Approaches to Addressing Nonmedical Services and Care Coordination Needs for Older Adults

2021 ◽  
pp. 016402752110339
Author(s):  
Jerel M. Ezell ◽  
Samiha Hamdi ◽  
Natasha Borrero
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Care Coordination ◽  
Care Home ◽  
Professional Communication ◽  
Medical Services ◽  
Structured Interviews ◽  
Age In Place ◽  
Services Delivery ◽  
Complex Coordination

Objective: Non-medical services care coordination for daily activities of living is crucial in improving older adults’ health and enabling them to age in place, but little is known about specific practices and barriers in this space. Methods: Semi-structured interviews were conducted with 41 professionals serving older adults in greater Chicago, Illinois—which consists of diverse urban, suburban, and semi-rural communities—to contextualize non-medical services needs and care coordination processes. Results: In-home care, home-delivered meals, non-emergency transportation, and housing support were cited as the most commonly needed services, all requiring complex coordination support. Respondents noted a reliance on inefficient phone/fax usage for referral-making and cited major challenges in inter-professional communication, service funding/reimbursement, and HIPAA. Conclusions: Non-medical services delivery for older adults is severely impacted by general siloing throughout the care continuum. Interventions are needed to enhance communication pathways and improve the salience and interdisciplinarity of non-medical services coordination for this population.

scholarly journals Interventions to Reduce Stigma of Dementia: First Insights From a Rural Community-Based Participatory Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 879-879
Author(s):  
Juanita Bacsu ◽  
Shanthi Johnson ◽  
Megan O’Connell ◽  
Marc Viger
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Support Groups ◽  
Structured Interviews ◽  
Contributing Factors ◽  
Community Based ◽  
People With Dementia ◽  
Related Stigma ◽  
Asking Questions

Abstract Age is the greatest risk factor for dementia, and the number of rural older adults is rising. Although dementia-related stigma is widely documented, few studies focus on ways to reduce stigma, especially within rural communities. This late breaker presentation aims to: 1) explore the contributing factors of dementia-related stigma in rural communities; and 2) identify interventions to reduce stigma of dementia in rural communities. Drawing on a community-based participatory approach, data were collected through semi-structured interviews with 18 older adults, and a focus group with 7 community leaders in rural Saskatchewan, Canada. Thematic analysis was used to identify key themes and patterns within the data. Contributing factors of dementia-related stigma ranged from fear to lack of dementia knowledge. Several anti-stigma interventions were identified including: forming support groups; hosting educational workshops; inviting guest speakers with dementia; talking openly about dementia; learning more about dementia; asking questions; sharing your lived-experiences; being inclusive; developing inter-generational programs; and avoiding assumptions and hurtful jokes. As the rural population ages, there is a growing need for interventions, programs, and policies to address stigma of dementia. Engaging in rural partnerships and collaborative research is essential to developing community-informed strategies to reduce dementia-related stigma and improve the quality of life for people with dementia.

scholarly journals Challenges and Supports to Aging in Place in a Gentrifying Context

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 873-873
Author(s):  
Manish Kumar ◽  
Laura Richman
Keyword(s):  
Older Adults ◽  
Social Capital ◽  
Affordable Housing ◽  
Low Income ◽  
Healthy Aging ◽  
Aging In Place ◽  
Well Being ◽  
Neighborhood Change ◽  
Structured Interviews ◽  
Age In Place

Abstract Neighborhoods play a central role in healthy aging, with changes to neighborhoods having a profound impact on older adults’ ability to age in place. Using gentrification as an indicator of neighborhood change and applying the theoretical framework of the Environmental Press model (Lawton and Nahemow, 1973), this study examined the relationship between changing environments, affordable housing, and environmental attributes that support and hinder the health and well-being of older adults. A qualitative, case-study approach was used to interview low-income, majority Black older adults in a gentrifying area of Washington DC. 32 individuals (16 in non-profit and 16 in for-profit affordable housing) aged 55 and older participated in semi-structured interviews on perceptions of gentrification, neighborhood change, and challenges and supports to aging in place. Transcripts were then analyzed using the framework method of analysis. Although participants generally reported that gentrification improved their neighborhood’s built environment, many attributed it to a decline in social capital. Affordable housing provided an ability to age in place, though participants expressed uncertainty over their long-term ability to age in the context of continuing change. These findings suggest that while the physical changes accompanying gentrification may support older adults’ ability to age in place, its detrimental impact on social capital further increases their risk for social isolation. While affordable housing may enable older adults to age in place, fostering a greater sense of permanence and well-being will require additional policies that both increase accessibility to the physical amenities provided by gentrification and preserve older adults’ social capital.

