Health,communication, and aging: cancer and older adults

The diagnosis of cancer is devastating to the patient as well as to the formal and informal relationship support networks of the individual who must now cope with the disease. This article highlights the significant interpersonal communication and relationship issues that affect the overall quality of life for an older individual who has been diagnosed with cancer. Scholars who study the interpersonal behavior of older adults and those who study the consequences of a devastating diagnosis within the overall health communication context can make a significant contribution to our understanding of the process of cancer communication. Not only is the diagnosis of cancer life changing for the patient, but it also changes the dynamics of each relationship between the older adult who has cancer and those who will help to care for the cancer patient both in a formal institutional setting and at home. Our understanding of communication and aging for healthy as well as ill individuals can help us to better predict and explain the complexities of cancer communication.     

A study of attitudes toward medical care and health behaviors among older adults

In order to understand the attitudes of older adults toward medical care, we interviewed 480 persons living in Yokohama, and 180 persons living in Aikawa, Kanagawa, aged 45 to 84 years old. The following results were obtained; 1) Attitudes toward medical care can be classified into four types; self-determined medical care, self treatment attitudes, high dependence on the medical care system, and distrust of medical care. Those interviewees who had high self-determination in medical care and self treatment attitudes showed strong distrust of medical care. 2) There were two groups with trend toward low compliance to the advice of a physician for a physician diagnosed illness: the group that had strong self-determination in medical care, and the group that had high distrust of medical care. The interviewees who had a strong tendency to see a physician for potentially serious illness had high self treatment attitudes, but disease prevention behaviors was not associated with all of four types. 3) In both communities, those interviewees who were younger and with higher educational levels showed strong distrust of medical care and had more self-determination attitudes. Those interviewees who had actually experienced problems in medical treatment showed less dependence on medical care and more distrust of medical care compared to those who had not. In Yokohama, distrust of medical care appeared to be higher among those interviewees who did not have a family doctor than those who had. 4) Distrust of medical care and self-determination in medical care was significantly higher in Yokohama than in Aikawa. The differences in the distribution of educational level and family doctors were a part of the reason for area differences in attitudes of distrust of medical care.     

Assessing the effectiveness of interventions to promote advance directives among older adults: a systematic review and multi-level analysis

Many studies have investigated the effectiveness of interventions in promoting advance directives (ADs) but there is uncertainty as to what works best, and in whom. We conducted a systematic review of the evidence in this regard, using both classical meta-analysis approaches and multi-level analyses. Eleven databases were searched for relevant reports published through March 2007. All prospective studies were eligible, whether involving a single group or several and, in the latter case, regardless of the allocation mechanism. Outcomes included formal and informal ADs assessed by chart review or self-report. Heterogeneous sets of outcomes were pooled under a random-effects model. The search yielded 55 studies, half of which targeted outpatients. Most groups of subjects were educated in a single session led by one healthcare professional. Outcomes were measured within six months of the intervention in 73% of cases. The largest set of single-arm studies yielded an overall AD completion rate of 45.6%. Across randomized trials, the largest pooled odds ratio was 4.0, decreasing to 2.6 when all comparative studies were included. Multi-variable analyses identified the provision of oral information over multiple sessions as the most successful intervention. This was true regardless of the target population. These findings support the effectiveness of educational interventions in increasing the formulation of ADs and provide practical advice on how best to achieve this goal.     

Development of the patient approach and views toward healthcare communication (PAV-COM) measure among older adults

ABSTRACT: BACKGROUND: This study examines the psychometric properties of 9 items on the Patient Activation component of the Medicare Current Beneficiary Survey (MCBS) that assess how patients approach and communicate with their physicians. The MCBS is a nationally representative, cross-sectional survey of Medicare beneficiaries. METHODS: We analyzed MCBS data collected in 2002 and 2005 from 15,165 adults aged 65 and older. Exploratory factor analysis was conducted using maximum likelihood to estimate a polychoric correlation matrix on the 2002 data, and confirmatory factor analysis was performed using the 2005 data. RESULTS: Exploratory factor analysis of the 2002 data showed a 2-factor solution: approach to interactions (5 items) and views about physician's healthcare communication (6 items). Findings were confirmed using the 2005 data. Items were combined to form the Patient Approach and Views toward Healthcare Communication (PAV-COM) scale (range 1 to 100; Cronbach's alpha of 0.75, and item-rest correlations between 0.33 and 0.54). Higher PAV-COM scores were associated with greater fulfillment of preventive health behaviors such as vaccinations and cancer screenings. CONCLUSIONS: The PAV-COM measure is a valid tool for assessing patient approaches and views toward communication with physicians. This measure can be used to evaluate interventions to improve patient participation during healthcare encounters.     

