Personal Social Networks of Community-Dwelling Oldest Old During the Covid-19 Pandemic—A Qualitative Study

The COVID-19 pandemic and its related restrictions have affected the everyday life of older people. Advanced age is a significant predisposing factor for a more severe COVID-19 infection, increasing the risk for hospitalization and mortality. Even though restrictions have been, thus, well-grounded, they may also have had detrimental effects on the social well-being of older people. Personal networks and social activity are known protective factors against the premature decline in health and functioning, and it is widely acknowledged that social isolation increases feelings of loneliness, poor quality of life, and even the risk for diseases and disabilities among older adults. This qualitative study investigated changes in personal networks among community-dwelling oldest-old individuals (persons aged 80 and over) during the first and second waves of the COVID-19 pandemic in Finland. The data is part of the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE85+) study, which is an ongoing large longitudinal population-based study in Finland. In this qualitative sub-study, we analyzed fifteen in-depth telephone interviews using directed content analyses and identified five types of changes in personal social networks during the pandemic. In type 1, all social contacts were significantly reduced due to official recommendations and fear of the virus. Type 2 included modified ways of being socially active i.e., by deploying new technology, and in type 3, social contacts increased during the lockdown. In type 4, personal social networks were changed unexpectedly or dramatically due to a death of a spouse, for example. In type 5, we observed stable social networks, which had not been affected by the pandemic. At an individual level, one person could have had different types of changes during the pandemic. These results highlight the heterogeneity of the oldest olds' personal social networks and changes related to them during the exceptional times of the COVID-19 pandemic. Social activity and personal networks play an important role in the well-being of the oldest old, but individual situations, needs, and preferences toward personal social networks should be taken into account when planning social activities, policies, and interventions.

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Prioritization and management of calls from older people to GP out-of-hours services

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab021 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Suzanne Smith ◽

Lucia Carragher

Keyword(s):

Older People ◽

Service Provision ◽

Emergency Services ◽

Oldest Old ◽

Community Dwelling ◽

Third Party ◽

Older Person ◽

Out Of Hours ◽

Accident And Emergency ◽

Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

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Do opposite ends of same factors underlie life satisfaction vs. depressive symptoms among older people?

Aging Clinical and Experimental Research ◽

10.1007/s40520-020-01765-z ◽

2021 ◽

Author(s):

Katja Pynnönen ◽

Katja Kokko ◽

Milla Saajanaho ◽

Timo Törmäkangas ◽

Erja Portegijs ◽

...

Keyword(s):

Life Satisfaction ◽

Depressive Symptoms ◽

Older People ◽

Executive Functions ◽

Physical Performance ◽

Well Being ◽

Community Dwelling ◽

Satisfaction With Life Scale ◽

Financial Situation ◽

Self Acceptance

Abstract Background Although depressive symptoms are more common among older than younger age groups, life satisfaction tends to remain stable over the life course, possibly because the underlying factors or processes differ. Aim To study whether the factors that increase the likelihood of high life satisfaction also decrease the likelihood of depressive symptoms among older people. Methods The data were a population-based probability sample drawn from community-dwelling people aged 75, 80, and 85 years (n = 1021). Participants’ life satisfaction was measured with the Satisfaction with Life Scale and depressive symptoms with the Centre for Epidemiologic Studies Depression Scale (CES-D). Physical performance, perceived financial situation, executive functions, loneliness, self-acceptance, and having interests in one’s life were studied as explanatory variables. The data were analyzed using cross-sectional bivariate linear modeling. Results Better physical performance, not perceiving loneliness, having special interests in one’s life, and higher self-acceptance were associated with higher life satisfaction and fewer depressive symptoms. Better financial situation was related only to life satisfaction. Executive functions were not associated with either of the outcomes. Discussion The opposite ends of the same factors underlie positive and negative dimensions of mental well-being. Conclusion Further studies are warranted to better understand how people maintain life satisfaction with aging when many resources may diminish and depressive symptoms become more prevalent.

