Minimising harm to older Victorians from heatwaves: A qualitative study of the role of community‐based health profession and carer organisations

Aim: To investigate the role of community‐based health profession and carer organisations in Victoria in minimising harm to older people from heatwaves. Methods: A qualitative study based on semistructured interviews was conducted in Victoria, Australia. Twelve people were interviewed, representing four professional groups that support the health of older Victorians who reside at home. Results: None of the health profession and carer organisations studied had formalised heatwave strategies; however, their staff conduct a range of activities before and during heatwaves that may reduce harm to older clients. Interviewees discussed roles their organisations could play in a heatwave response plan, including coordination, identification of high‐risk individuals and education. All saw a need for extra resources and training if responses to heatwaves were required more frequently. Conclusion: It may be feasible to utilise the existing services and infrastructure of community‐based health profession and carer organisations operating in Victoria within a State‐wide Heatwave Response plan; however, this will require extra resources, training and coordination.     

Asthma in the elderly

As the population increases in age, the diseases of older age will have increasing prevalence and place a greater burden on the health system. Despite asthma being usually considered a disease of younger people, asthma mortality is currently greatest in the over 55 age-group. Symptoms and emergency presentations for health care due to asthma place a great burden on the quality of life of those over age 55 with asthma. Asthma in older people is under-diagnosed due to patient and physiological factors. Medication strategies for asthma have been dominantly derived from younger cohorts so that effective medication strategies have usually not been explored in older people. Older people with asthma are very concerned regarding side effects of medication so that adherence to therapeutic regimes is often poor. In addition physical disability can lead to difficulty in accessing treatment and using inhaler devices. Practical strategies to improve asthma outcomes in older people have been studied infrequently and the goals of self-management suitable for younger age-groups may not be applicable in this group. Consequently, asthma in older people is deserving of further attention both to basic mechanisms of disease, precision in diagnosis and effective therapeutic strategies, including those that involve self-management and device use.     

Learning to Lead: Reflections from the Tideswell‐AGS‐ADGAP Emerging Leaders in Aging Program Scholars

The Tides well Emerging Leaders in Aging (ELIA) Program is a 1‐year leadership training program focused on developing a sustainable pipeline of leaders in aging who are poised to lead initiatives that will optimize the health of older people. The Tides well ELIA Program is jointly administered by the American Geriatrics Society, the Association of Directors of Geriatric Academic Programs, and Tides well at University of California, San Francisco (UCSF), a program within the Division of Geriatrics at UCSF. The ELIA Program prepares early to midcareer healthcare professionals in aging (scholars) for their transition into key leadership roles that involve one or more areas of patient care, education, and research. The program emphasizes the understanding of one's own and others' inherent work strategies and communication styles as integral to leading programs. Approximately 15 ELIA scholars are selected annually to participate in this interactive leadership development program. We conducted a qualitative analysis of program evaluations from 2015 to 2018 scholars (n = 47) to determine effectiveness and impact. All scholars (100%) completed the end‐of‐training survey. Scholars' satisfaction with the program is high. Scholars reported heightened leadership development and improvements in leadership skills, including communication, team building, and self‐awareness. Scholars also reported enhancement of personal leadership attributes that contributed to career advancement. The Tides well ELIA Program accelerates scholars' personal career development, positively impacts their institutions, and ultimately benefits older people. Sustaining leadership programs such as the Tides well ELIA Program is vital to ensure a continuous pipeline of leaders skilled in both advocating for and advancing the health of older Americans. J Am Geriatr Soc 67:434–436, 2019.     

Oral health beliefs and practices among Greek and Italian older Australians: A focus group approach

Introduction: The oral health of older Australians is a major public health challenge in the twenty‐first century. However, little is known about the oral health status and needs of older migrants. Aims: This paper uses a qualitative methodology to obtain a better understanding of the oral health meanings and experiences of Greek and Italian older migrants. Methods: Seventeen focus group discussions were conducted, made up of 172 participants, recruited from eight Italian and nine Greek elderly clubs in Melbourne. Results: Participants were aware of the major oral diseases and treatments available. The data suggests that, although they knew of the need for periodic dental check‐ups, there were barrier, which interfered with seeking check‐ups. Participants also held a number of false beliefs, and strong negative attitudes towards dentistry. Conclusion: If programs are to increase the use of oral health services, specific barriers, myths, false beliefs and negative attitudes must be addressed.     