Satisfaction with oncology care among patients with advanced cancer and their caregivers

Purpose

Satisfaction with care is important for quality assurance in oncology, but may differ between patients and caregivers. We aimed to assess satisfaction with cancer care in paired analyses of these groups, examine differences between them, and identify areas for potential intervention.

Methods

Patients with advanced cancer and their caregivers were recruited from 24 medical oncology outpatient clinics. Satisfaction with care was measured using the FAMCARE (caregivers) and FAMCARE-Patient (patients) scales. Quality of life (QOL) was measured with the Caregiver QOL Index-Cancer (caregivers) and FACIT-Sp (patients). The paired t test assessed differences in overall satisfaction and individual scores. In addition, scores were dichotomized into satisfied versus not satisfied, and McNemar’s test was used to assess differences. Multivariable linear regression analyses assessed predictors of patient and caregiver satisfaction, respectively.

Results

Satisfaction ratings in the 191 patient–caregiver pairs were high, but patients were more satisfied (p = 0.02). Both groups were least satisfied with information regarding prognosis and pain management. Caregivers were significantly less satisfied than patients regarding coordination of care (p = 0.001) and family inclusion in treatment/care decisions (p < 0.0001). In both groups, higher education was associated with lower satisfaction (p ≤ 0.01), while better QOL predicted greater satisfaction (p < 0.0001).

Conclusions

Communication regarding pain control and prognosis were identified as key areas for improvement. Caregivers seem to desire greater involvement in treatment decisions, though this must be balanced with patient autonomy.     

Art intervention among Finnish older people and their caregivers: Experiences of art pedagogies

The benefits of art therapies on older people's health have been well documented. However, studies into the perspectives of pedagogues on conducting arts interventions are scarce and no empirical evidence of the views of professional pedagogues views have been published to date. In this study, seven professional art pedagogues were interviewed using a thematic interview approach focusing on the pedagogues’ experiences of conducting arts interventions with a family caregiver and care recipient dyads. The interviews were analysed inductively using thematic content analysis. According to the analysis, three intersecting themes were found that both steered the pedagogical process and emerged from the process: holistic pedagogy, professional development and witnessing. The themes revealed a further understanding of approaches to the interviewees’ teaching and the value of participatory community arts in practice. The pedagogues’ experiences encourage art pedagogy to be acknowledged in a wider context within communities and healthcare environments. Further studies on interdisciplinary projects in collaboration with art pedagogues and healthcare professionals are encouraged.     

Vaccination coverage among older adults: a population-based study in India

ObjectiveTo estimate the prevalence and explore the predictors of vaccine uptake among older adults in India.MethodsWe used data from the national Longitudinal Ageing Study in India, a national household survey conducted during 2017–2018. Based on interviewees’ self-reports, we calculated population-weighted estimates of the uptake of influenza, pneumococcal, typhoid and hepatitis B vaccines among 64 714 Indian adults aged 45 years or older. We performed multivariable binary logistic regression analysis to examine the sociodemographic and health-related predictors of uptake of the vaccinations.FindingsThe coverage of each of the studied vaccinations was less than 2%. The estimated percentages of respondents reporting ever being vaccinated were 1.5% (95% confidence interval, CI: 1.4–1.6) for influenza, 0.6% (95% CI: 0.6–0.7) for pneumococcal disease, 1.9% (95% CI: 1.8–2.0) for typhoid and 1.9% (95% CI: 1.8–2.0) for hepatitis B. Vaccine uptake was higher among respondents with cardiovascular disease, diabetes or lung disease than those without any of these conditions. Uptake of influenza vaccine was higher among those with lung disease, while hepatitis B vaccine uptake was higher among those with cardiovascular disease or diabetes. Male sex, urban residence, wealthier household, more years of schooling, existing medical conditions and sedentary behaviours were significant predictors of vaccine uptake.ConclusionTargeted policies and programmes are needed for improving the low vaccination coverage among older adults in India, especially among those with chronic diseases. Further research could examine vaccine access, vaccine hesitancy, and vaccine-related information and communication channels to older adults and their health-care providers.     

