scholarly journals Hypertension management: experiences, wishes and concerns among older people—a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030742 ◽  
Author(s):  
Emma van Bussel ◽  
Leony Reurich ◽  
Jeannette Pols ◽  
Edo Richard ◽  
Eric Moll van Charante ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Community Dwelling ◽  
Hypertension Management ◽  
Anticipated Regret ◽  
Qualitative Interview Study ◽  
Data Saturation ◽  
Explicit Consideration ◽  
Perceived Involvement ◽  
The Right

ObjectivesSixty-five per cent of older people have hypertension, but little is known about their preferences and concerns regarding hypertension management. Guidelines on hypertension lack consensus on how to treat older people without previous cardiovascular disease (CVD). This asks for explicit consideration of patient preferences in decision making. Therefore, the aim of this study was to explore older peoples’ experiences, preferences, concerns and perceived involvement regarding hypertension management.DesignQualitative interview study.SettingParticipants were selected from 11 general practitioner (GP) practices in the Netherlands and purposively sampled until data saturation was achieved. Semistructured interviews were conducted, audio recorded and analysed by two researchers using thematic analysis.ParticipantsFifteen community dwelling older people aged 74–93 years with hypertension and without previous CVD participated.ResultsInterviewees rarely started the conversation about hypertension management with their GP, although they did have concerns. Reasons for not discussing the subject included low priority of hypertension concerns, reliance on GPs or trust in GPs to make the right decision on their behalf. Also, interviewees anticipated regret of reducing medication, fearing vascular incidents. Interviewees would like to discuss tailoring treatment to their needs, deprescription of medication and ways to reduce side effects. They expected GPs to be more transparent on treatment effects.ConclusionOlder people describe having little involvement in hypertension management, although they have several concerns. Since GPs are also known to be hesitant to bring up this subject, we signal a conspiracy of silence about antihypertensive medication. Through breaking this silence, GPs can facilitate shared decision-making on hypertension management and better tailored care.

scholarly journals Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context

2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Saranda Bajraktari ◽  
Marlene Sandlund ◽  
Magnus Zingmark
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Older People ◽  
Nordic Countries ◽  
Community Dwelling ◽  
Preventive Interventions ◽  
Positive Effects ◽  
Scoping Reviews ◽  
Health Promoting ◽  
Community Dwelling Older People

Abstract Background Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries. Methods This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O′Malley’s framework, and the Medical Research Council’s (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus. Results Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors. Conclusions All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are ‘Senior meetings’, ‘preventive home visits’ and ‘exercise interventions’ on its own or combined with other components.

Older people's views about ageing well in a rural community

2020 ◽  
pp. 1-18
Author(s):  
Stephen Neville ◽  
Sara Napier ◽  
Jeffery Adams ◽  
Kay Shannon ◽  
Valerie Wright-St Clair
Keyword(s):  
Older People ◽  
Rural Community ◽  
Qualitative Data ◽  
Age Groups ◽  
Community Dwelling ◽  
Policy Makers ◽  
Social Wellbeing ◽  
Wide Range ◽  
Community Dwelling Older People ◽  
The Right

Abstract Maintaining physical, psychological and social wellbeing is integral to older adults being able to age well in their community. Therefore, an environment that facilitates and supports ageing well is imperative. The aim of this study was to explore the views of older people about their preparation for ageing well in a rural community. Forty-nine community-dwelling older people aged between 65 and 93 years participated in a semi-structured and digitally recorded interview. The resulting qualitative data were analysed using a thematic approach. Three main themes were identified: (a) ‘sensible planning: the right place and the right people’; (b) ‘remaining independent: “it's up to me”’; and (c) ‘facing challenges: “accepting my lot”’. Findings from this study identify that across all age groups, these older people were actively and realistically preparing for ageing well. All valued their independence, believing individually they were responsible for being independent and planning for their future. Consequently, environmental planners, policy makers and practitioners need to understand that older people are a heterogeneous group and ageing policies should be geared towards older people's individual abilities and circumstances. Consideration of diversity enables inclusion of older people with a wide range of abilities and needs to achieve the perceived goals of ageing well.

scholarly journals Getting the right fit: Convergence between preferred and perceived involvement in treatment decision making among medical oncology outpatients

2018 ◽  
Vol 2 (1) ◽  
pp. e101 ◽  
Author(s):  
Elise Mansfield ◽  
Jamie Bryant ◽  
Mariko Carey ◽  
Heidi Turon ◽  
Frans Henskens ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Oncology ◽  
Treatment Decision ◽  
Treatment Decision Making ◽  
Perceived Involvement ◽  
The Right

scholarly journals Urgent assessment and ongoing care for infection in community-dwelling older people: a qualitative study of patient experience

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043541
Author(s):  
Abigail Moore ◽  
Sara McKelvie ◽  
Margaret Glogowska ◽  
Daniel S Lasserson ◽  
Gail Hayward
Keyword(s):  
Older People ◽  
Ambulatory Care ◽  
Community Dwelling ◽  
Severe Illness ◽  
Hospital Acquired Infection ◽  
Qualitative Interview Study ◽  
Semistructured Interviews ◽  
Community Dwelling Older People ◽  
Hospital Acquired ◽  
Diagnosis Of Infection

