intelligence in the Identification and Management of Frailty: A Scoping Review Protocol. BMJ Open 2023; 13:e076918. [PMID: 38154888 PMCID: PMC10759108 DOI: 10.1136/bmjopen-2023-076918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Rapid population ageing and associated health issues such as frailty are a growing public health concern. While early identification and management of frailty may limit adverse health outcomes, the complex presentations of frailty pose challenges for clinicians. Artificial intelligence (AI) has emerged as a potential solution to support the early identification and management of frailty. In order to provide a comprehensive overview of current evidence regarding the development and use of AI technologies including machine learning and deep learning for the identification and management of frailty, this protocol outlines a scoping review aiming to identify and present available information in this area. Specifically, this protocol describes a review that will focus on the clinical tools and frameworks used to assess frailty, the outcomes that have been evaluated and the involvement of knowledge users in the development, implementation and evaluation of AI methods and tools for frailty care in clinical settings. METHODS AND ANALYSIS This scoping review protocol details a systematic search of eight major academic databases, including Medline, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ageline, Web of Science, Scopus and Institute of Electrical and Electronics Engineers (IEEE) Xplore using the framework developed by Arksey and O'Malley and enhanced by Levac et al and the Joanna Briggs Institute. The search strategy has been designed in consultation with a librarian. Two independent reviewers will screen titles and abstracts, followed by full texts, for eligibility and then chart the data using a piloted data charting form. Results will be collated and presented through a narrative summary, tables and figures. ETHICS AND DISSEMINATION Since this study is based on publicly available information, ethics approval is not required. Findings will be communicated with healthcare providers, caregivers, patients and research and health programme funders through peer-reviewed publications, presentations and an infographic. REGISTRATION DETAILS OSF Registries (https://doi.org/10.17605/OSF.IO/T54G8).
Collapse
Affiliation(s)
- Sathya Karunananthan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Arya Rahgozar
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramtin Hakimjavadi
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hui Yan
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kunal A Dalsania
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Bishwajit Ghose
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Nadia Sourial
- Department of Health Management, Evaluation & Policy, Université de Montréal, Montreal, Québec, Canada
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Manpreet Thandi
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
21
|
Swarbrick C, Poulton T, Martin P, Partridge J, Moppett IK. Study protocol for a national observational cohort investigating frailty, delirium and multimorbidity in older surgical patients: the third Sprint National Anaesthesia Project (SNAP 3). BMJ Open 2023; 13:e076803. [PMID: 38135325 DOI: 10.1136/bmjopen-2023-076803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Older surgical patients are more likely to be living with frailty and multimorbidity and experience postoperative complications. The management of these conditions in the perioperative pathway is evolving. In order to support objective decision-making for patients, services and national guidance, accurate, contemporary data are needed to describe the impact and associations between frailty, multimorbidity and healthcare processes with patient and service-level outcomes. METHODS AND ANALYSIS The study is comprised of an observational cohort study of approximately 7500 patients; an organisational survey of perioperative services and a clinician survey of the unplanned, medical workload generated from older surgical patients. The cohort will consist of patients who are 60 years and older, undergoing a surgical procedure during a 5-day recruitment period in participating UK hospitals. Participants will be assessed for baseline frailty and multimorbidity; postoperative morbidity including delirium; and quality of life. Data linkage will provide additional details about individuals, their admission and mortality.The study's primary outcome is length of stay, other outcome measures include incidence of postoperative morbidity and delirium; readmission, mortality and quality of life. The cohort's incidence of frailty, multimorbidity and delirium will be estimated using 95% CIs. Their relationships with outcome measures will be examined using unadjusted and adjusted multilevel regression analyses. Choice of covariates in the adjusted models will be prespecified, based on directed acyclic graphs.A parallel study is planned to take place in Australia in 2022. ETHICS AND DISSEMINATION The study has received approval from the Scotland A Research Ethics Committee and Wales Research Ethics Committee 7.This work hopes to influence the development of services and guidelines. We will publish our findings in peer-reviewed journals and provide summary documents to our participants, sites, healthcare policy-makers and the public. TRIAL REGISTRATION NUMBER ISRCTN67043129.
Collapse
Affiliation(s)
- Claire Swarbrick
- Anaesthesia & Critical Care, University of Nottingham, Nottingham, UK
- Anaesthesia, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Tom Poulton
- Anaesthesia, Perioperative Medicine, and Pain Medicine, Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, Victoria, Australia
- Critical Care, University College London, London, UK
| | - Peter Martin
- Applied Health Research, University College London, London, UK
| | - Judith Partridge
- Division of Health and Social Care Research, King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Iain Keith Moppett
- Anaesthesia & Critical Care, University of Nottingham, Nottingham, UK
- Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
22
|
Xu S, Gong Z, Wang F, Cao M, Liu J, Chen C, Zhang N, Kang J, Xu C, Peng N. Intervention of muscle-building and antifrailty exercise combined with Baduanjin for frailty of different functional levels: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e074827. [PMID: 38101837 PMCID: PMC10729122 DOI: 10.1136/bmjopen-2023-074827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/26/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Frailty has been currently considered as a multidimensional concept, including physical, cognitive and social frailty. Frailty has also been associated with a range of adverse events, which might increase the risks of disability, falls, fractures, delirium and death. Increasing evidence has shown that multicomponent exercise training can improve physical and cognitive function, delay or reverse frailty. However, there is still a lack of exercise intervention programmes for the frail older adults in China. This trial aims to investigate the effects of the muscle-building and antifrailty exercise combined with Baduanjin on the physical function of frail older adults, as well as the effectiveness and safety of the intervention. METHODS AND ANALYSIS This study is a prospective randomised controlled trial. A total of 192 patients, aged 70 years or older, who are diagnosed as prefrailty or frailty based on the Fried criteria will be included. Prior written and informed consent will be obtained from every subject. These subjects will be randomly assigned to the exercise intervention group (n=96) and the control group (n=96). The exercise intervention group will undergo different exercise programmes for different levels of physical function. They will perform the muscle-building and antifrailty exercise three times per week for 30-60 min for 24 weeks. The control group will implement health education on frailty and maintain the old lifestyle without any intervention.The primary outcomes include the change in frailty and functional capacity, assessed according to the Fried Scale and the Short Physical Performance Battery. Secondary outcomes include the changes in body composition, Activities of daily living, Mini-Mental State Examination, The Geriatric Depression Scale-15 and the haematological indicators. ETHICS STATEMENT The study has been approved by the Medical Ethics Committee of the PLA General Hospital (approval no.: S2022-600-02). TRIAL REGISTRATION NUMBER ChiCTR2300070535.
