Search

Purpose: This paper aims to provide a response to the previously published paper on "Gerontocracy". Design/methodology/approach: This paper views care services through the lens of safeguarding, risks and responsibility in contradistinction from the largely economic and cost relevant argument put forward in the original paper. Findings: This paper articulates the contribution of informal carers to integrated care solutions solely from an economic perspective overlooks the wider human and social dimensions of care provision in society. Originality/value: Engaging in the wider debate about the status, contribution of informal carers to care solutions highlights the complexity of the carers' role in society which should evoke a more holistic debate of this important topic. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim was to conduct a synthesis of the literature on value‐creating care for older persons with incontinence provided with toileting assistance and containment strategies, from the perspectives of older persons and healthcare professionals. Background: Incontinence is a health problem for many persons worldwide and the problem will increase as the global population ages. It can have a profound impact on a person's wellbeing, and assistance with toileting and containment strategies is common in home care settings and nursing homes. Design: The design was a literature review with an iterative, reflexive and critical approach. Methods: A critical interpretive synthesis was conducted. Ten papers published between 2011 and 2019 were analysed. The PRISMA ‐ScR Checklist was used in this review. Results: Based on the findings, the conceptual construct 'The art of connectedness' was developed, built on co‐created care, personalised care and reflective care between the older person and healthcare professionals. Co‐created care is based on establishing a relationship, building trust and respecting preferences. Personalised care consists of meeting the person's needs, promoting comfort and maintaining self‐determination. Reflective care entails showing empathy, upholding the person's dignity and developing professional competence. Conclusions: Value‐creating care consists conceptually of a connectedness that starts with co‐creating the care together with the older person in a close relationship. Assistance is given and received based on the older person's individual needs and is highly valued by the older person as it helps them maintain self‐determination. Reflective care is of importance for healthcare professionals. Relevance for practice: The findings are hoped to enhance healthcare professionals' understanding of how to improve the clinical encounter in nursing when providing assistance. They may also stimulate critical reflection among healthcare professionals on how to improve assistance to meet the older person's values. [ABSTRACT FROM AUTHOR]

Co‐methodological working is gaining increasing traction in healthcare, but studies with older people have been slower to develop. Our aim was to investigate how and how well older people have been engaged in healthcare intervention design, development or delivery using co‐methodologies. We conducted a systematic search of four electronic databases to identify international literature published between 2009 and November 2019. We included peer‐reviewed empirical research of any design. Three authors screened papers. Our review is reported in accordance with the Joanna Briggs Institute manual for scoping reviews, we have referred to the preferred reporting items for systematic reviews and meta‐analyses statement. We data extracted to a bespoke spreadsheet and used the Co:Create Co‐production Matrix to guide quality appraisal. Included studies (n = 48) were diverse in nature of interventions, co‐methodologies and reporting. We offer a narrative summary of included papers. Establishing how older people were engaged in co‐methodological work was largely straightforward. How well this was done was more challenging, however we have identified gems of good practice and offered directions for future practice. The Co:Create Co‐Production Matrix was the best fit for evaluating papers, however it is not intended as a measure per se. In essence we argue that notions of 'best' and 'scores' are an oxymoron in co‐methodological working, what is important that: (a) researchers embrace these methods, (b) incremental change is the way forward, (c) researchers need to do what is right for people and purpose and (d) have time to consider and articulate why they are choosing this approach and how best this can be achieved for their particular situation. Future evaluation of participant's experience of the process would enable others to learn about what works for who and in what circumstances. [ABSTRACT FROM AUTHOR]

The article presents the discussion on improving emotional well-being in older adults. Topics include seeking to understand mental health needs of veterans across mental health conditions; and examining innovative interventions using novel approaches such as mindfulness, meditation, nature, performance art, and visual art.

Purpose The purpose of this paper is to examine how external change agents (ECAs) engaged to disseminate a national quality register (NQR) called Senior alert nationwide in the Swedish health care and elderly care sectors interpret their work. To study this, sensemaking theories are used.Design/methodology/approach This is a qualitative inductive interview study including eight ECAs. To analyze the data, a thematic analysis is carried out.Findings Well-disseminated NQRs support health care organizations’ possibility to work with quality improvement and to improve care for patient groups. NQRs function as artifacts that can influence how health care professionals make sense of their work. In this paper, a typology depicting how the ECAs make sense of their dissemination work has been developed. The ECAs are engaged in prospective sensemaking. They describe their work as being about creating future good results, both for patients and affiliated organizations, and they can balance different quality aspects.Originality/value The number of NQRs increased markedly in Sweden and elsewhere, but there are few reports on how health care professionals working with the registers interpret their work. The use of ECAs to disseminate NQRs is a novel approach. This paper describes how the ECAs are engaged in prospective sensemaking – an under-researched perspective of the sensemaking theory. [ABSTRACT FROM AUTHOR]

This paper presents a new approach called EmbedHDP, which aims to enhance the evaluation models utilized for assessing sentence suggestions in nursing care record applications. The primary objective is to determine the alignment of the proposed evaluation metric with human evaluators who are caregivers. It is crucial due to the direct relevance of the provided provided to the health or condition of the elderly. The motivation for this proposal arises from challenges observed in previous models. Our analysis examines the mechanisms of current evaluation metrics such as BERTScore, cosine similarity, ROUGE, and BLEU to achieve reliable metrics evaluation. Several limitations were identified. In some cases, BERTScore encountered difficulties in effectively evaluating the nursing care record domain and consistently providing quality assessments of generated sentence suggestions above 60%. Cosine similarity is a widely used method, but it has limitations regarding word order. This can lead to potential misjudgments of semantic differences within similar word sets. Another technique, ROUGE, relies on lexical overlap but tends to ignore semantic accuracy. Additionally, while BLEU is helpful, it may not fully capture semantic coherence in its evaluations. After calculating the correlation coefficient, it was found that EmbedHDP is effective in evaluating nurse care records due to its ability to handle a variety of sentence structures and medical terminology, providing differentiated and contextually relevant assessments. Additionally, this research used a dataset comprising 320 pairs of sentences with correspondingly equivalent lengths. The results revealed that EmbedHDP outperformed other evaluation models, achieving a coefficient score of 61%, followed by cosine similarity, with a score of 59%, and BERTScore, with 58%. This shows the effectiveness of our proposed approach in improving the evaluation of sentence suggestions in nursing care record applications. [ABSTRACT FROM AUTHOR]

