scholarly journals Exploring Existential Loneliness Among Frail Older People as a Basis for an Intervention: Protocol for the Development Phase of the LONE Study (Preprint)

2019 ◽  
Author(s):  
Anna-Karin Edberg ◽  
Ingrid Bolmsjö
Keyword(s):  
Older People ◽  
Health Care Professionals ◽  
Large Body ◽  
Complex Interventions ◽  
Significant Others ◽  
Evidence Base ◽  
Development Phase ◽  
Frail Older People ◽  
Existential Loneliness ◽  
Intervention Protocol

BACKGROUND International research concerning end-of-life issues emphasizes the importance of health care professionals (HCPs) being prepared to deal with existential aspects, like loneliness, in order to provide adequate care. The last phase of life is often related to losses of different kinds, which might trigger feelings of isolation in general and existential loneliness (EL) in particular. There is a large body of research concerning loneliness among older people in general, but little is known about the phenomenon and concept of EL in old age. OBJECTIVE This study aims to describe the framing, design, and first results of the exploratory phase of an intervention study focusing on EL among older people: the LONE study. This stage of the study corresponds to the development phase, according to the Medical Research Council framework for designing complex interventions. METHODS The LONE study contains both theoretical and empirical studies concerning: (1) identifying the evidence base; (2) identifying and developing theory through individual and focus group interviews with frail older people, significant others, and HCPs; and (3) modeling process and outcomes for the intervention. This project involves sensitive issues that must be carefully reviewed. The topic in itself concerns a sensitive matter and the study group is vulnerable, therefore, an ethical consciousness will be applied throughout the project. RESULTS The results so far show that EL means being disconnected from life and implies a feeling of being fundamentally separated from others and the world, whether or not one has family, friends, or other close acquaintances. Although significant others highlighted things such as lack of activities, not participating in a social environment, and giving up on life as aspects of EL, the older people themselves highlighted a sense of meaningless waiting, a longing for a deeper connectedness, and restricted freedom as their origins of EL. The views of HCPs on the origin of EL, the place of care, and their own role differed between contexts. CONCLUSIONS The studies focusing on identifying the evidence base and developing theory are published. These results will now be used to identify potential intervention components, barriers, and enablers for the implementation of an intervention aimed at supporting HCPs in encountering EL among older people. INTERNATIONAL REGISTERED REPOR RR1-10.2196/13607

scholarly journals Exploring Existential Loneliness Among Frail Older People as a Basis for an Intervention: Protocol for the Development Phase of the LONE Study

10.2196/13607 ◽  
2019 ◽  
Vol 8 (8) ◽  
pp. e13607 ◽  
Author(s):  
Anna-Karin Edberg ◽  
Ingrid Bolmsjö
Keyword(s):  
Older People ◽  
Health Care Professionals ◽  
Large Body ◽  
Complex Interventions ◽  
Significant Others ◽  
Evidence Base ◽  
Development Phase ◽  
Frail Older People ◽  
Existential Loneliness ◽  
Intervention Protocol

Background International research concerning end-of-life issues emphasizes the importance of health care professionals (HCPs) being prepared to deal with existential aspects, like loneliness, in order to provide adequate care. The last phase of life is often related to losses of different kinds, which might trigger feelings of isolation in general and existential loneliness (EL) in particular. There is a large body of research concerning loneliness among older people in general, but little is known about the phenomenon and concept of EL in old age. Objective This study aims to describe the framing, design, and first results of the exploratory phase of an intervention study focusing on EL among older people: the LONE study. This stage of the study corresponds to the development phase, according to the Medical Research Council framework for designing complex interventions. Methods The LONE study contains both theoretical and empirical studies concerning: (1) identifying the evidence base; (2) identifying and developing theory through individual and focus group interviews with frail older people, significant others, and HCPs; and (3) modeling process and outcomes for the intervention. This project involves sensitive issues that must be carefully reviewed. The topic in itself concerns a sensitive matter and the study group is vulnerable, therefore, an ethical consciousness will be applied throughout the project. Results The results so far show that EL means being disconnected from life and implies a feeling of being fundamentally separated from others and the world, whether or not one has family, friends, or other close acquaintances. Although significant others highlighted things such as lack of activities, not participating in a social environment, and giving up on life as aspects of EL, the older people themselves highlighted a sense of meaningless waiting, a longing for a deeper connectedness, and restricted freedom as their origins of EL. The views of HCPs on the origin of EL, the place of care, and their own role differed between contexts. Conclusions The studies focusing on identifying the evidence base and developing theory are published. These results will now be used to identify potential intervention components, barriers, and enablers for the implementation of an intervention aimed at supporting HCPs in encountering EL among older people. International Registered Report Identifier (IRRID) RR1-10.2196/13607

scholarly journals Contrasts in older persons’ experiences and significant others’ perceptions of existential loneliness

