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Background: The ageing of the population has become an escalating problem in China, which has led to an increasing demand for healthcare throughout society. The care services of elderly institutions, as a more mature way of aging, can alleviate various social problems brought about by ageing to a certain extent. The aim of this paper is to explore the degree of acceptance of institutional care by rural elderly people in Shandong Province and the factors that influence whether rural elderly people accept institutional care services. Methodology: Based on the theory of planned behavior, an analytical framework was constructed for the willingness of rural elderly people to receive nursing services from elderly care institutions. Using survey data from 192 rural elderly people in Shandong Province, descriptive statistics, binary logistic regression, and horizontal comparative analysis methods were used to analyze the willingness of rural elderly people to provide for the elderly and its influencing factors. Result: Only 17.71% of respondents expressed willingness to receive services from elderly care institutions. Among them, education level, trust in elderly care institutions, and support from adult children have a significant positive impact on whether rural elderly people receive nursing services from elderly care institutions; The number of children, the level of understanding of elderly care institutions, neighbors' choices of elderly care methods, and their ability to contribute to the family have a significant negative impact on whether rural elderly people receive nursing services from elderly care institutions. There are significant differences in the willingness and influencing factors of rural elderly people to provide for the elderly among different regions. Conclusion: The non-acceptance of institutional care by rural older people is a general phenomenon rather than a sample characteristic, thus justifying the supplementary status of institutional care services. The pension intention of the rural elderly in Shandong Province is obviously affected by personal will factors, and the influencing factors are various. The traditional concept of old-age care in Shandong province has a strong path-dependent effect on the choice of the rural elderly. There is heterogeneity in the willingness and influencing factors of the rural elderly in different regions and countries. Based on this, this paper puts forward the following suggestions: strengthen the spiritual and cultural construction of residents; The government should pay attention to the correct guidance of public opinion; And increase pension subsidies. It is hoped that reduce the burden of national elderly care through these suggestions. [ABSTRACT FROM AUTHOR]

Background: Based on the Chinese model of medical-elderly care integration, this paper aims to explore the impact of different investment levels on the performance of the medical-elderly care integrated institutions.Methods: Using the method of system dynamics, this paper establishes the performance evaluation model of medical-elderly care integrated institutions, sets the system element input, service level, and policy support as the key factors, and uses Vensim PLE software for simulation.Results: The three key factors have different degrees of positive impact on the performance of medical-elderly care integrated institutions. On the whole, policy support has the most significant impact on the performance of institutions, followed by the level of medical-elderly care integrated services. Institutional input mainly has a great impact on the performance of institutions in the early stage. In addition, the model simulation results also show the emergence effect: the improvement rate of institutional performance under the comprehensive simulation is higher than the sum of the improvement rates under the separate action of single factor.Conclusion: Government policies have played an important role in promoting the development of medical-elderly care integrated institutions. The service level and resource input can effectively promote the performance of medical-elderly care integrated institutions. Institutions should formulate development strategies from a systematic perspective, and pay attention to the integration of "medical" and "elderly care" resources. [ABSTRACT FROM AUTHOR]

Background: Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate "healthcare entrepreneurship", it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer's disease. Methods: A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have. Results: The study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship – two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level. Conclusion: Governmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients' mental disease and ultimate passing. [ABSTRACT FROM AUTHOR]

Background: A range of strategies are available that can improve the outcomes of older persons particularly in relation to basic activities of daily living during and after an acute care (AC) episode. This paper outlines the original development of outcome-oriented quality indicators (QIs) in relation to common geriatric syndromes and function for the care of the frail aged hospitalized in acute general medical wards. Methods: Design QIs were developed using evidence from literature, expert opinion, field study data and a formal voting process. A systematic literature review of literature identified existing QIs (there were no outcome QIs) and evidence of interventions that improve older persons' outcomes in AC. Preliminary indicators were developed by two expert panels following consideration of the evidence. After analysis of the data from field testing (indicator prevalence, variability across sites), panel meetings refined the QIs prior to a formal voting process. Setting: Data was collected in nine Australian general medical wards. Participants: Patients aged 70 years and over, consented within 24 h of admission to the AC ward. Measurements: The interRAI Acute Care – Comprehensive Geriatric Assessment (interRAI AC-CGA) was administered at admission and discharge; a daily risk assessment in hospital; 28-day phone follow-up and chart audit. Results: Ten outcome QIs were established which focused on common geriatric syndromes and function for the care of the frail aged hospitalized in acute general medical wards. Conclusion: Ten outcome QIs were developed. These QIs can be used to identify areas where specific action will lead to improvements in the quality of care delivered to older persons in hospital. [ABSTRACT FROM AUTHOR]

Background: Falls are common among older people in long-term care facilities (LTCFs). Falls cause considerable morbidity, mortality and reduced quality of life. Of numerous interventional studies of fall prevention interventions in LTCFs, some reduced falls. However, there are challenges to implementing these interventions in real-world (non-trial) clinical practice, and the implementation techniques may be crucial to successful translation. This systematic review thus aimed to synthesise the evidence on implementation strategies, implementation outcomes and clinical outcomes included in fall prevention intervention studies. Methods: A systematic search of six electronic databases (PubMed, CINAHL, EMBASE, PsycINFO, SCOPUS, Web of Science) and eight grey literature databases was conducted, involving papers published during 2001–2021, in English or Arabic, targeting original empirical studies of fall prevention interventions (experimental and quasi-experimental). Two seminal implementation frameworks guided the categorisation of implementation strategies and outcomes: the Expert Recommendations for Implementing Change (ERIC) Taxonomy and the Implementation Outcomes Framework. Four ERIC sub-categories and three additional implementation strategies were created to clarify overlapping definitions and reflect the implementation approach. Two independent researchers completed title/abstract and full-text screening, quality appraisal assessment, data abstraction and coding of the implementation strategies and outcomes. A narrative synthesis was performed to analyse results. Results: Four thousand three hundred ninety-seven potential papers were identified; 31 papers were included, describing 27 different fall prevention studies. These studies used 39 implementation strategies (3–17 per study). Educational and training strategies were used in almost all (n = 26), followed by evaluative strategies (n = 20) and developing stakeholders' interrelationships (n = 20). Within educational and training strategies, education outreach/meetings (n = 17), distributing educational materials (n = 17) and developing educational materials (n = 13) were the most common, with 36 strategies coded to the ERIC taxonomy. Three strategies were added to allow coding of once-off training, dynamic education and ongoing medical consultation. Among the 15 studies reporting implementation outcomes, fidelity was the most common (n = 8). Conclusion: This is the first study to comprehensively identify the implementation strategies used in falls prevention interventions in LTCFs. Education is the most common implementation strategy used in this setting. This review highlighted that there was poor reporting of the implementation strategies, limited assessment of implementation outcomes, and there was no discernible pattern of implementation strategies used in effective interventions, which should be improved and clearly defined. Trial registration: This systematic review was registered on the PROSPERO database; registration number: CRD42021239604. [ABSTRACT FROM AUTHOR]

Background: The paper aims to explore the elderly caregiving process in India from the perspective of both elderly as well as working women care providers, along with the challenges faced and the coping strategies adopted by them during the process. Methods: In-depth interviews with 48 participants (care providers and care receivers) from 25 multi-generational households were conducted in the slums of Mumbai and analysed using QSR-NVivo-10. Results: Working women care providers supported the needs of the dependent elderly along with performing household chores and paid work. However, the way the care was perceived and demanded, was not often same as delivered by the care providers. Care provider suffered silently with poor social, physical and emotional welling in absence of support system and lack of time. Sometimes, physically exhausted care providers unknowingly resorted to elderly abuse and neglect. At the same time, a bidirectional flow of support from elderly also existed in the form of childcare, household chores and financial support. Though caregiving overstrained the care providers, strong family ties, acknowledgement of the contributions of the elderly during their young days, and the desire to set a precedent for the young generation did not let them step back from their duties. The main coping mechanism for both care receivers and providers was largely centred around the notion of acceptance of their situation. Conclusion: Conversations between generations can help in enhancing family ties and reduce conflicts. The support of family and community can also ease the burden of caregiving. [ABSTRACT FROM AUTHOR]

Background: With the intensification of China's aging population, the demand for elderly care services has become increasingly prominent. At the same time, rapid development of internet technology provides more convenience and possibilities for the elderly. However, the coordinated development between the internet and elderly care services still faces challenges. This study aims to measure the level of coupling and coordinated development between the internet and elderly care services in China, and analyze the influencing factors, in order to provide reference for promoting elderly care services. Methods: In this paper, the entropy method and coupling coordination degree model were used to measure the coupling coordination development index of the internet and elderly care services in China from 2012 to 2021. In addition, considering that the coordinated development between the two is affected by many factors, the Tobit model was used to analyze the main factors affecting the integration of the internet and elderly care services. Results: (1) The coupling and coordination of the Internet and senior care services is in its infancy, but the coupling and coordination of the two is on the rise, and there is still a lot of room for development in the future. (2) In terms of time scale, the coupling coordination development level between the internet and elderly care services in China has gone through three stages of "disorder recession-transition coordination-coordinated development". (3) In terms of influencing factors, government management ability has a more positive impact on the development of the integration of the Internet and senior care services, financial support, scientific and technological investment and the level of innovation play a mild pulling role, while the level of informatization to a certain extent restricts the level of integration of the Internet and senior care services. Conclusion: In order to promote the coordinated development of China's Internet and senior care services, it is necessary to comprehensively understand the current situation and development space of China's Internet and senior care services coupling coordination degree, accurately grasp the dynamic trend of China's Internet and senior care services coupling and coordinated development, promote the stage of leapfrogging, and fully consider the influencing factors, so as to realize the optimal allocation of policies and resources. These measures will help to promote a more coordinated and sustainable development of the internet and elderly care services in China. [ABSTRACT FROM AUTHOR]