Collapse
Affiliation(s)
- Shuaixuan Xu
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Institute of Psychiatry and Neuroscience, Xinxiang Medical University, Xinxiang, Henan, China
| | - Zhuyun Gong
- Department of Outpatient, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Fang Wang
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Mengyu Cao
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jinwei Liu
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Chao Chen
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Nihui Zhang
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Jingwen Kang
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Chuang Xu
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Nan Peng
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
23
|
Sturge J, Miedema E, Elf M, Nordin S. Socially sustainable housing and built environments to support the health and social inclusion of older adults: protocol for a scoping review and stakeholder consultation. BMJ Open 2023; 13:e075447. [PMID: 38081665 PMCID: PMC10729231 DOI: 10.1136/bmjopen-2023-075447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Housing and the ageing population are issues that pose challenges for social, health and economic policies. Therefore, there is a need for more knowledge on how to design housing and public infrastructure to improve the social engagement and well-being of older adults who age in place. This project aims to provide an overview of the existing literature on design features that support socially sustainable living environments for older adults. METHODS AND ANALYSIS A systematic scoping methodology was used to identify and summarise the findings. Four databases were searched (CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, Medline and Embase) to identify the articles. Articles were included if published in English in the last 15 years (eg, from January 2008 to June 2023) without restricting the study location or country. Articles were included if they were based on empirical qualitative, quantitative and mixed-method data. The results of the review will be discussed with a panel of 15 stakeholders (n=15) from Canada, Sweden and the Netherlands (five per country). The interdisciplinary stakeholders will have expertise in housing, architecture, engineering and social and health services. The consultations will provide content expertise to the literature findings and an opportunity to build evidence-based solutions that support the design of socially sustainable living environments for older persons. ETHICS AND DISSEMINATION Ethical clearance for this project has been granted by the Swedish Ethical Review Authority for Dalarna University (dnr 2023-01543-01) and the Natural Sciences and Engineering Sciences (NES) Ethics Committee at the University of Twente in the Netherlands (dnr 230407) has approved this project. Stakeholders will be asked to provide signed consent to participate in the study. The results of this project will be disseminated through web seminars, community advisory groups, peer-reviewed journals and policy documents to support the development of housing and public health policy. TRIAL REGISTRATION NUMBER OSF, https://doi.org/10.17605/OSF.IO/PR2NC.
Collapse
Affiliation(s)
- Jodi Sturge
- Department of Design, Production and Management, University of Twente, Enschede, The Netherlands
| | - Elke Miedema
- Faculty of Architecture and the Built Environment, TU Delft, Delft, The Netherlands
| | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Susanna Nordin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| |
Collapse
|
24
|
Comans T, Nguyen K, Gray L, Flicker L, Williamson P, Dodd S, Kearney A, Cunningham C, Morris T, Nunn J, Trepel D, Almeida OP, Kenny D, Welch A, Lowthian JA, Quinn J, Petrie G, Dao-Tran TH, Manchha A, Kurrle SE. Measuring the success of programmes of care for people living with dementia: a protocol for consensus building with consumers to develop a set of Core Outcome Measures for Improving Care (COM-IC). BMJ Open 2023; 13:e073884. [PMID: 38072498 PMCID: PMC10729031 DOI: 10.1136/bmjopen-2023-073884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION The Core Outcome Measures for Improving Care (COM-IC) project aims to deliver practical recommendations on the selection and implementation of a suite of core outcomes to measure the effectiveness of interventions for dementia care. METHODS AND ANALYSIS COM-IC embeds a participatory action approach to using the Alignment-Harmonisation-Results framework for measuring dementia care in Australia. Using this framework, suitable core outcome measures will be identified, analysed, implemented and audited. The methods for analysing each stage will be codesigned with stakeholders, through the conduit of a Stakeholder Reference Group including people living with dementia, formal and informal carers, aged care industry representatives, researchers, clinicians and policy actors. The codesigned evaluation methods consider two key factors: feasibility and acceptability. These considerations will be tested during a 6-month feasibility study embedded in aged care industry partner organisations. ETHICS AND DISSEMINATION COM-IC has received ethical approval from The University of Queensland (HREC 2021/HE001932). Results will be disseminated through networks established over the project, and in accordance with both the publication schedule and requests from the Stakeholder Reference Group. Full access to publications and reports will be made available through UQ eSpace (https://espace.library.uq.edu.au/), an open access repository hosted by The University of Queensland.
Collapse
Affiliation(s)
- Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Kim Nguyen
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Len Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia
| | - Paula Williamson
- Department of Health and Data Science, University of Liverpool, Liverpool, UK
| | - Susanna Dodd
- Department of Health and Data Science, University of Liverpool, Liverpool, UK
| | - Anna Kearney
- Department of Health and Data Science, University of Liverpool, Liverpool, UK
| | - Colm Cunningham
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- HammondCare International, London, UK
| | - Thomas Morris
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- HammondCare, Sydney, New South Wales, Australia
| | - Jack Nunn
- Science for All, Melbourne, Victoria, Australia
- La Trobe University, Melbourne, Victoria, Australia
| | - Dominic Trepel
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Osvaldo P Almeida
- WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia
| | - Danelle Kenny
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Alyssa Welch
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Judy A Lowthian
- Bolton Clarke Research Institute, Bolton Clarke, Brisbane, Queensland, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John Quinn
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Wynnum Manly Dementia Alliance, Brisbane, Queensland, Australia
| | - Glenys Petrie
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Wynnum Manly Dementia Alliance, Brisbane, Queensland, Australia
| | - Tiet-Hanh Dao-Tran
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Asmita Manchha
- Bolton Clarke Research Institute, Brisbane, Queensland, Australia
| | - Susan E Kurrle
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
25
|
Ge Y, Wang S, Shi Q, Shi J, Tian J. Geospatial analysis of the hospitalisation rate of patients with rheumatoid arthritis in Hunan: a cross-sectional Chinese study. BMJ Open 2023; 13:e075088. [PMID: 38000823 PMCID: PMC10679990 DOI: 10.1136/bmjopen-2023-075088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/10/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE Little is known about spatial variability of hospitalisation rate (HR) of patients with rheumatoid arthritis (RA) worldwide, especially in China. METHODS A cross-sectional study was conducted among patients with RA admitted to hospitals in Hunan Province. Global Moran's I and local indicators of spatial association were used to explore the geospatial pattern of the HR of patients with RA. Generalised estimating equation analysis and geographically weighted regression were used to identify the potential influencing factors of the HR of patients with RA. RESULTS There were a total of 11 599 admissions, and the average HR was 1.57 per 10 000 population in Hunan. We detected different cluster patterns of the HR among patients with RA by local indicators of spatial association. Age, ethnicity, average temperature, average temperature range, average rainfall, regions, gross domestic product per capita, and doctors and hospitals per 10 000 people were risk factors for the HR. However, only average temperature, gross domestic product per capita and hospitals per 10 000 people showed different regression coefficients on the HR in different counties. The increase in hospitals increased the probability of HR from east to west in Hunan with a positive coefficient, while temperature decreases increased the risk of HR from south to north negatively. Similarly, the growth of gross domestic product per capita decreased the probability of HR from southwest to northeast. CONCLUSION A non-random spatial distribution of the HR of patients with RA was demonstrated in Hunan, and average temperature, gross domestic product per capita and hospitals per 10 000 people showed different regression coefficients on the HR in different counties. Our study indicated that spatial and geostatistics may be useful approaches for further study among patients with RA.