2018 ◽  
Vol 26 (6) ◽  
pp. 1623-1637 ◽  
Author(s):  
Helena Larsson ◽  
Anna-Karin Edberg ◽  
Ingrid Bolmsjö ◽  
Margareta Rämgård
Keyword(s):  
Health Care ◽  
Older People ◽  
Health Care Professionals ◽  
Older Persons ◽  
Significant Others ◽  
Care Staff ◽  
Health Care Staff ◽  
Older Person ◽  
Existential Loneliness ◽  
Frail Older Persons

Background: As frail older people might have difficulties in expressing themselves, their needs are often interpreted by others, for example, by significant others, whose information health care staff often have to rely on. This, in turn, can put health care staff in ethically difficult situations, where they have to choose between alternative courses of action. One aspect that might be especially difficult to express is that of existential loneliness. We have only sparse knowledge about whether, and in what way, the views of frail older persons and their significant others concerning existential loneliness are in concordance. Objective: To contrast frail older (>75) persons’ experiences with their significant others’ perceptions of existential loneliness. Methods: A case study design was chosen for this study. Individual interviews with frail older persons (n = 15) and interviews with their significant others (n = 19), as well as field notes, served as a basis for the study. A thematic analysis was used to interpret data. Ethical considerations: This study was conducted in accordance with the principles of research ethics. Findings: The findings showed three themes: (1) Meaningless waiting in contrast to lack of activities, (2) Longing for a deeper connectedness in contrast to not participating in a social environment and (3) Restricted freedom in contrast to given up on life. Discussion: Knowledge about the tensions between older persons’ and their significant others’ views of existential loneliness could be of use as a basis for ethical reflections on the care of older people and in the encounter with their significant others. Conclusion: It is of importance that health care professionals listen to both the frail older person and their significant other(s) and be aware of whose voice that the care given is based on, in order to provide care that is beneficial and not to the detriment of the older person.

69 What Health Outcomes Matter to Frail Older People?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i21-i21
Author(s):  
K S Tipping
Keyword(s):  
Health Care ◽  
Focus Group ◽  
Older People ◽  
Health Outcomes ◽  
Health Care Professionals ◽  
Focus Group Interview ◽  
Group Interview ◽  
Health Priorities ◽  
Frail Older People ◽  
Clinical Frailty Scale

Abstract Introduction The purpose of this project was to explore what health outcomes matter to frail older people. This would provide information that would be of use to both providers and payers of health care services to align their priorities in line with these. Frailty is an important and relevant topic in healthcare. In England 5% of people aged 60-69 have frailty. This rises to 65% in people aged over 90. There are 1.8 million people aged over 60 and 0.8 million people aged over 80 living with frailty. (English Longitudinal Study of Ageing (2016)). This number is due to increase. The aims of this research were: To review the literature on health outcomes in older people including frail older people.To conduct a focus group interview with frail older people to ascertain their views on health outcomes.To disseminate and share the reviews and study findings via presentations and publications. Ethics Ethical approval was granted by the University of Liverpool’s Health and Life Sciences Research Ethics Committee (application number 4163). Methods A systematic review of the literature was undertaken. Thereafter a focus group interview was held with six frail older people. The participants were aged 65 years and over and had mild to moderate frailty using the Clinical Frailty Scale. The interview recording was transcribed, and common themes identified and analysed. Results Eight themes were identified from the focus group: - Trust in medical professionalsVulnerability of being an older person in hospitalPolypharmacy and wastage of medicationDischarge Planning & Co-Ordination of Care at HomeTaking responsibility for your own healthNomenclatureAutonomyFalls Conclusion This study has identified themes that can be utilised to raise awareness among health care professionals on what matters to frail older people. The study findings will hopefully provide an opportunity for meaningful discussions around what is needed to better meet these desired health outcomes. References 1. Akpan A, Roberts C, Bandeen-Roche K, Batty B, Bausewein C, Bell D, et al. Standard set of health outcome measures for older persons. BMC Geriatr 2018;18(1):36. 2. Naik AD, Dindo LN, Van Liew JR, Hundt NE, Vo L, Hernandez-Bigos K, et al. Development of a Clinically Feasible Process for Identifying Individual Health Priorities. Journal of the American Geriatrics Society 2018;66(10):1872–9.