The International Union of Basic and Clinical Pharmacology (IUPHAR) Geriatric Committee aims to improve the use of drugs in older adults and develop new therapeutic approaches for the syndromes and diseases of old age through advocacy, education, and research. In the present paper, we propose strategies relevant to drug development and evaluation, spanning preclinical and the full range of clinical studies. Drugs for older adults need to consider not only age, but also other characteristics common in geriatric patients, such as multimorbidity, polypharmacy, falls, cognitive impairment, and frailty. The IUPHAR Geriatric Committee's position statement on 'Measurement of Frailty in Drug Development and Evaluation' is included, highlighting 12 key principles that cover the spectrum of translational research. We propose that where older adults are likely to be major users of a drug, that frailty is measured at baseline and as an outcome. Preclinical models that replicate the age, frailty, duration of exposure, comorbidities, and co‐medications of the proposed patients may improve translation. We highlight the potential application of recent technologies, such as physiologically based pharmacokinetic–pharmacodynamic modeling informed by frailty biology, and Artificial Intelligence, to inform personalized medicine for older patients. Considerations for the rapidly aging populations in low‐ and middle‐income countries related to health‐care and clinical trials are outlined. Involving older adults, their caregivers and health‐care providers in all phases of research should improve drug development, evaluation, and outcomes for older adults internationally. [ABSTRACT FROM AUTHOR]

The population is aging, with frailty emerging as a significant risk factor for poor outcomes for older people who become acutely ill. We describe the development and implementation of the Frail Older Persons' Collaborative Program, which aims to optimise the care of frail older adults across healthcare systems in Queensland. Priority areas were identified at a co-design workshop involving key stakeholders, including consumers, multidisciplinary clinicians, senior Queensland Health staff and representatives from community providers and residential aged care facilities. Locally developed, evidence-based interventions were selected by workshop participants for each priority area: a Residential Aged Care Facility acute care Support Service (RaSS); improved early identification and management of frail older persons presenting to hospital emergency departments (GEDI); optimisation of inpatient care (Eat Walk Engage); and enhancement of advance care planning. These interventions have been implemented across metropolitan and regional areas, and their impact is currently being evaluated through process measures and system-level outcomes. In this narrative paper, we conceptualise the healthcare organisation as a complex adaptive system to explain some of the difficulties in achieving change within a diverse and dynamic healthcare environment. The Frail Older Persons' Collaborative Program demonstrates that translating research into practice and effecting change can occur rapidly and at scale if clinician commitment, high-level leadership, and adequate resources are forthcoming. What is known about the topic? Providing frailty-focused care can improve outcomes, particularly by avoiding unnecessary admissions to hospital and reducing hospital-acquired complications, such as delirium and functional decline. Several evidence-based interventions exist that apply to specific points in the trajectory of older frail patients from hospital presentation to discharge and beyond, but these are not generally well integrated across the entire patient journey. What does this paper add? This paper describes a whole-of-healthcare system approach to improving care and outcomes for frail older people in Queensland. Rather than developing new care initiatives, the approach was taken to invest in pre-existing evidence-based interventions developed and validated in Queensland clinical settings and scale them across the state over 3 years. What are the implications for practitioners? This state-wide scale-up of evidence-based interventions has profiled how the healthcare system can be redesigned to implement models that better support vulnerable older people. [ABSTRACT FROM AUTHOR]

Objective: The need for residential care services will grow significantly over the coming years as the general population in Australia continues to age. The aim of this study was to assess the adequacy of residential care services across New South Wales (NSW), Australia, in relation to the current and predicted future aging population. Method: This study was a secondary data analysis. Existing datasets were compiled for analysis by creation of a temporal geodatabase, with predicted population data from 2019 to 2029 linked to corresponding geographic zones. Results: Demand for operational places was over capacity in 2019, at 101.5%. From 2019 to 2029, this will grow to 120.2% of 2019 capacity by 2024 and to 135.6% by 2029. An additional 25 800 operational places will be required by 2029 to meet targets. During the previous decade of 2008–18, operational places grew by only 11 502 places. Conclusions: NSW was not providing an adequate level of residential aged care and, under current allocations, this problem will worsen substantially over time, with flow-on impacts for the health sector. With aged care reform a current federal government focus, the results of this study may guide decisions that better support the provision of residential aged care. What is known about this topic?: The recently completed Australian Royal Commission into aged care noted widespread system failure and highlighted the gaps in medical services that older Australians were experiencing. What does this paper add?: This paper reports that demand for residential aged care places in NSW was already over capacity in 2019 and that the availability of places varies considerably across the state. Further, an additional 25 800 operational places are required by 2029 to meet government targets. If the growth rate from the past decade is maintained, this will result in a shortfall of 14 298 aged care places in NSW alone. What are the implications?: Without significant increases in the current rate of growth for aged care places, the mainstream medical and health sectors will face significant additional pressures arising from unmet need in both older patients and their informal carers. [ABSTRACT FROM AUTHOR]

This paper examines caregiving for sick older family members in the context of socio‐economic transformations in rural China, combining empirical investigation with normative inquiry. The empirical part of this paper is based on a case study, taken from fieldwork in a rural Chinese hospital, of a son who took care of his hospitalized mother. This empirical study highlighted family members' weiqu (sense of unfairness)—a mental status from experiencing mistreatment and oppression in family care, yet with constrained power to explicitly protest or make care‐related choices. Underpinning people's weiqu and constrained choice, as informed by the conception of structural injustice, is the impact of unjust social structures, organized by unfavourable norms, discriminatory social policies and institutions targeting rural populations. By restraining individual choices and capacities in supporting health care for aging populations, these unjust structures create additional difficulties for and discriminations against rural families and their older members. Some policy recommendations are proposed to mitigate structural injustice so as to empower families and promote care for older people in rural settings. [ABSTRACT FROM AUTHOR]