Collapse
Affiliation(s)
- Yan Ge
- Department of Rheumatology and Immunology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, Changsha, Hunan, China
| | - Shiwen Wang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qianshan Shi
- Information Statistics Center of Health Commission of Hunan Province, Changsha, Hunan, China
| | - Jingcheng Shi
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jing Tian
- Department of Rheumatology and Immunology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, Changsha, Hunan, China
| |
Collapse
|
26
|
Ko SQ, Wang Z, Goh SLE, Soong JTY. Proportion of medical admissions that may be hospitalised at home and their service utilisation patterns: a single-centre, descriptive retrospective cohort study in Singapore. BMJ Open 2023; 13:e073692. [PMID: 37879677 PMCID: PMC10603527 DOI: 10.1136/bmjopen-2023-073692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES For eligible patient groups, hospital-at-home (HaH) programmes have been shown to deliver equivalent patient outcomes with cost reduction compared with standard care. This study aims to establish a benchmark of inpatient admissions that could potentially be substituted by HaH services. DESIGN Descriptive retrospective cohort study. SETTING Academic tertiary hospital in Singapore. PARTICIPANTS 124 253 medical admissions over 20 months (January 2016 to August 2017). PRIMARY AND SECONDARY OUTCOME MEASURES The primary measure was the proportion of hospitalised patients who may be eligible for HaH, based on eligibility criteria adapted for the Singapore context. The secondary measures were the utilisation patterns and outcomes of these patients. RESULTS Applying generalised eligibility criteria to the retrospective dataset showed that 53.0% of 124 253 medical admissions fitted the eligibility criteria for HaH based on administrative data. 46.8% of such patients had a length of stay <48 hours ('short-stay') and 53.1% had a length of stay ≥48 hours ('medium-stay'). The mortality rate and the 30-day readmission rate were lower in the 'short-stay' cohort (0.6%, 12.8%) compared with the 'medium-stay' cohort (0.7%, 20.3%). The key services used by both groups were: parenteral drug administration, blood investigations, imaging procedures and consultations with allied health professionals. CONCLUSIONS Up to 53.0% of medical admissions receive care elements that HaH programmes could provide. Applying estimates of functional limitations and patient preferences, we propose a target of ~18% of inpatient medical admissions to be substituted by HaH services. The methodology adopted in this paper is a reproducible approach to characterise potential patients and service utilisation requirements when developing such programmes.
Collapse
Affiliation(s)
- Stephanie Q Ko
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore
| | - Zhemin Wang
- Department of Medicine, Alexandra Hospital, Singapore
| | - Samuel Li Earn Goh
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore
| | - John T Y Soong
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore
| |
Collapse
|
27
|
Lønhaug-Næss M, Jakobsen MD, Blix BH, Bergmo TS, Hoben M, Moholt JM. Older high-cost patients in Norwegian somatic hospitals: a register-based study of patient characteristics. BMJ Open 2023; 13:e074411. [PMID: 37793934 PMCID: PMC10551970 DOI: 10.1136/bmjopen-2023-074411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Two-thirds of the economic resources in Norwegian hospitals are used on 10% of the patients. Most of these high-cost patients are older adults, which experience more unplanned hospital admissions, longer hospital stays and higher readmission rates than other patients. This study aims to examine the individual and clinical characteristics of older patients with unplanned admissions to Norwegian somatic hospitals and how these characteristics differ between high-cost and low-cost older patients. DESIGN Observational cross-sectional study. SETTING Norwegian somatic hospitals. PARTICIPANTS National registry data of older Norwegian patients (≥65 years) with ≥1 unplanned contact with somatic hospitals in 2019 (n=2 11 738). PRIMARY OUTCOME MEASURE High-cost older patients were defined as those within the 10% of the highest diagnosis-related group weights in 2019 (n=21 179). We compared high-cost to low-cost older patients using bivariate analyses and logistic regression analysis. RESULTS Men were more likely to be high-cost older patients than women (OR=1.25, 95% CI 1.21 to 1.29) and the oldest (90+ years) compared with the youngest older adults (65-69 years) were less likely to cause high costs (OR=0.47, 95% CI 0.43 to 0.51). Those with the highest level of education were less likely to cause high costs than those with primary school degrees (OR=0.74, 95% CI 0.69 to 0.80). Main diagnosis group (OR=3.50, 95% CI 3.37 to 3.63) and dying (OR=4.13, 95% CI 3.96 to 4.30) were the clinical characteristics most strongly associated with the likelihood of being a high-cost older patient. CONCLUSION Several of the observed patient characteristics in this study may warrant further investigation as they might contribute to high healthcare costs. For example, MDGs, reflecting comprehensive healthcare needs and lower education, which is associated with poorer health status, increase the likelihood of being high-cost older patients. Our results indicate that Norwegian hospitals function according to the intentions of those having the highest needs receiving most services.
Collapse
Affiliation(s)
- Morten Lønhaug-Næss
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Monika Dybdahl Jakobsen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
- Center for Care Research North, UiT The Arctic University of Norway, Tromso, Norway
| | - Bodil Hansen Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
- Western Norway University of Applied Sciences, Bergen, Norway
| | - Trine Strand Bergmo
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
- Digital Health Services, Norwegian Center for E-health Research, Tromso, Norway
| | - Matthias Hoben
- Faculty of Health, School of Health Policy & Management, York University, Toronto, Ontario, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jill-Marit Moholt
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
- Center for Care Research North, UiT The Arctic University of Norway, Tromso, Norway
| |
Collapse
|
28
|
Griffiths S, Spencer E, Wilcock J, Bamford C, Wheatley A, Brunskill G, D'Andrea F, Walters KR, Lago N, O'Keeffe A, Hunter R, Tuijt R, Harrison Dening K, Banerjee S, Manthorpe J, Allan L, Robinson L, Rait G. Protocol for the feasibility and implementation study of a model of best practice in primary care led postdiagnostic dementia care: PriDem. BMJ Open 2023; 13:e070868. [PMID: 37597869 PMCID: PMC10441044 DOI: 10.1136/bmjopen-2022-070868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/03/2023] [Indexed: 08/21/2023] Open
Abstract
INTRODUCTION Care is often inadequate and poorly integrated after a dementia diagnosis. Research and policy highlight the unaffordability and unsustainability of specialist-led support, and instead suggest a task-shared model, led by primary care. This study is part of the PriDem primary care led postdiagnostic dementia care research programme and will assess delivery of an evidence-informed, primary care based, person-centred intervention. The intervention involves Clinical Dementia Leads (CDLs) working in primary care to develop effective dementia care systems that build workforce capacity and support teams to deliver tailored support to people living with dementia and their carers. METHODS AND ANALYSIS This is a 15-month mixed-methods feasibility and implementation study, situated in four National Health Service (NHS) primary care networks in England. The primary outcome is adoption of personalised care planning by participating general practices, assessed through a patient records audit. Feasibility outcomes include recruitment and retention; appropriateness and acceptability of outcome measures; acceptability, feasibility and fidelity of intervention components. People living with dementia (n=80) and carers (n=66) will be recruited through participating general practices and will complete standardised measures of health and well-being. Participant service use data will be extracted from electronic medical records. A process evaluation will explore implementation barriers and facilitators through methods including semistructured interviews with people living with dementia, carers and professionals; observation of CDL engagement with practice staff; and a practice fidelity log. Process evaluation data will be analysed qualitatively using codebook thematic analysis, and quantitatively using descriptive statistics. Economic analysis will determine intervention cost-effectiveness. ETHICS AND DISSEMINATION The study has received favourable ethical opinion from Wales REC4. NHS Confidentiality Advisory Group support allows researchers preconsent access to patient data. Results will inform intervention adaptations and a future large-scale evaluation. Dissemination through peer-review journals, engagement with policy-makers and conferences will inform recommendations for dementia services commissioning. TRIAL REGISTRATION NUMBER ISRCTN11677384.
