The factors associated with entry to formal care for the elderly in Scotland: A longitudinal analysis

BackgroundLosing independence is a concern for older people, and sadly a reality for many. In Scotland there is an ageing population and unlike the rest of the UK, a policy to provide free personal and nursing care for those in need of assistance; this makes loss of independence high on the agenda of government, local authorities, care providers, older people and their families alike. ObjectivesThis study aimed to investigate the factors associated with entry to formal care for older people in Scotland. In addition to socio-demographic, geographical and health characteristics, this study considered three lesser studied or novel factors: living in a flat, population density and recent employment. MethodsA Scottish Longitudinal Study project (https://sls.lscs.ac.uk/) provided a 5.3% representative sample of the Scottish population for longitudinal analysis. This included people aged 65 and older in 1991 whose care-entry status was then followed-up in 2001. FindingsAssociations were found for age, sex, marital status, longterm illness, housing tenure, recent employment, urban/rural classification and population density. Notably, whilst living in rural areas had a protective association with formal care home entry (OR 0.35 [95% CI 0.29,0.43]), paradoxically, living in areas with a low population density was associated with greatly increased odds (OR 9.05 [95% CI 7.34, 11.19]). ConclusionsThis study indicates that the factors associated with care-entry in the Scottish population are similar to those in other Western countries. Possible explanations and justifications for the apparently paradoxical association found for population density are discussed. This finding might be relevant in populations outside Scotland, and future research should explore this.

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A theoretical and empirical review of psychological factors associated with falls-related psychological concerns in community-dwelling older people

International Psychogeriatrics ◽

10.1017/s1041610214002701 ◽

2015 ◽

Vol 27 (7) ◽

pp. 1071-1087 ◽

Cited By ~ 33

Author(s):

C. C. Hughes ◽

I. I. Kneebone ◽

F. Jones ◽

B. Brady

Keyword(s):

Older People ◽

Psychological Factors ◽

Community Dwelling ◽

Activity Level ◽

Future Research ◽

Negative Consequences ◽

Factors Associated ◽

Moderate Evidence ◽

Tentative Evidence ◽

Community Dwelling Older People

ABSTRACTBackground:Four constructs are encompassed by the term “falls-related psychological concerns” (FrPC); “fear of falling” (FOF), “falls-related self-efficacy” (FSe), “balance confidence” (BC) and “outcome expectancy” (OE). FrPC are associated with negative consequences including physical, psychological, and social. Identifying factors associated with FrPC could inform interventions to reduce these concerns.Methods:Sixty-two empirical papers relating to psychological factors associated with FrPC in community-dwelling older people (CDOP) were reviewed. Four levels of evidence were used when evaluating the literature: good, moderate, tentative, and none.Results:Evidence that anxiety predicted FOF, BC, and OE was tentative. Moderate evidence was found for anxiety predicting FSe. Good evidence was found for depression predicting FSe. Moderate evidence was found for depression predicting both FOF and BC. No evidence was found for depression predicting OE. Tentative evidence was found for FSe predicting depression. Good and moderate evidence was found for quality of life (QoL) being predicted by FOF and BC respectively. Tentative evidence was found for FSe predicting QoL. Moderate evidence was found for QoL predicting both FSe and BC. No evidence was found for QoL predicting FOF. Good and moderate evidence was found for activity avoidance/restriction (AA/AR) being predicted by FOF and FSe respectively. Tentative evidence was found for BC and OE predicting AA/AR, as well as for AA/AR predicting FOF. Moderate evidence for activity level (AL) predicting FOF was identified, however the evidence of this predicting FSe and BC was tentative. Evidence for FOF, FSe, and BC predicting AL was tentative as was evidence to suggest FOF predicted coping.Conclusions:Mixed evidence has been found for the association of psychological factors in association with FrPCs. Future research should employ theoretically grounded concepts, use multivariate analysis and longitudinal designs.

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Managing diabetes in people with dementia: a realist review

Health Technology Assessment ◽

10.3310/hta21750 ◽

2017 ◽

Vol 21 (75) ◽

pp. 1-140 ◽

Cited By ~ 5

Author(s):

Frances Bunn ◽

Claire Goodman ◽

Peter Reece Jones ◽

Bridget Russell ◽

Daksha Trivedi ◽

...

