A Mixed-Methods Analysis of Care Arrangements of Older People with Limited Physical Abilities Living Alone in Italy

Older people with limited physical abilities, who live alone without cohabiting family members, need support ageing in place and to perform daily living activities. In this respect, both the available informal and formal care seem crucial. The present study aimed to explore the current role of the care arrangements of older people, especially if they have functional limitations. Qualitative interviews were carried out in 2019 within the “Inclusive ageing in place” (IN-AGE) research project, involving 120 older people who lived at home, alone, or with a private personal care assistant (PCA) in three Italian regions (Lombardy, Marche, and Calabria). A mixed-methods analysis was conducted. Results showed that support networks are still mainly made up of family members, but also of domestic home help (DHH) and PCAs, friends/neighbours, and public services, albeit the latter provide support in a residual way, while the former is not as intensive as it was in the past. Frequency and geographical/living proximity of help play a role, emerging also as a territorial differentiation. The paucity or absence of support, especially from the family, risks compromising the ability of ageing in place. It seems, thus, necessary to innovate and improve, in particular, home services, also through real formal and informal care integration.

Ageing people with intellectual disabilities and the association between frailty factors and social care: A Swedish national register study

The aim of this study was to describe the social care provided for different age groups of people with intellectual disability, 55 years or above, and to investigate the association between such care and frailty factors for those with diagnosed level of intellectual disabilities. Descriptive and logistic regression analyses were used. Commonest forms of social care among the 7936 people were Residential care, Daily activities and Contact person. Home help and Security alarm increased with age. The frailty factors significantly associated with increased social care were age, polypharmacy and severe levels of intellectual disabilities. Persons most likely to be in residential care were in the age group 65–79 with polypharmacy and severe disability. The results indicate a need for further research of how frailty factors are considered in social care and longstanding medication, especially then severe intellectual disability hinders communication. A national strategic plan for preventive interventions should be developed to ensure the best possible healthy ageing.

INFLUENCE OF WORK FROM HOME ON QUALITY OF WORK LIFE OF EMPLOYEESWORKING IN BPO INDUSTRY, PUNE

Globally, the Business Process Outsourcing (BPO) sector have grown rapidly over the last two decades, driven by the transfer of processes from companies in developed countries to ones in emerging economies. Work from home (WFH) has been fruitful during Covid-19 lockdown as per Governments mandate. As a result, about 90% of employees worked from home with 65% of them from homes in metros and rest 35% from homes in small towns.The main purpose was to study the benefit of work from home help employees enjoy better quality of work life (QWL) and the influence that productivity and promotions have on employees quality of work life working under work from home model through randomly assigning some employees of BPO companies in Pune. From the study it reported that employees working from home experienced of having a high positive attitude, less stress at work and improved wellbeing were the results of good quality of wok life. They were more likely to be happy with work and were also less likely to quit their job than those in the comparison group, but were less likely to be promoted than similar-performing peers working in the office. Further it also suggested that organisationscanconductvirtual employee training with best quality of work life initiatives in place will be an added advantage to both employees and employers receiving the full merits of improved workplace productivity and flexibility,strengthen team bonds, increase opportunities for upward mobility and retain employees than those who went into the office on a regular basis.

Socio-demographic differences in polypharmacy and potentially inappropriate drug use among older people with different care needs and in care settings in Stockholm, Sweden

Aims: Polypharmacy and potentially inappropriate medications (PIM) are risk factors for negative health outcomes among older people. This study aimed to investigate socio-demographic differences in polypharmacy and PIM use among older people with different care needs in a standard versus an integrated care setting. Methods: Population-based register data on residents aged ⩾65 years in Stockholm County based on socio-demographic background and social care use in 2014 was linked to prescription drug use in 2015. A logistic regression analysis was used to estimate socio-demographic differences in polypharmacy and PIM, adjusting for education, age group, sex, country of birth, living alone, morbidity and dementia by care setting based on area and by care need (i.e. independent, home help or institutionalised). Results: The prevalence of polypharmacy and PIM was greater among home-help users (60.4% and 11.5% respectively) and institutional residents (74.4% and 11.9%, respectively). However, there were greater socio-demographic differences among the independent, with those with lower education, older age and females having higher odds of polypharmacy and PIM. Morbidity was a driver of polypharmacy (odds ratio (OR)=1.19, confidence interval (CI) 1.16–1.22) among home-help users. Dementia diagnosis was associated with reduced odds of polypharmacy and PIM among those in institutions (OR=0.78, CI 0.71–0.87 and OR 0.52, CI 0.45–0.59, respectively) and of PIM among home-help users (OR=0.53, 95% CI 0.42–0.67). Conclusions: Polypharmacy and PIM were associated with care needs, most prevalent among home-help users and institutional residents, but socio-demographic differences were most prominent among those living independently, suggesting that municipal care might reduce differences between socio-demographic groups. Care setting had little effect on inappropriate drug use, indicating that national guidelines are followed.

