How “care values” as discursive practices effect the ethics of a care-setting

2019 ◽  
Vol 8 (3) ◽  
pp. 298-311
Author(s):  
Jeannine Therese Moreau ◽  
Trudy Rudge
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Social Order ◽  
Social Practice ◽  
Care Setting ◽  
Functional Decline ◽  
Discursive Practices ◽  
Content Type ◽  
Hospitalized Older Adults ◽  
Measurement Efficiency

Purpose This paper examines how certain care values permeate, legitimize and authorize hospitalized-older-adults’ care, technologies and practices. The purpose of this paper is to expose how values are not benign but operate discursively establishing “orders of worth” with significant effect on the ethics of the care-setting. Design/methodology/approach The paper draws from a discursive ethnography to see “up close” on a surgical unit how values influence nurse/older-adult-patient care occasions in the domain of older-adults and functional decline. Data are from participant observations, conversations, interviews, chart reviews and reviewed literature. Foucauldian discursive analytics rendered values recognizable and analyzable as discursive practices. Discourse is a social practice of knowledge production constituting and giving meaning to what it represents. Findings Analysis reveals how care values inhere discourses like measurement, efficiency, economics, risk and functional decline (loss of capacity for independent living) pervading care technologies and practices, subjugating older adults’ bodies to techniques, turning older persons into measurable objects of knowledge. These values determine social conditions of worth, objectifying, calculating, normalizing and homogenizing what it means to be old, ill and in hospital. Originality/value Seven older adult patients and attendant nurses were followed for their entire hospitalization. The ethnography renders visible how care values as discursive practices rationalize the social order and operations of everyday care. Analytic outcomes offer insights of how dominant care values enabled care technologies and practices to govern hospitalized-older-adults as a population to be ordered, managed and controlled, eliding possibilities of engaging humanistic patient-centered care.

Depressive Symptoms and Malnutrition are Associated with Other Geriatric Syndromes and Increase Risk for 30-Day Readmission in Hospitalized Older Adults: A Prospective Cohort Study

2022 ◽  
Author(s):  
Laura Tay ◽  
Melvin Chua ◽  
Yew Yoong Ding
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Functional Decline ◽  
Oral Intake ◽  
Index Admission ◽  
Geriatric Syndromes ◽  
Poor Oral Intake ◽  
Hospitalized Older Adults ◽  
Minimal Adjustment

Abstract Background: Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods: Consecutive admissions of patients >65 years to a general medical department were recruited over 15 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for intermediary events including poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results: We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) patients. Depressive symptoms (OR 1.55, 95% CI 1.15-2.07), malnutrition (OR 1.59, 95% CI 1.14-2.23), higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P<0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR=1.62, 95% CI 1.22-2.16), had poor oral intake (OR=1.35, 95% CI 1.02-1.79) and functional decline during admission (OR=1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty, delirium, cognitive impairment and poor oral intake during hospitalization (P<0.05). In minimal adjustment set identified by DAG, depressive symptoms (OR=1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was attenuated after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR=1.40, 95% CI 0.99-1.98, P=0.06). Conclusion: The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

Translation and adaption of short version of IQCODE into Hausa and its psychometric evaluation among outpatients older adults

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Tolulope Adeniji ◽  
Adetoyeje Y. Oyeyemi
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Internal Consistency ◽  
Screening Tool ◽  
Receiver Operating Curve ◽  
Cognitive Screening ◽  
Cronbach’S Alpha ◽  
Cognitive Changes ◽  
Content Type ◽  
Cronbach's Alpha