Keyword(s):

Older People ◽

Intervention Strategy ◽

Realist Review ◽

Cochrane Library ◽

Future Research ◽

Care Providers ◽

Long Term Conditions ◽

People With Dementia ◽

Increased Risk

BackgroundDementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes.ObjectivesTo identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research.DesignRealist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders.ParticipantsTwenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference.Data sourcesThe following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing – UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA).ResultsWe included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context–mechanism–outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia.LimitationsThere is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven.ConclusionsThis review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes.Study registrationThis study is registered as PROSPERO CRD42015020625.FundingThe NIHR HTA programme.

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Telehealth and digital developments in society that persons 75 years and older in European countries have been part of: a scoping review

BMC Health Services Research ◽

10.1186/s12913-021-07154-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Moonika Raja ◽

Jorunn Bjerkan ◽

Ingjerd G. Kymre ◽

Kathleen T. Galvin ◽

Lisbeth Uhrenfeldt

Keyword(s):

Social Support ◽

Older People ◽

Scoping Review ◽

New Technology ◽

European Countries ◽

Future Research ◽

Ageing Population ◽

New Device ◽

Digital Devices ◽

New Devices

Abstract Background Demographic changes are leading to an ageing population in Europe. People are becoming more dependent on digital technologies and health ministries invest increasingly in digitalisation. Societal digital demands impact older people and learning to use new telehealth systems and digital devices are seen as a means of securing their needs. Methods The present study undertakes a scoping review in order to map relevant evidence about telehealth and digital developments in society involving citizens aged 75 and over in European countries. It focuses on their experiences and the main barriers to, and facilitators of, societal digital demands. A framework proposed by Arksey and O`Malley was used to guide the scoping review process. The studies included in the review covered telehealth, digital technology and digital devices, and the context covered participants` own home or surroundings. A comprehensive search on PubMed/MEDLINE, CINAHL, Scopus, Embase and Open Grey was undertaken. Results Out of 727 identified citations, 13 sources which met the inclusion criteria (9 original study articles, 2 theses, 1 letter about a product and 1 project report). Few of the studies identified have investigated European citizens 75 years and older separately. The studies included varied in their design, location and focus. Older people have experienced both telehealth and digital devices making life easier and the opposite. The outstanding facilitator found was that technology should be easy to use, and difficulty in remembering the instructions was seen as an important barrier. Interestingly, both social support and lack of social support were found as facilitators of using new devices. Conclusions Telehealth may give a sense of security but learning to use a new device often takes extra effort. Older people were more open to new devices if the possible advantages of the new technology outweighed the effort that would be involved in adopting a new strategy. As technology develops rapidly, and life expectancy in Europe is anticipated to rise continually, there is a need for new and additional research among older European citizens. Future research should cover the technical solutions most relevant to older people today, social support and participants` access to the devices.

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Market-Oriented Policies on Care for Older People in Urban China: Examining the Experiment-Based Policy Implementation Process

Journal of Social Policy ◽

10.1017/s0047279421000131 ◽

2021 ◽

pp. 1-19

Author(s):

WENJING ZHANG

Keyword(s):

Older People ◽

Policy Process ◽

Policy Making ◽

Urban China ◽

Ageing Population ◽

Care Providers ◽

Discretionary Power ◽

Care Needs ◽

Care Systems ◽

Care For Older People

Abstract The rapidly ageing population and increasing care needs provide the rationale for care systems progressively shaped by a growing market in a global context. In China the approach to policy making, which has been largely experimental, has involved market-oriented reforms since the 1980s. While marketisation processes have been well studied in various European care systems, very little is known about their implementation in the Chinese context. Based on qualitative interviews with local government officials and care providers in Shanghai, this article discusses the Chinese policy process in the field of care for older people and the barriers to effective implementation. It investigates the experiment-based marketisation policy process, the power hierarchy and the lines of accountability of the state in the care field. Multi-layered barriers are identified in the market-oriented policy process. These include (1) inherent bureaucratic obstacles at practice level: reluctance to exercise discretionary power, administrative inefficiency, incoherence of care schemes and poor inter-department communication; and (2) complexities and failures at policy-making level: the infeasibility of policies, underestimation of operational capacity and inadequate involvement of practice knowledge. These findings have implications for balancing the efficiency, effectiveness and sustainability of care policies in an era of public service austerity.

