scholarly journals EXPLORING PALLIATIVE CARE DISPARITIES IN RACIALLY AND ETHNICALLY DIVERSE COMMUNITY-DWELLING OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S746-S746
Author(s):  
Daniel S Gardner ◽  
Meredith Doherty
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Service Use ◽  
Ethnic Disparities ◽  
Community Dwelling ◽  
Medically Underserved ◽  
Care Needs ◽  
Serious Illness ◽  
Diverse Community ◽  
Community Dwelling Older Adults

Abstract Despite the growth and recognized benefits of palliative care for people with serious illness and their families, there are significant racial and ethnic disparities in access to and utilization of services, particularly among older adults living in impoverished, medically-underserved communities. This paper presents preliminary findings from a mixed-method, CBPR study exploring the experiences, supportive care needs, and service use of diverse older adults living with serious illness in an urban, medically-underserved community in the U.S. Systematic analyses of focused, semi-structured interviews with 45 older adults identified cultural, environmental, financial, and structural barriers to palliative care, and identified the critical importance of familial, social, spiritual, and formal networks of support in coping with serious illness and associated symptoms. The investigators describe implications for practice and policy that addresses palliative care disparities, and strategies for engaging with communities to extend culturally-sensitive palliative care to diverse, community-dwelling older adults and their social networks.

scholarly journals Assessing the palliative care needs and service use of diverse older adults in an urban medically-underserved community

2019 ◽  
Vol 8 (5) ◽  
pp. 769-774
Author(s):  
Daniel S. Gardner ◽  
Nina S. Parikh ◽  
Carolina H. Villanueva ◽  
Angela Ghesquiere ◽  
Cara Kenien ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Service Use ◽  
Medically Underserved ◽  
Care Needs ◽  
Underserved Community ◽  
Palliative Care Needs

scholarly journals Exploring Community-Dwelling Older Adults’ Considerations About Values and Preferences for Future End-of-Life Care: A Study from Sweden

2020 ◽  
Vol 60 (7) ◽  
pp. 1332-1342 ◽  
Author(s):  
Malin Eneslätt ◽  
Gert Helgesson ◽  
Carol Tishelman
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Community Dwelling ◽  
Participatory Action ◽  
Action Research Project ◽  
Care Needs ◽  
Swedish Version ◽  
Using Data ◽  
Eol Care ◽  
Community Dwelling Older Adults

Abstract Background and Objectives There is a substantial body of research on advance care planning (ACP), often originating from English-speaking countries and focused on health care settings. However, studies of content of ACP conversations in community settings remain scarce. We therefore explore community-dwelling, older adults’ reasoning about end-of-life (EoL) values and preferences in ACP conversations. Research Design and Methods In this participatory action research project, planned and conducted in collaboration with national community-based organizations, we interviewed 65 older adults without known EoL care needs, about their values and preferences for future EoL care. Conversations were stimulated by sorting and ranking statements in a Swedish version of GoWish cards, called the DöBra cards, and verbatim transcripts were analyzed inductively. Results While participants shared some common preferences about EoL care, there was great variation among individuals in how they reasoned. Although EoL preferences and prioritizations could be identical, different individuals explained these choices very differently. We exemplify this variation using data from four participants who discussed their respective EoL preferences by focusing on either physical, social, existential, or practical implications. Discussion and Implications A previously undocumented benefit of the GoWish/DöBra cards is how the flexibility of the card statements support substantial discussion of an individual’s EoL preferences and underlying values. Such in-depth descriptions of participants’ reasoning and considerations are important for understanding the very individual nature of prioritizing EoL preferences. We suggest future users of the DöBra/GoWish cards consider the underlying reasoning of individuals’ prioritizations to strengthen person-centeredness in EoL conversations and care provision.

