scholarly journals COVID 19: prioritise autonomy, beneficence and conversations before score-based triage

2020 ◽  
Author(s):  
Esther Peiying Ho ◽  
Han-Yee Neo
Keyword(s):  
Critical Care ◽  
Older People ◽  
Epidemiological Data ◽  
Adverse Outcomes ◽  
Best Interest ◽  
Health Crisis ◽  
Therapeutic Goals ◽  
Functional Deficits ◽  
Situational Pressure

Abstract At the start of the COVID-19 pandemic, mounting demand overwhelmed critical care surge capacities, triggering implementation of triage protocols to determine ventilator allocation. Relying on triage scores to ration care, while relieving clinicians from making morally distressing decisions under high situational pressure, distracts clinicians from what is essentially deeply humanistic issues entrenched in this protracted public health crisis. Such an approach will become increasingly untenable as countries flatten their epidemic curves. Decisions regarding intensive care unit admission are particularly challenging in older people, who are most likely to require critical care, but for whom benefits are most uncertain. Before applying score-based triage, physicians must first discern if older people will benefit from critical care (beneficence) and second, if he wants critical care (autonomy). When deliberating beneficence, physicians should steer away from solely using age-stratified survival probabilities from epidemiological data. Instead, decisions must be based on individualised risk-stratification that encompasses evidence-based predictors of adverse outcomes specific to older adults. Survival will also need to be weighed against burden of treatment, as well as longer term functional deficits and quality-of-life. By identifying the robust older people who may benefit from critical care, clinicians should proceed to elicit his values and preferences that would determine the treatment most aligned with his best interest. During these dialogues, physicians must truthfully convey the emergent clinical reality, discern the older person’s therapeutic goals and discuss the feasibility of achieving them. Given that COVID-19 is here to stay, these conversations aimed at achieving goal-cordant care must become a new clinical norm.

scholarly journals P636 The natural history of COVID-19 in patients with IBD: A nationwide study by the Hellenic Society for the Study of IBD

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S571-S571
Author(s):  
G Bamias ◽  
G Kokkotis ◽  
D Christodoulou ◽  
V Delis ◽  
A Gatopoulou ◽  
...  
Keyword(s):  
Natural History ◽  
Epidemiological Data ◽  
Adverse Outcomes ◽  
Chronic Illnesses ◽  
Health Crisis ◽  
Modifying Factors ◽  
Frequent Administration ◽  
History Of ◽  
Inflammatory Bowel ◽  
Benign Course

Abstract Background COVID-19 has evolved into a global health crisis, variably affecting the management of patients with chronic illnesses. Patients with inflammatory bowel disease (IBD) may represent a vulnerable population due to the frequent administration of immune-modifying treatments. Methods We aimed to depict the natural history of COVID-19 infection in Greek patients with IBD at a nationwide level via the unbiased reporting of all cases that were registered during the first and second waves of the pandemic. Following a national call from the Hellenic Society for the study of IBD, we enrolled all IBD patients with established diagnosis of COVID-19. Clinical and epidemiological data, including COVID-19 modifying factors and IBD-associated therapies were analysed against adverse outcomes (hospitalization, ICU admission, and death). Results We identified 80 patients with IBD who were diagnosed with COVID-19 during the study period (male:65%; median age=44 [IQR=26] years; CD:62.5%). Adverse outcomes were reported in 16 patients (20%), including 3 ICU admissions (3.75%) and 2 deaths (2.5%). Negative prognostic factors for adverse outcomes included age, Body Mass Index, and hypertension, as well as dyspnoea, fatigue and abdominal pain at presentation. In contrast, treatment with biologics, in particular anti-TNF agents, exerted a protective effect against an unfavorable course COVID-19. Patients on subcutaneous biologics were more likely to halt treatment due to the infection as compared to those on intravenous medications. Conclusion Patients with IBD who developed COVID-19 had a benign course with adverse outcomes being scarce. Treatment with biologics had a beneficial effect, supporting the continuation of therapy during the pandemic.