The number of older self-funders in England is growing in the context of tight eligibility criteria and fixed financial thresholds to access statutory adult social care. Older people who self-fund their social care fall largely under the radar of statutory services and of research. Our study aimed to listen closely to the stories that older people tell about finding, managing and paying for their care. We interviewed 65 older people living in the community who were funding all or some of their social care. This paper focuses on narrative analysis of selected transcripts from these interviews. It sheds light on how older people represent their experiences of self-funding and what underpins these constructions. A key finding is that the disjunctions within older people's accounts between the care they want and the care they receive reflect wider political and structural tensions in the funding and delivery of care. Older self-funders temper their expectations in light of their experience of shortfalls in the system. This enables them to adjust to the deficiencies but obscures and perpetuates poor care. The discussion considers the findings in relation to: the fundamental incompatability of body labour and commodified care; the shared precarity of older people and care workers; and the individualisation of risks that makes older people and their carers responsible for making a failing care system 'work'. Our analysis adds to the case for major reform of adult social care, including a revaluing of the status and employment conditions of front-line care workers. [ABSTRACT FROM AUTHOR]

Across the world acute hospitals are under unprecedented pressures due to shrinking budgets and increasing demand, against this backdrop they are also experiencing record levels of activity in Accident & Emergency and delayed transfers of care. Reducing pressure on hospitals by avoiding unnecessary admissions and delayed discharges has risen up the global policy agenda. However, reviews of strategies and policies have rarely involved discussions about the role that hospital social workers play in achieving timely hospital discharge. Yet discharge planning has become a, if not the, central function of these professionals. This paper presents the results of a small-scale exploratory study of hospital social work in an acute hospital in Northern Ireland. The findings reveal that the work of hospital social workers is characterised by increased bureaucracy, an emphasis on targets and a decrease in the time afforded to forming relationships with older people. Hospital social workers highlight concerns that the emphasis on discharge planning and pressures associated with the austerity agenda limits their capacity to provide other more traditional roles such as advocacy and counselling. It is argued that hospital social work should not be narrowly defined as 'simply' co-ordinating discharge plans. The tension that arises between expediting hospital discharge and advocating for older people and their families is also discussed. [ABSTRACT FROM AUTHOR]

In response to rapid population ageing, digital technology represents the greatest resource in supporting the implementation of active and healthy ageing principles at clinical and service levels. However, digital information platforms that deliver coordinated health and social care services for older people to cover their needs comprehensively and adequately are still not widespread. The present work is part of a project that focuses on creating a new personalised healthcare and social assistance model to enhance older people's quality of life. This model aims to prevent acute events to favour the elderly staying healthy in their own home while reducing hospitalisations. In this context, the prompt identification of criticalities and vulnerabilities through ICT devices and services is crucial. According to the human-centred care vision, this paper proposes a decision-support algorithm for the automatic and patient-specific assignment of tailored sets of devices and local services based on adults' health and social needs. This decision-support tool, which uses a tree-like model, contains conditional control statements. Using sequences of binary divisions drives the assignation of products and services to each user. Based on many predictive factors of frailty, the algorithm aims to be efficient and time-effective. This goal is achieved by adequately combining specific features, thresholds, and constraints related to the ICT devices and patients' characteristics. The validation was carried out on 50 participants. To test the algorithm, its output was compared to clinicians' decisions during the multidimensional evaluation. The algorithm reported a high sensitivity (96% for fall monitoring and 93% for cardiac tracking) and a lower specificity (60% for fall monitoring and 27% for cardiac monitoring). Results highlight the preventive and protective behaviour of the algorithm. [ABSTRACT FROM AUTHOR]

Purpose Academic researchers are increasingly required, and rightly so, to demonstrate the impact of their work beyond the gates of the university. This has led to an increasing focus, especially in response to funded calls, on developing research partnerships that cross disciplines, sectors and borders to help address our grand societal challenges. The purpose of this paper is to set out learning from the work of the organisation the Centre for Ageing Research and Development in Ireland (CARDI) and reflections on how to bring forward effective research partnerships involving users.Design/methodology/approach This paper is based on reflections and learning from the organisation CARDI which delivered a highly successful programme of interdisciplinary, cross-sectoral and cross-country research partnerships in both rural and urban areas between 2007 and 2015, across the island of Ireland.Findings Research partnerships that wish to involve users require time, commitment, support, understanding and a willingness to change and be challenged. This paper highlights that there are methodological, philosophical, moral, economic and of course, practical aspects to be considered.Research limitations/implications This reflective paper is based on a case study from the island of Ireland during the period 2007–2015 working in the area of ageing and older people.Practical implications The author emphasises that for research partnerships involving users to be successful, they need to not only consider the most effective research methods but also focus on the overarching purpose of the work and adopt an ethos and practice that maximises each partner's knowledge and expertise to their full potential.Social implications This reflective paper focused on the characteristics associated with partnership success, i.e. communication style, values, philosophy and practice and argues that establishing effective and inclusive partnerships requires time, the appropriate framework and reviewing the process on an ongoing basis.Originality/value The issue of user involvement in research partnerships requires much more consideration. Researchers, government, funders, businesses and service providers are increasingly recognising the benefits of "user" involvement to help design programmes and services that are most effective. Nowhere is this more important than in planning and delivering services, policy and programmes for our ageing population. [ABSTRACT FROM AUTHOR]

Although accumulated research has demonstrated the negative impacts of workplace violence and called for effective solutions from a human resource management (HRM) perspective, a valid measure of anti‐violence HRM practices is missing. In this paper, we develop a scale of anti‐violence HRM practices that is critical for both theoretical advancement and managerial practices in health care and aged care contexts. Through an inductive approach in Study 1, we generated items for the scale to be used in health care and aged care contexts, which we then subjected to a content validity test in Study 2. Using the newly developed scale, we further demonstrated in Study 3 that anti‐violence HRM practices that are implemented in aged care facilities reduce workers' experienced violence, improve workers' emotional wellbeing, and enhance workers' organisational and career commitment. [ABSTRACT FROM AUTHOR]

With the significant increase in global ageing and its derivative risks, governments and academic communities have been widely concerned with research on facilities of combined medical and nursing care for the elderly (FCMNCE). Using Citespace and VOSviewer bibliometric software, in this paper, we explore the evolutionary phases, hotspots, and trends in research on FCMNCE. First, the concept and connotation of FCMNCE are clarified. Secondly, based on a bibliometric analysis of the number of annual publications, disciplinary distribution, publication sources, and country distribution, we classify research on FCMNCE into four phases: the exploratory phase of influencing factors, the constructive phase of combined medical and nursing care patterns, the improvement phase of life quality, and the synergistic development phase of science and technology. Thirdly, based on a bibliometric analysis of keyword clustering, annual overlap, and burst keywords, the research hotspots of FCMNCE are identified. Finally, we predicts that future research on FCMNCE will be characterized by the trends of smart elderly facilities, smart medical services, and public health risks. Our conclusion can help researchers to understand the research status and development trends of FCMNCE and select future research directions based on their disciplinary background. [ABSTRACT FROM AUTHOR]