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IMPACT OF OFFLINE AND ONLINE SOCIAL NETWORKS ON LONELINESS AND MENTAL HEALTH AMONG ITALIAN OLDER PEOPLE

Innovation in Aging ◽

10.1093/geroni/igz038.1945 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S529-S529

Author(s):

Daniele Zaccaria ◽

Georgia Casanova ◽

Antonio Guaita

Keyword(s):

Mental Health ◽

Social Networks ◽

Social Network ◽

Older People ◽

Online Social Networks ◽

Social Network Sites ◽

Well Being ◽

Controlled Study ◽

Face To Face ◽

Causal Impact

Abstract In the last decades the study of older people and social networks has been at the core of gerontology research. The literature underlines the positive health effects of traditional and online social connections and also the social networks’s positive impact on cognitive performance, mental health and quality of life. Aging in a Networked Society is a randomized controlled study aimed at investigating causal impact of traditional face-to-face social networks and online social networks (e.g. Social Network Sites) on older people’ health, cognitive functions and well-being. A social experiment, based on a pre-existing longitudinal study (InveCe - Brain Aging in Abbiategrasso) has involved 180 older people born from 1935 to 1939 living in Abbiategrasso, a municipality near Milan. We analyse effects on health and well-being of smartphones and Facebook use (compared to engagement in a more traditional face-to-face activity), exploiting the research potential of past waves of InveCe study, which collected information concerning physical, cognitive and mental health using international validate scale, blood samples, genetic markers and information on social networks and socio-demographic characteristics of all participants. Results of statistical analysis show that poor social relations and high level of perceived loneliness (measured by Lubben Scale and UCLA Loneliness scale) affect negatively physical and mental outcomes. We also found that gender and marital status mediate the relationship between loneliness and mental wellbeing, while education has not significant effect. Moreover, trial results underline the causal impact of ICT use (smartphones, internet, social network sites) on self-perceived loneliness and cognitive and physical health.

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Cardiovascular disease risk prediction in older people: a qualitative study

British Journal of General Practice ◽

10.3399/bjgp.2020.1038 ◽

2021 ◽

pp. BJGP.2020.1038

Author(s):

Denise Ann Taylor ◽

Katharine Wallis ◽

Sione Feki ◽

Sione Segili Moala ◽

Manusiu He-Naua Esther Latu ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Assessment ◽

Qualitative Study ◽

Older People ◽

Focus Groups ◽

Risk Prediction ◽

Heart Attack ◽

Clinical Decision Making ◽

Community Dwelling ◽

Cvd Risk

Background: Despite cardiovascular disease (CVD) risk prediction equations becoming more widely available for people aged 75 years and over, views of older people on CVD risk assessment are unknown. Aim: To explore older people’s views on CVD risk prediction and its assessment. Design and Setting: Qualitative study of community dwelling older New Zealanders. Methods: We purposively recruited a diverse group of older people. Semi-structured interviews and focus groups were conducted, transcribed verbatim and thematically analysed. Results: Thirty-nine participants (mean age 74 years) of Māori, Pacific, South Asian and European ethnicities participated in one of 26 interviews or three focus groups. Three key themes emerged, (1) Poor knowledge and understanding of cardiovascular disease and its risk assessment, (2) Acceptability and perceived benefit of knowing and receiving advice on managing personal cardiovascular risk; and (3) Distinguishing between CVD outcomes; stroke and heart attack are not the same. Most participants did not understand CVD terms but were familiar with ‘heart attack,’ ‘stroke’ and understood lifestyle risk factors for these events. Participants valued CVD outcomes differently, fearing stroke and disability which might adversely affect independence and quality of life, but being less concerned about a heart attack, perceived as causing less disability and swifter death. These findings and preferences were similar across ethnic groups. Conclusion: Older people want to know their CVD risk and how to manage it, but distinguish between CVD outcomes. To inform clinical decision making for older people, risk prediction tools should provide separate event types rather than just composite outcomes.

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Medication adherence in community-dwelling older people exposed to chronic polypharmacy

Journal of Epidemiology & Community Health ◽

10.1136/jech-2020-214238 ◽

2021 ◽

pp. jech-2020-214238

Author(s):

Carlotta Franchi ◽

Ilaria Ardoino ◽

Monica Ludergnani ◽

Gjiliola Cukay ◽

Luca Merlino ◽

...