上海市中老年社区居民对性教育态度及相关因素分析

目的 了解上海市中老年社区居民对性教育的态度及其相关因素。方法 2020年6月至2022年12月,通过多阶段抽样方法,对上海市≥50岁中老年社区居民开展一项横断面调查。样本量估计数为735人。问卷包括社会人口学特征、健康特征、性教育史等相关信息。采用多因素logistic回归模型分析中老年社区居民对性教育态度的相关因素。结果 研究对象824人中,男性489人,女性335人,年龄（65.1±8.1）岁,年龄范围为60~69岁（45.3%）。49.4%的参与者支持在中老年人群中开展性教育（男性：45.2%;女性：55.5%）。多因素logistic回归分析结果显示,男性（aOR=0.61,95%CI：0.44~0.83）、≥70岁（aOR=0.62,95%CI：0.40~0.94）、城镇居民（aOR=2.54,95%CI：1.81~3.58）、自评健康状况为好/非常好（aOR=1.64,95%CI：1.04~2.58）、有抑郁症状（aOR=0.37,95%CI：0.15~0.85）、接受过性教育（aOR=8.64,95%CI：4.62~17.70）与其对性教育的态度有关。结论 上海市中老年社区居民中支持性教育的比例不高。该人群对性教育的态度与自评健康状况、抑郁症状、性教育史相关,专业医疗人员或医疗机构应着重关注具有关键特征的中老年社区居民,定制化干预以期提高我国中老年居民性健康教育支持意愿,促进性教育在该人群中的普及。     

Long-term mortality among older adults with burn injury: a population-based study in Australia

Objective

To assess if burn injury in older adults is associated with changes in long-term all-cause mortality and to estimate the increased risk of death attributable to burn injury.

Methods

We conducted a population-based matched longitudinal study – based on administrative data from Western Australia’s hospital morbidity data system and death register. A cohort of 6014 individuals who were aged at least 45 years when hospitalized for a first burn injury in 1980–2012 was identified. A non-injury comparison cohort, randomly selected from Western Australia’s electoral roll (n = 25 759), was matched to the patients. We used Kaplan–Meier plots and Cox proportional hazards regression to analyse the data and generated mortality rate ratios and attributable risk percentages.

Findings

For those hospitalized with burns, 180 (3%) died in hospital and 2498 (42%) died after discharge. Individuals with burn injury had a 1.4-fold greater mortality rate than those with no injury (95% confidence interval, CI: 1.3–1.5). In this cohort, the long-term mortality attributable to burn injury was 29%. Mortality risk was increased by both severe and minor burns, with adjusted mortality rate ratios of 1.3 (95% CI: 1.1–1.9) and 2.1 (95% CI: 1.9–2.3), respectively.

Conclusion

Burn injury is associated with increased long-term mortality. In our study population, sole reliance on data on in-hospital deaths would lead to an underestimate of the true mortality burden associated with burn injury.     

Assessing the association of walking with health services use and costs among socioeconomically disadvantaged older adults

BACKGROUND: The costs of physical inactivity are beginning to be recognized. Research to pinpoint these costs will provide needed information for researchers and policy-makers to develop cost-effective physical activity promotion programs. We present the association of walking with health services use and costs within a sample of 695 older, urban primary care patients. METHODS: A survey provided most data, but utilization and cost data were obtained from a medical records system. Multivariate models were developed to assess the association of walking with health services use and costs, adjusting for sociodemographic characteristics, chronic disease, health status, and previous utilization. RESULTS: Thirty-eight percent of respondents reported walking 0 minutes per week, 49% walked 1 to 119 minutes, and 13% walked 120 minutes or more. In the multivariate analyses, a report of walking 120 or more minutes was associated with a lower risk of emergency room visit and hospital stay in the subsequent year. No association was found between walking and primary care visits and total cost. CONCLUSION: These analyses suggest an association of walking 120 minutes or more with decreased emergency room visits (OR = 0.5, P = 0.046) and hospital stays (OR = 0.6, P = 0.034). This suggests that physical activity promotion among socioeconomically disadvantaged older adults has the potential to provide cost savings. This will not be known, however, until physical activity can be promoted and maintained among these adults.     