Objective: To investigate the experience of nurses involved in decision‐making to transfer residents from a residential aged care facility (RACF) to their local hospital emergency department. This paper reports on the findings of the second phase of a two‐phase study. Methods: Qualitative semi‐structured interviews with 19 aged care nurses were conducted. Interviews were audio‐taped and transcribed verbatim, and a thematic analysis was carried out. Results: The analysis revealed five major themes that influenced decision‐making in relation to the transfer of a resident from the residential aged care facility to the emergency department: conflict with key stakeholders; knowledge and experience; policy and process; stakeholder perception; and recognition and support. Conclusions: Robust outreach programs, support from other health‐care professionals, and improving interdisciplinary understanding and communication between aged care nurses, paramedics and the emergency department would be advantageous to ensure effective care delivery and decision‐making. [ABSTRACT FROM AUTHOR]

Increasing in elderly population put extra pressure on healthcare systems globally in terms of operational costs and resources. To minimize this pressure and provide efficient healthcare services, the application of the Internet of Things (IoT) and wearable technology could be promising. These technologies have the potential to improve the quality of life of the elderly population while reducing strain on healthcare systems and minimizing their operational cost. Although IoT and wearable applications for elderly healthcare purposes were reviewed previously, there is a further need to summarize their current applications in this fast-developing area. This paper provides a comprehensive overview of IoT and wearable technologies' applications including the types of data collected and the types of devices for elderly healthcare. This paper provides insights into existing areas of IoT/wearable applications while presenting new research opportunities in emerging areas of applications, such as robotic technology and integrated applications. The analysis in this paper could be useful to healthcare solution designers and developers in defining technology supported futuristic healthcare strategies to serve elderly people and increasing their quality of life. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores how changes in demography, service use and the aged care system have implications for the appropriateness of the denominator in the aged care provision ratio. Methods: Official statistics were analysed to create five alternative scenarios for residential care planning in a 2000‐2027 time series. Results: The four age‐based denominators and a revised denominator incorporating age‐ and sex‐specific disability rates generated diverse levels of absolute supply. The 75+ denominator produced 1400 fewer beds than the 70+ denominator by 2018, but over 14 000 additional beds by 2027. Conclusion: The 70+ based ratio developed almost forty years ago has served its purpose reasonably well. However, changes in the nature of the aged care system, different patterns of use by age and sex, and demographic changes suggest that long‐term aged care planning requires careful review in choosing a more robust version of the provision ratio for the future. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to discuss and urge further deliberation on possible strategies to help geriatric and special needs patients to receive dental care during the pandemic. Design/methodology/approach: This paper contains literature review of published research articles related to past epidemics, COVID-19 and older persons. Findings: Accurate prediction of adverse outcomes, detection of unidentified problems, improved estimation of residual life expectancy and appropriate use of geriatric interventions is required to understand the necessity of the treatment and effect of possible COVID-19 contraction during the treatment. Research limitations/implications: The authors reviewed the only published literature and collated the lessons learnt from past epidemics, as the natural history of the COVID-19 is not known. Practical implications: Future dentists must be trained in crisis management to deal with pandemics more effectively. The dental fraternity should be equipped to provide some sort of "psychological counseling and reassurance" prior to dental care to vulnerable individuals with comorbidities and special needs. Originality/value: There are very few published articles focused on unique dental care plans for geriatric and special needs patients. [ABSTRACT FROM AUTHOR]

As a country with the fastest population aging rate in the world, China's existing elderly care and medical resources are not enough to meet the growing and complex needs of elderly care and health services. The Chinese government is actively promoting the integrated development of medical and elderly care institutions, but it has yet to give full play to the inexpensive and existing advantages of traditional Chinese medicine in the treatment of diseases and rehabilitation of the elderly, by sorting out the advantages of "TCM + intelligent pension" in medical expenses, pension costs, disease prevention, intelligent pension services, and so on. In view of the current problems existing in China's pension, this paper mainly proposes to solve the pension dilemma in China from several aspects: improving the supervision and evaluation system, increasing capital investment, building a unified digital medical and pension service platform, and strengthening the talent training in the field of traditional Chinese medicine integration. The application of the "TCM + smart elderly care" system into the medical and elderly care service system is promoted to effectively improve the operation efficiency of the whole medical and elderly care service system and the satisfaction of elderly families. [ABSTRACT FROM AUTHOR]

In order to explore how to realize home care for the elderly with mobility difficulties, this paper proposes a home care system for the elderly with mobility difficulties based on intelligent perception. This method explores the research of home care for mobility disabilities by recommending key technical problems and solutions based on information represented by intelligent perception. The research shows that the home care system based on intelligent perception can effectively solve the nursing problems of the elderly, which is about 60% more efficient than the traditional methods. The combination of intelligent perception and reasonable home care mode will improve the social and economic benefits of health services and promote the balance between supply and demand of the whole health services. [ABSTRACT FROM AUTHOR]

Malnutrition in hospitalized patients remains a significant problem. Protected Mealtimes is a complex, inter-professional ward-based intervention that was first introduced in the United Kingdom to address this issue. Now implemented internationally, the approach still remains in key policy documents including the National Health Service Essence of Care. This review aims to synthesize the nutrition, satisfaction and quality of life patient/resident outcomes that arise from the implementation of Protected Mealtimes in hospitals and residential aged care facilities and to consider fidelity issues that have been reported in previous research. A defined search strategy was implemented in seven databases to identify full text papers of original research that evaluated Protected Mealtimes implementation. After screening, data were extracted from eight studies (7 quantitative and 1 qualitative study) that were conducted in hospitals. There was no research identified from the aged care sector. There were few positive outcomes that resulted from Protected Mealtimes implementation, many fidelity issues with the intervention were reported. It is apparent that Protected Mealtimes provide few, if any, benefits for hospitalized patients. It is a complex, multi-pronged initiative that has limited fidelity and limited outcomes. As such, we recommend that disinvestment by policy makers for hospitals should be considered, with the implementation of other evidence based mealtime initiatives. We provide no recommendation for disinvestment in the aged care sector, since the approach has not been evaluated against any of the eligible outcomes of this review. [ABSTRACT FROM AUTHOR]