Background: With the growing challenge of an aging population, emerging technologies are increasingly being integrated into the production, organization, and delivery of aged care services. Geographic Information System (GIS), a computer-based tool for spatial information analysis and processing, has made significant strides in the allocation of care recources and service delivery for older adults, a notably vulnerable group. Despite its growing importance, cross-disciplinary literature reviews on this theme are scare. This scoping review was conducted to encapsulate the advancements and discern the future trajectory of GIS applications in aged care services. Methods: A comprehensive search across nine databases yielded 5941 articles. Adhering to specific inclusion and exclusion criteria, 61 articles were selected for a detailed analysis. Results: The 61 articles span from 2003 to 2022, with a notable increase in publications since 2018, comprising 41 articles (67% of the total) published between 2018-2022. Developed countries contributed 66% of the papers, with 45% focusing on accessibility issues. In the domain of aged care services, GIS has been predominantly utilized for model construction, mapping, and site selection, with a growing emphasis on addressing the unique needs of different subgroups of older adults. Conclusion: The past two decades have seen substantial growth in the application of GIS in aged care services, reflecting its increasing importance in this field. This scoping review not only charts the historical development of GIS applications in aged care services but also underscores the need for innovative research approaches. Future directions should emphasize the integration of GIS with diverse methodologies to address the heterogeneous needs of older adults and improve the overall delivery of aged care services. Such advancements in GIS applications have the potential to significantly enhance the efficiency, accessibility, and quality of care for the aging population. [ABSTRACT FROM AUTHOR]

Background: To meet the needs of diversified pension services and the construction of aged care institutions is one of the urgent livelihood issues in China. Under the major national needs of pension and care for the elderly, it is necessary to optimize the allocation of pension and care for the elderly resources, and formulate operational coping strategies and optimization plans. It is of great significance to deal with the urgent problem of population aging in a timely and scientific way. Methods: The economic benefits and social costs of aged care institutions are regarded as objective functions. To satisfy the economic benefits, it is necessary to reduce the social costs, and its construction quantity can only be an integer. The multi-objective genetic algorithm is improved with integer programming, and the global optimal solution is achieved after several times of searching. Under the multi-objective optimization model, the improved genetic algorithm was combined with the superior and inferior solution distance method to solve the genetic algorithm, and the corresponding objective function value was obtained after rounding. Finally, Pareto optimal solution set is selected by multi-objective decision, and the result of construction planning is obtained. Results: Based on multi-attribute decision analysis and taking three years as the construction cycle, the planning scheme of aged care institutions construction in each district of Nanjing in the next 15 years was proposed. In addition, considering the intelligent trend of future pension, the proportion of home-based pension is increasing year by year, and the model is promoted to meet the needs of diversified pension services. With the gradual increase of the elderly population in Nanjing, the proportion of intelligent home-based care has been increasing year by year since 2027, and the construction demand of aged care institutions has also increased. The number of construction at all levels rises gradually in each cycle, and the increase is more obvious after 2027. Conclusions: The layout and planning of aged care institutions proposed in this paper not only considers economic and environmental benefits, but also combines the current situation of aged care institutions in various districts of Nanjing. The model is reasonable and effective, and has practical application value. It will help China optimize the allocation of elderly care resources under the target of active aging, and scientifically and comprehensively deal with the problem of population aging. [ABSTRACT FROM AUTHOR]

Background: The Australian government has implemented a compulsory aged care accreditation system to guide and monitor the risk management approach in registered residential aged care (RAC) homes. This research assessed the contribution of electronic health records (EHR) to risk management in RAC homes in relation to the extent that aged care accreditation fulfils its role.Methods: A convenience sample of 5560 aged care accreditation reports published from 2011 to 2018 was manually downloaded from the Accreditation Agency web site. A mixed-method approach of text data mining and manual content analysis was used to identify any significant differences in failure to meet accreditation outcomes among the RAC homes. This took account of whether EHR or paper records were used, year of accreditation, and size and location of the homes.Results: It appears that aged care accreditation was focused on structure and process, with limited attention to outcome. There was a big variation between homes in their use of measurement indicators to assess accreditation outcomes. No difference was found in outcomes between RAC homes using EHR and those using paper records. Only 3% of the RAC homes were found to have failed some accreditation outcomes. Failure in monitoring mechanism was the key factor for failing many accreditation outcomes. The top five failed outcomes were Human Resource Management, Clinical Care, Information Systems, Medication Management and Behavioural Management.Conclusions: Sub-optimal outcomes have limited the effectiveness of accreditation in driving and monitoring risk management for care recipient safety in RAC homes. Although EHR is an important structure and process component for RAC services, it made a limited contribution to risk management for accreditation in Australian RAC homes. Either EHR was not effective, or the accreditation process was not robust enough to recognize its influence. Aged care accreditation in Australia needs to develop further outcome-based measures that are supported by robust data infrastructure and clear guidance. [ABSTRACT FROM AUTHOR]

Background: The implementation of a data-driven approach within the health care system happens in a rapid pace; including in the eldercare sector. Within Swedish eldercare, data-driven health approach is not yet widely implemented. In the specific context of long-term care for older adults, quality of care is as much determined by how social care is being performed as it is by what kind medical care that is provided. In particular, relational aspects have been proven to have a crucial influence on the experience of quality of care for the actors involved. Drawing on ethnographic material collected at a Swedish nursing home, this paper explores in what way the relational aspects of care could potentially become affected by the increased use of a data-driven health approach. Methods: An ethnographic approach was adopted in order to investigate the daily care work at a long-term care facility as it unfolded. Fieldwork was conducted at a somatic ward in a Swedish long-term care facility over 4 months (86 h in total), utilizing the methods of participant observation, informal interviews and document analysis. The material was analyzed iteratively throughout the entire research process adopting thematic analysis. Results: Viewing our ethnographic material through an observational lense problematising the policy discourse around data-driven health approach, two propositions were developed. First, we propose that relational knowledge risk becoming less influential in shaping everyday care, when moving to a data-driven health approach. Second, we propose that quality of care risk becoming more directed on quality of medical care at the expense of quality of life. Conclusion: While the implementation of data-driven health approach within long-term care for older adults is not yet widespread, the general development within health care points towards a situation in which this will become reality. Our study highlights the importance of taking the relational aspects of care into consideration, both during the planning and implementation phase of this process. By doing this, the introduction of a data-driven health approach could serve to heighten the quality of care in a way which supports both quality of medical care and quality of life. [ABSTRACT FROM AUTHOR]

Background: Limited attention has been paid to how and why older adults choose to engage with technology-facilitated health care (e-health), and the factors that impact on this. This scoping review sought to address this gap.Methods: Databases were searched for papers reporting on the use of e-health services by older adults, defined as being aged 60 years or older, with specific reference to barriers and facilitators to e-health use.Result: 14 papers were included and synthesised into five thematic categories and related subthemes. Results are discussed with reference to the Unified Theory of Acceptance and Use of Technology2. The most prevalent barriers to e-health engagement were a lack of self-efficacy, knowledge, support, functionality, and information provision about the benefits of e-health for older adults. Key facilitators were active engagement of the target end users in the design and delivery of e-health programs, support for overcoming concerns privacy and enhancing self-efficacy in the use of technology, and integration of e-health programs across health services to accommodate the multi-morbidity with which older adults typically present.Conclusion: E-health offers a potential solution to overcome the barriers faced by older adults to access timely, effective, and acceptable health care for physical and mental health. However, unless the barriers and facilitators identified in this review are addressed, this potential will not be realised. [ABSTRACT FROM AUTHOR]

Background: To identify facilitators and barriers that residents, medical and nursing students perceive in their Interprofessional Education (IPE) in a clinical setting with other healthcare students. Methods: A systematic review was carried out to identify the perceptions of medical students, residents and nursing students regarding IPE in a clinical setting. PubMed, CINAHL, ERIC and PsycInfo were searched, using keywords and MeSH terms from each database's inception published prior to June 2014. Interprofessional education involving nursing and medical students and/or residents in IPE were selected by the first author. Two authors independently assessed studies for inclusion or exclusion and extracted the data. Results: Sixty-five eligible papers (27 quantitative, 16 qualitative and 22 mixed methods) were identified and synthesized using narrative synthesis. Perceptions and attitudes of residents and students could be categorized into 'Readiness for IPE', 'Barriers to IPE' and 'Facilitators of IPE'. Within each category they work at three levels: individual, process/curricular and cultural/organizational. Readiness for IPE at individual level is higher in females, irrespective of prior healthcare experience. At process level readiness for IPE fluctuates during medical school, at cultural level collaboration is jeopardized when groups interact poorly. Examples of IPE-barriers are at individual level feeling intimidated by doctors, at process level lack of formal assessment and at cultural level exclusion of medical students from interaction by nurses. Examples of IPE-facilitators are at individual level affective crises and patient care crises situations that create feelings of urgency, at process level small group learning activities in an authentic context and at cultural level getting acquainted informally. These results are related to a model for learning and teaching, to illustrate the implications for the design of IPE. Conclusions: Most of the uncovered barriers are at the cultural level and most of the facilitators are at the process level. Factors at the individual level need more research. [ABSTRACT FROM AUTHOR]