Asthma: Time to confront some inconvenient truths

Despite major advances in the understanding of the pathogenesis of asthma and improvements in management, the accompanying benefits from public health initiatives and clinical practice have arguably been less than expected. For example, there are no effective public health strategies or treatment regimes that reduce the risk of developing asthma or influence its natural history. These represent priority areas for future translational research, which would need to investigate genetic and environmental interactions and vaccine strategies. In terms of asthma management it is tempting to focus on novel drug therapies; however, a case can be made that the priority is to undertake research that leads to improvements in the use of existing treatments through public health and primary care initiatives. Guidelines represent an important component of this approach, with recommendations for asthma imbedded within respiratory guidelines that can be implemented in the developing world where other acute and chronic respiratory disorders are common. This approach offers the best opportunity to close the gap between what is currently achieved in asthma management and that which is potentially achievable.     

Asthma management and outcomes in Australia: a nation-wide telephone interview survey

Background and objective: Asthma is a high‐burden disease for which effective treatment is available. In Australia, there has been a public health campaign directed at increasing the implementation of effective management with the aim of improving asthma outcomes. The aim of this study was to assess the burden of asthma and describe current asthma management in Australia. Methods: A computer‐assisted telephone interview survey was conducted in 2003/04 among randomly selected participants. Current asthma was defined as self‐reported asthma, confirmed by doctor, which was still present and/or associated with symptoms in the last 12 months. Results: From 46 855 eligible telephone numbers dialled there were 14 271 (30.5%) responses to the screening questionnaire. Among 1734 respondents with current asthma, 1205 (69.5%) completed the detailed questionnaire. Among these, 24.2% of adults and 14.3% children had symptoms during the day or night on most days; 11.3% of adults and 6.0% of children avoided exercise because of asthma symptoms during exercise and 19.4% of adults and 29.7% of children had sought urgent medical care because of an exacerbation of asthma during the preceding year. Among adults with asthma, only 35.6% with daily symptoms and 41.4% with symptoms on most days were taking inhaled steroids. Only 31.1% of adults with daily symptoms had a written asthma action plan. Conclusion: Compared with similar international studies, this study revealed a lower prevalence of frequent asthma symptoms and a higher prevalence of use of inhaled steroids among people with asthma. However, there remains ample scope for improvement in management of patients with frequent symptoms.     

“My Older Clients Fall Through Every Crack in the System”: Geriatrics Knowledge of Legal Professionals

With the number of older adult arrestees and prisoners increasing rapidly, legal professionals increasingly provide front‐line identification and response to age‐related health conditions (including cognitive and physical impairments) that may affect legal outcomes, such as the ability to participate in one's defense or stay safe in jail. The goals of this study were to assess the ability of legal professionals to recognize and respond to age‐related conditions that could affect legal outcomes and to identify recommendations to address important knowledge gaps. This was a mixed quantitative–qualitative study. Legal professionals (N = 72) in the criminal justice system were surveyed to describe their demographic characteristics, expertise, and prior aging‐related training and to inform the qualitative interview guide. Those surveyed included attorneys (district attorneys (25%), public defenders and legal advocates (58%)), judges (6%), and court‐affiliated social workers (11%). In‐depth qualitative interviews were then conducted with a subset of 10 legal professionals who worked with older adults at least weekly. Results from the surveys and interviews revealed knowledge deficits in four important areas: age‐related health, identification of cognitive impairment, assessment of safety risk, and optimization of services upon release from jail. Four recommendations to close these gaps emerged: educate legal professionals about age‐related health, train professionals to identify cognitive and sensory impairment, develop checklists to identify those at risk of poor health or safety, and improve knowledge of and access to transitional services for older adults. These findings suggest that geriatrics knowledge gaps of legal professionals exist that may contribute to adverse medical or legal outcomes for older adults involved in the criminal justice system and that partnerships between healthcare and legal professionals are needed to address these challenges.     