Study protocol for Prospective RELOC-AGE: A longitudinal mixed-methods study exploring associations of housing, relocation and active and healthy ageing in Sweden (Preprint)

BACKGROUND Background: While housing and neighbourhood features have the potential to impact opportunities for active ageing, there is a lack of knowledge related to how older people reason regarding their housing situation and how housing and fulfilment of relocation are associated with active and healthy ageing. OBJECTIVE Objective: The objectives of Prospective RELOC-AGE are to study housing choices and relocation and explore effects on active and healthy ageing among men and women 55 years or older in Sweden considering relocation. METHODS Methods: The estimated sample (n=2800) will include people aged 55+ being listed for relocation at either of two housing companies: a local public housing company in Southern Sweden and a national condominium provider (NCP). Prospective RELOC-AGE has a two-level longitudinal mixed-methods design and include quantitative surveys (implemented by a professional survey company) and a telephone interview for a baseline data collection in 2021, with follow-ups with the same procedures in 2022 and 2023. The survey and interviews include questions related to present housing and neighbourhood, relocation plans and expectations, a range of perspectives on active and healthy ageing, and demographics. Linking to national registers will provide additional data on e.g., home help and health care use, objective housing and neighbourhood characteristics. The study is registered at ClinicalTrials.gov NCT04765696 [1]. To explore what housing attributes older adults considering relocation find important, and to what extent, when making their decisions on housing, we will develop a Discrete Choice Experiment to be implemented with a subsample of participants. Further, a Grounded Theory (GT) approach will be applied to collect in-depth interview data from participants who have moved to another dwelling, within 6 months after the move. A follow-up interview 12 months later will focus on participants´ deepened experience over time in terms of fulfilled expectations relocation experiences. RESULTS Results: As of submission of this protocol (June 2021) recruitment has commenced with approximately n=960 respondents to the survey and with ongoing telephone interviews. We anticipate recruitment and data collection based on surveys and interviews to continue during 2021. CONCLUSIONS Conclusions: Prospective RELOC-AGE has the capacity to generate new policy-relevant knowledge on associations of housing, relocation and active and healthy ageing. Such knowledge is relevant for the development of proactive approaches to housing in old age on the individual, group as well as societal levels. CLINICALTRIAL ClinicalTrials.gov NCT04765696

Transitions between levels of dependency among older people receiving social care – a retrospective longitudinal cohort study in a Swedish municipality

Background Knowledge is scarce on how needs for home help and special housing evolve among older people who begin to receive support from municipal social care. The purpose of this study was to describe baseline distributions and transitions over time between levels of dependency among older persons after being granted social care in a Swedish municipality. Methods Based on a longitudinal cohort study in a Swedish municipality, data was collected retrospectively from municipal records. All persons 65 years or older who received their first decision on social care during 2010 (n = 415) were categorized as being in mild, moderate, severe, or total dependency, and were observed until the end of 2013. Baseline distributions and transitions over time were described descriptively and analysed with survival analysis, with the Kaplan-Meier estimator, over the entire follow-up period. To test potential differences in relation to gender, we used the Cox-Proportional hazards model. Results Baseline distributions between mild, moderate, severe, and total dependency were 53, 16, 24, and 7.7%. During the first year, between 40 and 63% remained at their initial level of dependency. Among those with mild and moderate levels of dependency at baseline, a large proportion declined towards increasing levels of dependency over time; around 40% had increased their dependency level 1 year from baseline and at the end of the follow-up, 75% had increased their dependency level or died. Conclusions Older people in Sweden being allocated home help are at high risk for decline towards higher levels of dependency, especially those at mild or moderate dependency levels at baseline. Taken together, it is important that municipalities make use of existing knowledge so that they implement cost-effective preventative interventions for older people at an early stage before a decline toward increasing levels of dependency.

The Rights of Elders in Ireland during COVID-19

This article reflects on COVID-19 restrictions imposed on elders in Ireland through the lens of the right to private and family life (Article 8 ECHR), focusing on stay at home orders and recommendations advising elders to avoid social contact. Furthermore, we examine restrictions on visiting nursing homes given the high death toll in that setting. In our analysis, we zero in on the principles of foreseeability and proportionality, highlighting areas of concern and aspects that we submit should be considered in a proportionality assessment. Ultimately, we argue that it is a mistake to view the COVID-19 pandemic solely as an emergency. In this manner, the solutions suggested through the law – restrictions on movement and visitation bans – are too narrow and fail to address the underlying structures, such as, issues in the healthcare system, the limited home help for elderly and poor conditions in nursing homes.

Intersecting vulnerabilities. Elderly care provided in the domestic environment

This article analyses to what extent the forms of hire in the elderly care sector, as defined by recent Spanish law, enable this work to be professionalised. Using a qualitative piece of research based on semi-structured interviews with a variety of social actors involved in the social organisation of care, we embark on the comparative study of those types of hire that have been particularly affected by the legal changes: private hire by families and the Home Help Service. Our conclusion is that in domestic environments, the physical, emotional and moral aspects that characterise care pose specific barriers to professionalisation and these impact most notably on the special vulnerabilities of migrants employed in domestic care. The high expectations raised by the new legislation about the sector’s professionalisation have failed to be realised.