Involvement of older adults in shared decision-making on care transitions in the UK: An interpretative qualitative systematic review.

Family and unpaid caregivers often play an active role in managing the care of older adults with activity limitations. To examine caregivers' experiences with older adults' health care workers. This survey study constitutes a secondary analysis of a sample of 1916 family and unpaid caregivers to 1203 community-living older adults with activity limitations who participated in the 2017 National Health and Aging Trends Study. Data analysis was performed January to August 2019. Caregiver sociodemographic characteristics, caregiving intensity, and frequency speaking with or emailing older adults' health care workers. Caregiver-reported experiences when interacting with older adults' health care workers in the prior year, including being listened to, being asked about understanding of treatments, and being asked about help needed in managing older adults' care. Caregivers (mean [SE] age, 59.4 [0.5] years; 63.7% women) assisting community-living older adults with activity limitations reported that they never (56.3%), sometimes or rarely (33.0%), or often (10.7%) spoke with or emailed older adults' health care workers in the prior year. Most caregivers who interacted with older adults' health care workers reported being always (70.6%) or usually (18.2%) listened to and always (54.4%) or usually (17.7%) being asked about their understanding of older adults' treatments. Fewer caregivers reported being always (21.3%) or usually (6.9%) asked whether they needed help managing older adults' care, and nearly one-half (45.0%) were never asked. Caregivers who interacted with older adults' health care workers often (vs sometimes or rarely) were more likely to report being always or usually listened to (94.8% vs 86.9%; P = .004), being asked about understanding treatments (80.1% vs 69.5%; P = .02), and being asked about needing help (40.8% vs 24.1%; P < .001). No other exposures were consistently associated with caregiver experiences. Measures of caregiving intensity, including caring for an older adult with dementia, were not associated with being listened to or asked about understanding, but were associated with being asked about needed help. Although caregivers of persons with dementia were more likely than caregivers of persons without dementia to report always being asked about needed help (26.9% vs 19.0%), a high percentage in both groups were never asked (41.2% vs 46.5%) (P = .007). These findings reinforce the need for strategies to better support family and unpaid caregivers, who are the main source of assistance to older adults with physical and/or cognitive limitations.

Population aging is a pressing global issue. As it progresses, older adults’ demand for public transport will increase. Ensuring their equitable access is vital for social equity. Meanwhile, physiological changes and travel preferences in older adults create unique bus usage patterns, making them more susceptible to the built environment. To test this, we compared bus travel behavior between older adults and young people in Wuhan, China. Our results showed that older adults travel more often, with a longer morning peak and less pronounced evening peak. We developed the GWRBoost model, combining Geographic Weighted Regression (GWR) and eXtreme Gradient Boosting (XGBoost), to explore the spatial heterogeneity and nonlinear impact of the built environment on bus travel for both groups. The study found significant differences in how the built environment affects bus ridership between older adults and young people. For older adults, proximity to the nearest bus stop is most critical, regardless of weekday or weekend. These variables also show spatial variations and nonlinear relations with bus ridership for both groups. These findings improve our understanding of older adults’ travel and offer insights for optimizing their travel environment and promoting transportation equity.

Purpose Health-promoting behaviours (HPBs) are considered the key to determining health among older adults with hypertension. Increasing our understanding of older adults’ views on HPBs could facilitate the development of interventions aimed at improving their quality of life. This study aims to describe the perceptions of older adults with high blood pressure concerning their HPBs and associated factors. Methods Semi-structured interviews with 40 individuals in Thailand were used to collect the data, which were analysed using thematic analysis. Results The results were categorized into five main themes related to personal, social, and environmental factors. Older adults explained that their experiences with HPBs involve taking responsibility for controlling blood pressure by following a doctor’s prescription, modifying their lifestyles to be healthier, sustaining social relationships, and experiencing spiritual growth through religious practices for inner peace. Older adults also identified environmental factors that influenced their engagement in HPBs depending on their residential areas. Conclusions The findings of this study highlight the importance of practices in which professionals support and encourage older adults to perform HPBs to maintain health and improve their well-being.