The Quality of Life of Older People With a Disability in Ireland

2007 ◽  
Author(s):  
Kathy Murphy ◽  
Eamon O'Shea ◽  
Adeline Cooney ◽  
Dympna Casey
Keyword(s):  
Quality Of Life ◽  
Older People

Telehealth During COVID-19 for Remote Vision Rehabilitation of a Patient with mTBI

2020 ◽  
pp. 191-198
Keyword(s):  
Veterans Health ◽  
Health Administration ◽  
Web Based ◽  
Home Setting ◽  
Therapeutic Goals ◽  
Vision Rehabilitation ◽  
Novel Coronavirus ◽  
Performance Challenges ◽  
Perception Of Performance

Background: Binocular and accommodative vision problems are common after mild traumatic brain injury (mTBI). Traditionally, the management of visual dysfunctions following mTBI included in-office vision rehabilitation with a trained eye care provider. The concept of providing telehealth for remote vision rehabilitation in mTBI patients is a relatively novel practice that has not been widely utilized until the recent outbreak of the 2019 novel coronavirus (COVID-19) pandemic. Case Report: We describe the implementation of telehealth for remote vision rehabilitation during COVID-19 within the Veterans’ Health Administration (VHA) system in an adult patient with multiple confirmed histories of mTBI. Conclusion: Our telehealth remote vision rehabilitation was successfully implemented utilizing established VHA’s web-based videoconferencing tools. Therapeutic goals identified prior to COVID 19 were addressed without any challenges. The delivery of vision rehabilitation intervention via telehealth allowed for the continuance of services within the home setting that led to improvements in functional vision, decreased perception of performance challenges, and improved quality of life.

Financial Interdependence among Malay Older People in the Community: An interpretative phenomenological analysis

2017 ◽  
Vol 2 (5) ◽  
pp. 135
Author(s):  
Ahmad Shahir Abdul Mutalib ◽  
Akehsan Haji Dahlan ◽  
Ajau Danis
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Interpretative Phenomenological Analysis ◽  
Publishing House ◽  
Phenomenological Analysis ◽  
Financial Assistance ◽  
Depth Interview ◽  
International Publishing ◽  
Open Access Article

This study explores the practice of financial interdependence among Malay older people who live in the community in Malaysia. Eleven Malay older people participated in this qualitative study by an in-depth interview. The data was analyzed using six stages of the interpretative phenomenological analysis. Two main themes emerged from the interview transcripts are issues regarding living expenses and financial assistance. Financial interdependence is one of the most effective ways for the Malay older people in the community in Malaysia to adapt their retired status, to achieve maximum life satisfaction and productivity thereby improving their overall quality of life.Keywords: Financial interdependence, Older people, Quality of life, Interpretative phenomenological analysisISSN: 2398-4287© 2017. The Authors. Published for AMER ABRA by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.

scholarly journals Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review

2019 ◽  
Vol 97 (1) ◽  
pp. 113-175 ◽  
Author(s):  
CATHERINE J. EVANS ◽  
LUCY ISON ◽  
CLARE ELLIS‐SMITH ◽  
CAROLINE NICHOLSON ◽  
ALESSIA COSTA ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Service Delivery ◽  
Older People ◽  
End Of Life ◽  
Rapid Review ◽  
Service Delivery Models ◽  
Delivery Models

The Physical Context of Child Development

2021 ◽  
Vol 30 (1) ◽  
pp. 41-48
Author(s):  
Gary W. Evans
Keyword(s):  
Child Development ◽  
Observational Studies ◽  
Physiological Stress ◽  
Personal Characteristics ◽  
Adverse Outcomes ◽  
Structural Quality ◽  
Physical Context ◽  
Physical Setting ◽  
Physical Features