Background: Accurately predicting the future development trend of population aging is conducive to accelerating the development of the elderly care industry. This study constructed a combined optimization grey prediction model to predict the structure and density of elderly population. Methods: In this paper, a GT-FGM model is proposed, which combines Theta residual optimization with fractional-order accumulation operator. Fractional-order accumulation can effectively weaken the randomness of the original data sequence. Meanwhile, Theta residual optimization can adjust parameter by minimizing the mean absolute error. And the population statistics of Shanghai city from 2006 to 2020 were selected for prediction analysis. By comparing with the other traditional grey prediction methods, three representative error indexes (MAE, MAPE, RMSE) were conducting for error analysis. Results: Compared with the FGM model, GM (1,1) model, Verhulst model, Logistic model, SES and other classical prediction methods, the GT-FGM model shows significant forecasting advantages, and its multi-step rolling prediction accuracy is superior to other prediction methods. The results show that the elderly population density in nine districts in Shanghai will exceed 0.5 by 2030, among which Huangpu District has the highest elderly population density, reaching 0.6825. There has been a steady increase in the elderly population over the age of 60. Conclusions: The GT-FGM model can improve the prediction accuracy effectively. The elderly population in Shanghai shows a steady growth trend on the whole, and the differences between districts are obvious. The government should build a modern pension industry system according to the aging degree of the population in each region, and promote the balanced development of each region. [ABSTRACT FROM AUTHOR]

Objectives: The transition of an older family member into a residential aged care facility (RACF) is often challenging for both the person being admitted and their family carer. This review aimed to identify the protective and contributing factors to adverse mental health outcomes among family carers following the decision to move a family member to a RACF.Method: A search of CINAHL, PubMed and PsycINFO was conducted for empirical papers published in English between 2004 and 2019, exploring the mental health or quality of life (QoL) of family carers of those recently admitted, or considering admission, to a RACF. Articles were reviewed by two authors for inclusion.Results: Twenty-three studies met the inclusion criteria. Pre-existing depressive symptoms and poor subjective health were related to adverse mental health outcomes following admission. Information from the facility, support to change roles, and factors related to carer's health and demographics, were associated with changes in the mental health outcomes of carers during the transition of their relative to a RACF. Key protective factors of carer's mental health outcomes following the transition of their relative to a RACF are flow and transparency of information between carer and the facility staff, and staff efforts to involve carers in providing emotional support to their relative, in monitoring care, and advocating for their quality of life.Conclusion: There is evidence to suggest factors such lack of flow and transparency of information between carer and the facility staff may predispose carers to poor mental health and QoL following the transition of a relative to a RACF. Key protective factors of carer's mental health following admission are staff efforts to involve carers in providing emotional support to their relative, in monitoring care, and advocating for their quality of life. This review also indicates that the combination of factors that puts family carers more at risk of poor mental health and lower quality of life throughout the transition period. Policy and practice should follow recommendations that consider a combination of the above factors when addressing the needs of family carers before and after admission of an older person to RACF. [ABSTRACT FROM AUTHOR]

Objective: Falling is one of the main causes of death and morbidity in the elderly. This study aims to explore the association between elderly patients with chronic diseases and their health-related behaviors and falls in the elderly, and to provide clues for the prevention and intervention of injuries caused by falls in the elderly.Methods: Based on the basic demographic characteristics data, number of chronic diseases, health-related behaviors, and physical and mental health data of 5867 elderly people aged 60 and above in the 2018 CHARLS data, this paper used ordered logit regression to analyze the correlation between chronic diseases and their health-related behaviors and falls of Chinese elderly. On this basis, it also distinguishes whether there is care or not, explores whether the related factors of falls of elderly people will be different, and tests the intermediary effect of health status to further explore its mechanism.Results: The number of chronic diseases and health-related behaviors in the four dimensions of sleeptime, drinking, smoking, and activity are significantly correlated with falls in the elderly. Among them, health status plays a significant mediating role in the relationship of the number of chronic diseases and sleeptime and activity on the falls of the elderly. In addition, compared with the elderly without care, the risk of falls in the elderly in care is only related to the number of chronic diseases and sleeptime, while the elderly without care is related to the number of chronic diseases and multiple factors such as smoking, drinking and activity.Conclusion: Falls are significantly associated with chronic disease and health-related behaviors, while risk or protective factors for falls vary according to whether older adults are cared for. Therefore, targeted interventions can be made for the factors that affect the fall of the elderly according to different situations. [ABSTRACT FROM AUTHOR]

Background: The increasing aging population has led to a shortage of geriatric chronic disease caregiver, resulting in inadequate care for elderly people. In this global context, many older people rely on nonprofessional family care. The credibility of existing health websites cannot meet the needs of care. Specialized health knowledge bases such as SNOMED—CT and UMLS are also difficult for nonprofessionals to use. Furthermore, professional caregiver in elderly care institutions also face difficulty caring for multiple elderly people at the same time and working handovers. As a solution, we propose a smart care system for the elderly based on a knowledge graph. Method: First, we worked with professional caregivers to design a structured questionnaire to collect more than 100 pieces of care-related information for the elderly. Then, in the proposed system, personal information, smart device data, medical knowledge, and nursing knowledge are collected and organized into a dynamic knowledge graph. The system offers report generation, question answering, risk identification and data updating services. To evaluate the effectiveness of the system, we use the expert evaluation method to score the user experience. Results: The results of the study showed that compared to existing tools (health websites, archives and expert team consultation), the system achieved a score of 8 or more for basic information, health support and Dietary information. Some secondary evaluation indicators reached 9 and 10 points. This finding suggested that the system is superior to existing tools. We also present a case study to help the reader understand the role of the system. Conclusion: The smart care system provide personalized care guidelines for nonprofessional caregivers. It also makes the job easier for institutional caregivers. In addition, the system provides great convenience for work handover. [ABSTRACT FROM AUTHOR]

Background: As the number of older people increases, so does the need for care. However, the workforce in eldercare cannot increase at the rate required to match the needs. Welfare technologies, such as surveillance cameras, can replace physical visits and be used at night to monitor older people in order to keep them safe, while not disturbing their sleep. The aim of the paper is to analyze obstacles and opportunities associated with implementation and use of surveillance cameras at nursing homes from the perspectives of the practitioners who use the technology, their working environment and the conditions of the older people with cognitive impairment who live in nursing homes. Methods: Individual semi-structured interviews were conducted with the eldercare personnel at nursing homes to understand their experiences of implementation and use of surveillance cameras. The transcribed interviews were analyzed using qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) was used as a guidance tool. Results: The results show that the eldercare personnel experienced lack of adequate information, education and support related to using surveillance cameras. Several benefits are highlighted, such as better working environment and that the residents were not unnecessarily disturbed at night. However, the results also show that it is important to clarify that surveillance cameras cannot replace the human presence. Conclusions: The conclusions from this study are the importance of prerequisites for implementation, and that using surveillance cameras contributed to improvements in the working environment at night and created possibilities to maintain security and integrity for older people living in nursing homes. [ABSTRACT FROM AUTHOR]

Background: Vouchers, which are demand-side subsidies to targeted groups, are a type of consumer-led near-cash social transfer for specified benefits that have been used in education, health and other sectors. To provide better access to residential care services and an additional choice for elderly people in need, a novel means-tested residential care service voucher has been introduced in Hong Kong for elderly people to purchase places in the private sector to enable consumer-directed care. The objectives of this paper are to analyze the perspectives of voucher users and their carers toward the voucher scheme and to identify key elements in the design that will contribute to meeting the scheme's objectives. Methods: An exploratory sequential mixed method design was adopted with initial explorative qualitative data collection of the perspectives of elderly people and their carers (Phase 1), which informed the design of the subsequent questionnaire survey (Phase 2). Thirty carers in 5 focus groups and 20 individual interviews with elderly people were conducted between April and May 2018. A total of 401 respondents (373 carers and 28 elderly people) completed the survey questionnaire. Findings from both phases were integrated both narratively and via a joint display. Results: Five key themes summarized the features in two main elements of the design and implementation of the voucher scheme: awareness, meaning that inadequate knowledge and understanding of voucher schemes hinder participation; service needs and types, indicating that the urgent need for residential care services is the key reason for participation; shared responsibility, meaning that a high copayment level discourages participation; choice and flexibility, reflecting appreciation of the additional choices provided by voucher schemes although the availability of residential care beds limits choices; and service quality, indicating mixed perceptions of service quality and the impact of the voucher scheme. Voucher users believe that the voucher scheme is more helpful for relieving the financial burden (98.7%), reducing carers' stress (97.0%) and reducing the waiting time for subsidized homes for elderly people (89.0%) than for increasing choice and flexibility (78.1%) and improving service quality (62.1%). Conclusions: This study demonstrates how the design of a voucher scheme affects its take-up by targeted beneficiaries. When a voucher scheme is implemented in a long-term care system, it must consider the congruence with existing policies in long-term care provision and financing. The voucher scheme in Hong Kong has been able to generate the utilization of nonsubsidized places in homes for elderly people that were underutilized, but its effectiveness is limited by inadequate knowledge and understanding of the voucher scheme and the availability of residential care places. Giving the purchasing power and choice of providers to beneficiaries has the potential to enhance the quality of services, which will contribute to meeting the objectives. The study findings carry significant implications for long-term care policies and provide insights into the key features of the voucher scheme for residential care services and how to best design and implement a voucher scheme for elderly people in the context of policy objectives and a long-term care policy. [ABSTRACT FROM AUTHOR]