Keyword(s):

Medication Adherence ◽

Older People ◽

Oldest Old ◽

Medication Possession Ratio ◽

Community Dwelling ◽

Administrative Database ◽

Lombardy Region ◽

Drug Classes ◽

Community Dwelling Older People ◽

Lower Adherence

BackgroundTo evaluate medication adherence and associated factors of seven of the most common drug classes prescribed to community-dwelling older people.MethodsThis is a retrospective cohort study on medication adherence in community-dwelling older people (65–94 years old) on chronic polypharmacy and recorded from 2013 to 2015 in the administrative database of the Lombardy region (Northern Italy). Adherence was assessed for diabetic drugs, antithrombotic agents, drugs acting on the renin–angiotensin system, statins, bisphosphonates, antidepressants and drugs for obstructive airway diseases by calculating the medication possession ratio (MPR). Patients were then divided in fully (MPR ≥80%), partially (40%≤MPR<80%) and poorly adherent (10%<MPR<40%).ResultsAmong 140 537 patients included in the study, only 19.3% was fully adherent to all the therapies considered. Almost 40% of them were poorly adherent to at least one drug class, becoming 50% when patients exposed to four or more drug classes were considered. In adjusted regression model, being women (OR=1.14, 95% CI 1.13 to 1.16) and aged ≥80 years old (OR=1.22, 95% CI 1.20 to 1.24) were associated with an overall lower adherence. Instead, the participation to an experimental healthcare programme was associated with higher adherence (OR=0.92, 95% CI 0.87 to 0.96). Furthermore, being coprescribed with ≥10 drugs was associated with lower adherence to all the drug classes, with different effects (ORs from 0.42 to 0.73).ConclusionThis study overall shows a low medication adherence in community-dwelling older people on chronic polypharmacy, especially in women and oldest old. The implementation and promotion of healthcare programmes for these patients could help improve overall adherence to chronic drug therapies.

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Community ageing research 75+ study (CARE75+): an experimental ageing and frailty research cohort

BMJ Open ◽

10.1136/bmjopen-2018-026744 ◽

2019 ◽

Vol 9 (3) ◽

pp. e026744 ◽

Cited By ~ 7

Author(s):

Anne Heaven ◽

Lesley Brown ◽

John Young ◽

Elizabeth Teale ◽

Rebecca Hawkins ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Older People ◽

Science Studies ◽

Nursing Home Residents ◽

Well Being ◽

Community Dwelling ◽

Ageing Research ◽

Study Results

IntroductionThe Community Ageing Research 75+ Study (CARE75+) is a longitudinal cohort study collecting an extensive range of health, social and economic data, with a focus on frailty, independence and quality of life in older age. CARE75+ is the first international experimental frailty research cohort designed using Trial within Cohorts (TwiCs) methodology, to align applied epidemiological research with clinical trial evaluation of interventions to improve the health and well-being of older people living with frailty.Methods and analysisProspective cohort study using a TwiCs design. One thousand community-dwelling older people (≥75 years) will be recruited from UK general practices. Nursing home residents, those with an estimated life expectancy of 3 months or less and people receiving palliative care will be excluded. Data collection assessments will be face to face in the person’s home at baseline, 6 months, 12 months, 24 months and 48 months, including assessments of frailty, cognition, mood, health-related quality of life, comorbidity, medications, resilience, loneliness, pain and self-efficacy. A modified protocol for follow-up by telephone or web based will be offered at 6 months. Consent will be sought for data linkage and invitations to additional studies, including intervention studies using the TwiCs design. A blood sample biobank will be established for future basic science studies.Ethics and disseminationCARE75+ was approved by the NRES Committee Yorkshire and the Humber—Bradford Leeds 10 October 2014 (14/YH/1120). Formal written consent is sought if an individual is willing to participate and has capacity to provide informed consent. Consultee assent is sought if an individual lacks capacity.Study results will be disseminated in peer-reviewed scientific journals and scientific conferences. Key study results will be summarised and disseminated to all study participants via newsletters, local older people’s publications and local engagement events. Results will be reported on a bespoke CARE75+ website.Trial registration numberISRCTN16588124;Results stage

