Perceptions and attitudes towards exercise among Chinese elders – the implications of culturally based self‐management strategies for effective health‐related help seeking and person‐centred care

Background

Encouraging the uptake of physical activity among a culturally diverse elderly population presents a challenge for health‐care providers across the world. Little is known about the health‐care needs of these populations, for example the increasingly ageing group of Chinese elders in many parts of the world who are now facing later life and increasing challenges to their health.

Objective

This study aimed to explore behaviours and attitudes towards exercise among older Chinese immigrants in the UK to provide insights into the health of Chinese populations in the UK and elsewhere.

Design

A Grounded Theory approach using purposive and theoretical sampling with in‐depth semi‐structured interviews.

Setting and participants

Chinese elders were recruited from Chinese communities in the North West of England. Thirty‐three participants were interviewed face‐to‐face and audio‐recorded.

Results

Participants self‐managed exercise based on cultural perceptions of health and ingrained Chinese values. Professional support and information was lacking and relied on folk norms rather than person‐centred recommendations for healthy living. Inappropriate exercise regimes could act as a substitute for seeking health‐related advice when exercise was often used as a self‐monitored barometer to assess their perceived health status.

Discussion and conclusion

Chinese elders may undertake inappropriate exercise, leading to high‐risk situations, if appropriate professional information is not provided. Health‐care practitioners should devote attention to understanding Chinese elders'' attitudes towards exercise, as this may ultimately lead to successful health promotion activities. A person‐centred approach that acknowledges and works with self‐management practices is advocated.     

‘You have got to stick to your times’: Care workers and managers’ experiences of working in extra care housing

Extra care housing (ECH) has been lauded as an innovative model of housing with care for older people that promotes and supports independent living. The study used a qualitative design to explore how care is delivered in four extra care settings in England over 20 months during 2016–2017. This paper reports findings from semi‐structured interviews with 20 care workers and seven managers. The article argues that, despite being heralded as a new model, care workers in ECH face similar organisational pressures as those working in more conventional settings and, in turn, the care which they are able to provide to residents mimics traditional forms of care.     

我国老年人健康管理工作现况分析及启示

  目的  探讨家庭关怀度与社会支持对老年人健康促进行为的影响。  方法  于2016年10月采用整群抽样法, 对河北省邯郸市1 455名≥60岁老人应用家庭关怀度指数量表（APGAR）、社会支持评定量表（SSRS）、健康促进生活方式评定量表–Ⅱ（HPLP-Ⅱ）及自编的一般情况问卷进行入户调查。  结果  与低家庭关怀组相比,高家庭关怀组的老年人健康促进总分及各维度得分较高（P < 0.05)。社会支持满意组的老年人健康促进行为得分较高（P < 0.05)。家庭关怀度和社会支持与老年健康促进行为呈正相关（r = 0.531,P < 0.05)。多元逐步回归分析结果,婚姻状况（β ′ = 4.458,β = 0.096）、月收入（β ′ = – 1.728,β = – 0.080）、家庭结构（β ′ = 2.463,β = 0.072）、慢性病（β ′ = – 4.188,β = – 0.200）、长期用药（β ′ = 3.572,β = 0.085）、家庭关怀度（β ′ = 2.344,β = 0.164）、社会支持（β ′ = 1.263,β = 0.528）是健康促进行为的影响因素,可解释健康促进行为47.4 %的变异量。  结论  家庭关怀度和社会支持影响老年人的健康促进行为。     

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.     

Self‐reported health,healthcare service use and health‐related needs: A comparison of older and younger homeless people

The number of older homeless people with a limited life expectancy is increasing. European studies on their health‐related characteristics are lacking. This study compared self‐reported health, healthcare service use and health‐related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross‐sectional data from 378 participants who completed 2.5‐year follow‐up, we analysed differences in self‐reported health, healthcare service use, and health‐related needs between homeless adults aged ≥50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health‐related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non‐acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter‐based or community outreach programmes that proactively provide multidisciplinary healthcare services.     

“The people make it fun,the activities we do just make sure we turn up on time.” Factors influencing older adults’ participation in community‐based group programmes in Perth,Western Australia

Rapid ageing in western societies is placing increasing strain on health and social care services. In response, governments and health agencies have sought to promote healthy ageing through a range of interventions, many of which aim to enhance social engagement and participation among older people. Such interventions are based on evidence that being socially engaged through participation in various activities leads to better physical, mental and psychosocial health outcomes. The research reported here employed focus groups and individual interviews to address research aims: (a) identify enablers and barriers to participation in community‐based group activities among a sample of older people (n = 35, median age 71 years) living in a local government area in the northern suburbs of Perth, Western Australia, and (b) examine how these factors differ between those who regularly participate and those who do not. Our research highlighted four themes: Friendship and Function; Availability and Accessibility; Competing Responsibilities and Priorities; and Changing of the Guard. In particular, this research highlighted the importance of group activities in offering social support as a platform to develop friendships. The findings also indicated that opportunities for social interaction should be embedded in the structure of the group, beyond that which may occur incidentally during activities. This is important, given that while interest may motivate older people to join a group, a sense of belonging and connectedness generated through the group is more likely to maintain their attendance. Barriers included limited availability of local programmes, limited accessibility related to programme scheduling, and lack of programmes relevant to those who do not find traditional seniors’ centres appealing. Recommendations include incorporating social engagement as an outcome measure when evaluating the efficacy of programmes targeting older people, and encouraging local governments to work with seniors’ centres in developing activities attractive to a broader cohort of older people.     