Background: Hospitalisation rates for older people are increasing, with end-of-life care becoming a more medicalised experience. Innovative approaches are warranted to support early identification of the end-of-life phase, communicate prognosis, provide care consistent with people's preferences, and improve the use of healthcare resources. The Intervention for Appropriate Care and Treatment (InterACT) trial aimed to increase appropriate care and treatment decisions for older people at the end of life, through implementation of a prospective feedback loop. This paper reports on the care review outcomes.Methods: A stepped-wedge randomised controlled trial was conducted in three large acute hospitals in Queensland, Australia between May 2020 and June 2021. The trial identified older people nearing the end of life using two validated tools for detecting deterioration and short-term death. Admitting clinical teams were provided with details of patients identified as at-risk with the goal of increasing awareness that end of life was approaching to facilitate appropriate patient centred care and avoid non-beneficial treatment. We examined the time between when the patient was identified as 'at-risk' and three outcomes: clinician-led care review discussions, review of care directive measures and palliative care referrals. These were considered useful indicators of appropriate care at the end of life.Results: In two hospitals there was a reduction in the review of care directive measures during the intervention compared with usual care at 21 days (reduced probability of - 0.08; 95% CI: - 0.12 to - 0.04 and - 0.14; 95% CI: - 0.21 to - 0.06). In one hospital there was a large reduction in clinician-led care review discussions at 21 days during the intervention (reduced probability of - 0.20; 95% CI: - 0.28 to - 0.13). There was little change in palliative care referrals in any hospital, with average probability differences at 21 days of - 0.01, 0.02 and 0.04.Discussion: The results are disappointing as an intervention designed to improve care of hospitalised older people appeared to have the opposite effect on care review outcomes. The reasons for this may be a combination of the intervention design and health system challenges due to the pandemic that highlight the complexity of providing more appropriate care at the end of life.Trial Registration: Australia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019). [ABSTRACT FROM AUTHOR]

Background: Mealtimes are embedded routines of residents living in residential aged care facilities (RACFs) that directly impact their health and quality of life. Little is known about how mealtime experiences are informed and affected by structures such as government and organisational policies and processes. This scoping review used Giddens' (The constitution of society: outline of the theory of structuration, 1984) Structuration Theory to investigate how governance structures related to mealtime practices inform residents' mealtime experiences.Methods: Using Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) scoping review framework, a systematic database, grey literature and policy search was completed in May 2020 and updated in July 2021. From 2725 identified articles, 137 articles were included in data charting and deductive analysis, and 76 additional Australian government policy papers were used interpretatively.Results: Data charting identified that the included studies were prominently situated in Western countries, with a progressive increase in publication rate over the past two decades. Qualitative findings captured structures that guide RACF mealtimes, how these relate to person-centred mealtime practices, and how these facilitate residents to enact choice and control.Conclusions: Current policies lack specificity to inform the specific structures and practices of RACF mealtimes. Staff, residents, organisational and governance representatives possess different signification, legitimation and domination structures, and lack a shared understanding of policy, and how this influences processes and practices that comprise mealtimes. [ABSTRACT FROM AUTHOR]

Background: Many older people live at home, often with complex and chronic health and social care needs. Integrated care programs are increasingly being implemented as a way to better address these needs. To support older people living at home, it is also essential to maintain their safety. Integrated care programs have the potential to address a wide range of risks and problems that could undermine older people's ability to live independently at home. The aim of this scoping review is to provide insight into how integrated care programs address safety risks faced by older people living at home - an area that is rather underexplored.Methods: Safety was conceptualised as preventing or reducing the risk of problems, associated with individual functioning and behaviour, social and physical environments, and health and social care management, which could undermine older people's ability to live independently at home. For this scoping review a systematic literature search was performed to identify papers describing integrated care programs where at least one intervention component addressed safety risks. Data were extracted on the programs' characteristics, safety risks addressed, and the activities and interventions used to address them.Results: None of the 11 programs included in this review explicitly mentioned safety in their goals. Nevertheless, following the principles of our conceptual framework, the programs appeared to address risks in multiple domains. Most attention was paid to risks related to older people's functioning, behaviour, and the health and social care they receive. Risks related to people's physical and social environments received less attention.Conclusion: Even though prevention of safety risks is not an explicit goal of integrated care programs, the programs address a wide range of risks on multiple domains. The need to address social and environmental risks is becoming increasingly important given the growing number of people receiving care and support at home. Prioritising a multidimensional approach to safety in integrated care programs could enhance the ability of health and social care systems to support older people to live safely at home. [ABSTRACT FROM AUTHOR]

Background: Nurses contribute the largest portion of Uganda's health workforce providing care to individuals of all ages and communities. However, despite the growing number of the elderly population in Uganda with improved life expectancy, there is hardly any study that has looked at the elderly health care competencies in the nursing training programs at various levels. This paper provides an overview of the gaps in elderly health care competencies in nursing education in Uganda. Methods: We conducted a descriptive qualitative cross-sectional study that involved document review, Key Informant Interviews (KIIs) with nursing leaders, and Focus Group Discussions (FGDs) with faculty at all levels of nursing training and nurses in practice. Data was analyzed using latent and manifest content analysis with Open Code software 4.03. Common categories were identified and incorporated into a matrix to create themes. Results: Almost all the curricula and minimum standards for training nurses at certificate, diploma, and degree levels lack a module and nursing competencies on elderly nursing care. This is aggravated by a lack of faculty trained in elderly health care skills, and a lack of specialized wards for nursing elderly care clinical training among others. Conclusions: There is hardly any elderly health care training module and elderly nursing competencies at all levels of nursing training in Uganda. [ABSTRACT FROM AUTHOR]

Background: As older people age, they have different health needs compared to younger people. South African elder care policy places a strong emphasis on ageing in community rather than institutional settings, but the primary healthcare system is not geared to address the health needs of older people living in community settings.Methods: This paper presents findings of nine focus groups conducted with community-dwelling older adults in three areas (high, medium and low-income) in Cape Town, South Africa over 2 months in 2017. These discussions addressed primary health services available to older persons, their ability to access these services and their expectations and experiences of care.Results: Findings showed that while participants in the high-income area had few challenges accessing quality care or support services, services available in lower-income areas were much less responsive and participants displayed low trust in the healthcare system, feeling that their needs were overlooked. Participants who experienced poor doctor-patient communication often failed to comply with treatment, while those who experienced patient-centered communication, either through the private sector or NGO-public sector partnerships had better perceptions of care.Conclusions: Older persons' complex health needs cannot be adequately addressed by a process-driven approach to care. Supporting patient-centered communication and care may help health workers to understand older persons health needs and improve patient understanding, trust and co-operation. This paper suggests the importance of community support services in enhancing health access and developing systems that enable healthcare providers to better understand and respond to older persons' needs in resource-constrained settings. [ABSTRACT FROM AUTHOR]

Background: Care homes provide long term care for older people. Countries with standardised approaches to residents' assessment, care planning and review (known as minimum data sets (MDS)) use the aggregate data to guide resource allocation, monitor quality, and for research. Less is known about how an MDS affects how staff assess, provide and review residents' everyday care. The review aimed to develop a theory-driven understanding of how care home staff can effectively implement and use MDS to plan and deliver care for residents.Methods: The realist review was organised according to RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines. There were three overlapping stages: 1) defining the scope of the review and theory development on the use of minimum data set 2) testing and refining candidate programme theories through iterative literature searches and stakeholders' consultations as well as discussion among the research team; and 3) data synthesis from stages 1 and 2. The following databases were used MEDLINE via OVID, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ASSIA [Applied Social Sciences Citation Index and Abstracts]) and sources of grey literature.Results: Fifty-one papers informed the development of three key interlinked theoretical propositions: motivation (mandates and incentives for Minimum Data Set completion); frontline staff monitoring (when Minimum Data Set completion is built into the working practices of the care home); and embedded recording systems (Minimum Data Set recording system is integral to collecting residents' data). By valuing the contributions of staff and building on existing ways of working, the uptake and use of an MDS could enable all staff to learn with and from each other about what is important for residents' care CONCLUSIONS: Minimum Data Sets provides commissioners service providers and researchers with standardised information useful for commissioning planning and analysis. For it to be equally useful for care home staff it requires key activities that address the staff experiences of care, their work with others and the use of digital technology.Registration: PROSPERO registration number CRD42020171323. [ABSTRACT FROM AUTHOR]

Background: This paper describes the collection and integration of mixed methods data to facilitate the final selection of items for the Quality of Life - Aged Care Consumers (QOL-ACC) instrument. The aim of the wider project is to develop a preference-based quality of life instrument that can be used for quality assessment and economic evaluation. Older people have been involved at every stage of the development of the QOL-ACC to ensure that the final instrument captures their perspectives and preferences.Methods: Mixed methods data was collected on draft items for the QOL-ACC instrument across six key quality of life dimensions (mobility, pain management, emotional well-being, independence, social connections, and activities). Qualitative face validity data was collected from older people (aged 66 to 100 years) living in the community and in residential aged care via semi-structured interviews (n = 59). Quantitative data was collected from older people (aged 65 to 91 years) receiving aged care services in the community via an online survey (n = 313). A traffic light pictorial approach was adopted as a practical and systematic way to categorise and present data in a meaningful way that was easy for non-academic workshop members to understand and to be able to discuss the relative merits of each draft item.Results: The traffic light approach supported the involvement of consumer and aged care provider representatives in the selection of the final items. Six items were selected for the QOL-ACC instrument with one item representing each of the six dimensions.Conclusions: This methodological approach has ensured that the final instrument is psychometrically robust as well as meaningful, relevant and acceptable to aged care consumers and providers. [ABSTRACT FROM AUTHOR]

