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Age and Ageing is now inviting papers on healthcare improvement for older people. In this article we outline the nature and scope of healthcare improvement and reference improvement models and the tools and methods of improvement science. We emphasise the issues of sustainability, including scale and spread; evaluation – including associated ethical consideration and the involvement of patients and the public in healthcare improvement and associated research. Throughout we refer to resources the authors have found useful in their own work, and provide a bibliography of sources and web-links which will provide essential guidance and support for potential contributors to this new category of submission to Age and Ageing. [ABSTRACT FROM AUTHOR]

Care homes enable people with advanced physical and cognitive impairment to live well with 24-h support from staff. They are a feature of care systems in most countries. They have proved pivotal to the coronavirus disease 2019 (COVID-19) response. We searched Age and Ageing for care-home articles published since 2015. From these we collated 42 into the Age and Ageing care-home collection. This collection draws together important papers that show how Age and Ageing is helping to shape and grow care-home research. The   collection outlines the technical issues that researchers face by grouping together important feasibility trials conducted in the sector. It looks at the challenges of measuring quality of life and working with routine data in care homes. It brings together observational studies considering loneliness, functional dependency, stroke outcomes, prescribing and acute deterioration. Health services research in care homes is represented by two studies that demonstrate realist evaluation as a way to make sense of service innovations. Papers are included that consider: non-pharmacological strategies for residents with dementia, end-of-life care, sexuality and intimacy and the care-home workforce. Given the importance of the COVID-19 pandemic in care homes, all of the care home COVID-19 papers published in Age and Ageing to date are included. Finally, a group of papers that present innovative approaches to research in care homes, each of which give voice to residents and/or staff, are collated and presented as a way of moving towards a more resident and care home centred research agenda. [ABSTRACT FROM AUTHOR]

Background Telehealth technologies are playing an increasing role in healthcare. This study aimed to review the literature relating to the use of telehealth technologies in care homes with a focus on teledentistry. Methods Khangura et al.'s (Evidence summaries: the evolution of a rapid review approach. Syst Rev 2012; 1 :10) rapid review method included an electronic database search on Embase, PubMed, Web of Science and OpenGrey. Out of 1525 papers, 1108 titles and abstracts were screened, and 75 full texts assessed for eligibility. Risk of bias was assessed using the Mixed Methods Assessment Tool 2018. Results Forty-seven papers (40 studies) from 10 countries, published 1997–2021, were included in the review, four studies related to teledentistry. Whilst some preferred in-person consultations, perceived benefits by stakeholders included reduced hospitalization rates (n  = 14), cost-savings (n  = 8) and high diagnostic accuracy (n  = 7). Studies investigating teledentistry using intra-oral cameras reported that teleconsultations were feasible with potentially high diagnostic accuracy (n  = 2), cost-savings (n  = 1) and patient acceptability (n  = 1). Conclusion There is limited published research on teledentistry, but wider telehealth research is applicable to teledentistry, with findings suggesting that telehealth technologies play a role in care homes consultations that are acceptable, cost-saving and with potential diagnostic accuracy. Further research is needed on the mode, utility and acceptability of teledentistry in care homes. [ABSTRACT FROM AUTHOR]

Objectives Informal care provided by adult children is of great importance for older adults' well-being in China. This paper investigates and compares the functional transitions among older adults living in rural areas who receive care from daughters' and from sons' families. Methods This study utilizes the "Well-being of Elderly Survey in Anhui Province" (WESAP) from 2001 to 2021. Our sample included 2,797 individuals aged 60 years or older. Functional status was based on the activities of daily living and the instrumental activities of daily living. We employed a random-effects ordered logit model to examine the functional transitions among the older adults. Results Receiving care from daughters' families is significantly associated with a lower likelihood of functional decline compared to receiving care from sons' families in rural China. The advantage associated with daughter care becomes more pronounced among older individuals with a severe functional difficulty compared to those with a mild or moderate functional difficulty. The difference is prevalent among older adults aged 75 and older, with less wealth or multiple chronic diseases, or who live alone. Furthermore, among those with severe functional difficulties, the daughter advantage is more significant for fathers as compared to mothers. Discussion Nowadays, daughters' families can provide high-quality informal care, often surpassing that offered by sons' families. This daughter advantage becomes even more significant among older adults who have a higher need for family care, such as those with severe disabilities and limited financial resources. [ABSTRACT FROM AUTHOR]

