Goal negotiation with older people in three day care settings

Drawing on a wider study of effectiveness in three models of day care, this paper explores the process and outcome of goal negotiation with older people in a day hospital, an outreach service and a day centre. Using qualitative data from interviews with day care attenders and focus groups with service providers, differing perspectives on goal setting and achievement are presented. It concludes with a brief discussion of this approach in the wider context of promoting older people's participation in decision-making in day care settings, where the espoused emphasis is on maintaining and maximising personal autonomy and independent living.     

Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States

Objective

To compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults.

Data Sources and Study Setting

We used claims of 100% of 2012–2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma.

Study Design

Survival differences were estimated after applying propensity-score-based overlap weights. Subgroup analyses were performed for ambulance-transported patients and by external cause. We assessed the roles of prehospital care, hospital quality, and volume.

Data Collection

Data were obtained from the Centers for Medicare and Medicaid Services.

Principal Findings

Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 (95% confidence interval [CI]: 1.8, 2.6) percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 (95% CI: 1.9, 2.8) pp for falls and 2.3 (95% CI: 0.2, 4.4) pp for motor vehicle crashes. Differences persisted at 1 year. Level 1 and 2 trauma centers had similar outcomes. Hospital quality and volume did not explain these differences. In the ambulance-transported subgroup, after adjusting for prehospital variables, no statistically significant differences remained.

Conclusions

Trauma centers may not provide longer survival than similarly sized non-trauma hospitals for severely injured older adults.     

Longitudinal association between home and community-based services provision and cognitive function in Chinese older adults: Evidence from the Chinese Longitudinal Healthy Longevity Survey

Few studies have assessed the impact of home and community-based services (HCBSs) provision on cognitive function among older adults over time. This study examined the longitudinal association between HCBSs provision and cognitive function in Chinese older adults. The study included 5,134 participants aged 65 years and older in the Chinese Longitudinal Healthy Longevity Survey from 2008 to 2014. The Mini-Mental State Examination (MMSE) was used to evaluate cognitive function over the same time period. Participants were asked what kind of HCBSs were provided in his or her community. However, they were not asked whether services were utilised. The study used the number of HCBSs provided each wave to represent the strength of HCBSs, and used the MMSE score of each wave to represent the older adults’ cognitive function status. A latent growth model was used to explore the relationship between HCBSs provision and cognitive function of older adults. The number of HCBSs provided was positively associated with older adults’ cognitive function (2008: β = 0.03, p = 0.031; 2011: β = 0.06, p < 0.001; 2014: β = 0.06, p < 0.001) after controlling for gender, age, residence, education, income, medical insurance, activities of daily living disability, instrumental activities of daily living disability, serious illness, living arrangement and marital status. Results provided longitudinal evidence that an increase in HCBSs provision at a national level can result in better cognitive function in Chinese older adults.     

社区老年人社会经济地位与轻度认知功能障碍的相关性研究

目的  探讨老年人社会经济地位(socioeconomic status,SES)与轻度认知功能障碍(mild cognitive impairment,MCI)患病的关联。方法  数据来源于湖北老年记忆队列(the Hubei Memory and Aging Cohort Study,HMACS);共纳入7 887名≥65岁老年人,他们完成了3全套神经心理评估和临床体格检查。SES通过受教育程度、职业性质和家庭人均月收入综合评定;MCI由专家组根据Petersen标准和中国痴呆与认知障碍诊治指南进行诊断;多因素logistic回归分析模型分析老年人SES与MCI患病的关联。结果  共纳入7 887名调查对象,平均年龄(71.74±5.58)岁,MCI检出率为23.00%(95% CI: 22.07%~23.93%);低SES组MCI检出率(44.65%)高于中SES组MCI检出率(16.89%)和高SES组MCI检出率(9.18%);女性高于男性;农村高于城市。分层分析发现：城市男性低SES组MCI患病风险为高SES组的6.276倍(OR=6.276, 95% CI: 4.017~9.805),城市女性低SES组MCI患病风险为高SES组的3.978倍(OR=3.978, 95% CI: 2.943~5.376);依据现有SES标准,农村女性老年人SES分布不均匀。结论  低SES组老年人MCI检出率较高,认知功能障碍的防控要密切关注低SES组老年人,特别是社区低收入、低教育程度的老年人。     

Mixed care networks of community‐dwelling older adults with physical health impairments in the Netherlands

As part of long‐term care reforms, home‐care organisations in the Netherlands are required to strengthen the linkage between formal and informal caregivers of home‐dwelling older adults. Information on the variety in mixed care networks may help home‐care organisations to develop network type‐dependent strategies to connect with informal caregivers. This study first explores how structural (size, composition) and functional features (contact and task overlap between formal and informal caregivers) contribute to different types of mixed care networks. Second, it examines to what degree these network types are associated with the care recipients' characteristics. Through home‐care organisations in Amsterdam, the Netherlands, we selected 74 frail home‐dwelling clients who were receiving care in 2011–2012 from both informal and formal caregivers. The care networks of these older adults were identified by listing all persons providing help with five different types of tasks. This resulted in care networks comprising an average of 9.7 caregivers, of whom 67% were formal caregivers. On average, there was contact between caregivers within 34% of the formal–informal dyads, and both caregivers carried out at least one similar type of task in 29% of these dyads. A principal component analysis of size, composition, contact and task overlap showed two distinct network dimensions from which four network types were constructed: a small mixed care network, a small formal network, a large mixed network and a large formal network. Bivariate analyses showed that the care recipients’ activities of daily living level, memory problems, social network, perceived control of care and level of mastery differed significantly between these four types. The results imply that different network types require different actions from formal home‐care organisations, such as mobilising the social network in small formal networks, decreasing task differentiation in large formal networks and assigning co‐ordination tasks to specific dyads in large mixed care networks.     