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Substance Use Among Older People Living With HIV: Challenges for Health Care Providers

Frontiers in Public Health ◽

10.3389/fpubh.2019.00094 ◽

2019 ◽

Vol 7 ◽

Cited By ~ 9

Author(s):

Sherry Deren ◽

Tara Cortes ◽

Victoria Vaughan Dickson ◽

Vincent Guilamo-Ramos ◽

Benjamin H. Han ◽

...

Keyword(s):

Health Care ◽

Substance Use ◽

Older People ◽

Health Care Providers ◽

People Living With Hiv ◽

Care Providers ◽

Living With Hiv

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Acceptance of the HPV Vaccine in a Multiethnic Sample of Latinx Mothers

Qualitative Health Research ◽

10.1177/1049732320980697 ◽

2021 ◽

Vol 31 (3) ◽

pp. 472-483

Author(s):

Ana Cristina Lindsay ◽

Madelyne J. Valdez ◽

Denisse Delgado ◽

Emily Restrepo ◽

Yessica M. Guzmán ◽

...

Keyword(s):

Health Care Providers ◽

Thematic Analysis ◽

Hpv Vaccine ◽

Female Adolescents ◽

Future Research ◽

Care Providers ◽

Foreign Born ◽

Structured Interviews ◽

Direct Benefits ◽

Multiethnic Sample

This descriptive qualitative study explored Latinx mothers’ acceptance of the human papillomavirus (HPV) vaccine for their adolescent children. Data were collected through individual, semi-structured interviews and analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Twenty-two ( n = 22), mostly foreign-born, Latinx mothers of male and female adolescents participated in the study. Three main themes and nine subthemes emerged from the analyses. Findings identified the need for increased efforts to raise awareness and knowledge among Latinx mothers of the direct benefits of the HPV vaccine for sons, including stressing prevention of HPV-associated cancers in males. Findings also underscore the need for improved health care providers’ communication and recommendation of the HPV vaccine for Latinx adolescent males. Future research should intervene upon the study’s findings to address barriers that remain and affect Latinx mothers’ acceptance and uptake of the HPV vaccine for their children, in particular their sons.

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Ways that nurse practitioner students self-explain during diagnostic reasoning

Diagnosis ◽

10.1515/dx-2020-0136 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Leah Burt ◽

Susan Corbridge ◽

Colleen Corte ◽

Laurie Quinn ◽

Lorna Finnegan ◽

...

Keyword(s):

Problem Solving ◽

Health Care Providers ◽

Nurse Practitioner ◽

Descriptive Analysis ◽

Diagnostic Errors ◽

Diagnostic Reasoning ◽

Knowledge Structures ◽

Future Research ◽

Biological Knowledge ◽

Care Providers

Abstract Objectives An important step in mitigating the burden of diagnostic errors is strengthening diagnostic reasoning among health care providers. A promising way forward is through self-explanation, the purposeful technique of generating self-directed explanations to process novel information while problem-solving. Self-explanation actively improves knowledge structures within learners’ memories, facilitating problem-solving accuracy and acquisition of knowledge. When students self-explain, they make sense of information in a variety of unique ways, ranging from simple restatements to multidimensional thoughts. Successful problem-solvers frequently use specific, high-quality self-explanation types. The unique types of self-explanation present among nurse practitioner (NP) student diagnosticians have yet to be explored. This study explores the question: How do NP students self-explain during diagnostic reasoning? Methods Thirty-seven Family NP students enrolled in the Doctor of Nursing Practice program at a large, Midwestern U.S. university diagnosed three written case studies while self-explaining. Dual methodology content analyses facilitated both deductive and qualitative descriptive analysis. Results Categories emerged describing the unique ways that NP student diagnosticians self-explain. Nine categories of inference self-explanations included clinical and biological foci. Eight categories of non-inference self-explanations monitored students’ understanding of clinical data and reflect shallow information processing. Conclusions Findings extend the understanding of self-explanation use during diagnostic reasoning by affording a glimpse into fine-grained knowledge structures of NP students. NP students apply both clinical and biological knowledge, actively improving immature knowledge structures. Future research should examine relationships between categories of self-explanation and markers of diagnostic success, a step in developing prompted self-explanation learning interventions.