Gender differences in health service use for mental health reasons in community dwelling older adults with suicidal ideation

2012 ◽  
Vol 25 (3) ◽  
pp. 374-381 ◽  
Author(s):  
Helen-Maria Vasiliadis ◽  
Sarah Gagné ◽  
Natalia Jozwiak ◽  
Michel Préville
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Suicidal Ideation ◽  
Service Use ◽  
Community Dwelling ◽  
Symptoms Of Depression ◽  
Antidepressant Use ◽  
One Year ◽  
Promotion Campaigns ◽  
Community Dwelling Older Adults

ABSTRACTBackground: To ascertain gender-specific determinants of antidepressant and mental health (MH) service use associated with suicidal ideation.Methods: Data used in this study came from the ESA (Enquête sur la Santé des Aînés) survey carried out in 2005–2008 on a large sample of community-dwelling older adults (n = 2,004). Multivariate logistic regression analyses were carried out.Results: The two-year prevalence of suicidal ideation was 8.4% and 20.3% had persistent suicidal thoughts at one-year follow-up. In males, the prevalence of antidepressant and MH service use in respondents with suicidal ideation reached 32.2% and 48.9%, respectively. In females, the corresponding rates were 42.6% and 65.6%. Males were less likely to consult MH services than females when their MH was judged poorly. Male respondents with higher income and education were less likely to use antidepressant and MH services. However, males using benzodiazepines were more likely than females to be dispensed an antidepressant. Among respondents with suicidal ideation, gender was not associated with service use. Younger age, however, was associated with antidepressant use.Conclusions: Increased promotion campaigns sensitizing men to the prodromal symptoms of depression and the need to foster access to MH care when the disorder is manageable may be needed.

Perceptions and Attitudes About Hospice and Palliative Care Among Community-Dwelling Older Adults

2012 ◽  
Vol 30 (2) ◽  
pp. 153-161 ◽  
Author(s):  
Erika Manu ◽  
Terri L. Mack-Biggs ◽  
Caroline A. Vitale ◽  
Andrej Galecki ◽  
Tisha Moore ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Community Dwelling ◽  
Perceptions And Attitudes ◽  
Hospice And Palliative Care ◽  
Community Dwelling Older Adults

scholarly journals Reliabilities of mean and variability of ambulatory pain among community dwelling older adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 892-892
Author(s):  
Jinshil Hyun ◽  
Jiyue Qin ◽  
Cuiling Wang ◽  
Mindy Katz ◽  
Jelena Pavlovic ◽  
...  
Keyword(s):  
Older Adults ◽  
Individual Variability ◽  
Community Dwelling ◽  
Health Consequences ◽  
Subjective Pain ◽  
Aging Study ◽  
Diverse Community ◽  
Pain Experiences ◽  
Ecological Momentary ◽  
Community Dwelling Older Adults

Abstract Individual’s pain experiences vary substantially over time periods, and the variability in pain may be an important metric to predict health consequences. However, research on its reliability is lacking among older adults. We aimed to examine the reliabilities of both intra-individual mean (IIM) and intra-individual variability (IIV) of subjective pain reports assessed using ecological momentary assessments (EMA) among racially diverse, community dwelling older adults. Participants were from the Einstein Aging Study (N=311, age=70-91) and completed a 14-day EMA protocol which included self-reports of pain intensity 6 times a day. Pain IIV was quantified using intraindividual standard deviation (iSD). We followed Wang and Grimm(2012)’s approach to calculate the reliability of IIM and IIV. Over a 2-week period, we found excellent reliabilities for both pain IIM (.99) and pain IIV (.91), showing that these measures are reliable and can be used to link with various health outcomes among community dwelling older adults. We also estimated the average number of assessments that produce acceptable levels of reliability. The average of 2 assessments for pain IIM and 23 assessments for pain IIV produced values that exceeded reliability score of .80, suggesting that a briefer study design may be used to reduce participants’ burden with reliable pain metrics. Future studies need to examine whether pain IIV is associated with cognitive, emotional, and physical health among older adults and whether intervention studies that target to reduce pain IIV improve health consequences.

scholarly journals CARE DEPENDENCY: EXPERIENCES AND EXPECTATIONS OF COMMUNITY-DWELLING OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S624-S624
Author(s):  
Jan S Jukema ◽  
Sharon Oude Veldhuis ◽  
Jacqueline Van Alphen ◽  
Jopie Jorritsma ◽  
Frits De Lange
Keyword(s):  
Older Adults ◽  
Ethic Of Care ◽  
Influential Factors ◽  
Community Dwelling ◽  
Care Needs ◽  
Living Situation ◽  
Equal Distribution ◽  
Study Results ◽  
Diverse Groups ◽  
Community Dwelling Older Adults