Formal home‐care utilisation by older adults in Ireland: evidence from the Irish Longitudinal Study on Ageing (TILDA)

The aim of this study was to provide a population‐based estimate of the utilisation of publicly financed formal home care by older adults in Ireland and to identify the principal characteristics of those utilising formal home care. Data were collected through computer‐aided personal interviews from a representative sample of community living older adults in Ireland. The interviews were conducted between 2009 and 2011 as part of the first wave of the Irish Longitudinal Study on Ageing (TILDA). The study is cross‐sectional in design and limited to participants aged 65 years and older (n = 3507). Results reveal that 8.2% (95% CI 7.1%–9.3%) of participants utilised publicly financed formal home care in the form of home help and/or personal care. Key determinants of formal home‐care utilisation were Instrumental Activity of Daily Living (IADL) difficulty (Adj OR 3.8, 95% CI 2.7–5.3), older age (Adj OR 3.4, 95% CI 2.4–4.8) and living alone (Adj OR 2.6, 95% CI 1.9–3.8). Almost half of those utilising formal care did not self‐report an Activity of Daily Living (ADL) difficulty or an IADL difficulty. Government policy aims to reduce the need for long‐term residential care by providing formal home care for older adults with low to moderate levels of dependency. This requires an increasing emphasis on personal care provision in the home. No evidence was found in this study to suggest that a shift in emphasis from formal domestic to personal care is taking place in Ireland. The absence of standardised assessment and eligibility criteria are deemed to be barriers to reorientation of the system. From a health services perspective, the current situation is not sustainable into the future and requires a focused policy response.     

What is the impact of day care on older people with long-term conditions: A systematic review

There is a lack of robust evidence regarding outcomes for day care use among older people living with long-term conditions (LTCs). Day care is provided by independent, private and voluntary and charitable sectors. This systematic review aims to establish current evidence of outcomes for older people with LTCs attending day care services and outcomes on carers, across all service models. Narrative synthesis of quantitative and qualitative data was undertaken. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was carried out across eight electronic databases and reference lists of key journals between 2004 and October 2020 were searched. Searches returned 1,202 unique titles. Forty-five articles from 16 countries met the criteria on review of title, abstract and full article. There is limited evidence suggesting improved levels of perceived psychological health, quality of life, perceived general health, physical health and functioning for older people attending day care who have LTCs. The respite function of day care resulted in positive outcomes for carers. Studies evaluating outcomes for participants or carers were limited in quantity and quality. There is limited information regarding outcomes for day care attendance for older people with multiple LTCs from existing literature. Further research focusing on LTCs and day care attendance would benefit this field.     

Reconciling conceptualizations of relationships and person‐centred care for older people with cognitive impairment in acute care settings

Relationships are central to enacting person‐centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person‐centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long‐term care. The acute care setting is characterized by archetypal constraints which differentiate it from long‐term care, in terms of acuity and haste, task‐orientated work patterns and influence from “the rule of medicine,” all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re‐interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re‐presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person‐centred care versus relationship‐centred care by arguing that these are complementary rather than mutually exclusive and can be brought together in one theoretical framework acknowledging personhood as relational in essence.     

Community social capital and cognitive function among older adults in rural north-east China: The moderator role of income

This study investigated the moderating role of income in the relationship between community social capital and cognitive function among community-dwelling older adults in rural China. Data were derived from a community survey conducted in Dongliao county, Jilin province, China, in 2019. Trained interviewers completed face-to-face interviews with 458 respondents. Multiple group analysis was applied to examine the proposed model. The latent constructs of cognitive social capital and structural social capital were established in low-income and high-income groups in rural Chinese contexts. Factor loading invariance of social capital constructs was established across the two income groups. The results showed that income has moderating effects on the relationship between social capital constructs and cognitive function. Social capital that was significantly associated with cognitive function was statistically significant in low-income group only. The findings highlight the important role of income in understanding the mechanism linking social capital to cognitive function in a rural Chinese context. Social policies and interventions should pay particular attention to older adults with low economic status. Policy and intervention implications are discussed.     

Factors related to depression among higher income mothers with young children in day care centers

This study examined the association between maternal depression, maternal separation anxiety, social support, and maternal involvement in the day care center. A factor analysis identified a cluster of maternal involvement variables, including the amount of time spent in the center, frequency of communication with caregivers, maternal participation in caregiving, and mid-day visits to the center. The sample consisted of 54 mothers with infants in on-site, near-site, and off-site centers. Mothers who were more involved in the center reported less depression.     