Cold‐related respiratory symptoms in the general population

Introduction: Cold‐related respiratory symptoms are common among northern populations, especially among people suffering from respiratory diseases. However, the prevalence of such symptoms in the general population and the threshold temperatures at which the symptoms start to emerge are poorly known. Objectives: The present study determined the prevalence and threshold temperatures of self‐reported respiratory symptoms related to cold, separately for healthy people and those with respiratory disease. Materials and Methods: Six thousand five hundred ninety‐one men and women aged 25 years–74 years from the national FINRISK study were queried about cold‐related respiratory symptoms. The results were expressed as age‐adjusted prevalence figures and coefficients from multivariate regressions. Results: Cold‐related respiratory symptoms were more often reported by people with asthma (men 69%/women 78%) and by subjects with chronic bronchitis (65%/76%) than the healthy subjects (18%/21%). A binomial regression showed an increase of symptom prevalence by age and excesses of 4%, 50% and 21% units because of female sex, asthma and chronic bronchitis, respectively. The reported threshold temperature for cold‐related symptoms was ?14°C for males and ?15°C for females, and it showed some increase by age (0°C–5°C), asthma (2°C) and chronic bronchitis (3°C). The threshold temperature for mucus production was exceptional as it decreased by age (2°C–5°C) and asthma (2°C). The effects of smoking and education were marginal. Conclusion: Cold‐related respiratory symptoms are common in patients with chronic respiratory diseases, but they start to emerge at relatively low temperatures. In a cold climate, the cold‐related symptoms may have an impact on the health‐related quality of life. Please cite this paper as: Harju T, Mäkinen T, Näyhä S, Laatikainen T, Jousilahti P and Hassi J. Cold‐related respiratory symptoms in the general population. The Clinical Respiratory Journal 2010; 4: 176–185.     

Rheumatic diseases and sexuality: Disease impact and self-management strategies

Objective

To explore how intimate relationships and sexuality are influenced by rheumatic diseases and to describe self‐management strategies used to manage disease consequences.

Methods

To ensure that data were grounded in patients' language and experiences, individual and focus group interviews were conducted. Purposeful sampling was used to ensure variation in age, sex, disease duration, diagnosis, and marital status among the informants. Participants were men and women ages 18 years or older, were diagnosed with inflammatory rheumatic disease by a rheumatologist, and had a disease duration of ≥2 years.

Results

The mean age of the 23 participants was 44 years, the mean disease duration was 13.6 years, and the mean ± SD modified Health Assessment Questionnaire score was 1.58 ± 0.46. Four key themes summarized the main issues described by the informants: between disease and normality, relational aspects, disease‐related sexual challenges, and self‐management strategies. The results reveal that the disease constituted a disruption in life, requiring a new orientation of sexual identity and relationship. Participants' experiences of sexuality went beyond specific sexual activity, including aspects such as body image and relational issues, illustrating a multidimensional perception of sexuality. A large inter‐ and intrapersonal variety of impact and a wide range of management strategies were reported.

Conclusion

This study shows that sexuality is a vital area of life for people living with arthritis. It is a source of physical pleasure and intimacy with their partner, but may cause anxiety and distress when affected by rheumatic disease. However, various self‐management strategies are applied to enhance intimate relationships and sexual activity. Knowledge and openness concerning sexual issues need to be emphasized as part of the competence of health professionals and researchers.     

COVID‐19 and older people in Asia: Asian Working Group for Sarcopenia calls to action

The coronavirus disease 2019 (COVID‐19) pandemic has casted a huge impact on global public health and the economy. In this challenging situation, older people are vulnerable to the infection and the secondary effects of the pandemic and need special attention. To evaluate the impacts of COVID‐19 on older people, it is important to balance the successful pandemic control and active management of secondary consequences. These considerations are particularly salient in the Asian context, with its diversity among countries in terms of sociocultural heritage, healthcare setup and availability of resources. Thus, the Asian Working Group for Sarcopenia summarized the considerations of Asian countries focusing on responses and difficulties in each country, impacts of health inequity related to the COVID‐19 pandemic and proposed recommendations for older people, which are germane to the Asian context. More innovative services should be developed to address the increasing demands for new approaches to deliver healthcare in these difficult times and to establish resilient healthcare systems for older people. Geriatr Gerontol Int 2020; 20: 547–558 .     