Purpose: Despite numerous established benefits of exercise, many older adults do not get enough. The purpose of this study was to identify facilitators and barriers to physical activity/exercise; gain greater understanding of older adults’physical activity self-efficacy; and increase understanding of how to reduce sedentary behavior.Design: Cross-sectional descriptiveMethods: Quantitative with convenience sample of 66 older adultsFindings: Nearly one third of participants reported engaging in regular physical activity. They tended to have rather strong physical activity self-efficacy and limited barriers to being active.Conclusions: The sample had limited involvement in physical activity or exercise, despite feeling confident in their ability to be active. There could be additional barriers or motivating factors that are preventing them from being more active.Clinical Evidence: Honest and directed conversation about older adults’ understanding and attitudes towards exercise, paired with an individualized plan tailored to their interests and lifestyle could help increase physical activity/exercise.

This study explored the attitudes of New Zealand (NZ) general dental practitioners (GDPs) towards older adults living within the community and the barriers and difficulties caring for their oral health needs. Adults are living longer and retaining teeth. Their dentitions are complex and alongside their dental needs, older adults often experience age-related systemic disease or decline. Ageism and stereotypical views of older adults impedes access to dental care. While there is some understanding of older adults and ageism from the perspective of dental students, there is a paucity of knowledge about dentists' management of this patient demographic. A mixed-methods survey questionnaire collected quantitative and qualitative data. Quantitative data were analysed descriptively followed by bivariate analysis. Qualitative data responses to open-ended questions were analysed thematically. A total of 382 GDPs participated (response rate of 24%) and demonstrated positive attitudes and low levels of ageism towards older adults who they enjoyed treating. Confidence was positively related to clinical experience, and most dentists had engaged in gerodontology updates. Barriers to care for older adults were perceived to be beyond their control and mostly related to cost, chronic disease or age-related change. Consent processes could create difficulty and so collaboration with family or caregivers was important. The GDPs displayed positive attitudes and confidence towards older adults who are a rewarding patient cohort. Gerodontology education during training and following graduation is critical to enhance oral health outcomes for older patients.

Date Presented 4/17/2015 Results of a qualitative study aimed at understanding how low-income older adults conceptualize “home safety” are presented. An understanding of older adults’ point of view can facilitate communication about the benefits and outcomes of interventions to improve safety and function.

Although adults aged 60 years and older currently represent 6% of the total population of Mongolia, they are projected to increase to 19% by 2050. More than 21% of Mongolians live below the poverty line. Social security payments represent the main source of income for many retirees. With little government funding, eldercare services are limited, creating a large gap between service needs and availability. Before an effective system of eldercare can be developed, in-depth understanding of older adults’ needs and resources is required. A mixed methods design was used. Four-hundred twenty-seven Mongolians aged 55 years and older were surveyed. Two focus groups with 10 older adults and eight in-depth interviews with senior center stakeholders were conducted between June 2019 and August 2019. Descriptive statistics were run to determine frequencies of participants’ service needs. Linear regression examined the relationship between age groups, service needs, and ability to pay for services. Focus group and interview transcripts were analyzed for underlying themes. Findings indicated high service needs among older adults. Retirement homes, assisted living, home care, and places to socialize were identified as the most needed services. Lack of services, employment opportunities, and income sources concerned them the most. Ability to pay for services was negatively correlated with age groups. Qualitative analysis yielded two themes: importance of services and lack of resources. Further research on starting and sustaining networks of supportive services for older adults living in Mongolia is needed.

Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, particularly addressing social needs, and prioritize future research questions. GEAR engaged 49 interdisciplinary stakeholders, derived clinical questions, and conducted searches of electronic databases to identify ED discharge care transition interventions in older adult populations. Informed by the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) framework, data extraction and synthesis of included studies included the degree that intervention components addressed social needs and their association with patient outcomes. GEAR convened a consensus conference to identify topics of highest priority for future care transitions research. Our search identified 248 unique articles addressing care transition interventions in older adult populations. Of these, 17 individual care transition intervention studies were included in the current literature synthesis. Overall, common care transition interventions included coordination efforts, comprehensive geriatric assessments, discharge planning, and telephone or in-person follow-up. Fourteen of the 17 care transition intervention studies in older adults specifically addressed at least one social need within the PRAPARE framework, most commonly related to access to food, medicine, or health care. No care transition intervention addressing social needs in older adult populations consistently reduced subsequent health care utilization or other patient-centered outcomes. GEAR stakeholders identified that determining optimal outcome measures for ED-home transition interventions was the highest priority area for future care transitions research. ED care transition intervention studies in older adults frequently address at least one social need component and exhibit variation in the degree of success on a wide array of health care utilization outcomes.

Guiding Principles for the Care of Older Adults with Multimorbidity: An Approach for Clinicians

Background The importance of sleep has become increasingly recognized in geriatric research. There is a growing body of evidence that links poor sleep with numerous adverse health outcomes in older adults. As a result, assessing sleep quality and patterns in later life has become essential for accurately diagnosing and effectively treating sleep problems and their associated consequences. The Geriatric Sleep Questionnaire-6 (GSQ-6) is a widely used self-report questionnaire that assesses sleep quality and disturbances specifically among older adults. This study aimed to translate the scale into Arabic and evaluate its psychometric properties in an older Arabic-speaking adults’ population. Methods The GSQ-6 was translated into Arabic using forward and backward translation procedures, and was administered to a convenience sample of 539 older adults along with the 13-item Older People Quality of Life-Brief (OPQOL-brief), the 15-item Resilience Scale of Older Adults (RSOA), and the 11-item Older Adult Neglect and Abuse Scale (NAS) for validation purposes. Reliability was examined using Cronbach’s alpha and McDonald’s omega coefficients. Confirmatory factor analysis (CFA) was also conducted to test the unidimensional factor structure. Results The CFA results supported the unidimensional factor structure proposed by the developers (CFI = 0.967, TLI = 0.945, RMSEA = 0.077. The McDonald’s omega values for the Arabic GSQ-6 was 0.70, indicating acceptable internal consistency. The measurement model had an equivalent factor structure, loadings, intercepts, and residuals across sex. correlated negatively with quality of life and resilience, and positively with neglect and abuse scores, supporting the validity of our Arabic translation. Conclusion The Arabic version of the GSQ-6 demonstrated good psychometric properties. The findings support its use as a valid and reliable measure for evaluating sleep quality among the Arabic-speaking older adult population.

ObjectiveThis study investigates how family care responsibilities impact older single adults' approach to and experience on the dating market.BackgroundThere is a growing population of single older adults, but very little understanding of their experiencing seeking romantic partners. Prior dating and marriage research has focused primarily on younger adults or single parents seeking remarriage. There is evidence of parenthood negatively impacting the search for a partner, but it is unclear how caregiving responsibilities impact this process for older adults.MethodHere, 100 older adults, 50 men and 50 women ages 60–83, were recruited from online dating websites and interviewed about their experiences seeking romantic partners.ResultsMany men and women postponed dating until carework was complete. Additionally, men found women with care responsibilities less desirable, but women preferred men who were close to their families. Men were only less desirable when women believed the men would increase a woman's carework responsibilities.ConclusionThis study reveals how family caregiving responsibilities have a noticeable and gendered impacted on older adults' experiences with repartnering. This study extends marriage market and marital search theories by highlighting the complicated and influential role of family, particularly family carework responsibilities, in older adults' opportunities and status on the dating and marriage market.