scholarly journals THE EVALUATION OF INTERPROFESSIONAL EDUCATION IN PRIMARY CARE: A SOCIAL NETWORK ANALYSIS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S47-S47
Author(s):  
Linda C Smit ◽  
Jeroen Dikken ◽  
Nienke M Moolenaar ◽  
Marieke J Schuurmans ◽  
Niek J De Wit ◽  
...  
Keyword(s):  
Social Network ◽  
Social Network Analysis ◽  
Network Analysis ◽  
Older People ◽  
Health Care Professionals ◽  
Interprofessional Education ◽  
Social Care ◽  
Care Providers ◽  
Frail Older People ◽  
Health And Social Care

Abstract Effective, safe, person-centred care relies on skilled interprofessional collaboration (IPC) and practice. Little is known about interprofessional education (IPE) to increase IPC in the context of care for frail older people in the community. This study evaluates the effectiveness of IPE on IPC of primary health and social care providers providing care to frail older people in three districts in the Netherlands. A before-after study among 55 health care professionals using social network analysis was performed. The number of contacts increased on average with two contacts. The reciprocity in the districts increased with 15%, 2% and 13%. The diversity of contacts increased between 6% and 10% (p <.001; p .055; p .371). The IPE effectuated a larger, more collaborative, and diverse interprofessional network of health and social care professionals providing care to frail older people suggesting a ripple-effect of networked interventions.

scholarly journals Existentiell ensamhet hos sköra äldre personer: äldre personers upplevelser samt dokumentation i patientjournalen

2020 ◽  
Author(s):  
◽  
Marina Sjöberg
Keyword(s):  
Older People ◽  
Well Being ◽  
The Other ◽  
Central Position ◽  
Frail Older People ◽  
Negative Experience ◽  
Life Study ◽  
Clinical Notes ◽  
Existential Loneliness ◽  
Individual Interviews

The overall aim of this thesis was to illuminate the meanings of existential loneliness(EL) and describe how it was eased, as narrated by frail older people, as well as toexamine existential aspects documented in patient records in specialised palliative care.Two of the constituent studies of this thesis were qualitative with an explorative anddescriptive design (i.e., studies I and II), and two studies were based on a retrospectivepatient record review, of which one was quantitative with an exploratory design (StudyIII) and the other was qualitative with a descriptive design (Study IV). The datacollection for studies I and II was based on individual interviews with frail older people75 or more years old. Studies III and IV were based on a randomly selected sample ofpatient records of frail older people who died in specialised palliative care during 2017.The data were collected using a pilot-tested review template to identify aspects of thedocumentation relating to the aims of the studies.The findings of Study I indicated that EL was a negative experience. Four themeswere identified related to meanings of EL: being trapped in a frail and deterioratingbody, being met with indifference, having nobody to share life with, and lacking purposeand meaning. The first theme was considered an overarching theme due to its closeinterrelatedness with the other three themes. The comprehensive understanding of ELamong frail older people was ‘being disconnected from life’, an experience of at leastmomentary abandonment, being left to one’s fate, and living a meaningless life. Study IIshowed that existential loneliness was eased when being acknowledged by others, beingthe focus of others’ concern, encountering intimacy, and having meaningful exchangesof thoughts and feelings. It was further eased when the participants could bracketnegative thoughts and feelings, that is, when they could adjust and accept the presentsituation, view life in the ‘rear-view mirror’, be in contact with spiritual dimensions, andwithdraw and distract themselves. Existential loneliness could be either in the forefront(i.e., feelings of ill-being) (Study I) or in the background (i.e., feelings of well-being)(Study II). The findings of Study III indicated that performed interventions were the14most common subject of documented clinical notes, mostly related to pharmacologicalinterventions. Pain was the most common documented problem, followed by circulatoryproblems, nutrition problems, and anxiety. Clinical notes concerning wishes and wellbeing-related details were documented, but not frequently. Overall symptom assessmenttools, especially multi-dimensional tools, were used to a small extent. More people whoreceived care in palliative in-patient wards died alone than did people who received carein their own homes. Study IV was based on notes extracted from 84 patient records.The results indicated that documented existential aspects had both negative and positiveconnotations and were related to the patients’ loss of freedom and self-determination,loneliness and community, anxiety and inner peace, and despair and hope. The notesconcerning existential aspects were, however, not recorded in a structured way and nocare plans relating to existential aspects were found.According to the studies, both ill-being and well-being were evident, and the livedbody occupied a central position in all studies. The frail body increased the patients’vulnerability and limited their living space. Meaningful activities and meaningfulcommunity and exchange with others eased the existential loneliness. Existentialloneliness remains invisible to others as long as nobody talks about it, and it remainsinvisible in the documentation as long as it is not documented in a structured way.This thesis demonstrates the importance of making existential loneliness and existentialaspects visible in encounters with frail older people and in the clinical documentation.