Purpose: This paper explores residents' perceptions and experiences of extra care housing as an integrated model of housing with care. Design/methodology/approach: Data were collected in a longitudinal qualitative study based on four extra care housing schemes. Data from interviews with residents, care workers, managers and local commissioners were analysed thematically. Findings: The integration of housing with care enabled many older people to manage their care proactively. However, the increasing number of residents with complex health and care needs, including chronic illness, led some residents to question the ability of the model to support residents to live independently. Research limitations/implications: The study struggled to recruit sufficient residents from the specialist dementia setting who were able to communicate their consent to take part in the research. In addition, the quality of qualitative data collected in interviews with participants at this setting reduced over successive rounds of interviews. Practical implications: The study suggests the need to ensure that residents are fully informed about levels of care and support is available when considering a move into extra care housing. Originality/value: This paper provides a timely opportunity to consider extra care housing as an example of an integrated housing service, particularly in light of the current challenges facing the sector. [ABSTRACT FROM AUTHOR]

This exploratory study examined general practitioners' (GPs) perspectives on delivering end-of-life care in the New Zealand residential aged care context. A general inductive approach to the data collected from semi-structured interviews with 17 GPs from 15 different New Zealand general practices was taken. Findings examine: (1) GPs' life experience; (2) the GP relationship with the facilities and provision of end-of-life care; (3) the GP interaction with families of dying residents; and (4) GP relationship with hospice. The nature of the GP relationship with the facility influenced GP involvement in end-of-life care in aged care facilities, with GPs not always able to direct a facility's end-of-life care decisions for specific residents. GP participation in end-of-life care was constrained by GP time availability and the costs to the facilities for that time. GPs reported seldom using hospice services for residents, but did use the reputation (cachet) associated with hospice practices to provide an authoritative buffer for their end-of-life clinical decisions when talking with families and residents. GP training in end-of-life care, especially for those with dementia, was reported as ad hoc and done through informal mentoring between GPs. This paper is on a topic of increasing policy importance. With the aging of the population, the pressure on our aged care facilities will become intense. This paper highlights how GPs, the main source of clinical supervision in residential aged care, do their job and what the issues are that facilitate and impede their participation. [ABSTRACT FROM AUTHOR]

Aiming at the problems of poor fairness of resource allocation and long time-consuming allocation of traditional methods, a method of resource optimization allocation under dynamic monitoring of medical care combined with elderly care mode is proposed. The integrated medical and elderly care model is analyzed, the role of dynamic monitoring in the optimal allocation of resources in the integrated medical and elderly care model is discussed, and a general model for optimal allocation of medical and elderly resources based on the analysis results is established. Based on the criterion of "minimum variance of estimation error," a combined prediction model is established to obtain the combined prediction results. The investment objects of the optimal allocation of resources in the elderly care model are clustered in advance by using the clustering method, and the investment objects of the optimal allocation of resources in the elderly care model are comprehensively evaluated by using the principal component analysis method. According to the actual results of the comprehensive evaluation, the improved whale algorithm is used to allocate pension resources reasonably, and the fairness and applicability of the allocation results are analyzed experimentally. The results show that the method proposed in this paper has strong rationality and can effectively realize the rational distribution of pensions. [ABSTRACT FROM AUTHOR]

With the increasingly serious population aging, economic system transformation, and social transformation, the elderly have an increasingly strong demand for the elderly care service industry, but the development of China's elderly care service industry started late, and there are still many problems. For how to build a better elderly care service model, under the current situation of shortage of elderly care resources, community elderly care may become a solution. By analyzing the status quo, existing problems and development trends of home-based care services in Hangzhou's community, and learning from foreign experience, it explores the establishment of a "integrated physical, medical, and nursing care" community health management model for the elderly and provides a perfect solution for the development of Hangzhou's community elderly care services countermeasures and suggestions for mode operation. Based on the evaluation, problem analysis, and empirical research on the current situation of home care services in Hangzhou communities, this paper draws on relatively mature community care practices, proposes to build a community elderly health management model that combines medical care and care, and improves and innovates the overall design and medical care of the elderly service model measures for the health management of the elderly in the integrated community. The experimental results of this study show that, according to the demand for elderly care services, elderly people in need of care account for 86.6%, 79.5%, and 68.4% of the elderly population, especially in the areas of medical care, life care, and housekeeping services. [ABSTRACT FROM AUTHOR]

In England, care to support people living at home is largely commissioned by local authorities (statutory organisations with responsibility for social care in specific localities) from non‐statutory home‐care providers (for‐profit, not‐for‐profit, voluntary). This paper explores how managers of these services perceive commissioning arrangements and their impact on home‐care providers, the care workforce and service users. Little formal research of providers' experiences of working with local authorities in a commissioning model is available. A qualitative study employed semi‐structured telephone interviews with 20 managers of for‐profit home‐care providers from 10 selected local authority areas in England. Data were analysed using thematic analysis to identify main and subsidiary themes. Home‐care providers reported operating in a complex and changeable partnership with commissioners, characterised by: (a) relationships ranging from transactional to collaborative, (b) providers expressing a strong sense of public service motivation, (c) commissioning practices that were complex to negotiate, time‐consuming and overly prescriptive, (d) frequent changes in commissioning practices and a perceived lack of strategic planning, which were reported as contributing to uncertainty and tension for providers and confusion for service users. Attempting to operate a market model with tightly prescribed contracts is likely to be unsustainable. An alternative approach based on a collaborative model of joint responsibility for providing home care is recommended drawing on a conceptual framework of principal–steward relationships in contracting. [ABSTRACT FROM AUTHOR]

This paper develops a satellite account for the US health sector and measures productivity growth in health care for the elderly population between 1999 and 2012. We measure the change in medical spending and health outcomes for a comprehensive set of 80 conditions. Medical care has positive productivity growth over the time period, with aggregate productivity growth of 1.5 percent per year. However, there is significant heterogeneity in productivity growth. Care for cardiovascular disease has had very high productivity growth. In contrast, care for people with musculoskeletal conditions has been costly but has not led to improved outcomes. (JEL E01, H51, I10) [ABSTRACT FROM AUTHOR]