Sub-optimal patient and physician communication in primary care consultations: its relation to severe and difficult asthma.

INTRODUCTION: Asthma control can be influenced by a range of non-medical issues, including psychosocial factors. Little is known about the views of patients, particularly those with severe and/or difficult asthma, towards their asthma control and their asthma-related primary care consultations. AIMS AND OBJECTIVES: To explore patients' experiences of their asthma and primary care asthma consultations in order to identify target areas for intervention. METHODS: This was a qualitative study of 14 asthma patients based in grounded theory. Questions were asked about: asthma understanding; control issues; and interactions with primary care health professionals. Data were analysed using the constant comparative method and framework approach. RESULTS: Participants with severe and/or difficult asthma normalised control issues, were reluctant to discuss non-medical factors with healthcare professionals (HCPs), reported poorer communication with HCPs, and were reluctant to raise relevant but non-medical factors in the consultation. CONCLUSIONS: Our data identifies that patients, particularly those with severe and/or difficult asthma and poor control, underplay symptoms and do not discuss non-medical factors which may impact on asthma control in primary care consultations. This poor communication is associated with patients underestimating disease severity and/or what could be achieved in terms of disease control. Training HCPs in the use of patient-centred communication skills may optimise asthma management in primary care.     

Managing depression in patients with vision impairment: A descriptive study of practitioners' beliefs and confidence

Aim: Depression is common in older adults with vision impairment yet it often remains unidentified and untreated. Eye health professionals (EHPs) and rehabilitation workers (RWs) may be able to assist in detecting depression. This study identified EHPs' and RWs' beliefs about depression and confidence in working with patients with vision impairment and depression. Methods: A self‐administered cross‐sectional survey of 94 EHPs and RWs assessed beliefs about the symptoms and treatment for depression, and confidence in working with depressed people with vision impairment. Results: Participants showed awareness of both the symptoms and treatment options for depression. However, some important misconceptions were identified and many symptoms of depression were commonly attributed to vision loss. Participants lacked confidence in communicating about depression with patients and their families. Conclusions: Training programs are needed to enable EHPs and RWs to confidently identify depression and discuss appropriate treatment and referral options with their patients.     

Incidence and prevalence of adult asthma is associated with low socio‐economic status

Background: Low socio‐economic status is often related to health problems; however, previous studies on asthma, usually cross‐sectional, yield inconsistent results. In this study, longitudinal and cross‐sectional data on the association between socio‐economic status and asthma as well as respiratory symptoms among adults are presented. Methods: A postal questionnaire was sent on two occasions, 1996 and 2006, to a randomly selected sample of subjects aged 20–69 years in 1996. In total, 4479 subjects participated in both surveys. The questionnaire included questions on asthma, respiratory symptoms and possible determinants. Logistic regression analysis, adjusted for potential confounders, was used to study the association between asthma, respiratory symptoms and socio‐economic status. Results: Manual workers in service had the highest prevalence and cumulative incidence for all investigated symptoms and asthma. Despite a large decrease in smokers, the increase in incident bronchitic symptoms was higher than the increase of incident asthma and incident asthmatic symptoms. Low socio‐economic status, rhinitis and a family history of asthma were risk factors for having and developing asthma and respiratory symptoms. Conclusion: Low socio‐economic status is significantly associated with an increased risk for prevalent and incident asthma and respiratory symptoms in this longitudinal population‐based survey. The increase in risk was most pronounced in manual workers. Several studies have recently shown an association between low socio‐economic status and respiratory symptoms and we conclude that asthma can not be considered as a disease that mainly affects the middle and upper socio‐economic classes. Please cite this paper as: Ekerljung L, Sundblad B‐M, Rönmark E, Larsson K and Lundbäck B. Incidence and prevalence of adult asthma is associated with low socio‐economic status. The Clinical Respiratory Journal 2010; 4: 147–156.     