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Rehabilitation during intensive treatment of acute leukaemia including allogenic stem cell transplantation: a qualitative study of patient experiences

BMJ Open ◽

10.1136/bmjopen-2019-029470 ◽

2019 ◽

Vol 9 (11) ◽

pp. e029470

Author(s):

Lene Østergaard Jepsen ◽

Lone Smidstrup Friis ◽

Mette Terp Hoybye ◽

Claus Werenberg Marcher ◽

Dorte Gilså Hansen

Keyword(s):

Qualitative Study ◽

Social Life ◽

Acute Leukaemia ◽

Social Activity ◽

Well Being ◽

Outpatient Setting ◽

Curative Intent ◽

Allogenic Stem Cell Transplantation ◽

Health Initiatives ◽

Final Interview

ObjectivesThe diagnosis and treatment of acute leukaemia (AL) affect physical, psychosocial and existential functioning. Long-lasting treatment periods with impaired immune system, hygienic and social restrictions challenge patient well-being and rehabilitation as compared with other individuals with cancer. This study elucidates how AL patients, treated with curative intent in an outpatient setting, assess their physical, psychosocial and existential capability during and following treatment, and furthermore reports on the health initiatives offered to support their rehabilitation.Design, setting, participants and interventionsWe conducted qualitative, semi-structured individual interviews with 16 AL patients, 6 months after end of treatment in the patients’ homes. This was the final interview, in a line of three, carried out as part of a larger qualitative study.ResultsThe data were analysed thematically through an inductive ongoing process consisting of four steps. The final step, selective coding, resulted in the three categories: physical activity, mental well-being and social activity. None of the patients were satisfied with their physical capability at the time of interview and experienced substantial impairment of functional capabilities. All patients struggled with anxiety and expressed a need for continuous progress in treatment and well-being to feel safe. It took an unexpected large effort to regain a meaningful social life, and patients still had to prioritise activities.ConclusionsAL patients suffered physically, psychologically and existentially throughout their illness trajectory. Rehabilitation initiatives deriving from the healthcare system and municipalities held room for improvement. Future programmes should pay attention to the contextual changes of treatment of this patient group and individuals’ changing needs and motivation of physical exercise.

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‘I’ve never drunk very much water and I still don’t, and I see no reason to do so’: a qualitative study of the views of community-dwelling older people and carers on hydration in later life

Age and Ageing ◽

10.1093/ageing/afz141 ◽

2019 ◽

Vol 49 (1) ◽

pp. 111-118 ◽

Cited By ~ 5

Author(s):

Cini Bhanu ◽

Christina Avgerinou ◽

Kalpa Kharicha ◽

Yehudit Bauernfreund ◽

Helen Croker ◽

...

Keyword(s):

Qualitative Study ◽

Older People ◽

Later Life ◽

Adverse Outcomes ◽

Community Dwelling ◽

Drinking Patterns ◽

Adequate Hydration ◽

Perceived Importance ◽

Community Dwelling Older People ◽

Informal Carers

Abstract Background dehydration is associated with significant adverse outcomes in older people despite being largely preventable and treatable. Little research has focused on the views of community-dwelling older people on hydration, healthy drinking and the perceived importance of drinking well in later life. Objectives to understand community-dwelling older people and informal carers’ views on hydration in later life and how older people can be supported to drink well. Methods qualitative study using interviews and a focus group exploring hydration and nutrition in later life (24 older people at risk of malnutrition and dehydration, 9 informal carers) and thematic analysis. Results this article presents the findings on hydration alone. Four themes are presented: perceptions of healthy drinking, barriers to and facilitators of drinking in later life and supporting older people to drink well. The perceived importance of adequate hydration in later life was polarised. Concerns about urinary incontinence and knowledge gaps were significant barriers. Consideration of individual taste preference and functional capacity acted as facilitators. Distinct habitual drinking patterns with medications and meals exist within individuals. Many relied on thirst at other times or when fluid demands are greater (such as hot weather), a known unreliable prompt in later life. Conclusions older people could be supported to drink well by building upon existing habitual drinking patterns. Primary care and public health should consider individual barriers, facilitators and tailored education. A multidisciplinary approach to promote hydration should be incorporated into care for older people with more complex needs.

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