Collapse
Affiliation(s)
- Sarah Griffiths
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Emily Spencer
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alison Wheatley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Brunskill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Federica D'Andrea
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Kate R Walters
- Research Department of Primary Care & Population Health, UCL, London, UK
| | | | - Aidan O'Keeffe
- Mathematical Sciences, University of Nottingham, Nottingham, UK
| | - Rachael Hunter
- Research Department of Primary Care & Population Health, UCL, London, UK
| | | | | | - Sube Banerjee
- Office of Vice Chancellor, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- Health & Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Rait
- Research Department of Primary Care & Population Health, UCL, London, UK
| |
Collapse
|
29
|
Olsen JK, Wehberg S, Waldorff FB, Henriksen DP, Lykkegaard J. Variation in daytime general practice services and association with out-of-hours use for older patients: protocol for a Danish cohort study. BMJ Open 2023; 13:e073229. [PMID: 37500276 PMCID: PMC10387735 DOI: 10.1136/bmjopen-2023-073229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Out-of-hours primary care services cannot provide the same continuity and coordination of care as general practice. Thus, patients with high risk of complex care trajectories should, when possible, be treated by the general practitioner during daytime opening hours. This study aims to analyse the variation among general practices in the frequencies of daytime services for persons aged ≥75 years and how it relates to the patients' use of out-of-hours services. METHODS AND ANALYSIS Register-based cohort study of all Danish citizens aged ≥75 years, of whom >98% are listed with a general practice. Using Poisson regression, we will estimate each practice's excess variation in delivered daytime services compared with the expected based on the characteristics of its listed patients. Delivered daytime services will be analysed overall and separately for face-to-face, phone, email, home visit and preventive services. The association with the use of out-of-hours services will be analysed by Poisson regression. ETHICS AND DISSEMINATION Complying with European data protection rules, the legal services at University of Southern Denmark (Research & Innovation Organisation) approved the data processing activities regarding this project (journal number 11.593). According to section 14.2 of the Act on Research Ethics Review of Health Research Projects, because the study is based solely on register data, approval from the ethics committee and informed consent are not required. Results from the study will be disseminated as publications in peer-reviewed scientific journals and at international conferences.
Collapse
Affiliation(s)
- Jonas K Olsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Frans Boch Waldorff
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Jesper Lykkegaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
30
|
Elliott J, van Wyk P, Butler R, Giosa JL, Sims Gould J, Tong CE, Taabazuing MM, Johnson H, Coyne P, Mitchell F, Whate A, Callon A, Carson J, Stolee P. Developing an in-depth understanding of patient and caregiver engagement across care transitions from hospital: protocol for a qualitative study exploring experiences in Canada. BMJ Open 2023; 13:e077436. [PMID: 37479510 PMCID: PMC10364181 DOI: 10.1136/bmjopen-2023-077436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Patient and caregiver engagement is critical, and often compromised, at points of transition between care settings, which are more common, and more challenging, for patients with complex medical problems. The consequences of poor care transitions are well-documented, both for patients and caregivers, and for the healthcare system. With an ageing population, there is greater need to focus on care transition experiences of older adults, who are often more medically complex, and more likely to require care from multiple providers across settings. The overall goal of this study is to understand what factors facilitate or hinder patient and caregiver engagement through transitions in care, and how these current engagement practices align with a previously developed engagement framework (CHOICE Framework). This study also aims to co-develop resources needed to support engagement and identify how these resources and materials should be implemented in practice. METHODS AND ANALYSIS This study uses ethnographic approaches to explore the dynamics of patient and caregiver engagement, or lack thereof, during care transitions across three regions within Ontario. With the help of a front-line champion, patients (n=18-24), caregivers (n=18-24) and healthcare providers (n=36-54) are recruited from an acute care hospital unit (or similar) and followed through their care journey. Data are collected using in-depth semi-structured interviews. Workshops will be held to co-develop strategies and a plan for future implementation of resources and materials. Analysis of the data will use inductive and deductive coding techniques. ETHICS AND DISSEMINATION Ethics clearance was obtained through the Western University Research Ethics Board, University of Windsor Research Ethics Board and the University of Waterloo Office of Research Ethics. The findings from this study are intended to contribute valuable evidence to further bridge the knowledge to practice gap in patient and caregiver engagement through care transitions. Findings will be disseminated through publications, conference presentations and reports.
Collapse
Affiliation(s)
- Jacobi Elliott
- Lawson Health Research Institute, London, Ontario, Canada
- Specialized Geriatric Services, St. Joseph's Health Care London, London, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paula van Wyk
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Roy Butler
- Senior Leadership, St. Joseph's Health Care London, London, Ontario, Canada
| | - Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, Toronto, Ontario, Canada
| | | | - Catherine E Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary Margaret Taabazuing
- Department of Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Helen Johnson
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paige Coyne
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
- Henry Ford Health System, Detroit, Michigan, USA
| | - Fallon Mitchell
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Alexandra Whate
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne Callon
- Patient and Caregiver Partner, London, Ontario, Canada
| | - Judith Carson
- Patient and Caregiver Partner, Waterloo, Ontario, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
31
|
Silies KT, Vonthein R, Pohontsch NJ, Huckle TA, Sill J, Olbrich D, Inkrot S, Frielitz FS, Lühmann D, Scherer M, König I, Balzer K. Expanded nursing competencies to improve person-centred care for nursing home residents with complex health needs (Expand-Care): study protocol for an exploratory cluster-randomised trial. BMJ Open 2023; 13:e072955. [PMID: 37433733 DOI: 10.1136/bmjopen-2023-072955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Older age is associated with multimorbidity, chronic diseases and acute deteriorations and leads to complex care needs. Nursing home residents are more often unnecessarily transferred to emergency departments or hospitals than community dwellers-largely due to a lack of qualified staff and diffusion of responsibility in the institutions. In Germany, only few academically trained nurses work in nursing homes, and their potential roles are unclear. Therefore, we aim to explore feasibility and potential effects of a newly defined role profile for nurses with bachelors' degree or equivalent qualification in nursing homes. METHODS AND ANALYSIS A pilot study (Expand-Care) with a cluster-randomised controlled design will be conducted in 11 nursing homes (cluster) in Germany, with an allocation ratio of 5:6 to the intervention or control group, aiming to include 15 residents per cluster (165 participants in total). Nurses in the intervention group will receive training to perform role-related tasks such as case reviews and complex geriatric assessments. We will collect data at three time points (t0 baseline, t1 3 months and t2 6 months after randomisation). We will measure on residents' level: hospital admissions, further health services use and quality of life; clinical outcomes (eg, symptom burden), physical functioning and delivery of care; mortality, adverse clinical incidents and changes in care level. On nurses' level, we will measure perception of the new role profile, competencies and implementation of role-related tasks as part of the process evaluation (mixed methods). An economic evaluation will explore resource use on residents' (healthcare utilisation) and on nurses' level (costs and time expenditure). ETHICS AND DISSEMINATION The ethics committees of the University of Lübeck (Nr. 22-162) and the University Clinic Hamburg-Eppendorf (Nr. 2022-200452-BO-bet) approved the Expand-Care study. Informed consent is a prerequisite for participation. Study results will be published in open-access, peer-reviewed journals and reported at conferences and in local healthcare providers' networks. TRIAL REGISTRATION NUMBER DRKS00028708.