scholarly journals PLANNING FOR AGING IN PLACE IN RURAL AREAS: PERCEPTIONS AND NEEDS OF OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S252-S252
Author(s):  
Raven H Weaver ◽  
Cory Bolkan
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Rural Areas ◽  
Chronic Conditions ◽  
Family Care ◽  
Computer Assisted ◽  
Service Access ◽  
Community Resources ◽  
Care Needs ◽  
Age In Place

Abstract Most individuals prefer to live independently in their homes, but will need support to age-in-place safely. Rural-dwelling individuals historically have worse health, limited income, and restricted access to adequate services/supports compared to their urban counterparts. Community-based aging services organizations (i.e., Area Agency on Aging; AAA) offer in-home health, social support, and information/referral to community resources that support older adults in both urban and rural communities. A representative sample of adults aged 60+ (N=253, mean age=74) were surveyed via computer-assisted-telephone interviews about their health status, needs, and service utilization. Over half (54%) lived in rural counties, which was significantly associated with receiving insufficient health care services (X2=9.227, p=.002). Insufficient service access was also associated with experiencing a fall (X2=7.315, p=.007). While 53% reported having chronic conditions, most individuals still reported good health and their top reported needs included: yard work, interior/exterior house repairs, and housework. Content analysis of open-ended survey responses regarding future care needs revealed participants anticipate help from family/friends or neighbors; reliance on physicians for referrals; and expect insurance to cover their needs. Participants had varying awareness levels of available community resources and identified concerns about adequacy of services (e.g., mental health; transportation) and health insurance barriers (e.g., reimbursement; vision/dental coverage). Preparing for future needs and anticipating changing functional capacity is critical, especially among rural-dwelling older adults with chronic conditions. To improve ability for adults with diverse needs to age-in-place, preventive services/supports that span the continuum of care needs and that complement informal family care are necessary.

scholarly journals LGBT OLDER ADULTS AND THEIR PETS IN SOUTHERN APPALACHIA: RESULTS OF QUALITATIVE RESEARCH AND FUTURE RESEARCH DIRECTIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S201-S201
Author(s):  
Maureen MacNamara
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Service Providers ◽  
Future Research ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Social Service Delivery ◽  
Service Delivery Systems ◽  
Future Research Directions ◽  
Rural Appalachia

Abstract This session reports on older LGBT adults’ perspectives of roles that pets played in relation to older adults’ aging-in-place experiences. The goal of this study is to advance understanding of the role of pets in the lives of older LGBT adults living in rural communities. The qualitative study used individual, semi-structured interviews with 11 older adults residing in rural Appalachia. Individuals were recruited using purposive sampling techniques, including recruitment through LGBT friendly service providers, a lesbian listserv, and snowball sampling. The majority of respondents reported that pets played a role in social support and some in social capital. One respondent described a utilitarian relationship with animals that is important to understanding the roles animals may play in rural communities in terms of "belongingness". After reviewing study findings, we will provide recommendations for including information about pets in formal social service delivery systems and conclude with implications for future research.

scholarly journals A novel blended placement model improves dietitian students’ work-readiness and wellbeing and has a positive impact on rural communities: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Narelle T Greenlees ◽  
Sabrina W. Pit ◽  
Lynda J Ross ◽  
Jo J McCormack ◽  
Lana J Mitchell ◽  
...  
Keyword(s):  
Rural Communities ◽  
Focus Groups ◽  
Local Community ◽  
Positive Impact ◽  
Student Experience ◽  
Work Readiness ◽  
Structured Interviews ◽  
Services Delivery ◽  
Workforce Shortages ◽  
Readiness Skills

Abstract Background Clinical placement models that require students to relocate frequently can cause stress, which may impact the student experience and development of work-readiness skills. A blended placement, where placements are undertaken concurrently at one location has potential to address these issues by providing a positive placement experience. Blended long-stay placements undertaken in rural communities increase consistent service provision and may help encourage students to work rurally, with potential to reduce workforce shortages. The aim of this study was to pilot test the feasibility of blended placement models and explore the student experience and skills development. A secondary aim was to explore a fully blended long-stay rural placement and the benefits to the rural community. Methods An exploratory qualitative design was used. Focus groups were conducted with dietitian student who participated in usual placements (n = 14) or blended placements (n = 9). Individual semi-structured interviews were conducted with five student supervisors who participated in blended placements. Focus groups and interviews were recorded, transcribed verbatim and analysed together using inductive thematic analyses. Results The overarching theme across all blended model placements was ‘enhanced work-readiness’, including increased flexibility, organisational skills and better preparedness for mixed roles. Enhanced work-readiness was influenced by three themes: stress and wellbeing impacts learning, working in two areas of practice concurrently allows for deeper learning, and blended placements meet supervisor needs. Fully blended long-stay rural placements revealed additional benefits. Firstly, in relation to the overarching theme ‘enhanced work-readiness’: students on these placements also developed extra skills in innovation, social accountability, interprofessional collaboration, conflict resolution and teamwork. Secondly, a new overarching theme emerged for fully blended long-stay rural placements: ‘increased community connections’ which included additional health services delivery, deeper personal experience and more rewarding student-supervisor relationships. Thirdly, two extra themes emerged that influenced work-readiness and community impact: ‘local organisational support and resources’ and ‘enhanced innovative and interprofessional learning opportunities’. Conclusions Blended placements enhance work-readiness skills by providing an alternative model to that commonly applied, and providing flexibility in education programs. Additionally, fully blended long-stay rural placements positively influence the local community through impacting the student experience as well as providing more dietetics services and may therefore assist in reducing dietetics workforce shortages and health inequity.