Introduction: With effective antiretroviral therapy (ART), many persons living with HIV (PLHIV) live to old age. Caring for aged PLHIV necessitates the engagement of caregivers and patients to establish agreed-upon goals of treatment. However, there is limited literature on friendly and centered models of care for elderly PLHIV. We explored strategies to improve care in HIV clinics among PLHIV aged 50 years and above in Uganda. Methods: We conducted 40 in-depth interviews in two hospitals with elderly PLHIV aged 50 years and above who had lived with HIV for more than ten years. We explored strategies for improving care of elderly PLHIV at both health facility and community levels. The in-depth interviews were audio-recorded and transcribed verbatim. The thematic approach guided data analysis. Results: The elderly PLHIV suggested the following strategies to improve their care: creating geriatric clinics; increasing screening tests for non-communicable diseases in the ART clinics; community and home-based ART delivery; workshops at health facilities to provide health education on aging effectively; creating community support groups; financial assistance for the elderly PLHIV and advances in science. Conclusions: There is need to improve community HIV care especially for the elderly and social and economic support in the community. Involving the elderly PLHIV in developing strategies to improve their health goes a long way to improve the patients' quality of care. There is a need to incorporate the raised strategies in HIV care or older adults. [ABSTRACT FROM AUTHOR]

Background and Purpose: The caregiving's impact on informal carers' quality of life and gender-based stereotypes make older individuals' informal care a complex process for which our knowledge is still limited. The purpose of this review is to identify how gender relates to informal carers' experiences of providing care for people aged 60 years and over with mental and physical health needs by synthesising the available empirical data published between 2000 to 2020.Design and Methods: The systematic method for reviewing and synthesising qualitative data was performed using the PRISMA checklist and ENTREQ statement. The CASP tool was used to examine the quality of the included papers. Thematic synthesis was used as the methodological framework.Results: This review produced two analytical themes, the impact of gender on the caregivers' labour and negotiating gender identity with self, society, and cultural norms. While informal caregivers share motivators, a linkage between traditional gender stereotypes impacts caregiving burden and coping strategies. Informal carers' experiences entail a constant pursuit of self-agency after acquiring the caregiver role. Cultural values and their intersection with gender appear to influence caregivers' healthy adjustment into their new caregiving identities. The flexibility to move beyond gender boundaries could mediate caregivers' negotiations between self and society on developing their new caregiving identity. Providing intensive informal primary care to older people affects both men's and women's mental and physical health. Gender ideals of the feminine nurturing role further disadvantage women as they determine the caregiving arrangements, the strategies and resources to sustain the caring burden, and the adaptability to experience their new caregiving role positively. Men appear more flexible to debate their hegemonic masculinity and defend their existence in the caregiving role.Conclusion and Implications: Transgressing gender lines and expanding gender possibilities can ease the caregiving burden and strengthen caregivers coping potentials. Health professionals can empower informal careers to challenge gender binaries and expand gender possibilities by intentionally injecting the language of diversity in caring information and caring processes. The review findings outline a path for research on gender identity development in older people's care. [ABSTRACT FROM AUTHOR]

Background: In the healthcare system in Germany, different institutions and actors play specific roles in the discharge and transition of patients from hospitals into primary care (Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen, Wettbewerb an der Schnittstelle zwischen ambulanter und stationärer Gesundheitsversorgung, 2012). However, there are shortcomings in these intersectoral transitions. Especially in older people with cognitive impairment (PCI), discharge management often lacks coordination and cooperation between healthcare providers. This frequently results in higher rates of unscheduled readmission. The project intersec-CM is a randomised controlled trial (RCT) that aims to explore up to what extent an intersectoral care management (ICM) can improve this transition. This ICM is delivered by nurses with special training in care management. The objective of this paper is to describe a mixed-methods process evaluation of the intersectoral care management intervention and the factors that facilitate and inhibit its implementation.Methods: Different study designs for process evaluations from previous literature were collected and analysed according to the dimension implementation fidelity, satisfaction with the intervention, feasible transfer into routine care, optimum point of time, frequency and execution of the intervention, and context factors.Results: The actor-network theory was chosen as the theoretic framework for the process evaluation. Based on this theory, a mixed-methods design was developed to combine and integrate qualitative and quantitative evaluation methods. The qualitative part includes semi-structured interviews using topic guides (phase 1) and later in-depth interviews with narrative portions (phase 3), which will be analysed by using the qualitative content analysis according to Kuckartz. The quantitative survey (phase 2) is conducted with standardised questionnaires.Discussion: Challenges in data collection include the development of interview guidelines, which require different terminologies depending on every specific actor targeted in the intervention. Conducting the interviews, there is a risk of misunderstanding the older PCI by the interviewer and vice versa. However, the combination of qualitative and quantitative approaches as different techniques of process evaluation may help to capture, integrate and analyse data on different dimensions of the intervention.Conclusions: The results of our process evaluation may serve as an implementation guideline for intersectoral care management in the German healthcare system. Furthermore, the approach to evaluate the process of a complex intervention in health care for older PCI may serve as a stimulus to broaden the evidence base also of other complex intervention studies to improve health care for this vulnerable group. The study was ethically approved by the Ethics Committee of the Ernst-Moritz-Arndt University of Greifswald. The study has been registered at the U.S. National Library of Medicine.Trial Registration: ClinicalTrials.gov NCT03359408 . Registered on 2 December 2017. The approximate date when recruitment to the process evaluation of the study will be completed is 31 May 2021. [ABSTRACT FROM AUTHOR]

Background: Hearing and vision loss in older people has been proven to affect physical and mental health and increase the speed of cognitive decline. Studies have demonstrated that certain practices and improved staff knowledge increase the effective care of residents' ears and eyes, yet it is not known which practices are being implemented in care homes. This study aimed to identify the gaps in staff knowledge regarding hearing and vision difficulties in older residents, and which practices known to improve ear and eye care in older care home residents are not commonly implemented in care homes in England.Methods: This study used a cross-sectional survey design. Survey questions were informed by the existing literature and were focused on practices, staff knowledge, and other aspects that have shown to affect residents' hearing and vision care. A convenience sample of care home staff were recruited from care homes across England between November 2018 and February 2019 via email and in paper format. Descriptive statistics and Chi-Square analysis were applied to identify the factors influencing the care being provided to care home residents.Results: A total of 400 care home staff responded from 74 care homes. The results revealed that less than half of staff respondents reported to use screening tools to identify hearing (46%) and vision impairments (43.8%); that care homes rarely have access to other assistive devices for hearing (16%) and vision loss (23.8%), and that audiology services do not regularly assess care home residents (46.8%). A majority of staff who responded were not confident in ear and eye care. Responses were found to be influenced by the respondents' job role, length of time working in care homes and also the care home type. Findings confirmed a lack of standardised practice and the importance of shared communication for promulgation of best practice.Conclusion: This study has identified that some practices known to facilitate ear and eye care are not commonly applied in a sample of English care homes. It has also shown that care home staff knowledge of ear and eye care is inconsistent. The information derived from this survey can be used to inform guidelines for best practice and inform needs for future research. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems are overloaded and changing. In response to growing demands on the healthcare systems, new models of healthcare delivery are emerging. Community paramedicine is a novel approach in which paramedics use their knowledge and skills beyond emergency health response to contribute to preventative and rehabilitative health. In our systematic review, we aimed to identify evidence of the community paramedicine role in care delivery for elderly patients, with an additional focus on palliative care, and the possible impact of this role on the wider healthcare system.Methods: A systematic review of peer-reviewed literature from MEDLINE, Embase, CINAHL, and Web of Sciences was undertaken to identify relevant full-text articles in English published until October 3, 2019. Additional inclusion criteria were studies focussing on extended care paramedics or community paramedics caring for elderly patients. Case studies were excluded. All papers were screened by at least two authors and underwent a quality assessment, using the Joanna Briggs Institute appraisal checklists for cross sectional, qualitative, cohort, and randomised controlled trial studies to assess the methodological quality of the articles. A process of narrative synthesis was used to summarise the data.Results: Ten studies, across 13 articles, provided clear evidence that Community Paramedic programs had a positive impact on the health of patients and on the wider healthcare system. The role of a Community Paramedic was often a combination of four aspects: assessment, referral, education and communication. Limited evidence was available on the involvement of Community Paramedics in palliative and end-of-life care and in care delivery in residential aged care facilities. Observed challenges were a lack of additional training, and the need for proper integration and understanding of their role in the healthcare system.Conclusions: The use of community paramedics in care delivery could be beneficial to both patients' health and the wider healthcare system. They already play a promising role in improving the care of our elderly population. With consistent adherence to the training curriculum and effective integration within the wider healthcare system, community paramedics have the potential to take on specialised roles in residential aged care facilities and palliative and end-of-life care. [ABSTRACT FROM AUTHOR]