Collapse
Affiliation(s)
- Katharina Theodora Silies
- Institut für Sozialmedizin und Epidemiologie, Sektion Forschung und Lehre in der Pflege, Universität zu Lübeck, Lubeck, Germany
| | - Reinhard Vonthein
- Institut für medizinische Biometrie und Statistik, Universität zu Lübeck, Lubeck, Germany
| | - Nadine Janis Pohontsch
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Tilman Alexander Huckle
- Institut für Sozialmedizin und Epidemiologie, Sektion Forschung und Lehre in der Pflege, Universität zu Lübeck, Lubeck, Germany
| | - Janna Sill
- Institut für Sozialmedizin und Epidemiologie, Sektion Forschung und Lehre in der Pflege, Universität zu Lübeck, Lubeck, Germany
| | - Denise Olbrich
- Zentrum für klinische Studien, Universität zu Lübeck, Lubeck, Germany
| | - Simone Inkrot
- Institut für Sozialmedizin und Epidemiologie, Sektion Forschung und Lehre in der Pflege, Universität zu Lübeck, Lubeck, Germany
| | - Fabian-Simon Frielitz
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lubeck, Germany
- Universitätskinderklinik Magdeburg, Professur für Telemedizin, Digitalisierung und Ökonomie in der Medizin, Universität Magdeburg, Magdeburg, Germany
| | - Dagmar Lühmann
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Inke König
- Institut für medizinische Biometrie und Statistik, Universität zu Lübeck, Lubeck, Germany
| | - Katrin Balzer
- Institut für Sozialmedizin und Epidemiologie, Sektion Forschung und Lehre in der Pflege, Universität zu Lübeck, Lubeck, Germany
| |
Collapse
|
32
|
Sunzi K, Li Y, Lei C, Zhou X. How do the older adults in nursing homes live with dignity? A protocol for a meta-synthesis of qualitative research. BMJ Open 2023; 13:e067223. [PMID: 37185199 PMCID: PMC10151859 DOI: 10.1136/bmjopen-2022-067223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION As the population continuous to age and family sizes decrease, residing in nursing homes has emerged as a crucial option for older adults' care. Ensuring a dignified life for older adults in nursing homes is critical for enhancing their overall quality of life. The primary objective of this study is to synthesise the evidence of qualitative research on the feelings and experiences of dignity among older adults living in nursing homes. This will enable a better understanding of the factors influencing the perception of dignity and its preservation, ultimately assisting older adults in achieving a more comfortable and fulfilling experience in nursing homes. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses will guide this meta-synthesis. We conducted an initial search on 1 June 2022, for studies published between the inception of each database and 2022, using the population exposure-outcome nomenclature. We searched the Embase, Web of Science, CINAHL, Cochrane Library and PubMed databases for relevant studies. For data synthesis, we will employ the Ritchie and Spencer framework, and the Supporting the Use of Research Evidence Framework will be used for data analysis. To minimise the risk of bias, we will critically appraise the selected studies using the Qualitative Assessment and Review Instrument. ETHICS AND DISSEMINATION This review does not involve human participants and, therefore, does not necessitate ethical approval. We plan to disseminate the protocol and findings through relevant channels, including publication in pertinent journals, presentations at conferences and symposia, and engagement with local and international health stakeholders. PROSPERO REGISTRATION NUMBER CRD42022343983. CONCLUSION This study aims to offer comprehensive evidence to guide nursing staff in providing dignity-focused interventions for older adult residents in nursing homes.
Collapse
Affiliation(s)
- Kejimu Sunzi
- Nursing Department, People's Hospital of Deyang City, Deyang, Sichuan, People's Republic of China
| | - Yadi Li
- Traditional Chinese Medicine Department, People's Hospital of Deyang City, Deyang, Sichuan, People's Republic of China
| | - Cheng Lei
- School of Public Health, Chongqing Medical University, Chongqing, Chongqing, People's Republic of China
| | - Xin Zhou
- Psychosomatic Medicine Department, People's Hospital of Deyang City, Deyang, Sichuan, People's Republic of China
| |
Collapse
|
33
|
Liu J, Xu S, Wang J, Yan Z, Wang Z, Liang Q, Luan X. Prevalence of cognitive frailty among older adults in China: a systematic review and meta-analysis. BMJ Open 2023; 13:e066630. [PMID: 37076151 PMCID: PMC10124291 DOI: 10.1136/bmjopen-2022-066630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the prevalence of cognitive frailty among older adults in China. DESIGN Systematic review and meta-analysis. METHODS We searched the Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure(CNKI), Wanfang, Chinese Biomedical Literature and Weipu (VIP) databases to collect information on the epidemiology of cognitive frailty among older adults in China. The study period was from the establishment of the database to March 2022. Two researchers independently screened the literature, extracted the data and assessed the risk of bias in the included studies. All statistical analyses were performed using Stata V.15.0. RESULTS We screened 522 records, of which 28 met the inclusion criteria. The results of the meta-analysis showed that the prevalence of cognitive frailty among older adults in China was 15%(95%CI (0.13%,0.17%)). The prevalence of cognitive frailty was higher in hospitals and nursing homes than in communities. Moreover, the prevalence of cognitive frailty was higher in women than in men. Furthermore, the prevalence rates of cognitive frailty in North China Hospital, older adults aged≥80 years, and illiterate individuals were 25%, 29%, and 55%, respectively. CONCLUSIONS In conclusion, in China, the prevalence of cognitive frailty is higher among older adults, is higher in women than in men, is higher in hospitals and nursing homes than in communities, and is higher in North China than other regions. Moreover, the higher the educational level, the lower the prevalence of cognitive frailty. Multimodal interventions for cognitive frailty, including increased exercise, nutritional support, increased socialisation opportunities and multifactorial strategies, may be effective in preventing cognitive frailty. These findings have important implications for adjusting healthcare and social care systems. PROSPERO REGISTRATION NUMBER CRD42023390486.