scholarly journals Challenges Faced by Older Adults With Cognitive Impairment and Their Caregivers in a Care Home

2019 ◽  
Vol 6 (1) ◽  
pp. 33
Author(s):  
Yaw Frimpong ◽  
Dai Baozhen ◽  
Bernard Sarpong
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Social Inclusion ◽  
Care Home ◽  
Future Research ◽  
Extreme Pressure ◽  
Structured Interviews ◽  
Financial Difficulties ◽  
Long Time ◽  
Institutional Abuse

This study examined the challenges faced by older adults with cognitive impairment and their caregivers in Kumasi Cheshire Home (Ghana). In-depth semi-structured interviews were conducted with 50 older adults with cognitive impairment and 9 professionals (caregivers). The findings of the study indicated that older adults in care homes are likely to face social inclusion difficulties, and institutional abuse in the form of being forced to eat or go to bed at a particular time, and medication difficulties since it takes quite a long time for the drugs to arrive in the care home. It also found out that the challenges professionals (caregivers) face include: financial difficulties, extreme pressure at work, among others. Lastly, it was again revealed that caregivers in the care home used spirituality as a coping strategy. Recommendations were made to assist in future research in the area and provide a strategic plan to improve the condition of adult healthcare for individuals with cognitive impairment

Urinary tract infections (UTIs); a leaflet for older adults, and carers: the development of a UTI leaflet for older adults and their carers

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696833 ◽  
Author(s):  
Leah Ffion Jones ◽  
Emily Cooper ◽  
Cliodna McNulty
Keyword(s):  
Older Adults ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Care Home ◽  
Asymptomatic Bacteriuria ◽  
Theoretical Domains Framework ◽  
Antibiotic Use ◽  
Primary Care Providers ◽  
Care Providers ◽  
Tract Infections

BackgroundEscherichia coli bacteraemia rates are rising with highest rates in older adults. Mandatory surveillance identifies previous Urinary Tract Infections (UTI) and catheterisation as risk factors.AimTo help control bacteraemias in older frail patients by developing a patient leaflet around the prevention and self-care of UTIs informed by the Theoretical Domains Framework.MethodFocus groups or interviews were held with care home staff, residents and relatives, GP staff and an out of hours service, public panels and stakeholders. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults. The leaflet was modified iteratively. Discussions were transcribed and analysed using Nvivo.ResultsCarers of older adults reported their important role in identifying when older adults might have a UTI, as they usually flag symptoms to nurses or primary care providers. Information on UTIs needs to be presented so residents can follow; larger text and coloured sections were suggested. Carers were optimistic that the leaflet could impact on the way UTIs are managed. Older adults and relatives liked that it provided new information to them. Staff welcomed that diagnostic guidance for UTIs was being developed in parallel; promoting consistent messages. Participants welcomed and helped to word sections on describing asymptomatic bacteriuria simply, preventing UTIs, causes of confusion and when to contact a doctor or nurseConclusionA final UTI leaflet for older adults has been developed informed by the TDF. See the TARGET website www.RCGP.org.uk/targetantibiotics/

scholarly journals 346 How Do we Increase Adherence to Home Exercise Programmes? Interviews with Older Adults and Physiotherapists

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Siti Khalijah ◽  
Suzanne Timmons
Keyword(s):  
Older Adults ◽  
Cardiovascular Health ◽  
Home Exercise ◽  
Video Content ◽  
Structured Interviews ◽  
Timed Up And Go ◽  
Convenience Sample ◽  
Improve Compliance ◽  
Exercise Programmes ◽  
Purposive Sample