Disability in the individual ADL,IADL, and mobility among older adults: A prospective cohort study

Objectives

To examine the risk of disability in 15 individual ADL, IADL, and mobility in older adults by age; and to assess the association of multimorbidity, gender, and education with disability.

Design & Setting

A prospective cohort study. The sample included 805 community-dwelling older people aged 60+ living in the Netherlands.

Measurements

Disability was assessed using the Katz-15 Index of Independence in Basic Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and one mobility item. Disability in any of these activities was defined as the inability to perform the activity without assistance. The risk of disability by age for each individual ADL, IADL, and for mobility was assessed using Generalized mixed models.

Results

Disability in activities as household tasks, traveling, shopping, and continence had the highest risk and increased rapidly with age. The risk traveling disability among people aged 65 with two comorbidities increase from 9% to 37% at age 85. Disability in using the telephone, managing medications, finances, transferring, and toileting, had a very low risk and hardly increased with age. Compared to those without chronic conditions, those with ≥ 3 chronic conditions had a 3 to 5 times higher risk of developing disability. Males had a higher risk of disability in managing medication (P=0.005), and preparing meals (P=0.019), whereas females had a higher risk of disability with traveling (P=0.001). No association between education and disability on the individual ADL, IADL, and mobility was observed.

Conclusions

Older adults were mostly disabled in physical related activities, whereas disability in more cognitive related activities was less often experienced. The impact of multimorbidity on disability in each activity was substantial, while education was not.

     

Everyday technology use among older adults in Sweden and Japan: A comparative study

Abstract

Background: As context may impact everyday technology (ET) use it is relevant to study this within different contexts.

Aims: To examine the usefulness of the Everyday Technology Use Questionnaire (ETUQ) in different contexts by investigating and comparing (1) the level of challenge of ETs in the ETUQ and (2) the relevance of and perceived ability to use ET in samples of Swedish and Japanese older adults.

Materials and methods: The Swedish and the Japanese samples (n?=?86/86) were interviewed using the ETUQ about relevance of and perceived ability to use ET. Data were analyzed using Rasch analysis, chi square and a general linear model. Moreover, Differential Item Functioning (DIF) was investigated.

Results: The hierarchy of ETs’ level of challenge was generally stable in the two contexts. On group-level, the relevance was somewhat higher and the perceived ability to use ET significantly higher in the Swedish sample than in the Japanese.

Conclusions and significance: The similarities and differences between the technological landscapes of Sweden and Japan could be detected by ETUQ, demonstrating its usefulness in both countries. The potential causes to the differences in relevance of and perceived ability to use ET between older adults in Sweden and Japan need further exploration.     

Change in quality of life among community-dwelling older adults: population-based longitudinal study

Quality of Life Research - This population-based study aimed to determine 5-year change in multidimensional QoL among community-dwelling older people, and to identify predictors of QoL change among...     

A pilot study of Trabajadora de salud,a lay health worker intervention for Latinas/os with traumatic brain injuries and their caregivers

Background

Latinas/os with traumatic brain injuries (TBIs) and their caregivers experience worse outcomes than others.