Collapse
Affiliation(s)
- Jian Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shengjia Xu
- The First Clinical College, Shandong University, Jinan, Shandong, China
| | - Jiurui Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zeping Yan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhiwei Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qian Liang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaorong Luan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong, China
| |
Collapse
|
34
|
Lalani M, Wytrykowski S, Hogan H. Approaches to improving patient safety in integrated care: a scoping review. BMJ Open 2023; 13:e067441. [PMID: 37015799 PMCID: PMC10083780 DOI: 10.1136/bmjopen-2022-067441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES This scoping review aimed to establish the approaches employed to improving patient safety in integrated care for community-dwelling adults with long-term conditions. DESIGN Scoping review. SETTING All care settings. SEARCH STRATEGY Systematic searches of seven academic and grey literature databases for studies published between 2000 and 2021. At the full-text review stage both the first and second reviewer (SW) independently assessed full texts against the eligibility criteria and any discrepancies were discussed. RESULTS Overall, 24 studies were included in the review. Two key priorities for safety across care boundaries for adults with long-term conditions were falls and medication safety. Approaches for these priorities were implemented at different levels of an integrated care system. At the micro-level, approaches involved care primarily in the home setting provided by multi-disciplinary teams. At the meso-level, the focus was on planning and designing approaches at the managerial/organisational level to deliver multi-disciplinary care. At the macro-level, system-wide approaches included integrated care records, training and education and the development of care pathways involving multiple organisations. Across the included studies, evaluation of these approaches was undertaken using a wide range of process and outcome measures to capture patient harm and contributory factors associated with falls and medication safety. CONCLUSIONS For integrated care initiatives to fulfil their promise of improving care for adults with long-term conditions, approaches to improve patient safety need to be instituted across the system, at all levels to support the structural and relational aspects of integrated care as well as specific risk-related safety improvements.
Collapse
Affiliation(s)
- Mirza Lalani
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
35
|
Cho YS, Kim GY, Choi JH, Baek SS, Seol HY, Lim J, Park JG, Moon IJ. Factors Influencing Hearing Aid Adoption in Patients With Hearing Loss in Korea. J Korean Med Sci 2022; 37:e11. [PMID: 35014225 PMCID: PMC8748670 DOI: 10.3346/jkms.2022.37.e11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this study was two-fold: 1) to identify differences in the characteristics of adopters and non-adopters of hearing aids (HAs); and 2) to investigate factors influencing the purchase of HA. METHODS This study was conducted among 1,464 subjects (818 male and 646 female) with hearing loss. A national face-to-face survey was performed from August 2019 to October 2020 by otologists or HA experts. The questionnaire consisted of three domains: demographic, audiological, and HA-related domains. Multivariate logistic regression analysis was performed after adjusting for degree of hearing loss. RESULTS The mean age of the participants was 70.4 ± 12.2 years. Of the 1,464 respondents, 1,190 (81.3%) had already purchased HA. We identified educational level, household income, hearing loss period, place of HA purchase, and government HA assistance program status as factors influencing HA adoption. Among these factors, third party reimbursement was the most important factor affecting HA purchase intent. The main reasons for not adopting HA were feeling that their hearing was adequate, inability to afford HA, and perceptions that HA are uncomfortable. CONCLUSION Various factors are involved in the purchase of HA, but disabled registration status and third party reimbursement were identified as the most critical factors. In the future, the government should take a more active role in increasing the distribution of HA to patients with hearing loss.
Collapse
Affiliation(s)
- Young Sang Cho
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga-Young Kim
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
| | - Jae Hyuk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Hye Yoon Seol
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
- Medical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Jihyun Lim
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
| | | | - Il Joon Moon
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
36
|
Guidet B. [Intensive care and Covid]. Bull Acad Natl Med 2022; 206:65-72. [PMID: 34744171 PMCID: PMC8560024 DOI: 10.1016/j.banm.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 09/16/2021] [Indexed: 01/04/2023]
Abstract
The health crisis linked to COVID-19 has put the whole hospital under stress. Intensive care units (ICU) have been on the front line to manage the most serious cases. The number of new admissions together with cumulative number of occupied intensive care beds have been and still are a key element in measuring the intensity of the crisis. Intensive care is a specialty largely unknown to the general public which is problematic when dealing with such difficult questions as should we give priority to health or to the economy; is there a loss of chance for non-COVID patients due to deprogramming? The increase in the demand for critical care has necessitated an extension of hospitalization capacities by transforming intermediate care beds into ICU beds, by creating neo-ICU, or in some regions by carrying out critical care, usually performed in ICU, in regular wards. Among the several limiting factors, human resources with qualified personnel was a key element together with the relative shortage of drugs. The mismatch between demand and supply has led to the establishment of rules for prioritizing access to ICU. This review deals with all these issues and can contribute to a reflection on the adaptation of the critical care department to cope with major sanitary crisis.
Collapse
Affiliation(s)
- B Guidet
- Inserm, service de réanimation, Sorbonne Université, hôpital Saint-Antoine, institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| |
Collapse
|
37
|
Xu Z, Liang X, Zhu Y, Lu Y, Ye Y, Fang L, Qian Y. Factors associated with potentially inappropriate prescriptions and barriers to medicines optimisation among older adults in primary care settings: a systematic review. Fam Med Community Health 2021; 9:fmch-2021-001325. [PMID: 34794961 PMCID: PMC8603289 DOI: 10.1136/fmch-2021-001325] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To identify factors that likely contribute to potentially inappropriate prescriptions (PIPs) among older adults in primary care settings, as well as barriers to medicines optimisation and recommended potential solutions. Design Systematic review. Eligibility criteria Quantitative studies that analysed the factors associated with PIPs among older adults (≥65 years) in primary care settings, and qualitative studies that explored perceived barriers and potential solutions to medicines optimisation for this population. Information sources PubMed, EMBASE, Scopus, CINAHL, PsycINFO, Web of Science, CNKI and Wanfang. Results Of the 13 167 studies identified, 50 were included (14 qualitative, 34 cross-sectional and 2 cohort). Nearly all quantitative studies examined patient-related non-clinical factors (eg, age) and clinical factors (eg, number of medications) and nine studies examined prescriber-related factors (eg, physician age). A greater number of medications were identified as positively associated with PIPs in 25 quantitative studies, and a higher number of comorbidities, physical comorbidities and psychiatric comorbidities were identified as patient-related clinical risk factors for PIPs. However, other factors showed inconsistent associations with the PIPs. Barriers to medicines optimisation emerged within four analytical themes: prescriber related (eg, inadequate knowledge, concerns of adverse consequences, clinical inertia, lack of communication), patient related (eg, limited understanding, patient non-adherence, drug dependency), environment related (eg, lack of integrated care, insufficient investment, time constraints) and technology related (eg, complexity of implementation and inapplicable guidance). Recommended potential solutions were based on each theme of the barriers identified accordingly (eg, prescriber-related factors: incorporating training courses into continuing medical education). Conclusions Older adults with more drugs prescribed and comorbidities may have a greater risk of receiving PIPs in the primary care setting, but it remains unclear whether other factors are related. Barriers to medicines optimisation among primary care older adults comprise multiple factors, and evidence-based and targeted interventions are needed to address these difficulties. PROSPERO registration number CRD42020216258.