Effects of Pet Ownership on the Health and Well‐being of Older People

Objective : To examine the view that having a pet is good for the health and well‐being of older people, particularly those who are socially isolated. Method : Benefits and disadvantages of owning a pet were explored in two studies. Data from the Health Status of Older People project were used to compare the health, health behaviours and well‐being of those who owned and did not own pets. In addition, twenty older people were interviewed in‐depth about pet ownership and its impact on their lives. Results : Few health or well‐being outcomes were predicted by pet ownership. Having a pet did not compensate for social isolation. The qualitative data largely substantiate and provide possible explanations for the survey findings. Conclusion : Pets may have some limited value in promoting health and well‐being in older people.     

Life with communication changes in Parkinson's disease

BACKGROUND: Acoustic and perceptual changes to speech in Parkinson's disease (PD) have been widely studied. Little empirical evidence exists concerning the individual's own perception of changes, the impact these have on their life and coping strategies to deal with them. OBJECTIVE: To establish if, and how, changes in communication impact on the lives of people with PD. DESIGN: In-depth interviews with qualitative analysis of content. SETTING: Community. SUBJECTS: Twenty-three men and 14 women with PD. METHODS: Participants were purposively sampled to give a mix of men, women, family circumstances, stage and duration of PD and severity of speech symptoms. Individuals were interviewed at home. Interviews were transcribed. Emergent themes were identified and fed back to participants for confirmation and clarification. RESULTS: Participants identified changes to voice and articulation. Language changes featured prominently. Four impact themes: (i) interaction with others, (ii) problems with conversations, (iii) feelings about intelligibility and (iv) voice; and four corresponding coping themes (a) helping others understand, (b) managing conversations, (c) monitoring and adjusting and (d) physical strategies emerged. Of main concern was not the nature of speech-voice-language changes, but how these affected self-concept, participation inside and outside the family and family dynamics. Individuals employed a range of fluid coping strategies moving from background withdrawal to foreground striving strategies. CONCLUSIONS: Speech and language changes in PD impact upon individual and family life long before frank impairment of intelligibility is apparent. The role of early referral to speech and language therapy is therefore worthy of detailed investigation.     

Addressing weight bias and discrimination: moving beyond raising awareness to creating change

Weight discrimination is the unjust treatment of individuals because of their weight. There have been very few interventions to address weight discrimination, due in part to the lack of consensus on key messages and strategies. The objective of the third Canadian Weight Bias Summit was to review current evidence and move towards consensus on key weight bias and obesity discrimination reduction messages and strategies. Using a modified brokered dialogue approach, participants, including researchers, health professionals, policy makers and people living with obesity, reviewed the evidence and moved towards consensus on key messages and strategies for future interventions. Participants agreed to these key messages: (1) Weight bias and obesity discrimination should not be tolerated in education, health care and public policy sectors; (2) obesity should be recognized and treated as a chronic disease in health care and policy sectors; and (3) in the education sector, weight and health need to be decoupled. Consensus on future strategies included (1) creating resources to support policy makers, (2) using personal narratives from people living with obesity to engage audiences and communicate anti‐discrimination messages and (3) developing a better clinical definition for obesity. Messages and strategies should be implemented and evaluated using consistent theoretical frameworks and methodologies.     

Ageing in place: Implications of morbidity patterns among older persons – findings from a cross‐sectional study in a developing country (Jamaica)

Aim: This paper describes morbidity patterns among older people, relevant health‐care resources in a localised population in a developing country (Jamaica) and implications for ageing in place in the community. Methods: Local morbidity patterns among older people were determined in Jamaica from a 2007 cross‐sectional study involving record searches at major hospitals and clinics. Age‐specific morbidity distributions were compiled. Data on health‐care staff complement were also collected. Results: Non‐communicable diseases predominate in older people in Jamaica; 50% of diagnoses related to cardiovascular disorders and diabetes. Staff‐to‐population ratios were low compared with other international data. Conclusion: A high prevalence of non‐communicable disease coupled with inadequate staffing threatens the likelihood of ageing in place in the Jamaican community. Secondary prevention efforts and social support services which enhance ageing in place are needed.     