Background: The development of ambulatory emergency care services, now called 'Same Day Emergency Care' (SDEC) has been advocated to provide sustainable high quality healthcare in an ageing population. However, there are few data on SDEC and the factors associated with successful ambulatory care in frail older people. We therefore undertook a prospective observational study to determine i) the clinical characteristics and frailty burden of a cohort in an SDEC designed around the needs of older patients and ii) the factors associated with hospital admission within 30-days after initial assessment.Methods: The study setting was the multidisciplinary Abingdon Emergency Medical Unit (EMU) located in a community hospital and led by a senior interface physician (geriatrician or general practitioner). Consecutive patients from August-December 2015 were assessed using a structured paper proforma including cognitive/delirium screen, comorbidities, functional, social, and nutritional status. Physiologic parameters were recorded. Illness severity was quantified using the Systemic Inflammatory Response Syndrome (SIRS> 1). Factors associated with hospitalization within 30-days were determined using multivariable logistic regression.Results: Among 533 patients (median (IQR) age = 81 (68-87), 315 (59%) female), 453 (86%) were living at home but 283 (54%) required some form of care and 299 (56%) had Barthel< 20. Falls, urinary incontinence and dementia affected 81/189 (43%), 50 (26%) and 40 (21%) of those aged > 85 years." Severe illness was present in 148 (28%) with broadly similar rates across age groups. Overall, 210 (39%) patients had a hospital admission within 30-days with higher rates in older patients: 96 (87%) of < 65 years remained on an ambulatory pathway versus only 91 (48%) of ≥ 85 years (p < 0.0001). Factors independently associated with hospital admission were severe illness (SIRS/point, OR = 1.46,95% CI = 1.15-1.87, p = 0.002) and markers of frailty: delirium (OR = 11.28,3.07-41.44, p < 0.0001), increased care needs (OR = 3.08,1.55-6.12, p = 0.001), transport requirement (OR = 1.92,1.13-3.27), and poor nutrition (OR = 1.13-3.79, p = 0.02).Conclusions: Even in an SDEC with a multidisciplinary approach, rates of hospital admission in those with severe illness and frailty were high. Further studies are required to understand the key components of hospital bed-based care that need to be replicated by models delivering acute frailty care closer to home, and the feasibility, cost-effectiveness and patient/carer acceptability of such models. [ABSTRACT FROM AUTHOR]

Background: The Translating Research in Elder Care (TREC) program is a longitudinal partnered program of research in Western Canada that aims to improve the quality of care and quality of life for residents and quality of worklife for staff in long-term care settings. This program of research includes researchers, citizens (persons living with dementia and caregivers of persons living in long-term care), and stakeholders (representatives from provincial and regional health authorities, owner-operators of long-term care homes). The aim of this paper is to describe how we used priority setting methods with citizens and stakeholders to identify ten priorities for research using the TREC data. Methods: We adapted the James Lind Alliance Priority Setting Partnership method to ensure our citizens and stakeholders could identify priorities within the existing TREC data. We administered an online survey to our citizen and stakeholder partners. An in-person priority setting workshop was held in March 2019 in Alberta, Canada to establish consensus on ten research priorities. The in-person workshop used a nominal group technique and involved two rounds of small group prioritization and one final full group ranking. Results: We received 72 online survey respondents and 19 persons (citizens, stakeholders) attended the in-person priority setting workshop. The workshop resulted in an unranked list of their ten research priorities for the TREC program. These priorities encompassed a range of non-clinical topics, including: influence of staffing (ratios, type of care provider) on residents and staff work life, influence of the work environment on resident outcomes, and the impact of quality improvement activities on residents and staff. Conclusions: This modified priority setting approach provided citizens and stakeholders with an opportunity to identify their own research priorities within the TREC program, without the external pressures of researchers. These priorities will inform the secondary analyses of the TREC data and the development of new projects. This modified priority setting may be a useful approach for research teams trying to engage their non-academic partners and to identify areas for future research. [ABSTRACT FROM AUTHOR]

Background: In this paper, we analyse the economic burden of elder care in the Czech Republic by assessing how family members of senior citizens engage in caregiving. To do this, we examined the time and cost associated with caregiving as a function of age, gender, and income of the caregiver.Methods: A questionnaire comprising 17 items was used to gather data from 155 informal caregivers whose seniors are affiliated with 200 registered home care agencies. Spearman rank correlation was adopted to analyse how caregivers' income, age and gender influences the costs accrued and time spent in caring for elders. The expenses are divided into direct and indirect. Publicly available sources are used to establish expenses on treatment and medication, which cannot be determined by the questionnaire survey.Results: Results show that around-the-clock care is the most common. Spouses of care recipients make up the highest number of caregivers, and women represent the largest portion of this group. Additionally, the more the time spent caring for an elder, the higher the cost associated with such care. The total annual burden of informal caregivers is determined by the sum of annual average indirect costs, amounting to € 36,888, and annual direct costs, amounting to € 2775, resulting in a total of € 39,663 per year.Conclusion: Czech social policymakers should begin to consider better packages for caregivers in the form of incentives and other monetary benefits to improve living standards and care for ageing seniors. [ABSTRACT FROM AUTHOR]

Background: Many countries are engaged in primary care reforms to support older adults who are living longer in the community. Health Teams Advancing Patient Experience: Strengthening Quality [Health TAPESTRY] is a primary care intervention aimed at supporting older adults that involves trained volunteers, interprofessional teams, technology, and system navigation. This paper examines implementation of Health TAPESTRY in relation to interprofessional teamwork including volunteers. Methods: This study applied Normalization Process Theory (NPT) and used a descriptive qualitative approach [1] embedded in a mixed-methods, pragmatic randomized controlled trial. It was situated in two primary care practice sites in a large urban setting in Ontario, Canada. Focus groups and interviews were conducted with primary care providers, clinical managers, administrative assistants, volunteers, and a volunteer coordinator. Data was collected at 4 months (June–July 2015) and 12 months (February–March 2016) after intervention start-up. Patients were interviewed at the end of the six-month intervention. Field notes were taken at weekly huddle meetings. Results: Overall, 84 participants were included in 17 focus groups and 13 interviews; 24 field notes were collected. Themes were organized under four NPT constructs of implementation: 1) Coherence- (making sense/understanding of the program's purpose/value) generating comprehensive assessments of older adults; strengthening health promotion, disease prevention, and self-management; enhancing patient-focused care; strengthening interprofessional care delivery; improving coordination of health and community services. 2) Cognitive Participation- (enrolment/buy-in) tackling new ways of working; attaining role clarity. 3) Collective Action- (enactment/operationalizing) changing team processes; reconfiguring resources. 4) Reflective Monitoring- (appraisal) improving teamwork and collaboration; reconfiguring roles and processes. Conclusions: This study contributes key strategies for effective implementation of interventions involving interprofessional primary care teams. Findings indicate that regular communication among all team members, the development of procedures and/or protocols to support team processes, and ongoing review and feedback are critical to implementation of innovations involving primary care teams. Trial registration: ClinicalTrials.gov, no. NCT02283723 November 5, 2014. Prospectively registered. [ABSTRACT FROM AUTHOR]

Objective: Constructing a demand-oriented Internet + community home care service indicator system, starting from the actual needs of the elderly, and quantifying the demand into specific service contents that can be provided, so as to realize the effective supply of services. It aims to provide a theoretical basis for the government to formulate relevant aging policies and provide a reference basis for promoting the innovation and development of the Internet + elderly care model. Methods: Based on existence needs, relationship needs and growth needs abbreviated as "Existence, Relatedness, Growth (ERG)" demand theory, through the discussion in the group meeting, form the expert consultation questionnaire of the demand-oriented Internet + community home care service indicator system, select experts in related fields to conduct two rounds of Delphi expert consultation, summarize the experts' opinions to determine the indicator system items, and use the Analytic Hierarchy Process (AHP) method to construct the judgment matrix to derive the weighting coefficients of the indicators, and establish the ultimate demand-oriented Internet + community home care service indicator system. Results: The effective recovery rates for the two rounds of expert consoulation questionnaires were 100%, with expert authority coefficients of 0.852 and 0.868, respectively. The Kendall coefficients for the second round of expert views varied from 0.226 to 0.431, with coefficients of variation for all indexes less than 0.25.The finalized demand-oriented Internet + community home care service indicator system includes 3 first-level indicators, 10 s-level indicators, and 46 third-level indicators. The consistency ratios of indicator judgment matrices at all levels are less than 0.10, suggesting that the hierarchical analysis findings are consistent, implying that the weight coefficient distribution is appropriate. Conclusion: The demand-oriented Internet + community home care service Indicator System, which was created through expert consultation and AHP method, has reasonable content and is more dependable as an evaluation tool for reliably assessing demand for elderly servic. [ABSTRACT FROM AUTHOR]

The ageing population of the culturally and linguistically diverse (CALD) population is increasing in Australia. This is because the number of early migrants in Australia is ageing, coupled with increasing family reunification. This scoping review aimed to describe the nature and extent of research on the barriers to aged care services for CALD older adults in Australia using Penchansky and Thomas's Access to Care Framework of five A's dimensions: availability, accessibility, accommodation, affordability, and acceptability. Arksey and O'Malley's five-step scoping review framework was adopted to search 6 databases from inception till August 2024. Title/abstract and full-text screening were conducted using predefined inclusion and exclusion criteria, with supplementary search of references from included articles to identify additional articles. Findings show that while all the five A's of access to care services were barriers for CALD older adults, accommodation and acceptability of services were the major areas of concern due to the lack of cultural sensitivity of such services in Australia. An additional barrier captured and termed as Awareness was noted in some of the included studies, highlighting the need to expand the five A's to 6 A's. Researchers, practitioners, and policymakers on ageing could leverage these findings to improve cultural practice sensitivities when supporting these populations. [ABSTRACT FROM AUTHOR]