Purpose This study aims at translating and adapting a common and widely used proxy rated cognitive screening tool – Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) into Hausa language and also to evaluate the instrument’s psychometric properties. Design/methodology/approach IQCODE was translated and adapted using a qualitative process involving experts and the adapted version was then evaluated against a gold standard (Diagnostic and Statistical Manual of Mental Disorder V criteria for neurocognitive disorders) with older adults subjects (N = 100), while its reliability (internal consistency) was also evaluated. Descriptive statistics of mean and frequencies, and inferential statistic of receiver operating curve analysis and Cronbach’s alpha coefficient were used for data analysis at an alpha level set at 0.05. Findings The Hausa IQCODE has a sensitivity value of 73.3%, specificity value of 71.8% and optimal cut-off values of between 3.2 and 3.3. For his adapted instrument the area under the Curve (AUC) curve is 0.79 (95% CI: 0.663–0.919; std. err: 0.066; P = 0.000), and Cronbach’s alpha value of 0.819 was obtained indicating that the adapted instrument has good internal consistency. Research limitations/implications The adapted IQCODE is a valid and reliable proxy based cognitive screening tool for the older adult Hausa speakers in Maiduguri. However, clinician and researcher might want to consider different optimal cut-off points when using this tool to screen or to monitor cognitive changes among older adults. Originality/value This research paper translated and adapted Hausa IQCODE into Hausa language. And it gives information on the validity and reliability of the adapted tool alongside with new optimal cut-off for cognitive screening by proxy among older adult patients in Nigeria.

scholarly journals Neuropsychological and Functional Impact of COVID-19 on Mild Cognitive Impairment

2020 ◽  
Vol 35 ◽  
pp. 153331752096087
Author(s):  
Kalpana P. Padala ◽  
Christopher M. Parkes ◽  
Prasad R. Padala
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Case Report ◽  
Mild Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Older Adult ◽  
Daily Living ◽  
Functional Decline ◽  
Depression And Anxiety ◽  
Physically Active

We present a case report to showcase that behavioral, cognitive, and functional decline may be associated with COVID-19 stay-home guidance among older adults with pre-existent cognitive impairment. In a functionally independent and physically active older adult with Mild Cognitive Impairment, there was worsening in depression and anxiety symptoms associated with the restrictions of COVID-19. Functional decline was also noted as assessed by Instrumental Activities of Daily Living. We discuss solutions to mitigate the effects of COVID-19 restrictions in this vulnerable population.

scholarly journals Technology implementation in delivery of healthcare to older people: how can the least voiced in society be heard?

2018 ◽  
Vol 12 (2) ◽  
pp. 76-90 ◽  
Author(s):  
Yvonne van Zaalen ◽  
Mary McDonnell ◽  
Barbara Mikołajczyk ◽  
Sandra Buttigieg ◽  
Maria del Carmen Requena ◽  
...  
Keyword(s):  
Older Adults ◽  
Older People ◽  
Older Adult ◽  
Social Relations ◽  
Technology Use ◽  
Great Emphasis ◽  
Older Person ◽  
Content Type ◽  
Mediating Role ◽  
Use Of Technology

PurposeThe purpose of this paper is to focus on ethical and judicial themes related to technology and the older adults.Design/methodology/approachDifferent consecutive phases in technology design and allocation will be discussed from a range of perspectives.FindingsLongevity is one of the greatest achievements of contemporary science and a result of development of social relations. Currently, various non-communicable diseases affect older adults and impose the greatest burden on global health. There is a great emphasis across Europe on caring for the older person in their own homes. Technology has a mediating role in determining the possibilities for good quality of life (QOL). The concept of assisting the older adult through the use of technology so as to access healthcare services has enormous potential. Although the potential of technology in healthcare is widely recognised, technology use can have its downsides. Professionals need to be aware of the risks, namely, those related to the privacy of the older person, which may accompany technology use.Research limitations/implicationsBy 2050, there will be more people aged over 65 than there are children. This phenomenon of global ageing constitutes a massive challenge in the area of health protection.Practical implicationsProfessionals need to be aware of the risks, for example, related to the privacy of the older person, that may accompany technology use.Social implicationsThere is a great emphasis across Europe on caring for the older person in their own homes. Technology has a mediating role in determining the possibilities for QOL.Originality/valueThe concept of assisting the older adult through the use of technology to avail of healthcare has enormous potential. Assistive technology, social media use and augmentative and alternative communication can have a positive effect on the QOL of older people, as long as they are supported enough in use of these technologies. However, ethical and juridical considerations are at stake as well.