中国听力残疾老年人生活自理能力影响因素分析

目的分析中国听力残疾老年人生活自理能力现状及其影响因素。方法运用2006年第二次全国残疾人抽样调查数据,以≥60岁单纯听力残疾者为研究对象,对听力残疾的老年人基础性生活自理能力现状进行描述性分析,运用多因素logistics回归对听力残疾的老年人生活自理能力相关因素进行分析。结果中国≥60岁听力残疾老年人生活不能自理率为23.62%。多因素logistics回归分析结果显示,年龄越高听力障碍残疾等级越高(极重度OR=2.97,95%CI=2.68~3.29)、家庭人均户收入低于等于国家平均水平听力障碍老年人发生生活不能自理的风险越高(OR=1.17,95%CI=1.08~1.28);居住在农村(OR=0.86,95%CI=0.79~0.95)、所在地为东部(OR=0.59,95%CI=0.55~0.63)、受教育程度高(高中及以上OR=0.62,95%CI=0.53~0.72)听力障碍老年人发生生活不能自理的风险越低。结论个体因素和环境因素构成的情境因素与听力残疾老年人活动受限密切相关,影响其日常生活功能。     

Zarit burden interview among caregivers of community-dwelling older adults in a caribbean setting (Jamaica): Reliability and factor structure

The Zarit Burden Interview has been the most popularly used tool for measuring caregiver burden and with the 60 years and over population in Jamaica and developing countries expected to increase, caregiver burden and its assessment assume increased importance. Establishing the reliability and underlying factor structure of instruments such as the ZBI is critical. This study sought to determine the reliability of the Zarit Burden Interview and to assess its underlying factor structure. The ZBI was administered to 180 caregivers of community dwelling older persons in Jamaica in a nationally representative sample across four geographic health regions in 2016. The factor structure was identified using exploratory factor analysis (EFA) with Varimax rotation. Cronbach's alpha was used to assess internal consistency/reliability of the instrument. The internal consistency/reliability of the ZBI instrument was high (Cronbach's α = 0.859) and the corrected item-total correlations ranged from 0.134 to 0.730. The ZBI mean score was found to be 16.92 ± 12.04. EFA produced a six-factor model comprised of 19 items which explained 48.97% of total variance, and was subsequently reduced to four (37.27% of total variance) via the use of parallel analysis and scrutiny of confidence intervals. The four factors identified were ‘personal strain’, ‘social relations disruption’, ‘resource strain/imbalance’ and ‘role intensity’. The ZBI-22 tool is a reliable instrument for evaluating caregiver burden among community dwelling older persons in Jamaica. A four factor model has emerged providing greater insights on the underlying constructs of the ZBI, the most widely used caregiver burden assessment tool.     

Self-medication behaviors among Japanese consumers: sex,age, and SES differences and caregivers’ attitudes toward their children’s health management

Insomnia is a common public health problem and the prevalence and impact of insomnia in primary care attendees is not well documented in the Asian population. To determine the prevalence of self-reported insomnia symptoms amongst adult primary care attendees and the association with socio-demographic factors; to ascertain the impact of insomnia on daily functioning and to describe the psychological profile of patients with insomnia. In this cross-sectional survey, 2049 adult patients (≥18 year old) attending seven primary care clinics in Peninsular Malaysia, completed the questionnaire asking about symptoms of insomnia (defined according to the International Classification of Sleep Disorders and DSM IV criteria) daytime impairment and psychological symptoms (assessed by Hospital Anxiety and Depression Scale). The response rate was 86.2%. A total of 60% reported insomnia symptoms, 38.9% had frequent insomnia symptoms (>3 times per week), 30.7% had chronic insomnia without daytime consequences and 28.6% had chronic insomnia with daytime dysfunction. Indian ethnicity (OR 1.79; 95%CI, 1.28-2.49), age ≥ 50 or older (OR 1.82; 95%CI, 1.10-3.01), anxiety symptoms (OR 1.65; 95%CI, 1.21-2.22) and depression symptoms (OR 1.65; 95%CI, 1.21-2.26) were risk factors for chronic insomnia with daytime dysfunction. Amongst those with chronic insomnia with daytime dysfunction, 47.8% had anxiety symptoms (OR, 2.01; 95%CI, 1.57-2.59) and 36.5% had depression symptoms (OR, 2.74; 95%CI, 2.04-3.68) based on HADs score. They also had tendency to doze off while driving and to be involved in road traffic accidents. A third of primary care attendees have insomnia symptoms and chronic insomnia, associated with significant daytime dysfunction and psychological morbidity. By identifying those at risk of having chronic insomnia, appropriate interventions can be commenced.