The SCI Exercise Self-Efficacy Scale (ESES): development and psychometric properties

Background  

Rising prevalence of secondary conditions among persons with spinal cord injury (SCI) has focused recent attention to potential health promotion programs designed to reduce such adverse health conditions. A healthy lifestyle for people with SCI, including and specifically, the adoption of a vigorous exercise routine, has been shown to produce an array of health benefits, prompting many providers to recommend the implementation of such activity to those with SCI. Successfully adopting such an exercise regimen however, requires confidence in one's ability to engage in exercise or exercise self-efficacy. Exercise self-efficacy has not been assessed adequately for people with SCI due to a lack of validated and reliable scales, despite self efficacy's status as one of the most widely researched concepts and despite its broad application in health promotion studies. Exercise self efficacy supporting interventions for people with SCI are only meaningful if appropriate measurement tools exist. The objective of our study was to develop a psychometrically sound exercise self-efficacy self-report measure for people with SCI.     

New jobs old roles – working for prevention in a whole‐system model of health and social care for older people

The Partnerships for Older People Projects programme provided government funding for local and health authorities to pilot prevention and intervention services in partnership with the voluntary sector and older people between 2006 and 2009. This local evaluation of a pilot in southern England undertaken between 2007 and 2009 used a Theory of Change approach to gathering and reflecting on data with different groups involved in the delivery of this whole‐system based model of prevention. The model was delivered in the same way in seven social services locality areas within a large county authority. The method of data gathering enabled structured reflection on the implementation, development and projected outcomes of the model and a consideration of the key learning of working in a whole‐system way with partners and stakeholders. The whole‐system model, although complex and challenging to implement, was considered overall to have been a success and provided significant learning for partners and stakeholders on the challenges and benefits of working across professional and sectoral boundaries. New posts were created as part of the model. Two of these, recruited to and managed by voluntary sector partners, were identified as ‘new jobs’, but echoed ‘old roles’ within community and voluntary sector based health and social care. The authors reflect on the parallels of these roles with previously existing roles and ways of working and reflect on how the whole‐system approach of this particular pilot enabled these new jobs to develop in particularly appropriate and successful ways.     

The (cost‐)effectiveness of preventive,integrated care for community‐dwelling frail older people: A systematic review

Integrated care is increasingly promoted as an effective and cost‐effective way to organise care for community‐dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for community‐dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost‐effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk‐of‐bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom‐reported outcomes such as well‐being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost‐effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected.     

Mechanisms to enhance the effectiveness of allied health and social care assistants in community‐based rehabilitation services: a qualitative study

This research aims to describe the factors associated with successful employment of allied health and social care assistants in community‐based rehabilitation services (CBRS) in England. The research involved the thematic analysis of interviews and focus groups with 153 professionally qualified and assistant staff from 11 older people's interdisciplinary community rehabilitation teams. Data were collected between November 2006 and December 2008. Assistants were perceived as a focal point for care delivery and conduits for enabling a service to achieve goals within interdisciplinary team structures. Nine mechanisms were identified that promoted the successful employment of assistants: (i) Multidisciplinary team input into assistant training and support; (ii) Ensuring the timely assessment of clients by qualified staff; (iii) Establishing clear communication structures between qualified and assistant staff; (iv) Co‐location of teams to promote communication and skill sharing; (v) Removing barriers that prevent staff working to their full scope of practice; (vi) Facilitating role flexibility of assistants, while upholding the principles of reablement; (vii) Allowing sufficient time for client–staff interaction; (viii) Ensuring an appropriate ratio of assistant to qualified staff to enable sufficient training and supervision of assistants; and (ix) Appropriately, resourcing the role for training and reimbursement to reflect responsibility. We conclude that upholding these mechanisms may help to optimise the efficiency and productivity of assistant and professionally qualified staff in CBRS.     

Prevention of falls,malnutrition and pressure ulcers among older persons – nursing staff's experiences of a structured preventive care process

A structured and systematic care process for preventive work, aimed to reduce falls, pressure ulcers and malnutrition among older people, has been developed in Sweden. The process involves risk assessment, team‐based interventions and evaluation of results. Since development, this structured work process has become web‐based and has been implemented in a national quality registry called ‘Senior Alert’ and used countrywide. The aim of this study was to describe nursing staff's experience of preventive work by using the structured preventive care process as outlined by Senior Alert. Eight focus group interviews were conducted during 2015 including staff from nursing homes and home‐based nursing care in three municipalities. The interview material was subjected to qualitative content analysis. In this study, both positive and negative opinions were expressed about the process. The systematic and structured work flow seemed to only partly facilitate care providers to improve care quality by making better clinical assessments, performing team‐based planned interventions and learning from results. Participants described lack of reliability in the assessments and varying opinions about the structure. Furthermore, organisational structures limited the preventive work.     