Clinical supervision in older adult mental health services

2019 ◽  
Vol 23 (4) ◽  
pp. 241-250
Author(s):  
Alessandra Merizzi
Keyword(s):  
Older Adults ◽  
Older People ◽  
Older Adult ◽  
Clinical Supervision ◽  
Health Care Professionals ◽  
Theoretical Models ◽  
Clinical Work ◽  
Therapeutic Work ◽  
Content Type ◽  
Self Reflection

Purpose The purpose of this paper is to explore how supervision is applied in the context of National Health Service services for older adults, with particular regard to the profession of clinical psychology and psychotherapy. Design/methodology/approach The clinical supervision theories that are considered in this exploration are the Seven-Eyed Model (Hawkins and Shohet, 2012) and the Cyclical Model (Page and Wosket, 2015). The discussion also integrates an overview of psychological dynamics as presented by the existing literature with the author’s reflections on the influence of ageing stereotypes in the therapeutic work with older adults. Findings The theoretical models of clinical supervision considered can offer a robust framework and pathway for supervisory work in psychology and psychotherapy for older people. However, this alone seems insufficient and needs to be combined with the supervisor’s knowledge on psychology of ageing as well as their own self-reflection on internalised ageing stereotypes. Practical implications The paper suggests a need for health care professionals, providing clinical supervision on older adult therapeutic work, to be familiar with the aspects analysed. Originality/value Clinical supervision handbooks overlook aspects related to age as an issue of difference. This paper adds value to the clinical work with older people through a novel attempt to link implications of ageing stereotypes with the therapeutic and supervisory practice.

Functional Decline in Hospitalized Older Adults: Can Nursing Make a Difference?

2012 ◽  
Vol 33 (4) ◽  
pp. 272-279 ◽  
Author(s):  
Marie Boltz ◽  
Barbara Resnick ◽  
Elizabeth Capezuti ◽  
Joseph Shuluk ◽  
Michelle Secic
Keyword(s):  
Older Adults ◽  
Functional Decline ◽  
Hospitalized Older Adults

scholarly journals Characteristics Associated With Functional Changes During Systemic Cancer Treatments: A Systematic Review Focused on Older Adults

2021 ◽  
Vol 19 (9) ◽  
pp. 1055-1062
Author(s):  
Kah Poh Loh ◽  
Vivian Lam ◽  
Katey Webber ◽  
Simran Padam ◽  
Mina S. Sedrak ◽  
...  
Keyword(s):  
Older Adults ◽  
Functional Status ◽  
Older Adult ◽  
Functional Decline ◽  
Functional Change ◽  
Cancer Treatments ◽  
Functional Changes ◽  
Systemic Treatments ◽  
Wide Range ◽  
Patient Reported

Background: Maintaining functional status is important to older adults with cancer, but data are limited on how systemic treatments affect functional status. We systematically reviewed changes in functional status during systemic cancer treatments and identified characteristics associated with functional decline and improvement. Methods: We searched PubMed, Embase, Web of Science, and Cochrane Register of Controlled Trials for articles examining characteristics associated with functional changes in older adults during systemic cancer treatment published in English between database inception and January 11, 2019 (PROSPERO CRD42019123125). Findings were summarized with descriptive statistics. Study characteristics between older adult–specific and non–older adult–specific studies were compared using the Fisher exact test. Results: We screened 15,244 titles/abstracts and 519 full texts. The final analysis included 44 studies, which enrolled >8,400 patients; 39% of studies focused on older adults (1 study enrolled adults aged ≥60 years, 10 enrolled adults aged ≥65 years, and 6 enrolled adults aged ≥70 years). Almost all studies (98%) used patient-reported outcomes to measure functional status; only 20% used physical performance tests. Reporting of functional change was heterogeneous, with 48% reporting change scores. Older adult–specific studies were more likely to analyze functional change dichotomously (29% vs 4%; P=.008). Functional decline ranged widely, from 6% to 90%. The most common patient characteristics associated with functional decline were older age (n=7 studies), worse performance status (n=4), progressive disease status (n=4), pain (n=4), anemia (n=4), and worse nutritional status (n=4). Twelve studies examined functional improvement and identified 11 unique associated characteristics. Conclusions: Functional decline is increasingly recognized as an important outcome in older adults with cancer, but definitions and analyses are heterogeneous, leading to a wide range of prevalence. To identify patients at highest risk of functional decline during systemic cancer treatments, trials need to routinely analyze functional outcomes and measure characteristics associated with decline (eg, nutrition).

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