Collapse
Affiliation(s)
- Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xujian Liang
- Department of General Practice, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yue Zhu
- Department of General Practice, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yiting Lu
- Zhongdai Community Healthcare Center, Huzhou, China
| | - Yuanqu Ye
- Baili Community Healthcare Center, The People's Hospital of Longhua, Shenzhen, China
| | - Lizheng Fang
- Department of General Practice, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yi Qian
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| |
Collapse
|
38
|
Testa L, Ryder T, Braithwaite J, Mitchell RJ. Factors impacting hospital avoidance program utilisation in the care of acutely unwell residential aged care facility residents. BMC Health Serv Res 2021; 21:599. [PMID: 34162385 PMCID: PMC8221986 DOI: 10.1186/s12913-021-06575-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/25/2021] [Indexed: 12/23/2022] Open
Abstract
Background An existing hospital avoidance program, the Aged Care Rapid Response Team (ARRT), rapidly delivers geriatric outreach services to acutely unwell or older people with declining health at risk of hospitalisation. The aim of the current study was to explore health professionals’ perspectives on the factors impacting ARRT utilisation in the care of acutely unwell residential aged care facility residents. Methods Semi-structured interviews were conducted with two Geriatricians, two ARRT Clinical Nurse Consultants, an ED-based Clinical Nurse Specialist, and an Extended Care Paramedic. Interview questions elicited views on key factors regarding care decisions and care transitions for acutely unwell residential aged care facility residents. Thematic analysis was undertaken to identify themes and sub-themes from interviews. Results Analysis of interviews identified five overarching themes affecting ARRT utilisation in the care of acutely unwell residents: (1) resident care needs; (2) family factors; (3) enabling factors; (4) barriers; and (5) adaptability and responsiveness to the COVID-19 pandemic. Conclusion Various factors impact on hospital avoidance program utilisation in the care of acutely unwell older aged care facility residents. This information provides additional context to existing quantitative evaluations of hospital avoidance programs, as well as informing the design of future hospital avoidance programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06575-1.
Collapse
Affiliation(s)
- Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| |
Collapse
|
39
|
Trevisan C, Del Signore S, Fumagalli S, Gareri P, Malara A, Mossello E, Volpato S, Monzani F, Coin A, Bellelli G, Zia G, Ranhoff AH, Antonelli Incalzi R. Assessing the impact of COVID-19 on the health of geriatric patients: The European GeroCovid Observational Study. Eur J Intern Med 2021; 87:29-35. [PMID: 33573885 PMCID: PMC7847394 DOI: 10.1016/j.ejim.2021.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/02/2020] [Accepted: 01/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite the growing evidence on COVID-19, there are still many gaps in the understanding of this disease, especially in individuals in advanced age. We describe the study protocol of GeroCovid Observational, a multi-purpose, multi-setting and multicenter initiative that aims at investigating: risk factors, clinical presentation and outcomes of individuals affected by COVID-19 in acute and residential care settings; best strategies to prevent infection in long-term care facilities; and, impact of the pandemic on neuropsychologic, functional and physical health, and on medical management in outpatients and home care patients at risk of COVID-19, with a special focus on individuals with dementia. METHODS GeroCovid involves individuals aged ≥60 years, at risk of or affected by COVID-19, prospectively or retrospectively observed since March 1st, 2020. Data are collected in multiple investigational sites across Italy, Spain and Norway, and recorded in a de-identified clinical e-Registry. A common framework was adapted to different care settings: acute wards, long-term care facilities, geriatric outpatient and home care, and outpatient memory clinics. RESULTS At September 16th, 2020, 66 investigational sites obtained their Ethical Committee approval and 1618 cases (mean age 80.6 [SD=9.0] years; 45% men) have been recorded in the e-Registry. The average inclusion rate since the study start on April 25th, 2020, is 11.2 patients/day. New cases enrollment will ended on December 31st , 2020, and the clinical follow-up will end on June 30th, 2021. CONCLUSION GeroCovid will explore relevant aspects of COVID-19 in adults aged ≥60 years with high-quality and comprehensive data, which will help to optimize COVID-19 prevention and management, with practical implications for ongoing and possible future pandemics. TRIAL REGISTRATION NCT04379440 (clinicaltrial.gov).
Collapse
Affiliation(s)
- Caterina Trevisan
- Geriatrics Unit and the GeroCovid Working Group, Department of Medicine (DIMED), University of Padua, Italy.
| | | | - Stefano Fumagalli
- Geriatric Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Pietro Gareri
- Center for Cognitive Disorders and Dementia - Catanzaro Lido, ASP Catanzaro, Italy
| | - Alba Malara
- Scientific Committee of National Association of Third Age Residences (ANASTE) Calabria, Lamezia Terme (Catanzaro), Italy
| | - Enrico Mossello
- Geriatric Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Coin
- Geriatrics Unit and the GeroCovid Working Group, Department of Medicine (DIMED), University of Padua, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Acute Geriatric Unit, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | | | - Anette Hylen Ranhoff
- Department of Clinical Science, University of Bergen, Norway and Diakonhjemmet Hospital, Oslo, Norway
| | - Raffaele Antonelli Incalzi
- Geriatrics Unit, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| |
Collapse
|
40
|
Hutchings A, Charlton K, do Rosario VA, Walton K. Nutritional screening and intervention of older adults living in the community referred by the My Aged Care online portal. Australas J Ageing 2021; 40:e215-e222. [PMID: 33683796 DOI: 10.1111/ajag.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess whether nutritional screening and intervention improve the nutritional status of older adults living in the community. METHODS The Kiama MOW service performed nutrition screening, after being trained by the research team and maintained the dataset. De-identified data was provided to the research team for analysis. Meals on Wheels staff also kept detailed notes during the nutrition screening process and in discussions with clients. These notes were provided to the research team along with the de-identified quantitative data, a summary of the measures taken following screening, including interventions that were recommended to clients by MOW staff. Staff were not formally interviewed about their experiences in conducting nutrition screening but their open-ended text comments were retrospectively summarised, as well as anecdotal comments made to the research team who were involved in training and supporting the MOW team during the intervention period. RESULTS Forty-one individuals (25 women, mean age = 79.8 ± 8.9 years) were referred (21 well-nourished, 16 at risk of malnutrition and 4 malnourished). After reassessment (n = 19), nutritional status had significantly improved (P = .008 for all referrals and P < .001 for those at risk of malnutrition or malnourished). The main interventions provided were as follows: nutrition education (100%), home-delivered meals (78%) and social outings including meals (17%). CONCLUSIONS The My Aged Care portal may be a feasible source of referral of this population to perform routine nutrition screening for appropriate intervention.