Exclusion of Older Adults from Cancer Clinical Trials: Review of the Literature and Future Recommendations

We currently still lack valid methods to dynamically measure resilience for stressors before the appearance of adverse health outcomes that hamper well-being. Quantifying an older adult's resilience in an early stage would aid complex decision-making in health care. Translating complex dynamical systems theory to humans, we hypothesized that three dynamical indicators of resilience (variance, temporal autocorrelation, and cross-correlation) in time series of self-rated physical, mental, and social health were associated with frailty levels in older adults. We monitored self-rated physical, mental, and social health during 100 days using daily visual analogue scale questions in 22 institutionalized older adults (mean age 84.0, SD: 5.9 years). Frailty was determined by the Survey of Health, Ageing and Retirement in Europe (SHARE) frailty index. The resilience indicators (variance, temporal autocorrelation, and cross-correlation) were calculated using multilevel models. The self-rated health time series of frail elderly exhibited significantly elevated variance in the physical, mental, and social domain, as well as significantly stronger cross-correlations between all three domains, as compared to the nonfrail group (all P < 0.001). Temporal autocorrelation was not significantly associated with frailty. We found supporting evidence for two out of three hypothesized resilience indicators to be related to frailty levels in older adults. By mirroring the dynamical resilience indicators to a frailty index, we delivered a first empirical base to validate and quantify the construct of systemic resilience in older adults in a dynamic way.

BackgroundTotal hip and knee arthroplasty are a highly performed surgery; however, patient satisfaction with surgery results and patient involvement in the decision-making process remains low. Patient decision aids (PtDAs) are tools used in clinical practices to facilitate active patient involvement in healthcare decision-making. Nonetheless, PtDA effects have not been systematically evaluated for hip and knee total joint arthroplasty (TJA) decision-making. The aim of this systematic review is to determine the effect of patient decision aids compared to alternative of care on quality and process of decision-making when provided to adults with hip and knee osteoarthritis considering primary elective TJA.MethodsThis systematic review will follow the Cochrane Handbook for Systematic Reviews. This protocol was reported based on the PRISMA-P checklist guidelines. Studies will be searched in CINAHL, MEDLINE, Embase, PsycINFO, and Web of Science. Eligible studies will be randomized control trial (RCT) evaluating the effect of PtDA on TJA decision-making. Descriptive and meta-analysis of outcomes will include decision quality (knowledge and values-based choice), decisional conflict, patient involvement, decision-making process satisfaction, actual decision made, health outcomes, and harm(s). Risk of bias will be evaluated with Cochrane’s risk of bias tool for RCTs. Quality and strength of recommendations will be appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE).DiscussionThis review will provide a summary of RCT findings on PtDA effect on decision-making quality and process of adults with knee and hip osteoarthritis considering primary elective TJA. Further, it will provide evidence comparing different types of PtDA used for TJA decision-making. This review is expected to inform further research on joint replacement decision-making quality and processes and on ways PtDAs facilitate shared decision-making for orthopedic surgery.Systematic review registrationPROSPERO CRD42020171334

BackgroundAccess to maternal healthcare services is an essential pre-requisite for improving women’s health. However, due to poor access and underutilization, women in developing countries remain vulnerable to various complications. Evaluation of quality maternal healthcare services in any country must include the opinions of the women being as a key stakeholder utilizing maternal healthcare services.AimThe present study was designed to evaluate the experiences, perceptions and expectations of pre-birth and post-birth women regarding utilization and delivery of maternal healthcare services in Pakistan.MethodologyA qualitative study design was used. Snow ball sampling technique was adopted to identify the respondents. Interviews were conducted using semi-structures interview guide till saturation point was achieved. The sample size at saturation point for different respondents was: pre-birth women (n = 9) and post-birth women (n = 9). All interviews were recorded after getting permission from the respondents. The interviews were transcribed verbatim and were then subjected to thematic analysis.ResultsThe age group for the pre-birth respondents was 23–43 years while for post-birth group it was 23–32 years. Most of the respondents from both groups were from urban setting. Most of them were either first time pregnant or were having experience of one pregnancy. Thematic analysis of the interviews yielded different themes and sub-themes including birth experience, maternal treatment pathway, identified barriers for quality maternal care, involvement in healthcare decision-making, impact of Covid 19, payment dynamics, role of digital health and recommendations for improving maternal care services.ConclusionThe results of the present study concluded that the overall quality of the maternal care services provided in Pakistan was not up to the mark. High rate of caesarian section was prevalent. Majority of the women were not involved in the decision-making process or provided with any birth plan or counselling regarding birth signs, family planning, danger and birth signs. The cost of maternal care was quite high and not affordable for all.