What instruments have been used to assess the mobility of community-dwelling older adults?

Abstract

Background: The primary aim of this review was to identify existing instruments that have been used to assess the mobility status of community-dwelling older adults. The secondary aims were to identify instruments that have face validity for measuring across the full mobility spectrum and to summarise and compare their clinimetric properties.

Methods: MEDLINE, CINAHL, PEDro, and EMBASE were searched until April 2007. The first stage included searching for papers that reported mobility outcome measures that had been applied to healthy community-dwelling older adults. The second stage identified these outcome measures and the third stage compared clinimetric properties of the instruments that had face validity for measuring across the full mobility spectrum (from bed-bound to high levels of independent mobility). Two independent reviewers extracted data from the included studies.

Results: From the 128 included papers, 14 outcome measures were identified, two of which, the Lower Extremity Functional Scale (LEFS) and the Elderly Mobility Scale (EMS), measured across the full spectrum of mobility. No clinimetric evidence was found for the LEFS amongst a community-dwelling older population and only evidence of known groups validity was identified for the EMS.

Discussion: An outcome measure that has face validity for measuring across the full mobility spectrum and has sufficient clinimetric evidence in a community dwelling population was not identified.

Conclusion: This review supports the need for the development of such an instrument.     

Culture, Socioeconomic Status, and Coronary Heart Disease Risk Factors in an African American Community

In this paper, cultural influences are examined in the relationship between socioeconomic status and health. Cultural definitions of material lifestyles are investigated as a correlate of disease risk in an African American community in the rural South. A new technique—called cultural consensus analysis—is used to test for a cultural model of lifestyles indicative of success. Survey data are then used to operationalize the degree to which individuals adhere in their own behavior to that cultural model; this measure is referred to as cultural consonance in lifestyle. Cultural consonance in lifestyle is more strongly associated with hypertension and smoking (but not serum lipids) than are conventional measures of socioeconomic status (occupation, income, and education). These results suggest that the extent to which individuals are unable to live in accordance with cultural norms regarding lifestyles may contribute to the risk of coronary heart disease in the African American community.     

Predicting Patient Satisfaction: A Study of Two Emergency Departments

To identify perceptions that predict overall patient (dis)satisfaction with Emergency Department (ED) care, we studied responses to a survey mailed to all discharged patients over a 6-month period (Academic Hospital), and to a telephone interview of a random sample of discharged patients over a 1-year period (Community Hospital). The survey and interview both assessed overall satisfaction, as well as satisfaction with perceived waiting times, information delivery, and expressive quality of physicians, nurses, and staff. Data for 1176 patients (training sample) and 1101 patients (holdout sample) who rated overall satisfaction as either very good or very poor (Academic Hospital), and for 856 patients (training sample) and 431 patients (holdout sample) who rated overall satisfaction as either excellent or poor (Community Hospital), were retained for analysis. For both hospitals, nonlinear tree models efficiently achieved overall classification accuracy exceeding 98% in training analysis and 95% in holdout analysis (all p < .0001). The findings suggest that overall patient (dis)satisfaction with care received in the ED is nearly perfectly predictable on the basis of patient-rated expressive qualities of ED staff, particularly physicians and nurses. Interventions designed to reinforce positive (and extinguish negative) expressive health-care provider behaviors may cut the number of extremely dissatisfied patients in half.     

Representations of HIV/AIDS management in South African newspapers

In South Africa, numerous strong policy statements emphasise the importance of involving communities in HIV/AIDS management, yet in practice such involvement tends to be tokenistic and minimal. Social representations in the public sphere constitute the symbolic dimension within which responses to HIV and AIDS are conceptualised and transformed into action. Through an analysis of newspaper articles, we explore the dominant representations of HIV/AIDS management circulating in the South African public sphere and examine how community engagement is depicted. We highlight the way media representations reflect narrow understandings of HIV and AIDS as a predominantly medical problem, while depicting HIV/AIDS management as a top-down activity dominated by prominent individuals, such as national leaders, health professionals and philanthropists, thus marginalising the role played by communities, who are often depicted as passive recipients of interventions by active outsiders. These representations fail to reflect the key role played by members of grassroots communities in responding to the HIV epidemic. Such representations provide flawed conceptual tools for shaping responses to the epidemic, given that HIV-related programmes are unlikely to have optimal outcomes unless they resonate with the perceived needs and interests of their target communities, as we contend that effective HIV/AIDS management is best achieved through active participation by communities in HIV/AIDS management strategies. We discuss the implications of a more 'civic-minded journalism.'     

Palliative care for people with non-malignant conditions in a New Zealand community

Abstract

Introduction: Little is known about the experiences of people with non-malignant, life-threatening conditions in the community who are not receiving hospice palliative care. The aim of this study was to understand the experiences and needs of people dying in the community with respiratory, renal, cardiac, neurological diseases, and cancer and those of the people caring for them, both formal health professionals and informal carers.

Subjects and Methods: This is qualitative research where 13 people with life-limiting illness, eight spousal caregivers, three adult children, three specialists, one general practitioner and one psychotherapist were interviewed – a total of 29 participants. Analysis was thematic and interpretive within a phenomenological framework.