Abstract Background Regular exercise and physical activity can maintain function and cardiovascular health, and prevent cognitive decline, in older adults. However, studies show that there is often poor adherence to home exercise programmes (HEP). The purpose of this study was to explore how HEP are perceived by both older adults and physiotherapists. Methods A convenience sample of 28 older adults attending outpatient physiotherapy clinics were given an exercise journal to record their adherence to the HEP prescribed by their physiotherapists for six weeks. Subsequently, semi-structured interviews were conducted with a purposive sample, and the corresponding prescribing physiotherapists, to achieve maximal variation in terms of HEP adherence, age and sex. The interviews were audio recorded, transcribed, and simple content analysis performed. Results Fourteen participants returned their exercise journal. Median age was 80; half were female; median Berg Balance Score and Timed-up-and-Go-Test were 49 and 16 seconds respectively. Participants exercised a median 79.8% of the prescribed dose, or 5.6 days per week. Seven older adults were interviewed; about half had a positive attitude towards exercise. They were also moderately positive about their HEP (comments ranged from “doable” and “nothing bad about it” to “enjoyable”). Barriers included time, mood, boredom, remembering to do the HEP, and variable health status. Enablers included simple instructions and design, family encouragement, and sense of achievement. Physiotherapists (n=5) perceived that many older adults aren’t compliant with HEPs, but there was some therapeutic nihilism (“you can’t force them”). Their HEP instructions varied from verbal to written instructions/diagrams; one physiotherapist used individualised video content. Notably, participants with good adherence understood their HEP well in terms of content and purpose, although this may be cause or effect. Conclusion To improve compliance with HEP, healthcare professionals need to take time to motivate the recipient, simplify their instructions, and trouble-shoot potential barriers at the time of prescription.

scholarly journals Sex disparities in cardiovascular health metrics among rural-dwelling older adults in China: a population-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaolei Han ◽  
Ziying Jiang ◽  
Yuanjing Li ◽  
Yongxiang Wang ◽  
Yajun Liang ◽  
...  
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Cardiovascular Health ◽  
Rural China ◽  
Descriptive Analysis ◽  
Population Based ◽  
Baseline Survey ◽  
Chinese Older Adults ◽  
Face To Face ◽  
Sex Disparities

Abstract Background Cardiovascular health (CVH) metrics among Chinese older adults are poorly understood. We investigated sex disparities in CVH metrics and their management among rural-dwelling older adults in China. Methods This community-based study included 5026 participants (age ≥ 65 years; 57.2% women) in the baseline survey of a multimodal intervention study in rural China. In March–September 2018, data were collected through face-to-face interviews, clinical examinations, and laboratory tests. We defined six CVH metrics (three behavioral factors—smoking, body mass index, and physical activity; three biological factors—blood pressure, total cholesterol, and blood glucose) following the modified American Heart Association’s recommendations. We performed descriptive analysis separately for men and women. Results Of all participants, only 0.8% achieved ideal levels in all six CVH metrics. Men were more likely than women to have ideal levels in all CVH metrics but smoking. Women had higher prevalence of ideal global (9.7% vs. 7.8%) and behavioral (18.3% vs. 9.5%) CVH metrics (p < 0.001), whereas men had higher prevalence of ideal biological CVH metrics (5.4% vs. 3.5%, p < 0.001). The prevalence of ideal global and behavioral CVH metrics increased with age in both women and men (p for trend< 0.001). Women were more likely to be aware of their hypertension and diabetes, and to receive antihypertensive treatment, while men were more likely to achieve the goal of high cholesterol treatment (p < 0.05). Conclusions The CVH metrics among older adults living in the rural communities in China are characterized by an extremely low proportion of optimal global CVH metrics and distinct sex differences, alongside poor management of major biological risk factors. Trial registration ChiCTR1800017758 (Aug 13, 2018).

Review of "Rhetorical work in emergency medical services: Communicating in the unpredictable workplace by Elizabeth Angeli," Angeli, E. L. (2019). Rhetorical work in emergency medical services: communicating in the unpredictable workplace. Routledge

2021 ◽  
Vol 9 (1) ◽  
pp. 39-41
Author(s):  
Elizabeth E. Weems
Keyword(s):  
Emergency Medical Services ◽  
Rhetorical Analysis ◽  
First Responders ◽  
Professional Communication ◽  
Medical Services ◽  
Emergency Medical

In Rhetorical Work in Emergency Medical Services: Communicating in the Unpredictable Workplace (2019), Elizabeth L. Angeli explores the unpredictable workplaces which are the locations of emergency medical services provided by first responders, the EMS personnel who receive 911 calls but may have little idea about what to expect once they arrive at the site of the emergency. While rhetoric of health medicine (RHM) is not a new area of rhetoric, Angeli found little research about EMS professional rhetoric, leaving a void in understanding the modes of communication in these ever-changing, life-altering workplaces. Her text began as part of her dissertation project but morphed into a rhetorical analysis/EMS rhetorical training pedagogy for Technical Professional Communication (TPC) and RHM as well as EMS trainers and trainees.

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