Background: China's government has invested a great deal of resources to improve the coverage rate of community care facilities for the elderly. However, the facilities that have been built are underutilized. Methods: Referring to the Anderson model, a framework for analyzing the utilization of community care facilities for the elderly was constructed. Descriptive statistics on survey data from 17 communities demonstrated the status of the utilization, and binary logistic regression analysis examined the influencing factors of the utilization. Results: Built community care facilities for the elderly are underutilized and there are significant differences in the influencing factors of the utilization between daily care facilities, medical care facilities, recreation facilities, and spiritual comfort facilities. Conclusions: The main reasons for the underutilization can be delineated as follows: (1) The demand for community care facilities is outstripped by the supply, resulting in a surplus; (2) Complex constraints on demand for facilities due to insufficient enabling resources; (3) Inadequacy of community care facilities in meeting expectations. (4) High substitutability of community care facilities; (5) Bureaucratic pressure hindering facility development. To address the underutilization of community care facilities, it is recommended to clarify the community responsibility boundaries for elderly care and the role that the market plays in community care facilities for the elderly. [ABSTRACT FROM AUTHOR]

Background and context: Providing care to the elderly is an emerging area of interest due to the increase in elderly population not only in the developed world but also in low and middle income countries. In Pakistan a country with an overall population of over 200 million, the elderly population amounts to 11.3 million. Caregiving of the elderly tends to occur within the kinship motivated by sociocultural norms as well as absence of government support facilities. While quantitative literature exists in Pakistan describing the "caregiver's burden," an in-depth analysis into the experiences of familial caregivers is missing. Methods: The research used qualitative methods with the aim to explore the lived experiences of 7 daughters and 3 daughters-in-law, living in Karachi, Pakistan providing care to the elderly requiring assistance in at least two tasks of daily living. Results: Five themes were developed inductively through the phenomenological method. All participants were Muslim and belonged to the upper economic strata of the society. Findings reveal that obligations to care are dominant in kinship circles particularly among women. Participants highlighted the importance of elderly in the Pakistani society, especially due to the religious lens that considers them as blessings. Daughter caregivers spoke about caregiving of their parents as a form of role reversal, emphasizing also upon the life-long emotional bond that served as a strong motivator. On the other hand, for daughter-in-law caregivers, motivations to care also stemmed from social expectations and kinship obligations. All participants reported multiple difficulties during the caregiving experience, despite existence of paid formal help, with respect to balancing multiple role demands and the nature of caregiving that requires constant effort. Results also illustrate that despite the desire to care for the elderly within a collectivist and patrilocal society, participants experienced multiple physical and emotional effects. However, a few also reported an increase in self-mastery and self-worth. Conclusion: This study reveals that despite increasing urbanization and more women working outside the home, providing care to the elderly appears to be centered within the kinship circle. The research makes important contributions to the ageing literature in Pakistan with relevance to other South Asian contexts. [ABSTRACT FROM AUTHOR]

Background: Ageing populations and care workforce shortages across Europe are causing challenges for care services for older people. Therefore, it is paramount that limited care resources are allocated optimally, based on the clients' care needs. Multiple functioning-related factors have been identified that determine the amount of care time clients receive, while organizational and other factors remain largely unexplored. The aim was to examine how various individual and organizational factors are associated with clients' received care time in different care settings. Methods: Cross-sectional observational study design with data from time and motion study, registers, and surveys was used. In total, 1477 home care clients and 1538 residents from assisted living facilities with 24/7 service participated, from 61 Finnish care units. Linear mixed-effect modeling was used to examine the association between individual and organizational-level variables and received care time. Results: Physical functioning was the strongest predictor of received care time in both care settings. In home care, greater pain, more unstable health, and higher team autonomy were associated with increased care time. In assisted living, depressive mood and higher staffing level of the organization were associated with care time. Clients who received informal care also received significantly more care time from nurses in both care settings. Conclusions: Physical functioning was the main driver of received care time. Interventions that maintain or improve physical functioning can help restrain the growing need of care resources, although it is important to ensure that each client receives care according to their holistic care needs. [ABSTRACT FROM AUTHOR]

Background: Global population aging poses a significant global challenge, necessitating an increased demand for proficient caregivers specialized in elderly care. In our study, a systematic review and meta-analysis were conducted to synthesize the evidence concerning nursing students' willingness to participate in caring for older people. Methods: Eligibility criteria focused on cross-sectional studies involving nursing students' willingness to participate in caring for older people and were reported in English or Chinese. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WANFANG databases were searched from inception until July 24, 2022. The methodological quality assessment in the included studies was evaluated using the AHRQ instrument. The pooled effects of the nursing students' willingness to participate in caring for older people were computed using a random-effects model. Funnel plots and Egger's test were employed to evaluate publication bias. Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity. Sensitivity analysis was conducted to verify the robustness of the meta-analysis findings. All statistical tests were conducted with Stata 16.0 software. Results: A total of 68 studies of medium or high quality met the eligibility criteria, involving 30,328 nursing students. The rate of nursing students' willingness to participate in caring for older people was 49.0% (95% CI = 46–53%, I2 = 98.1%, P = 0.000). The results of meta-regression analysis showed that the following four predictor variables were significantly associated with nursing students' willingness to participate in caring for older people: experience of living with and caring for older people, nursing as their first choice and their year-level in education, respectively. Subgroup analyses for these four predictor variables revealed the following pooled estimates of nursing students' willingness: having experience of living with older people (0.54, 95% CI = 0.46–0.62) vs. no such experience (0.38, 95% CI = 0.30–0.46), having experience of caring for older people (0.55, 95% CI = 0.48–0.63) vs. no such experience (0.38, 95% CI = 0.30–0.46), nursing as their first choice (0.54, 95% CI = 0.51–0.58) vs. not their first choice (0.44, 95% CI = 0.35–0.53), being in the first year of nursing education (0.44, 95% CI = 0.34–0.55), second year (0.45, 95% CI = 0.34–0.56), and third and fourth year (0.62, 95% CI = 0.53–0.71). Conclusion: The study found that approximately half of the nursing students confirmed their willingness to participate in caring for older people.The present study can serve as a resource for policymakers to increase the willingness of nursing students to participate in caring for older people. [ABSTRACT FROM AUTHOR]

Introduction: During 2020–2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings. Methods: A longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality. Results: During the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0–4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19–1.46, p < 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12–1.46, p < 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86–1.32, p = 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates. Conclusion: These findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents' care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research. [ABSTRACT FROM AUTHOR]

Background: Vitamin D supplement use is recommended best practice in residential aged care facilities (RACFs) for the prevention of falls, however has experienced delays in uptake. Following successful international efforts at implementing this evidence into practice, the ViDAus study sought to replicate this success for the Australian context. The aim of this paper is to report on the process outcomes of implementing this intervention.Methods: Forty-one RACFs were engaged in a multifaceted, interdisciplinary knowledge translation intervention. This focused on raising awareness to improve knowledge on vitamin D, and supporting facilities to identify barriers and implement locally devised strategies to improve the uptake of evidence based practice (EBP).Results: Staff members of participating facilities (n = 509 including nursing, care and allied health staff) were well engaged and accepting of the intervention, though engagement of servicing general practitioners (GPs) (n = 497) and pharmacists (n = 9) was poor. Facilities each identified between three and eight strategies focused on raising awareness, identifying residents to target for vitamin D and creating referral pathways depending upon their own locally identified barriers and capacity. There was variable success at implementing these over the 12-month intervention period. Whilst this study successfully raised awareness among staff, residents and their family members, barriers were identified that hindered engagement of GPs.Conclusions: The intervention was overall feasible to implement and perceived as appropriate by GPs, pharmacists, facility staff, residents and family members. More facilitation, higher-level organisational support and strategies to improve RACF access to GPs however were identified as important improvements for the implementation of vitamin D supplement use.Trial Registration: Retrospectively registered (ANZCTR ID: ACTRN12616000782437 ) on 15 June 2016. [ABSTRACT FROM AUTHOR]

Background: Home-based care may cover anything from 24-hour support for people with a disability, to short-term post-discharge care, or to periodic assistance with simple tasks such as domestic aid for frail older people. The process can be complex and time-consuming and requires coordination between the individual, their family caregivers, and healthcare providers. Receiving care at home can also lead to social isolation as older people may have limited opportunities for social interaction. This study aimed to investigate older people's experience and related factors while receiving home-based long-term care services. Methods: A qualitative study was used. Face-to-face individual interviews were conducted with people who were receiving nursing care in their homes (N = 17) and analyzed through thematic analysis. Results: Analysis of interview data resulted in the identification of three major themes that captured participants' personal experiences regarding long-term care in the home: (1) Challenges faced by older people receiving long-term care at home; (2) The impact of home care services on people's social well-being; and (3) Older people's contradictory emotions regarding care delivery. Conclusions: Findings of the study revealed that the most important and challenging factors in home care from the perspective of older people were social well-being, religious needs, and physical needs. They considered the nurses who provided these services as family members and the most significant helpers in their daily activities. Participants expressed a desire for more services in the future. [ABSTRACT FROM AUTHOR]