Abstract “Not to be a burden” is a common phrase used by community-dwelling older adults in discussing their dependency on others in care for their daily life. This attitude may lead to conflicts with relatives, neighbors, or professionals when in their opinion, care is necessary and, ultimately, may result in unmet care needs. The goal of this study is to gain a better understanding of how older adults experience their increased dependency on others and to contribute to the development of an ethic of care. Thirty-two participants of a larger research sample (n=64) from a descriptive qualitative research were purposefully selected, resulting in an equal distribution of the following variables: gender, living situation, living with or without partner, and having children or not. From a multiphase qualitative analysis with five researchers, including two senior citizens four themes emerged: (1) relationships in the context of care; (2) experiences with giving, receiving and asking for care; (3) future perspectives towards receiving and asking for care; and (4) actual practices of caregiving and receiving. Our study clarifies how community-dwelling older adults deal with the changes in their dependency on others. The study results highlight particular dynamics which appear, at least, partly in contrast with current policy regarding care at home. Moreover, it contributes to an empirical refinement of the concepts of dependency and interdependency in an ethic of care. Further studies are needed to clarify the influential factors on asking for care in diverse groups of older adults and the response from their network.

scholarly journals Self-management program versus usual care for community-dwelling older adults with multimorbidity: A pragmatic randomized controlled trial in Ontario, Canada

2020 ◽  
Vol 10 ◽  
pp. 2235042X2096339
Author(s):  
Kathryn Fisher ◽  
Maureen Markle-Reid ◽  
Jenny Ploeg ◽  
Amy Bartholomew ◽  
Lauren E Griffith ◽  
...  
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Service Use ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Home Care Services ◽  
Community Dwelling ◽  
Care Services ◽  
And Control ◽  
Community Dwelling Older Adults

Background: Multimorbidity, the co-existence of 2+ (or 3+) chronic diseases in an individual, is an increasingly common global phenomenon leading to reduced quality of life and functional status, and higher healthcare service use and mortality. There is an urgent need to develop and test new models of care that incorporate the components of multimorbidity interventions recommended by international organizations, including care coordination, interdisciplinary teams, and care plans developed with patients that are tailored to their needs and preferences. Purpose: To determine the effectiveness of a 6-month, community-based, multimorbidity intervention compared to usual home care services for community-dwelling older adults (age 65+ years) with multimorbidity (3+ chronic conditions) that were newly referred to and receiving home care services. Methods: A pragmatic, parallel, two-arm randomized controlled trial evaluated the intervention, which included in-home visits by an interdisciplinary team, personal support worker visits, and monthly case conferences. The study took place in two sites in central Ontario, Canada. Eligible and consenting participants were randomly allocated to the intervention and control group using a 1:1 ratio. The participants, statistician/analyst, and research assistants collecting assessment data were blinded. The primary outcome was the Physical Component Summary (PCS) score of the 12-Item Short-Form health survey (SF-12). Secondary outcomes included the SF-12 Mental Component Summary (MCS) score, Center for Epidemiological Studies of Depression (CESD-10), Generalized Anxiety Disorder (GAD-7), Self-Efficacy for Managing Chronic Disease, and service use and costs. Analysis of covariance (ANCOVA) tested group differences using multiple imputation to address missing data, and non-parametric methods explored service use and cost differences. Results: 59 older adults were randomized into the intervention (n = 30) and control (n = 29) groups. At baseline, groups were similar for the primary outcome and number of chronic conditions (mean of 8.6), but the intervention group had lower mental health status. The intervention was cost neutral and no significant group differences were observed for the primary outcome of PCS from SF-12 (mean difference: −4.94; 95% CI: −12.53 to 2.66; p = 0.20) or secondary outcomes. Conclusion: We evaluated a 6-month, self-management intervention for older adults with multimorbidity. While the intervention was cost neutral in comparison to usual care, it was not found to improve the PCS from SF-12 or secondary health outcomes. Recruitment and retention challenges were significant obstacles limiting our ability to assess intervention effectiveness. Yet, the intervention was grounded in internationally-endorsed recommendations and implemented in a practice setting (home care) viewed as a key upstream resource fostering independence in older adults. These features collectively support the identification of ways to recruit/retain older adults and test alternative implementation strategies for interventions that are based on sound principles of multimorbidity management.

Sign in / Sign up

Export Citation Format

Share Document