Collapse
Affiliation(s)
- Allison Hutchings
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karen Charlton
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Vinicius Andre do Rosario
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karen Walton
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
41
|
Wood M, Delate T, Stadler SL, Denham AM, Ruppe LK, Hornak R, Olson KL. Trends in high intensity statin use among secondary prevention patients 76 years and older. Pharm Pract (Granada) 2019; 17:1402. [PMID: 31275492 PMCID: PMC6594424 DOI: 10.18549/pharmpract.2019.2.1402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/11/2019] [Indexed: 11/21/2022] Open
Abstract
Background: High intensity statin therapy (HIST) is the gold standard therapy for
decreasing the risk of recurrent atherosclerotic cardiovascular disease
(ASCVD); however, little is known about the use of HIST in older adults with
ASCVD. Objectives: The aim of this cross-sequential study was to determine trends in statin
intensity in older adults over a 10-year timeframe. Methods: The study was conducted in an integrated healthcare delivery system. Patients
were 76 years or older with validated coronary ASCVD. Data were collected
from administrative databases. Statin intensity level was assessed in
eligible patients on January 1st and July 1st from January 1, 2007 to
December 31, 2016. Results: Overall, a total of 5,453 patients were included with 2,119 (38.9%)
and 3,334 (61.1%) categorized as HIST and Non-HIST, respectively.
Included patients had a mean age of 79.8 years and were primarily male and
white and had a cardiac intervention. The rate of HIST use increased from
14.5% to 41.3% over the study period (p<0.001 for
trend). Conversely, the rates of moderate and low intensity statin use
decreased from 61.8% and 9.8% to 41.2% and 4.8%,
respectively (both p<0.001 for trend). Similar trends were identified
for females and males. Conclusions: The percentage of patients with ASCVD 76 years and older who received HIST
substantially increased from 2007 to 2016. This trend was identified in both
females and males. Future comparative effectiveness research should be
conducted in this patient population to examine cardiac-related outcomes
with HIST and Non-HIST use.
Collapse
Affiliation(s)
- Michele Wood
- Clinical Pharmacy Specialist. Pharmacy Department, Kaiser Permanente Colorado. Aurora, CO (United States)
| | - Thomas Delate
- Clinical Research Scientist; Pharmacy Department; Kaiser Permanente Colorado. Aurora, CO (United States).
| | - Sheila L Stadler
- Clinical Pharmacy Specialist. Pharmacy Department, Kaiser Permanente Colorado. Aurora, CO (United States).
| | - Anne M Denham
- Clinical Pharmacy Specialist. Pharmacy Department, Kaiser Permanente Colorado. Aurora, CO (United States).
| | - Leslie K Ruppe
- Clinical Pharmacy Specialist. Pharmacy Department, Kaiser Permanente Colorado. Aurora, CO (United States).
| | - Roseanne Hornak
- Clinical Pharmacy Specialist. Pharmacy Department, Kaiser Permanente Colorado. Aurora, CO (United States).
| | - Kari L Olson
- Clinical Pharmacy Supervisor. Pharmacy Department, Kaiser Permanente Colorado. Aurora, CO (United States).
| |
Collapse
|
42
|
Diamond F. Ah, Look at All the Lonely People (And Resultant Health Problems Thereof). Manag Care 2018; 27:14-15. [PMID: 30142056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Robin Caruso, the chief togetherness officer at CareMore, knows that acute loneliness results in poor outcomes, increasing the risk of someone's mortality by 45%. Her team engages in "organic" conversations with CareMore's elderly beneficiaries to make them more engaged in their care, more socially connected, and more likely to exercise.
Collapse
|
43
|
Lindenfalk B, Vimarlund V. Guidance Through Use: Value as a Pathfinder in e-Health Services Implementation. Stud Health Technol Inform 2017; 245:151-155. [PMID: 29295071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The lack of awareness and confidence in eHealth solutions among certain stakeholders creates a barrier for the implementation of e-Health services. The aim of this paper is to explore issues that promote the development and implementation of patient-centered care services for the elderly. An exploratory case study approach is applied to a e-Health monitoring service that was developed and piloted in 38 homes for the elderly in Sweden and the Netherlands. The unit of analysis, concept of 'value-in-use', was used in order to determine how pilot participants felt about a service of this kind benefiting them the most. The findings were then translated into actionable considerations for implementing organizations. The results indicate a need for active participation, technical support infrastructure, mobility demands, and an extension of the concept of trust in e-Health services. The knowledge presented in the study is important for decisions makers, public organization strategists, and policy writers.
Collapse
Affiliation(s)
- Bertil Lindenfalk
- International Business School, Jönköping University, Jönköping, Sweden
| | - Vivian Vimarlund
- International Business School, Jönköping University, Jönköping, Sweden
| |
Collapse
|
44
|
Ko KD, Park SM, Lee K. Factors associated with the use of uterine cervical cancer screening services in korean elderly women. Korean J Fam Med 2012; 33:174-81. [PMID: 22787540 PMCID: PMC3391643 DOI: 10.4082/kjfm.2012.33.3.174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 05/02/2012] [Indexed: 11/18/2022] Open
Abstract
Background The Papanicolaou (Pap) smear test is an effective screening test for the early detection of uterine cervical cancer. The Pap test still plays an important role in Korean elderly women, as uterine cervical cancer remains a frequent form of cancer and an important cause of death. However, the participation rate and other factors related to the Pap test in Korean elderly women have been studied insufficiently. Methods This study included 654 individuals aged 65 and over who completed a cervical cancer screening questionnaire from the Third Korean National Health and Nutrition Examination Survey 2005. Using multiple logistic regression, odds ratios and confidence intervals for the association between attendance of the Pap test and sociodemographic or health-related factors were calculated. Results One hundred and eleven individuals (17.0%) of the study population showed compliance with Pap testing within the previous 2 years. We recognized that the most elderly women (75 years and over) or those with lower levels of education were less likely to have had the test. Conclusion Primary health care providers need to make efforts to improve attendance rates of Pap smear screening in Korean elderly women, individually taking into account previous Pap results, life expectancy, risk factors for cervical cancer, and preferences. More attention will especially be needed among the eldest elderly or less educated elderly women.
Collapse
Affiliation(s)
- Ki Dong Ko
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | | |
Collapse
|
45
|
Abstract
Treatment of residents living in aged care facilities presents a challenge to the traditional model of general practitioner (GP)-patient interactions, which rely on patients having the mobility to visit a GP's rooms, to transport themselves for follow-up tests, and are cooperative in taking medications. Aged care residents lack mobility and rely on caregivers for medications; subsequently treatment is often reactive, based on prescribing medications for known and newly diagnosed conditions. Comprehensive Medical Assessments (CMAs) are available at no cost to residents in aged care. However, less than 30% of the 170,000 residents in aged care have had a CMA conducted. A recent University of Sydney Health Informatics Research and Evaluation Unit study concluded that new models for aged care are warranted and that CMAs should play a central role in developing these new approaches. HealthCube has developed an electronic CMA process that underpins the Preventative Aged Care Service package, which promises to change aged care treatment through a new model of GP-patient engagement.
Collapse
Affiliation(s)
- Sue J Irvine
- Sue J Irvine BN, Grad Dip Mgt, AFACHSE, MAICD, MAIM, Chief Executive Officer, HealthCube Pty Ltd, PO Box 7426, St Kilda Road VIC 8004, AUSTRALIA, Tel: +61 2 6278-3148
| | - Ken Kroeger
- Ken Kroeger, Managing Director, HealthCube Pty Ltd, PO Box 7426, St Kilda Road VIC 8004, AUSTRALIA
| |
Collapse
|