ObjectivesTo explore the experience of infection from the perspective of community-dwelling older people, including access and preferences for place of care.DesignQualitative interview study, carried out between March 2017 and August 2018.SettingAmbulatory care units in Oxfordshire, UK.ParticipantsAdults >70 years with a clinical diagnosis of infection.MethodsSemistructured interviews based on a flexible topic guide. Participants were given the option to be interviewed with their caregiver. Thematic analysis was facilitated by NVivo V.11.ResultsParticipants described encountering several barriers when accessing an urgent healthcare assessment which were hard to negotiate when they felt unwell. They valued home comforts and independence if they received care for their infection at home, though were worried about burdening their family. Most talked about hospital admission being a necessity in the context of more severe illness. Perceived advantages included monitoring, availability of treatments and investigations. However, some recognised that admission put them at risk of a hospital-acquired infection. Ambulatory care was felt to be convenient if local, but daily transport was challenging.ConclusionsProviders may need to think about protocols and targeted advice that could improve access for older people to urgent healthcare when they feel unwell. General practitioners making decisions about place of care may need to better communicate risks associated with the available options and think about balancing convenience with facilities for care.

scholarly journals 55 The Case for A Best-Interest Meeting Decision Toolkit to Guide Preferred Place of Care and Interventions For Community Dwelling Older People Who Lack Mental Capacity

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
A Dar ◽  
R Wiltshire ◽  
P N Wright
Keyword(s):  
Decision Making ◽  
Older People ◽  
Hospital Setting ◽  
Community Services ◽  
Community Dwelling ◽  
Best Interest ◽  
Care Plans ◽  
Health And Social Care ◽  
Community Dwelling Older People ◽  
Patients Wishes

Abstract Introduction The Hammersmith and Fulham Community Independence Service (CIS), runs a “virtual ward” to allow people to remain independent in their own homes where possible. Place-of-care decisions made for community-dwelling older people who lack capacity are formulated in a best-interest meeting (BIM), involving health and social care professionals, family and carers. Often BIMs centre around beliefs and wishes of the patient or family but fail to objectively evaluate risks and mitigants of staying at home versus placement. We observed that BIMs were not being held on a consistent basis, and when held lacked the necessary structure for an effective decision-making forum. Even experienced professionals find it difficult to chair BIMs because of the complexity of the decision-making process. Not all involved parties may be represented. We found BIMs more likely to be held, attended and effective when structured to identify the major relevant considerations. Method The CIS “virtual ward” team developed a BIM decision toolkit, comprising: a check-list of risks and mitigants for home versus care home; a list of required attendees; who should document and chair the meeting; and who should action the interventions raised. From 6th January to 25th October 2019, BIMs were held for 48 patients on the CIS “virtual ward”. Results 234 interventions were carried out following toolkit-led BIMs. 1 month after BIM, 34 of 44 patients’ wishes (77%) were honoured (3 not recorded, 1 died). 3 months after BIM, 23 of 31 patients’ wishes (74%) were honoured (15 not recorded, 2 died). Case studies are included in the presentation. Conclusion We developed a toolkit to support decision-making for older community dwellers who lack capacity regarding their place of care. The toolkit assures standardisation and structure to minimise bias, whilst recognising personal beliefs and preferences. It enables any member of the multidisciplinary team to hold and lead a BIM, to reliably identify appropriate interventions and care plans which may not otherwise have been implemented or recognised. The majority of the patients reviewed using the BIM toolkit remained in their preferred place of care well after the team’s interventions. Further evaluation is required to compare CIS BIM toolkit-based outcomes against other community services which do not use this toolkit, and appraise the toolkit in a hospital setting.

Awareness and Decision Making in Professional Ethics

2000 ◽  
Vol 5 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Ronny Swain
Keyword(s):  
Decision Making ◽  
Professional Ethics ◽  
Ethical Decision Making ◽  
Code Of Ethics ◽  
Professional Autonomy ◽  
Ethical Awareness ◽  
Ethical Decisions ◽  
The Right ◽  
Aid Decision

The paper describes the development of the 1998 revision of the Psychological Society of Ireland's Code of Professional Ethics. The Code incorporates the European Meta-Code of Ethics and an ethical decision-making procedure borrowed from the Canadian Psychological Association. An example using the procedure is presented. To aid decision making, a classification of different kinds of stakeholder (i.e., interested party) affected by ethical decisions is offered. The author contends (1) that psychologists should assert the right, which is an important aspect of professional autonomy, to make discretionary judgments, (2) that to be justified in doing so they need to educate themselves in sound and deliberative judgment, and (3) that the process is facilitated by a code such as the Irish one, which emphasizes ethical awareness and decision making. The need for awareness and judgment is underlined by the variability in the ethical codes of different organizations and different European states: in such a context, codes should be used as broad yardsticks, rather than precise templates.

Would you Make the Right Decision? – Decision Making Biases in Economy - Related Dilemmas

2018 ◽  
Vol 9 (1) ◽  
pp. 59-66
Author(s):  
Zsuzsanna Gödör ◽  
Georgina Szabó
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Framing Effect ◽  
Economic Knowledge ◽  
Bank Account ◽  
Financial Decisions ◽  
Hungarian Population ◽  
The Moment ◽  
The Right ◽  
Decision Making Biases

Abstract As they say, money can’t buy happiness. However, the lack of it can make people’s lives much harder. From the moment we open our first bank account, we have to make lots of financial decisions in our life. Should I save some money or should I spend it? Is it a good idea to ask for a loan? How to invest my money? When we make such decisions, unfortunately we sometimes make mistakes, too. In this study, we selected seven common decision making biases - anchoring and adjustment, overconfidence, high optimism, the law of small numbers, framing effect, disposition effect and gambler’s fallacy – and tested them on the Hungarian population via an online survey. In the focus of our study was the question whether the presence of economic knowledge helps people make better decisions? The decision making biases found in literature mostly appeared in the sample as well. It proves that people do apply them when making decisions and in certain cases this could result in serious and costly errors. That’s why it would be absolutely important for people to learn about them, thus increasing their awareness and attention when making decisions. Furthermore, in our research we did find some connection between decisions and the knowledge of economics, people with some knowledge of economics opted for the better solution in bigger proportion

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