Objectives Research among older adults reveals that the loss of core network members is a risk factor for loneliness. Still, it is not clear whether all such losses induce similar levels of loneliness, particularly as network members are distributed at varied geographic distances. Neither is it clear whether tie addition—the other ubiquitous aspect of network turnover in later life—offsets the loneliness that arises from different network loss scenarios. Methods This paper scrutinized core network losses across multiple relationship–distance scenarios. We used the fourth and sixth waves of data from the Survey of Health, Ageing, and Retirement in Europe and estimated fixed-effect models. Results The loss of a child from a core network increases feelings of loneliness across variant distances, especially when not complemented by additional connections. Losing relatives or nonkin core connections in proximity (within 1 km and 5 km radius, respectively) is also associated with increased loneliness, yet such effects are also largely mitigated by the addition of new core network members. Discussion The relationship between core network member losses and loneliness can significantly differ based on the nature of the lost connection and its geographic distance. Active rebalancing of one's core network following losses and proactive network expansion can serve as pivotal strategies to prevent loneliness for the aging population. [ABSTRACT FROM AUTHOR]

Approximately one in five people will live to see their 100th birthday due to advancements in modern medicine and other factors. Over 65's constitute 42% of elective admissions and 43% of emergency admissions to hospitals. Increasingly, people are turning to technology to help improve health and care of the elderly. There is mixed evidence of the success of wearables in older populations with a key barrier being adoption. In contrast, passive sensors such as infra-red motion and plug sensors have had more success. These passive sensors give us a sequence of categorical "trigger" events throughout the day. This paper proposes a method for detecting subtle changes in sequences while taking account of the natural day-to-day variability and differing numbers of "trigger" events per day. [ABSTRACT FROM AUTHOR]

Current projections show that between 2000 and 2050, increasing proportions of older individuals will be cared for by a smaller number of healthcare workers, which will exacerbate the existing challenges faced by those who support this patient demographic. This review of a collection of Age and Ageing papers on the topic in the past 10 years explores (1) what best practice geriatrics education is and (2) how careers in geriatrics could be made more appealing to improve recruitment and retention. Based on these deeper understandings, we consider, as clinician educators, how to close the gap both pragmatically and theoretically. We point out paradigm shifting solutions that include innovations at the Undergraduate level, use of simulation, incorporation of learner and patient perspectives, upskilling professionals outside of Geriatrics and integration of practice across disciplines through Interprofessional Learning. We also identify an education research methodological gap. Specifically, there is an abundance of simple descriptive or justification studies but few clarification education studies; the latter are essential to develop fresh insights into how Undergraduate students can learn more effectively to meet the needs of the global ageing challenge. A case of improving understanding in delirium education is presented as an illustrative example of a new approach to exploring at greater depth education and outlines suggested directions for the future. [ABSTRACT FROM AUTHOR]

Background and Objectives Ageism is oftentimes sugarcoated within humor. Paper birthday cards are 1 delivery approach in which ageist messages are perpetuated and reinforced through humor. Research Design and Methods A convenience sample of birthday cards (k = 227), all indicating a decade of age, were acquired from 7 national retail stores in Colorado Springs, CO. The decades sampled ranged from 21 to 100. With a predeveloped codebook, 3 raters coded the decade birthday cards on various variables, including age group, ageist tone, and humor. Results Birthday cards intended for age 30–60 contained significantly more ageist messages compared to cards intended for age 21 and age 70–100, which did not show a significant difference from each other. Additionally, birthday cards with humor showed more ageist messages than cards without humor. Characteristics of decade birthday cards were also explored. Discussion and Implications Consumers need to learn to evaluate these ageist messages in birthday cards to reduce the perpetuation of damaging stereotypes. [ABSTRACT FROM AUTHOR]

From the year 2003 when the first walkability scale was published to date, person-environment fit models and empirical research, some of which was published in Health Promotion International , have encapsulated healthy communities in 'neighborhood walkability'. While there is no doubt that neighborhood walkability positively influences health-seeking behaviors and health, recent models suggest that their measurement and conceptualization have not emphasized the role played by psychosocial and personal factors in aging in place. Thus, the development of scales measuring human ecosystem factors has not recognized all critical factors suited for older adults. In this paper, we aim to draw on relevant literature to frame a more holistic construct, hereby referred to as Socially Active Neighborhoods (SAN), that would better support aging in place in older populations. Through a narrative review based on a systematic search of the literature, we define the scope of SAN and delineate some contextual implications for gerontology, health promotion and psychometric testing. SAN, unlike neighborhood walkability in its current measurement and conceptualization, incorporates critical theory-informed psychosocial factors (i.e. safety and disability friendliness of neighborhood infrastructure) that can encourage older adults with physiological and cognitive limitations to maintain physical and social activities as well as health in later life. The SAN is the result of our adaptation of key person-environment models, including the Context Dynamics in Aging (CODA) framework, that recognizes the role of context in healthy aging. [ABSTRACT FROM AUTHOR]