“…I've said I wish I was dead,you'd be better off without me”: A systematic review of people's experiences of living with severe asthma

Objective: Our aim was to conduct a systematic review and synthesis of qualitative evidence exploring the lived experience of adults with severe asthma. Data sources: We searched MEDLINE via OvidSP, PsycINFO via OvidSP, PubMed, CINAHL, EMBASE, Sociological Abstracts, Google Scholar, the journals Qualitative Health Research and Qualitative Research, and a study of experiences of living with asthma by the Health Experiences Research group. Study selections: Studies were included if they used qualitative methods and explored the subjective experiences of adults (≥18 years) with a clear diagnosis of severe asthma. Results: From 575 identified studies, five met the inclusion criteria. Synthesis revealed an overarching theme of efforts that people living with severe asthma engage in to achieve personal control over their condition. Individuals ‘strive for autonomy’ through dealing with symptoms and treatment, acquiring knowledge, making decisions and reclaiming identity. Conclusion: This systematic review found a paucity of qualitative studies reporting on people's perspectives of living with severe asthma, and a focus on clinical rather than personal issues. Our synthesis reveals that severe asthma was disempowering, and a threat to identity and life roles. What was important to people living with severe asthma was striving to achieve a greater level of personal control over their condition, but these efforts received little support from their healthcare providers. Thus, more attention should be paid to understanding the self-management strategies and personal goals of people living with severe asthma. This may assist in designing interventions to better support patient self-management and improve health outcomes.     

Psychosocial factors associated with fall-related hip fractures

BACKGROUND: fall-related injuries in older people are a major public health concern. This study examined the relationship between psychosocial determinants of healthy ageing and risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for promotion of healthy ageing strategies in population-based interventions for fall injury prevention. METHODS: a case-control study was conducted with 387 participants, with at least two controls recruited per case. Cases of fall-related hip fracture in community-dwelling people aged 65 and older were recruited from hospital admissions in Brisbane, Australia, in 2003-2004. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire assessing psychosocial factors, identified as determinants of healthy ageing, was administered at face-to-face interviews. RESULTS: psychosocial factors having a significant independent protective effect on hip fracture risk included being currently married [OR: 0.44 (0.22 to 0.88)], living in present residence for 5 years or more [OR: 0.43 (0.22 to 0.84)], having private health insurance [OR: 0.49 (0.27 to 0.90)], using proactive coping strategies [OR: 0.52 (0.29 to 0.92)], having a higher level of life satisfaction [OR: 0.47 (0.27 to 0.81)], and engagement in social activities in older age [OR: 0.30 (0.17 to 0.54)]. CONCLUSION: this study suggests that psychosocial determinants of healthy ageing are protective in fall-related hip fracture injury in older people. Reduction in the public health burden caused by this injury may then be achieved by implementing healthy ageing strategies involving community-based approaches to enhance the psychosocial environments of older people.     

Delivery of prevention and care to asthmatic children

Asthma-induced mortality increases especially among children; asthma induced morbidity impairs their day-to-day life as well as both their physical and psychological development. The treatment of asthma in children should reduce their symptoms. Although asthma medication appears to be efficient in clinical trials such is not the case in clinical practice and public health. The use of drugs and services depends upon the severity of the disease as well as upon cultural, personal and familial factors. These factors are crucial in the spontaneously inconsistent evolution of this disease. The management of asthmatic children should thus aim: 1) to alter behaviors—of both the patients and their parents who are often in charge of the treatment on a day-to-day basis and of the physician in order to organize a comprehensive therapeutic project for the sick children; 2) to enhance the collaboration between the different paramedical people involved in the treatment; 3) to improve the efficiency of the health system to allow it to achieve its goal of providing high-standard, accessible health care.