It’s not just about heart failure – voices of older people in transition to dependence and death

This paper explores the experiences of older people living with heart failure and their transitions from independence to dependence and for some death. New Zealand’s ageing population is predicted to increase from 12% in 2001 to 25% by the year 2051, similar to the worldwide trend of ageing. A high proportion of these people will have one or more chronic illnesses. Associated with the increase in survival is a growing body of research examining the needs of the older person with heart failure and finding particular problems with end of life care. Older people face many challenges in living with their heart failure, in particular the transition to dependence. To study the transition a longitudinal qualitative study using General Inductive approach was used. Participants were interviewed every 3 months for a 12‐month period during 2006–2008. A total of 79 interviews with 25 people were completed. Our findings showed that transition was not a simple linear process with the older person moving from one phase to another; instead their experiences illustrated the complexity of transitions they faced and what helped them to manage these. The older people in this study illustrated the importance of trust in health professionals and believed they would receive good care. Their fears revealed concerns about being a burden as they deteriorate and becoming more dependent. Understanding the complex issues related to transition to dependence can provide health professionals with a framework for assessment and approaches to providing the support required.     

Doing involvement: A qualitative study exploring the ‘work’ of involvement enacted by older people and their carers during transition from hospital to home

ContextBeing involved in one''s care is prioritised within UK healthcare policy to improve care quality and safety. However, research suggests that many older people struggle with this.DesignWe present focused ethnographic research exploring older peoples'' involvement in healthcare from hospital to home.ResultsWe propose that being involved in care is a dynamic form of labour, which we call ‘involvement work’ (IW). In hospital, many patients ‘entrust’ IW to others; indeed, when desired, maintaining control, or being actively involved, was challenging. Patient and professionals'' expectations, alongside hospital processes, promoted delegation; staff frequently did IW on patients'' behalf. Many people wanted to resume IW postdischarge, but struggled because they were out of practice.DiscussionPreference and capacity for involvement was dynamic, fluctuating over time, according to context and resource accessibility. The challenges of resuming IW were frequently underestimated by patients and care providers, increasing dependence on others post‐discharge and negatively affecting peoples'' sense and experience of (in)dependence.ConclusionsA balance needs to be struck between respecting peoples'' desire/capacity for non‐involvement in hospital while recognising that ‘delegating’ IW can be detrimental. Increasing involvement will require patient and staff roles to be reframed, though this must be done acknowledging the limits of patient desire, capability,and resources. Hospital work should be (re)organised to maximise involvement where possible and desired.Patient/Public ContributionOur Patient and Public Involvement and Engagement Panel contributed to research design, especially developing interview guides and patient‐facing documentation. Patients were key participants within the study; it is their experiences represented.     

Co‐ordinated action between youth‐care and sports: facilitators and barriers

In the Netherlands, youth‐care organisations and community sports clubs are collaborating to increase socially vulnerable youths’ participation in sport. This is rooted in the idea that sports clubs are settings for youth development. As not much is known about co‐ordinated action involving professional care organisations and community sports clubs, this study aims to generate insight into facilitators of and barriers to successful co‐ordinated action between these two organisations. A cross‐sectional study was conducted using in‐depth semi‐structured qualitative interview data. In total, 23 interviews were held at five locations where co‐ordinated action between youth‐care and sports takes place. Interviewees were youth‐care workers, representatives from community sports clubs, and Care Sport Connectors who were assigned to encourage and manage the co‐ordinated action. Using inductive coding procedures, this study shows that existing and good relationships, a boundary spanner, care workers’ attitudes, knowledge and competences of the participants, organisational policies and ambitions, and some elements external to the co‐ordinated action were reported to be facilitators or barriers. In addition, the participants reported that the different facilitators and barriers influenced the success of the co‐ordinated action at different stages of the co‐ordinated action. Future research is recommended to further explore the role of boundary spanners in co‐ordinated action involving social care organisations and community sports clubs, and to identify what external elements (e.g. events, processes, national policies) are turning points in the formation, implementation and continuation of such co‐ordinated action.     

Social change and birth cohort decrease in social support for older adults in China: A cross‐temporal meta‐analysis, 1994–2018

Social support not only plays an important role in the physical and mental health of the elderly people but also constitutes an essential resource for healthy ageing. With the rapid economic and social development during the last 40 years in China, the acceleration of urbanisation, and the disintegration of traditional extended families, the social support that Chinese older adults receive may be declining, leading to deterioration in quality of life for the rapidly ageing population. Cross‐temporal meta‐analysis was employed to investigate changes in older Chinese adults’ social support from 1994 to 2018. One hundred and thirty‐six studies (N = 82,722; age ≥ 60) that used the social support rating scale (SSRS) were analysed. Additionally, social support scores were correlated with social indicators to explore the relationship between social support and the environment of social development. Results show that social support scores decreased by 5.09 and 0.73 standard deviations over the past 24 years. Correlation with social indicators suggests that a decrease in social connectedness and an increase in economic imbalance may be responsible for the reduction in social support.