Aim: To identify organisational characteristics and practices that promote or inhibit the recognition of sexuality in the care of older people in health and aged care settings. Background: Sexuality in old age is poorly understood by health professionals and rarely addressed in care planning and delivery. Nurse managers are ideally placed to lead organisations in promoting a culture of acceptance that enables the expression of sexuality. Evaluation: A search for research/expert opinion papers published from January 2004 to February 2017 was undertaken. Two reviewers performed data extraction and appraisal of 34 included studies using Joanna Briggs Institute tools. The primarily qualitative research was analysed to identify 152 findings that were organised into 22 categories and combined into four syntheses. Key issue(s): An organisation's philosophies frame the way older people's sexuality is perceived. Cultivating a culture and environment of acceptance, engagement and knowledge and delivering care in a way that promotes opportunity for safe and private expression of sexuality are key enabling factors. Conclusion(s): Organisations and nurse leaders can support and facilitate older adults' expression of their sexuality through the review and development of philosophies, policies, procedures, staff attitudes and knowledge and the creation of a conducive environment. Implications for Nursing Management: Nurse managers play a pivotal role in developing a sexuality‐positive organisational ethos by ensuring policies, care practices, the environment and amenities are supportive of the expression of sexuality and by role modelling attitudes of respect and inclusivity. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine the relationship between aged care employees' perceived job quality and intention to stay in current aged care facilities, mediated by work-life interference.Design/methodology/approach This paper uses the nationally representative employee–employer matched data from the 2012 National Aged Care Workforce Census and Survey in Australia. It applies the theoretical lens of the Job Characteristics Model and a mediation analytical model that controls for a rich set of employee, employer and regional characteristics.Findings This paper finds that higher perceived job quality positively correlates with greater intention to stay and that work-life interference mediates the relationship between perceived job quality and intention to stay.Research limitations/implications This paper cannot make inference about causal relationship. Future studies on the aged care workforce should collect longitudinal data so that time-invariant unobservables can be eliminated in econometric modelling.Practical implications Efforts by the aged care sector to design quality jobs are likely to have significant positive correlation with the intention to stay, not only because employees are less likely to leave higher quality jobs per se, but also because higher quality jobs interfere less in the family lives of aged care workers, which itself is associated with greater intention to stay.Originality/value The results add to a small literature that has investigated how work-family variables can mediate between interventions that organisations put in place to improve work-life balance, and employee outcomes. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an overview of rural older veterans in the USA and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.Design/methodology/approach This is a descriptive paper summarizing population and program data about rural veterans.Findings VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.Originality/value This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans. [ABSTRACT FROM AUTHOR]

Background: The elderly represents a growing segment of the population for whom person-centred medicine (PCM) has been pointedly argued as highly relevant. This is due to demographic weight, clinical complexity, and ethical challenges. Therefore, it should be valuable to elucidate the key elements of person-centred care for this important population. Approaches for doing this may include analyses of aging-related studies selected from general population studies engaged for the systematic conceptualisation of PCM. Objectives: The purpose of this study was to delineate the conceptual profile of person-centred care for older people within the general framework of PCM. Methods: The main methodological approach employed in the present study was analyses of older-person studies selected from a large set of general population studies reviewed towards exploring the systematic conceptualization of PCM. That general study yielded eight principles as follows: (1) Ethical Commitment, (2) Cultural Sensitivity, (3) Holistic scope, (4) Relational Focus, (5) Individualised Care, (6) Common Ground for Collaborative Diagnosis and Care, (7) People-centred Systems of Care, and 8) Person-centred Education and Research. Results: It was found that the eight principles of PCM elucidated for the general population were present in older-person-centred care papers, although to various degrees across principles. It was evidenced that the principles on Ethical Commitment, Holistic Framework, Relationship Focus, Individualised Care, and Person-centred Education and Research had the greatest presence in the articles on older-person-centred medicine. Discussion: The considerable consistency found between the conceptual profile of person-centred care for older persons and the principles of PCM in the general population may reflect that the PCM perspective was historically pioneered within the old-age health field and that the PCM perspective continues to attract enormous interest in the old age field. This is highlighted by the fact that ethical commitment was a key motivator for the pioneering development of PCM in the geriatric field and that this principle has been prominently identified in recent systematic conceptualisation studies of PCM for the general population and appears as well among recent academic developments and proposals from major international institutions. Conclusions: The fundamental characteristics of older-person-centred care appear to have considerable consistency with the general principles of PCM, with particular attention to ethical commitment, holistic framework, communicative and relational focus, and attention to the values and needs of the older persons involved. [ABSTRACT FROM AUTHOR]

Australia is undergoing major aged care reforms, changing from the previous service provider‐driven approach to consumer‐directed care principles. In residential aged care, this has resulted in a significant reduction in government funding in order to support reform initiatives in home and community‐based care. There has been limited research on the impact of structural aspects of the reforms such as the effect of changes in funding focus. Using a qualitative descriptive research methodology, this study explores the impact of the reforms on staff at various levels of operational responsibility in residential aged care. Issues identified by participants centered on the capacity to deliver care in three areas, the impact of funding reduction, challenges in meeting increasingly complex needs of residents and their families, and new requirements for care roles within current limitations. This paper provides an insight into how and why operational issues have informed the findings of the current Australian Royal Commission into Aged Care Quality and Safety. It identifies areas of support for the aged care workforce that are crucial in fulfilling consumer‐focused care delivery. [ABSTRACT FROM AUTHOR]

Iran will encounter rapid population aging, resulting from increased life expectancy and fluctuating fertility rates during its eight-year war with Iraq (1980–1988). The need for long-term care in Iran is expected to increase dramatically. The purpose of this paper is to examine Iran's health care system and informal care upon discussing its demographic profile. Scant attention of policymakers on the country's demographic transformation has resulted in limited resources for quality elder care as well as budget constraints for relevant research. In this demographic and political context, the costs of formal care, the shortage of health workforce and infrastructures (i.e., long-term care facilities), and the continuation of traditional cultural values are the most significant reasons for heavy reliance on informal elder care. In addition to inadequate systemic support, the prevalence of domestic violence, abuse, and infantalization are largely attributable to insufficient knowledge among informal elder carers. [ABSTRACT FROM AUTHOR]