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Accuracy of State-Level Surveillance during Emerging Outbreaks of Respiratory Viruses: A Model-Based Assessment

Medical Decision Making ◽

10.1177/0272989x211022276 ◽

2021 ◽

pp. 0272989X2110222

Author(s):

Yuwen Gu ◽

Elise DeDoncker ◽

Richard VanEnk ◽

Rajib Paul ◽

Susan Peters ◽

...

Keyword(s):

Growth Rate ◽

Data Collection ◽

Disease Progression ◽

Health Care Providers ◽

Growth Rates ◽

State Level ◽

Future Research ◽

Care Providers ◽

State Surveillance ◽

First Come First Serve

It is long perceived that the more data collection, the more knowledge emerges about the real disease progression. During emergencies like the H1N1 and the severe acute respiratory syndrome coronavirus 2 pandemics, public health surveillance requested increased testing to address the exacerbated demand. However, it is currently unknown how accurately surveillance portrays disease progression through incidence and confirmed case trends. State surveillance, unlike commercial testing, can process specimens based on the upcoming demand (e.g., with testing restrictions). Hence, proper assessment of accuracy may lead to improvements for a robust infrastructure. Using the H1N1 pandemic experience, we developed a simulation that models the true unobserved influenza incidence trend in the State of Michigan, as well as trends observed at different data collection points of the surveillance system. We calculated the growth rate, or speed at which each trend increases during the pandemic growth phase, and we performed statistical experiments to assess the biases (or differences) between growth rates of unobserved and observed trends. We highlight the following results: 1) emergency-driven high-risk perception increases reporting, which leads to reduction of biases in the growth rates; 2) the best predicted growth rates are those estimated from the trend of specimens submitted to the surveillance point that receives reports from a variety of health care providers; and 3) under several criteria to queue specimens for viral subtyping with limited capacity, the best-performing criterion was to queue first-come, first-serve restricted to specimens with higher hospitalization risk. Under this criterion, the lab released capacity to subtype specimens for each day in the trend, which reduced the growth rate bias the most compared to other queuing criteria. Future research should investigate additional restrictions to the queue.

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A Scoping Review of Resilience in Survivors of Human Trafficking

Trauma Violence & Abuse ◽

10.1177/1524838020985561 ◽

2021 ◽

pp. 152483802098556

Author(s):

Logan Knight ◽

Yitong Xin ◽

Cecilia Mengo

Keyword(s):

Interpersonal Relationships ◽

Scoping Review ◽

National Origin ◽

Future Research ◽

Research Needs ◽

Standardized Measures ◽

Factors Associated ◽

Current State ◽

Case Files ◽

Sexual Trafficking

Resilience is critical among survivors of trafficking as they are mostly vulnerable populations who face multiple adversities before, during, and after trafficking. However, resilience in survivors of trafficking is understudied. This scoping review aims to clarify the current state of knowledge, focusing on definitions of resilience, how resilience has been studied, and factors associated with resilience among survivors. Five databases were searched using key words related to trafficking and resilience. Studies were included if they were published in English between 2000 and 2019 and focused on resilience with the study design including at least one of these four features: (a) use of standardized measures of resilience, (b) qualitative descriptions of resilience, (c) participants were survivors or professionals serving survivors, and (d) data sources such as case files or program manuals directly pertained to survivors. Eighteen studies were identified. Findings indicated that resilience was primarily described as emergent from interactions between the survivor and the environment. Resilience in trafficking appeared largely similar to resilience in other kinds of victimization. Nonetheless, trafficking survivors also may display resilience in alternative ways such as refusing treatment. Positive interpersonal relationships were the most commonly mentioned resilience factor. In addition, current research lacks studies featuring longitudinal designs, interventions, participatory methods, types of trafficking other than sexual trafficking, and demographic characteristics such as age, gender, and national origin. Future research needs to establish definitions and measures of resilience that are culturally and contextually relevant to survivors and build knowledge necessary for designing and evaluating resilience-enhancing interventions.

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Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

Qualitative Health Research ◽

10.1177/10497323211003861 ◽

2021 ◽

pp. 104973232110038

Author(s):

Cecilie Fromholt Olsen ◽

Astrid Bergland ◽

Jonas Debesay ◽

Asta Bye ◽

Anne Gudrun Langaas

Keyword(s):

Health Care ◽

Older People ◽

Health Care Providers ◽

Transitional Care ◽

Care Pathway ◽

Patient Flow ◽

Care Pathways ◽

Care Providers ◽

Patient Centered ◽

Care For Older People

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

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