scholarly journals 209 Deprescribing in Frail Older People Approaching End-of-Life: Development and Validation of STOPPFrail Version 2

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Denis Curtin ◽  
Paul Gallagher ◽  
Denis O'Mahony
Keyword(s):  
Life Expectancy ◽  
Literature Review ◽  
Older People ◽  
End Of Life ◽  
Geriatric Medicine ◽  
Evidence Base ◽  
Frail Older People ◽  
Delphi Consensus ◽  
Development And Validation ◽  
New Criteria

Abstract Background Older people with advanced frailty are commonly prescribed lengthy, burdensome medication regimens. When life expectancy is likely to be limited, many of the prescribed drugs may be inappropriate. STOPPFrail Criteria were developed in 2016 to assist clinicians with deprescribing decisions in frail older people with limited life expectancy. Due to an expanding evidence base, updating of the criteria was required. Methods A focused literature review was performed to reassess the original criteria and propose new criteria. Eight panelists, with expertise in geriatric medicine, general practice, palliative medicine, psychiatry and clinical pharmacology, reviewed and critiqued a new draft of STOPPFrail criteria. The revised list of criteria was then validated using Delphi consensus methodology. Results The expert panel agreed a final list of 27 criteria after two Delphi validation rounds. STOPPFrail version 2 proposes a method for identifying older people approaching end-of-life and emphasizes shared decision making in the deprescribing process. New criteria relating to the discontinuation of anti-hypertensive medications, anti-thrombotic therapies and vitamin D are included. Conclusion STOPPFrail version 2 has been expanded and updated for the purpose of assisting clinicians with deprescribing decisions in frail older adults approaching end-of-life. The criteria are based on an up-to-date literature review and consensus validation among a panel of experts.

scholarly journals Being disconnected from life: meanings of existential loneliness as narrated by frail older people

2017 ◽  
Vol 22 (10) ◽  
pp. 1357-1364 ◽  
Author(s):  
Marina Sjöberg ◽  
Ingela Beck ◽  
Birgit H Rasmussen ◽  
Anna-Karin Edberg
Keyword(s):  
Older People ◽  
Frail Older People ◽  
Existential Loneliness

scholarly journals Development of a Complex Intervention to Support Parents of Chronically Ill Adolescents in Transition From Pediatrics to Adult Care (ParTNer-STEPs)

2021 ◽  
Author(s):  
Ena Lindhart Thomsen ◽  
Bente Appel Esbensen ◽  
Signe Hanghøj ◽  
Helena Hansson ◽  
Kirsten Arntz Boisen
Keyword(s):  
Health Care Professionals ◽  
Participatory Design ◽  
Complex Interventions ◽  
Chronically Ill ◽  
Evidence Base ◽  
Transition Program ◽  
Successful Implementation ◽  
Adult Care ◽  
Mrc Framework ◽  
The Uk