Medication management for older persons can be complex. With over 50% of all hospital admissions being for people aged over 65 years, understanding age‐related functional, cognitive and social factor changes and their impact on medication use is critical for pharmacists working in most adult medicine areas. This paper provides an overview of critical elements of medication management for older persons for pharmacists. Key elements include age‐related changes impacting medication effectiveness and safety, frailty, geriatric syndromes, polypharmacy and deprescribing, minimising medication‐related harm at transitions of care, dose administration aids and other strategies to support individuals in medication management and multidisciplinary comprehensive geriatric assessment. [ABSTRACT FROM AUTHOR]

In the current ecology of care, social, rather than medical, support is critical in enabling frail older people to live at home. This paper reports findings from a qualitative study about how home care workers (HCWs) support persons with dementia living in the community. Semi-structured qualitative interviews were carried out in England with 14 family care-givers (FCGs) recruited from a single private home care provider. A thematic analysis of the data was undertaken using the constant comparative method. In every instance, it was FCGs who initiated domiciliary care for the person with dementia, highlighting ambiguity about who is the 'client'. Rather than focusing on the HCWs' work in undertaking practical tasks and personal care, respondents prioritised HCWs as companions, providing emotional and social support for their relatives. From an organisational perspective, respondents valued the capacity of the provider to deliver a consistent, personal, reliable and punctual service. These attributes were important in supporting their relative's agency and dignity. Respondents described HCWs engaging in skilled and sensitive communication with clients but considered 'character' and 'innate' caring abilities to be more important than those derived from training. The results highlight the need to acknowledge the family, rather than the individual client, as the functioning unit of care, and to recognise the highly skilled communicative and emotional work undertaken by HCWs. [ABSTRACT FROM AUTHOR]

Electronic information systems are becoming increasingly common in residential aged care in Australia. These systems contain valuable data generated during day‐to‐day care delivery for older adults. These data (termed 'routinely collected residential aged care provider data') are currently underutilised, however have potential significant benefits for both care delivery and research purposes. Routinely collected residential aged care provider data are more readily accessible, contain up‐to‐date information and can be linked to existing national or state‐based administrative data sets, while providing more granular details about care delivered at the coalface. The aim of this paper is to provide clinicians, researchers, policymakers and providers with an understanding of the strengths of these types of data, as well as identifying areas that require future development to maximise their potential to drive improvements in resident care and outcomes. These considerations include data quality, data standardisation and models for data governance, consent and consumer involvement. [ABSTRACT FROM AUTHOR]

The residential aged care industry in Australia will expand rapidly over the next 10 years leading to substantial increases in government expenditure. Recent and future reforms are likely leading to changes in the structure of the industry with a potential impact on quality of care. The purpose of this paper is to stimulate broader public debate, based on the available evidence, about the preferred structure of this important industry. It examines the literature on the impact structure has on the quality of services and compares this with a fresh analysis of current trends. The paper argues that future policy should be evidence based and explicit about the structure of the industry that will emerge from current policy reforms. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this paper is to investigate the utilisation of general practice Medicare Benefit Schedule (MBS) services aligned to Comprehensive Geriatric Assessment (CGA) within 6 months of an aged care eligibility assessment and its effects on mortality and transition to permanent residential aged care (PRAC). Design Retrospective cohort study from the Historical Cohort of the Registry of Senior Australians. Setting Community. Participants In total, 69,171 Individuals (aged 75+) receiving home care packages (HCPs) between 2011 and 2015. Outcome measures Mortality and transition to PRAC. Results The claims for a management plan with team care arrangement (TCA) within 3 months of the health assessment (i.e. CGA) was present in 5% and associated with 14% lower mortality (adjusted hazard ratio [aHR], 95%CI = 0.86, 0.80–0.93) compared to no claims, lower than that seen with partial CGA which was either health assessment claims only 7.0% (aHR, 95%CI = 0.93, 0.89–0.97) or management plan coupled with TCA claims only 9.0% (aHR, 95%CI = 0.91, 0.89–0.97). This pattern was seen in those frailer but not in those where the frailty index score was <0.21. Claims for management plans coupled with TCAs alone were associated with a 10% lower transition to PRAC (asHR, 95%CI = 0.90, 0.85–0.96) in those with FI score < 0.21 while this estimate was not significant in individuals with FI score ≥ 0.21. Conclusion It appears the conduct of a combination of interventions considered to be components of the CGA by GPs was associated with a lower risk of mortality that no claims or partial conduct of CGA. [ABSTRACT FROM AUTHOR]

The demand for healthy old-age care is growing rapidly in China. The traditional old-age care model can no longer meet elderly patients' demands for medical care and old-age care. To promote the development of medical care-integrated old-age care, a solution covering multiple aspects is necessary. In the context of the global development of healthy aging, China recently issued many policies to integrate old-age care with medical care, establishing protection for a large number of disabled elderly people. The Integrated Care of Older People (ICOPE) project is an international program developed by the World Health Organization. This paper reviews China's medical and old-age care integration model and the opportunities and challenges in implementing the ICOPE in the context of healthy aging in China. [ABSTRACT FROM AUTHOR]

In this paper, we deeply analyse and study the interactive telemedicine service system for elderly care in smart homes and design a data summarization method for large concurrent scenarios. The method first parses and reconstructs the data received by the system initially and then stores the reconstructed valid data into the local database, which realizes the fast data summarization under the heavy concurrency scenario. Secondly, a multiformat data adaptation method is designed for the problem that the data to be provided and processed are in various formats. The method uses a unified data format and adaptation process constraints to achieve centralized management of heterogeneous data from multiple sources, which provide a unified data support service for the system and upper-layer applications. Again, to deal with the application problem of highly correlated data, the data-sharing system provides data for each functional component of the telemedicine platform according to business requirements based on standardized data structure and unified storage management. This enables the barrier-free flow of multisource highly correlated data. When the consultation is in progress, the doctor can communicate with the patient with video and audio devices and, at the same time, can access the patient's historical medical records and the medical records uploaded by the patient; after the consultation is completed, the consultation doctor needs to fill in the consultation record. The consultation assistance module can statistically analyse the workload of doctors and other information according to the background data, and the telemedicine system will play an increasingly important role in the medical and health care business. [ABSTRACT FROM AUTHOR]