Conclusions: Non-malignant disease makes similar demands on patients, families and health professionals, yet malignant disease is more likely to have the terminal phase identified so that people can access palliative care services. There were a number of spousal caregivers, who also had life-limiting conditions thus increasing the level of burden experienced by not only themselves, but their families. This research identified the needs of individuals and their families with non-malignant conditions compared with those with malignant conditions and confirmed the findings of previous literature. Understanding the burden families' experience and how they rely on health professionals will assist in developing collaborative ways of working to break down barriers and provide palliative care for these individuals and their families.     

Working Things Out Through SPHE? A Journey from Community to Clinic and Back

Working Things Out is a DVD resource developed by young people who had experienced a mental health difficulty in which they tell their stories of how they successfully got through their own ‘tough times’. Participants in an Irish community-based epidemiological study, who had recovered from a mental health difficulty, joined young people attending a Child and Adolescent Mental Health Service to develop the resource to assist other young people in coping with their own mental health difficulties. While originally developed for use with clinical populations, the resource has been developed to enhance the Mental Health promotion component of the Social, Personal and Health Education (SPHE) Programme, which supports the personal development, health and well-being of Irish young people, and forms part of the school curriculum at both primary and secondary school levels. A preliminary pilot study evaluating its use in enhancing the effectiveness of mental health promotion in the SPHE programme has shown promising results, and the empirical effectiveness of the programme is currently being evaluated in a much larger and randomised controlled trial in some 18 Irish Secondary schools.     

Pilot Study of Pathophysiology of Constipation Among Community Diabetics

We aimed to compare gastrointestinal transit anddefecatory function in a random sample of people with orwithout diabetes mellitus in a US community who reportedconstipation or laxative use. In this pilot study we measured: gastric, small bowel, andcolonic transit by scintigraphy; vector manometry ofanal sphincters at rest and during squeeze; defecatorydynamics by balloon expulsion test; and scintigraphic measurement of anorectal angle at rest andduring defecation. Autonomic function tests wereperformed in diabetics. Diabetics with constipation hada higher prevalence of abnormal evacuation or prolonged colonic transit during the first 24 hr thancontrols (P = 0.07): three had prolonged 24-hr colonictransit, and three abnormal evacuation. Amongconstipated controls, only one had anismus. Overall,diabetics had slower colonic transit during the first 24hr than nondiabetics (P < 0.05). Community diabeticswho experience constipation or use laxatives have agreater prevalence of delayed 24-hr colonic transit or evacuatory dysfunction than communitycontrols.     

Young Malawians on the interaction between mental health and HIV/AIDS

Previous research has identified high levels of mental health problems among people affected by HIV. This study surveys specifically adolescents in southern Malawi on their experience of the impacts of living with HIV or AIDS on one's mental health. At the same time, the study explores the link between mental health problems and subsequent HIV-risk behaviour. Short texts relating everyday scenarios that depicted symptoms of three mental health problems (i.e.depression, anxiety and HIV-related brain impairment) formed the basis of in-depth discussions in 12 existing groups of secondary school students, orphans and vulnerable children, teenage mothers, and out-of-school youths, in both rural and urban settings. The responses show that these young people recognised the mental health sequelae of HIV/AIDS as impacting upon many aspects of one's life. The young people traced these 'interruptions' and 'disruptions' through deteriorating psychological and socio-economic conditions. They showed awareness of a two-way interaction between HIV/AIDS and mental illness, indicating that the latter can increase thoughts of suicide and HIV risk-taking behaviour. More importantly, they identified a number of locally derived community interventions, which if supported by statutory health and education services, can significantly ameliorate their situations. The findings provide avenues for practical integration of mental health provision within HIV prevention, education and care initiatives.     

Spatiotemporal Model of Family Engagement: A Qualitative Study of Family-Driven Perspectives on Family Engagement

The Family-School-Community Partnerships Practice Group of the National Community of Practice on Collaborative School Behavioral Health conducted a survey of 30 families across the United States in an effort to develop a family-driven definition of family engagement. Literature on family engagement is reviewed, qualitative methods using a grounded theory approach are described and a model of family engagement is presented. The resulting spatiotemporal model of family engagement puts forth family engagement as a process that represents a continuum, either moving toward increased partnership between families with children with mental health needs or sliding away from that goal, as part of a larger developmental process. We hope that this model may enable us to begin to recognize early when we fall into patterns that take us away from increased collaboration between systems and families, and to support identification of the next steps toward righting those relationships.     

Interpretive Community,Intersubjective Experiences,and Supervisees’ Paradoxes

Contemporary theorists believe that each expert's discourse has meaning only in the context of an interpretive community. For therapists, the analytic community serves this purpose, helping them to construct their patients’ experiences and to hold inherent intersubjective paradoxes; the community provides them with a vantage point from which they learn to acknowledge, tolerate, and accept these paradoxes. I will examine the role of this vantage point in holding one of the central paradoxes for therapists: the uniqueness of each therapeutic relationship which urges them to ‘reinvent psychoanalysis’ with each patient, and its similarity to other therapeutic relationships which urges them to draw on the analytic community's theoretical schemas. I will suggest that supervisors help their supervisees in this internal struggle by representing the analytic community's vantage point and by holding a parallel paradox: the uniqueness of each supervisory relationship, which urges them to ‘reinvent’ the theory of supervision for each supervisee, and its similarity to other supervisory relationships, which urges them to draw on the analytic community's theoretical supervisory schemas. Reasonably, the supervisors’ capacity to hold these paradoxes is gradually internalized by their supervisees, facilitating their growth as therapists.