Abstract Background Transfer from pediatric to adult care for chronically ill adolescents is associated with outpatient non-attendance and low treatment adherence in adolescents, and with anxiety and concerns among parents. Recent studies have shown that parent involvement results in better transitions. The aim of this paper was to describe the development, through participatory design, of a brief transition program targeted to parents of chronically ill adolescents.Methods The study was based on the UK Medical Research Council’s (MRC) framework on developing and testing complex interventions. To increase the program’s feasibility and relevance, participatory design was chosen as the overall method. A collaboration group of parents, adolescents and health care professionals (HCP) were actively involved in the development of the program. The program was developed in three development stages, in accordance with the MRC framework: 1) identifying the evidence base, 2) identifying theory, and 3) modelling process and outcomes. Results Together with the collaboration group, we developed a brief transition program targeting parents, by undertaking an iterative process, involving a literature review, individual interviews, workshops, online brainstorms and multiple pilot tests. The program, called ParTNer-STEPs (Parents in Transition – a Nurse-led Support and Transfer Educational Program) comprised three components: 1) an informative website, 2) online educational events for parents, and 3) transfer consultations with providers from both pediatrics and adult care.Conclusions The MRC framework was successfully applied to develop a brief transition program targeting parents of chronically ill adolescents. By incorporating the principles of participatory design in the development phase, we ensured that both parents’ and adolescents’ needs were represented and addressed in the program. Furthermore, the involvement of HCPs ensured the feasibility and relevance of the intervention in clinical practice and will increase the chances of successful implementation.Trial registration ClinicalTrials.gov ID NCT04969328

scholarly journals Special needs of frail people undergoing emergency laparotomy surgery

2020 ◽  
Vol 49 (4) ◽  
pp. 540-543
Author(s):  
Kathryn McCarthy ◽  
Jonathan Hewitt
Keyword(s):  
Older People ◽  
Population Group ◽  
Evidence Base ◽  
Emergency Laparotomy ◽  
Frail Older People ◽  
Operative Morbidity ◽  
Surgical Teams ◽  
One Year ◽  
The Uk ◽  
National Emergency

Abstract There are now over 30 000 emergency laparotomies under taken in the UK every year, a figure that is increasing year on year. Over half of these people are aged over 70 years old. Frailty is commonly seen in this population and becomes increasingly common with age and is seen in over 50% of elderly emergency laparotomies in people aged over 85 years old. In older people who undergo surgery one third will have died within one year of surgery, a figure which is worse in frail individuals. For those that do survive, post-operative morbidity is worse and 30% of frail older people do not return to their own home. In the UK, the National Emergency Laparotomy Audit (NELA) is leading the way in providing the evidence base in this population group. Beyond collecting data on every Emergency Laparotomy undertaken in the UK, it is also key in driving improvement in care. Their most recent report highlights that only 23% of patients over 70 years received geriatric involvement following surgery. More encouragingly, the degree of multidisciplinary geriatric involvement seems to be increasing. In the research setting, well designed studies focusing on the older frail emergency laparotomy patient are underway. It is anticipated that these studies will better define outcomes following surgery, improving the communication and decision making between patients, relatives, carers and their surgical teams.

scholarly journals Chair-Based Exercises for Frail Older People: A Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Kevin Anthony ◽  
Katie Robinson ◽  
Philippa Logan ◽  
Adam L. Gordon ◽  
Rowan H. Harwood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Evidence Base ◽  
Controlled Trials ◽  
Frail Older People ◽  
Exercise Programmes ◽  
Randomised Controlled ◽  
And Function ◽  
Harmful Effects

Introduction. Frail older people are often unable to undertake high-intensity exercise programmes. Chair-based exercises (CBEs) are used as an alternative, for which health benefits are uncertain.Objective. To examine the effects of CBE programmes for frail older people through a systematic review of existing literature.Method. A systematic search was performed for CBE-controlled trials in frail populations aged ≥65 years published between 1990 and February 2011 in electronic databases. Quality was assessed using the Jadad method.Results. The search identified 164 references: with 42 duplicates removed, 122 reviewed, 116 excluded, and 6 analysed. 26 outcome measures were reported measuring 3 domains: mobility and function, cardiorespiratory fitness, mental health. All studies were of low methodological quality (Jadad score ≤2; possible range 0–5). Two studies showed no benefit, and four reported some evidence of benefit in all three domains. No harmful effects were reported; compliance was generally good.Conclusion. The quality of the evidence base for CBEs is low with inconclusive findings to clearly inform practice. A consensus is required on the definition and purpose of CBEs. Large well-designed randomised controlled trials to test the effectiveness of CBE are justified.

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