The interplay of frailty, multimorbidity and polypharmacy in the older person results in complex care needs. Monitoring and proactive management of chronic diseases in this context can be challenging. Early identification of deterioration reduces the risk of hospitalisation in older people, particularly in residential care, where the person can be particularly vulnerable. Deterioration of a resident often results in an expectation of in-hospital care, which especially where there are life-limiting conditions, may not align to the wishes of the person and their family. However, links between tertiary hospital services with the expertise to upskill and mentor those providing the more complex care to residents of aged care facilities need to be developed. Current models of care need to be adapted to incorporate the provision of specialist nursing within residential facilities to support higher-level care delivered in the person's familiar environment, improve the person and family experience, and reduce the costs and potential for iatrogenic problems associated with hospitalisation. Vascular dysfunction is common in aged care and results in impaired healing and complex wounds. We developed a Vascular and Geriatric (VaG) model of care to support specialist care for aged care residents with vascular dysfunction. The VaG model enhances existing links between hospital and residential care settings and builds workforce capacity in residential care facilities by the use of clinical consultation, peer learning and networking to increase the vascular skill set initially of the hospital outreach nurse and then modelled to residential care clinicians. This paper reports the development and implementation of the VaG model as part of the Aged Care Outreach Service. [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]

Objectives: Nursing staff in residential aged care facilities (RACF)s often make decisions about the transfer of residents to the emergency department (ED). This paper describes the protocol of a study that aims to understand decision‐making process utilised by RACF registered nurses (RNs) and to explore the perceptions of RNs about the decision and communication process between RACF and ED. Methods: The proposed mixed‐method study will survey and interview RACF RNs to understand their decision to transfer a resident and collect information about older people referred to the ED. Data collection will involve telephone survey, ED information system (EDIS) data and semistructured interviews. Results: The project outcomes will provide an understanding of existing ED service provision, communication between facilities and the reasons for transfer of older person to ED. This may inform redesign in communication processes between the ED and local RACFs and outreach care from the ED to RACFs. [ABSTRACT FROM AUTHOR]

Objective. In order to provide evidence for improving the quality of managers in elderly care institutions, this paper explored the situation of managers of elderly care institutions in a city in Central China under the national guidelines for the combination of medical and elderly health care. Design. A cross-sectional study carried out in a city in Central China was designed. Setting. The online questionnaire was distributed to the managers of six elderly care institutions in a city in Central China. Participants. The questionnaire was sent to 61 recipients; from this, 60 responses were obtained. Results. There was a 98% response rate. The study found that most managers in elderly care institutions were middle-aged, with low education level and years of management. The job mobility was high, and 27% of the managers had no relevant certificates. Management years had a significant influence on the rate of certificate holding (P < 0.05). Some managers were less than 30 years old and had college degree or above, which indicated that people with young and high levels of education were more likely to become managers. However, there was no significant difference in educational level among managers of different ages (P > 0.05). 56.6% of the managers have received provincial or municipal training, and few managers have received the national level training. The education level is positively related to the access to training opportunities. More than half of the managers earn less than ¥3000 a month. The study showed that the education level was positively related to the career growth space (P < 0.05). Conclusions. Specialized training and high salary should be provided for managers to improve their elderly care skills and hence the quality of elderly care service. In addition, in order to improve the education level of managers, a long-term continuing education system should be established gradually. Through expanding the enrollment scale of the nursing school, carrying out training about elderly care skills, and issuing vocational skills certificates to those who pass the examination, the number of local nurses for the elderly will be increasing, and the quality of the elderly care service will be improving. [ABSTRACT FROM AUTHOR]

Aged care is becoming an increasingly significant feature of health care, but it is not an area physiotherapists have traditionally favored. Aging populations of increasingly chronically ill people represent the most important community of need in health care however, and so physiotherapists risk being marginalized if they do not adapt their practices to meet this growing need. Aged care may therefore represent a testing ground for a new physiotherapy, and the lessons learned in reforming physiotherapy for older adults may extend to all aspects of practice. In this paper, I explore how our current approach to aged care came about, and make the case for change. Having critiqued biomedicine, I also argue that the newer holistic models of health care are equally inadequate, because they attempt to dissolve important philosophical differences between physical, experiential, and social paradigms into an amorphous whole. I argue that these 'embodied' models of health make a holistic approach to aged care impossible and, instead, suggest new materialism and object-oriented ontologies as alternative physiotherapy paradigms. [ABSTRACT FROM AUTHOR]

Background: Internationally, it is recognised that the transition to a care home environment can be an emotional and stressful occasion for older people and their families. There is a paucity of research that takes into consideration the initial phase of the relocation process, incorporating individuals' experiences of the move. Aim: To explore individuals' experiences of moving into a care home. This paper has a specific focus on the preplacement (7 days) and immediate postplacement (within 3 days) period of the move to the care home. Design: A grounded theory method was used to conduct semi‐structured interviews with 23 participants. Results: Data analysis revealed five distinct categories that captured the experience of the preplacement and immediate postplacement period. These were as follows: (a) inevitability of the move: "I had to come here," (b) making the move: "Abrupt Departures," (c) decision‐making and exercising choice: "What can I do, I have no choice," (d) maintaining identity: "Holding on to self" and (e) maintaining connections: "I like my family to be near." Together, these five categories formed the basis of the concept "You're at their Mercy" which encapsulates the perceived transition experience of the older people within the study. Participants felt that the move was out of their control and that they were "at the mercy" of others who made decisions about their long‐term care. Conclusions: Moving to a care home represents a uniquely significant relocation experience for the individual. Key factors influencing the move were the individuals' perceived lack of autonomy in the pre‐ and postrelocating period of moving to a care home. Nurses have a key role to play in working with older people to influence policy and practice around decision‐making, planning and moving to a care home with greater emphasis on autonomy and choice so that older people do not feel "at the mercy" of others as they navigate such a major transition. Implications for practice: There is a need to standardise approaches and develop person‐centred interventions to support older people considering relocation to a care home and nurses have a key role to play in making this happen. [ABSTRACT FROM AUTHOR]