Assessment of indoor environment in Paris child day care centers

Background

Children are sensitive to indoor environmental pollution. Up until now there has been a lack of data on air quality in child day care centers.

Objectives

The aim of this study is to document the indoor environment quality of Paris child day care centers by repeated measurements, and to compare pollutant levels in child day care centers with levels in Paris dwellings.

Methods

We selected 28 child day care centers frequented by a random sample of babies who participated in the PARIS birth cohort environmental investigation, and visited the child day care centers for one week twice in one year. Biological contaminants assessed were fungi, endotoxin, dust mite allergens, and chemical pollutants: aldehydes, volatile organic compounds and nitrogen dioxide (NO₂). Relative humidity, temperature, and carbon dioxide levels were measured simultaneously. A standardized questionnaire was used to gather information about the buildings and their inhabitants.

Results

Airborne endotoxin levels in child day care centers were higher than those found in Paris dwellings. Dust mite allergens in child day care centers were below the threshold level for sensitization in the majority of samples, and in common with dwelling samples. Penicillium and Cladosporium were the most commonly identified genera fungi. The child day care center indoor/outdoor ratio for most chemical pollutants was above unity except for NO₂, the levels for NO₂ being significantly higher than those measured in homes.

Conclusion

Chemical and biological contamination in child day care centers appears to be low, apart from endotoxin and NO₂. Failure to take child exposure in child day care centers into account could result in an overestimation of children's exposure to other pollutants.     

Reconciling concepts of space and person‐centred care of the older person with cognitive impairment in the acute care setting

Although a large body of literature exists propounding the importance of space in aged care and care of the older person with dementia, there is, however, only limited exploration of the ‘acute care space’ as a particular type of space with archetypal constraints that maybe unfavourable to older people with cognitive impairment and nurses wanting to provide care that is person‐centred. In this article, we explore concepts of space and examine the implications of these for the delivery of care to older people who are cognitively impaired. Our exploration is grounded in theorisations of space offered by key geographers and phenomenologists, but also draws on how space has been constructed within the nursing literature that refers specifically to acute care. We argue that space, once created, can be created and that nursing has a significant role to play in the process of its recreation in the pursuit of care that is person‐centred. We conclude by introducing an alternative logic of space aimed at promoting the creation of more salutogenic spaces that invokes a sense of sanctuary, safeness, and inclusion, all of which are essential if the care provided to the older person with cognitive impairment is apposite to their needs. The concept of ‘person‐centred space’ helps to crystallize the relationship between space and person‐centred care and implies more intentional manipulation of space that is more conducive to caring and healing. Significantly, it marks a return to Nightingale's wisdom, that is, to put the person in the best possible conditions for nature to act upon them.     

Assessment of recent HIV testing among older adults in the United States

Older adults are the fastest growing segment of people living with HIV, and unfortunately many are unaware of their HIV status. Many providers are reluctant to ask older adults about their sexual histories, evaluate their risk factors, and test for HIV, and older adults have low perception of HIV risk. Using data from the 2013 to 2014 National Health and Nutrition Examination Survey, this study assessed the prevalence of recent HIV testing among older adults in the United States (n = 1,056) and identified predictors and barriers to recent HIV testing. The prevalence of recent HIV testing was 28%. Recent HIV testing was associated positively with male gender, education level, having public insurance, having same sex sexual behavior, African, and Hispanic ethnicity, whereas age, income-to-poverty ratio, and Asian ethnicity were associated negatively with recent HIV testing. Public health social workers are advised that targeted HIV testing for Asian, economically disadvantaged, female older adults is needed to increase HIV awareness and detection and to decrease late diagnosis of HIV. Provided public insurance was identified as a predictor of recent HIV testing, facilitating economically disadvantaged older adults’ eligibility for public insurance that will likely improve access to HIV testing services and increase HIV testing rates.     

Individual determinants of task division in older adults' mixed care networks

Older adults in need of long‐term care often receive help from both informal and formal caregivers. The division of tasks between these different types of caregivers may vary among such mixed care networks. Traditional models of task division suggest that formal and informal caregivers may either supplement each other or specialise in the care activities performed. Our study explores the determinants of various forms of task division in the Netherlands, using data collected in 2007 on 458 mixed care situations. Four types of task divisions of informal and formal care are distinguished: the complementation model [neither Activities of Daily Living (ADL) nor instrumental ADL (IADL) tasks shared, 14%], the supplementation model (both ADL and IADL tasks shared, 39%) and informal and formal specialisation (one type of task shared, one type of task not shared, 27% and 20% respectively). Marginal effects calculated with multinomial regression analyses show that the intensity of care provision, the informal caregivers' motives and the presence of privately paid help – more than care receiver's health – are related to type of task division with formal care. For example, when the informal caregiver provides more hours of help and out of a strong personal bond, the likelihood of informal specialisation increases, whereas the likelihood of formal specialisation decreases. When privately paid help is present, the complementation model is more likely, whereas the supplementation model is less likely to be found. Results are discussed regarding the differential consequences for co‐ordination and co‐operation in mixed care networks.