Background: Aged Care Assessment Teams are the assessment component of the Australian aged care system. Their purpose is to undertake needs-based assessments to determine an older person's eligibility for, and access to Commonwealth-funded aged care services. There are no measures that tell us if the aged care assessment service is of high quality from the perspective of the person being assessed. Quality measures have been developed and introduced in Australian residential aged care facilities. These however, have not considered the perspectives of those living in this setting. Quality measures for home care services have also been recommended. This research aims to address the gap in person-centred quality measures by asking current and future service users of aged care assessment services to vote on the importance of 24 person-centred quality indicators (PC-QIs), that were developed in a previous study using a modified Delphi method approach supported by engagement with a consumer led Advisory Board. Methods: This mixed methods study used the RAND/UCLA Appropriateness Method to reach consensus on a final set of PC-QIs. Twenty-five community-dwelling older people in Brisbane, Australia, voted on the importance of 24 PC-QIs using a five-point Likert scale. A consensus statement for PC-QI elimination was determined prior to participants voting. Voting was undertaken with participants individually either face-to-face or via telephone, in their homes. To capture any narrative provided by participants regarding each PC-QI, participant voting sessions were audio-recorded and subsequently transcribed verbatim. Quantitative data from participant votes for each PC-QI were calculated and statistically described by median, interquartile range, consensus met, percentile, percentile rank, rank order, median and standard deviation. PC-QIs were then assessed against the consensus statement for elimination and rank ordered according to importance to participants. Content analysis of qualitative data from audio transcriptions was conducted to determine the presence of certain words supporting participant votes for each PC-QI. Results: No PC-QIs were eliminated during voting. Variation existed among participants' ratings of importance for each PC-QI. Final quality domains, their respective title, quality indicator descriptor and supporting qualitative data are presented. Five PC-QIs had a median of five, no votes recorded below four, an interquartile range of zero, and a rank order score of one, two and four, out of a possible ten, indicating they were of highest importance to participants. Conclusion: Participants reached consensus on 24 evidence-based PC-QIs that represent measures of quality of aged care assessment services from the perspectives of current and future service users. Plain English Summary: In Australia, people 65 years or over, and Aboriginal and Torres Strait Islander Peoples 50 years or over, can apply to access aged care services funded by the Australian government (Australian Government, Department of Health and Aged Care. 2021-2022 Report on the Operation of the Aged Care Act 1997, 2022). Services the government funds include supporting older people to live at home, residential aged care if the person can't live at home, and short-term rehabilitation (Australian Government, Department of Health and Aged Care. 2021-2022 Report on the Operation of the Aged Care Act 1997, 2022). To access these services, a person needs to fill out an application form and undergo an aged care assessment. Another person can help complete the application. The purpose of the aged care assessment is to assess the person's needs to determine what aged care services they are eligible to access. There are no measures that tell us if the aged care assessment service is of high quality from the perspective of the person being assessed. Twenty-four measures of quality were developed in a previous study with support from a consumer Advisory Board (Smith S, Travers C, Roberts N, Martin‐Khan M. Health Expect, 2024). This study asked 25 older people living in Brisbane, the importance of the 24 measures, to decide if any should be eliminated. People were asked to vote using a number scale where number one meant it 'wasn't important', and five meant it was 'extremely important.' A consensus statement was agreed to decide if a measure would be eliminated. All measures were voted as being important with no measure eliminated. Quality Measures voted as being important included receiving assessments from knowledgeable health care staff, who treated them with dignity and respect, adopted a person-centred approach, established a collaborative relationship, and communicated clearly. [ABSTRACT FROM AUTHOR]

Objective: Based on the Omaha problem classification system, a sensitivity outcome index system for home nursing of elderly liver transplant patients was established. Methods: Through a comprehensive literature review and rigorous application of the Delphi method, a panel of 20 experts completed two rounds of effective letter consultation to obtain expert consensus opinions. The contents of indicators were determined based on this process, and the analytic hierarchy process was employed to confirm the weightage assigned to each indicator. Consequently, we established a sensitivity outcome index system for home care in elderly liver transplant patients. Results: The effective recovery rate of the questionnaire in two rounds of expert consultation was 100%, and the proportion of experts who gave opinions was 55% and 15%, respectively, indicating that the experts were highly active. The expert authority coefficients were calculated as 0.904 and 0.905, respectively, indicating a high degree of expert authority. In the second round, Kendall's coordination coefficients for primary, secondary, and tertiary indicators were determined to be 0.419, 0.418, and 0.394 (P < 0.001), indicating that expert opinions tended to be consistent. Finally, we established a comprehensive sensitivity outcome index system comprising 4 first-level indexes, 20 s-level indexes, and 72 third-level indexes specifically designed for elderly liver transplantation patients. Conclusion: The sensitivity outcome index system of home nursing for elderly liver transplant patients can provide theoretical basis for nursing staff to build accurate individualized continuous nursing model. [ABSTRACT FROM AUTHOR]

Introduction: In the emergency departments (EDs), usually the longest waiting time for treatment and discharge belongs to the elderly patients. Moreover, the number of the ED admissions for the elderly increases every year. It seems that the use of health information technology in geriatric emergency departments can help to reduce the burden of the healthcare services for this group of patients. This research aimed to develop a conceptual model for using health information technology in the geriatric emergency department. Methods: This study was conducted in 2021. The initial conceptual model was designed based on the findings derived from the previous research phases (literature review and interview with the experts). Then, the model was examined by an expert panel (n = 7). Finally, using the Delphi technique (two rounds), the components of the conceptual model were reviewed and finalized. To collect data, a questionnaire was used, and data were analyzed using descriptive statistics. Results: The common information technologies appropriate for the elderly care in the emergency departments included emergency department information system, clinical decision support system, electronic health records, telemedicine, personal health records, electronic questionnaires for screening, and other technologies such as picture archiving and communication systems (PACS), electronic vital sign monitoring systems, etc. The participants approved all of the proposed systems and their applications in the geriatric emergency departments. Conclusion: The proposed model can help to design and implement the most useful information systems in the geriatric emergency departments. As the application of technology accelerates care processes, investing in this field would help to support the care plans for the elderly and improve quality of care services. Further research is recommended to investigate the efficiency and effectiveness of using these technologies in the EDs. [ABSTRACT FROM AUTHOR]

Background: Person-centered care (PCC) is critical in addressing the diverse health priorities of older adults. Nurses play a pivotal role in implementing PCC, yet the nuances of the nurse-patient relationship in outpatient settings remain underexplored. This study aimed to gain insights into nurses' experiences, challenges, and strategies in caring for older adults through the lens of PCC. Methods: A qualitative descriptive design was employed, involving semi-structured interviews with 12 registered nurses from outpatient clinics serving older adults. Thematic analysis was conducted following the principles of trustworthiness and credibility. Results: Five main themes emerged: (1)Understanding and Implementing Person-Centered Care (PCC) (2) Experiences in Older Adult Care, highlighting the significance of trust-building, adapting care approaches, interdisciplinary collaboration, and emotional rewards; (3) Challenges in Care Delivery, including resource constraints, navigating family dynamics, keeping up with medical advances, and emotional strain; (4) Impact on Care Quality, encompassing consistency in care, patient satisfaction, professional development, and ethical considerations; and (5) Coping Strategies, such as peer support, work-life balance, reflective practice, and resilience building. Conclusions: The study underscores the complexities and rewards of the nurse-patient relationship in caring for older adults in outpatient settings. Nurses face formidable challenges but employ various coping strategies to maintain high-quality, person-centered care. Findings have implications for nursing practice, education, policy, and future research, emphasizing the need for supportive environments, continuous professional development, and recognition of the critical role nurses play in addressing the health priorities of the aging population. [ABSTRACT FROM AUTHOR]

Background: We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. Methods: Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. Results: With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. Conclusion: Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site. [ABSTRACT FROM AUTHOR]

Background: Family caregivers (FCs) encounter a variety of health problems in older people with chronic illness, necessitating a certain level of health literacy to access, understand, appraise and apply health information and services. This study aimed to develop and validate a scale for measuring health literacy among FCs of older people with chronic illness. Methods: Concept mapping was first employed to develop a conceptual model of health literacy of FCs. Scale domains were derived from the conceptual model, and item generation was performed using deductive and inductive methods. Quantitative methods, including merging scale dimensions and items, expert reviews, cognitive interviews, and item reduction analysis, were used to refine the scale. Confirmatory factor analysis was employed to validate the scale's structure. Concurrent validity, internal consistency, and test-retest reliability were also examined. Results: A 20-dimension conceptual model was developed, and 60 items were generated for the scale. Expert review (content validity index > 0.85) and cognitive interview with FCs confirmed the relevance and clarity of the majority of the generated scale items. Confirmatory factor analysis with 451 FCs of older people with chronic illness supported a 5-factor structure (symptom management, daily personal care and household tasks, care coordination, communication and relationship with the care recipient, and self-care of caregivers) with 42 finalized scale items, including four levels of health literacy skills (accessing, understanding, appraising and applying health information). Concurrent validity with the European Health Literacy Questionnaire (HLS-EU-Q47) was satisfactory (r = 0.67, p < 0.01). The Cronbach's α coefficient of the scale was 0.96, with subscales ranging from 0.84 to 0.91. The two-week test-retest reliability was 0.77 (p < 0.01). Conclusion: This study developed a conceptual model explaining the concept and factors of health literacy among FCs of older people with chronic illness that could provide the groundwork for future studies in developing relevant evidence-based interventions. A new Health Literacy Scale-Family Caregiver (HLS-FC) with satisfactory psychometric properties was developed in this study, which can be utilized to identify caregivers with insufficient health literacy and facilitate timely interventions by healthcare professionals. [ABSTRACT FROM AUTHOR]