Child development reflects interactions between personal characteristics and the physical and social environment. Psychology, however, lacks analysis of physical features that influence child development. In this article, I describe a preliminary taxonomy of physical-setting characteristics that can influence child development, focusing on environmental stressors such as noise, crowding, and chaos along with structural quality of housing, day care, and schools. Adverse outcomes associated with suboptimal physical settings during childhood include cognitive and socioemotional difficulties along with chronic physiological stress. Both direct effects on the child as well as indirect effects occurring via significant persons surrounding the child are described. Methodological limitations, particularly reliance on observational studies, are a weakness in the current literature, but increasingly more rigorously obtained findings yield converging evidence of the effects of physical settings on child development.

scholarly journals Understanding the Link between Family Caregiver Quality of Life and the Care Provided to Older People With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 153-154
Author(s):  
Afeez Hazzan
Keyword(s):  
Quality Of Life ◽  
Quality Of Care ◽  
Older People ◽  
Family Caregivers ◽  
Family Caregiver ◽  
Well Being ◽  
The United States ◽  
People With Dementia ◽  
The Impact

Abstract Dementia is one of the most rapidly growing diseases in the United States. In 2018, the direct costs to American society of caring for older people with dementia was approximately $277 billion. Primary informal caregivers are mainly responsible for the care of older people with dementia including Alzheimer’s disease. Caregivers perform a myriad of duties ranging from shopping for their loved ones’ groceries, helping with medications, and managing finances. The caregiving role becomes more demanding as the disease progresses over time, and studies have shown that the quality-of-life (QoL) experienced by caregivers of older adults who have dementia is lower than the QoL of caregivers for older people who do not have dementia. To the best of our knowledge, there has been no research conducted to investigate whether lower caregiver QoL affects the level or quality of care that caregivers provide to persons with dementia. In the current study, we interviewed family caregivers living in Rochester, New York to inquire about their quality of life and the care provided to older people living with dementia. Further, caregivers completed the 36-item Short Form Health Survey (SF-36) as well as a draft questionnaire for measuring the quality of care provided to older people living with dementia. Both quantitative and qualitative findings from this study reveals important relationships between family caregiver QoL and the care provided, including the impact of social support and financial well-being. The study findings could have significant impact, particularly for the provision of much needed support for family caregivers.

scholarly journals Quality of Life, Health and the Great Recession in Spain: Why Older People Matter?

2021 ◽  
Vol 18 (4) ◽  
pp. 2028
Author(s):  
Carla Blázquez-Fernández ◽  
David Cantarero-Prieto ◽  
Marta Pascual-Sáez
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Great Recession ◽  
Household Income ◽  
Macroeconomic Variables ◽  
Crisis Period ◽  
The Great Recession ◽  
Health Aging ◽  
Logistic Regressions

The financial crisis of 2008 precipitated the “Great Recession”. In this scenario, we took Spain as a country of study, because although it experienced significant negative shocks associated with macroeconomic variables (GDP or unemployment), its welfare indicators have been marked by limited changes. This study used data from waves 2 and 4 (years 2006–2007 and 2010–2012, respectively) of the Survey on Health, Aging and Retirement in Europe (SHARE). Specifically, through logistic regressions we have analysed the effects of socioeconomic, demographic, health and “Great Recession” factors on the quality of life (QoL) of elders in Spain. Although QoL did not change too much during the “Great Recession”, the results confirmed the importance of several factors (such as chronicity) that affect the satisfaction with the QoL among the older people. In this regard, statistically significant effects were obtained for individual exposure to recession. Therefore, a decrease in household income in the crisis period with respect to the pre-crisis period would increase by 44% the probability of reporting a low QoL (OR = 1.44; 95% CI: 1.00–2.07). Furthermore, gender differences were observed. Health and socioeconomic variables are the most significant when determining individual QoL. Therefore, when creating policies, establishing multidisciplinary collaborations is essential.

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