Introduction the COVID-19 pandemic poses a high risk to older people. The aim of this article is to provide a rapid overview of the COVID-19 literature, with a specific focus on older adults. We frame our findings within an overview of the disease and have also evaluated the inclusion of older people within forthcoming clinical trials. Methods we searched PubMed and bioRxiv/medRxiv to identify English language papers describing the testing, treatment and prognosis of COVID-19. PubMed and bioRxiv/medRxiv searches took place on 20 and 24 March 2020, respectively. Results screening of over 1,100 peer-reviewed and pre-print papers yielded n  = 22 on COVID-19 testing, n  = 15 on treatment and n  = 13 on prognosis. Viral polymerase chain reaction (PCR) and serology are the mainstays of testing, but a positive diagnosis may be increasingly supported by radiological findings. The current evidence for the effectiveness of antiviral, corticosteroid and immunotherapies is inconclusive, although trial data are largely based on younger people. In addition to age, male gender and comorbidities, specific laboratory and radiology findings are important prognostic factors. Evidence suggests that social distancing policies could have important negative consequences, particularly if in place for an extended period. Conclusion given the established association between increasing age and poor prognosis in COVID-19, we anticipate that this rapid review of the current and emergent evidence might form a basis on which future work can be established. Exclusion of older people, particularly those with comorbidities, from clinical trials is well recognised and is potentially being perpetuated in the field of current COVID-19 research. [ABSTRACT FROM AUTHOR]

Frailty represents an integrative prognostic marker of risk that associates with a myriad of age-related adverse outcomes in older adults. As a concept, frailty can help to target scarce resources and identify subgroups of vulnerable older adults that may benefit from interventions or changes in medical management, such as pursing less aggressive glycaemic targets for frail older adults with diabetes. In practice, however, there are several operational challenges to implementing frailty screening outside the confines of geriatric medicine. Electronic frailty indices (eFIs) based on the theory of deficit accumulation, derived from routine data housed in the electronic health record, have emerged as a rapid, feasible and valid approach to screen for frailty at scale. The goal of this paper is to describe the early experience of three diverse groups in developing, implementing and adopting eFIs (The English National Health Service, US Department of Veterans Affairs and Atrium Health—Wake Forest Baptist). These groups span different countries and organisational complexity, using eFIs for both research and clinical care, and represent different levels of progress with clinical implementation. Using an implementation science framework, we describe common elements of successful implementation in these settings and set an agenda for future research and expansion of eFI-informed initiatives. [ABSTRACT FROM AUTHOR]

Background Given the globally ageing population, care homes have an important role in delivering palliative and end-of-life care. Advance care planning (ACP) is promoted to improve the quality of end-of-life care in this setting. While many professionals can be involved in ACP, little is known about what influences multi-professional involvement and how multi-professional working impacts the ACP process in the UK. This study investigated multi-professional practice in relation to ACP in nursing homes. Design and methods An ethnography was undertaken in two UK nursing homes using multiple methods of data collection: observations, interviews and document review. Participants included the following: nursing home residents (n  = 6), relatives (n  = 4), nursing home staff (n  = 19), and visiting health and social care professionals (n  = 7). Analysis integrated thematic analysis, mapping of resident ACP trajectories and documentary analysis. Findings This paper suggests that multi-professional and relatives' involvement in ACP was disjointed. Continuity and coordination were disrupted by misalignment of visiting professional and nursing home organisational structures. Findings show a 'knotworking' approach to teamwork and power imbalance between nursing home staff and visiting professionals, such as general practitioners. While residents wished their relatives to be involved in their ACP, this was not formally recognised, and limited support existed to facilitate their involvement. Conclusion The structure and organisation of multi-professional and relatives' involvement in ACP led to fragmentation of the process. This marginalised the voice of both the resident and nursing home staff, thereby limiting ACP as a tool to enhance quality of end-of-life care. [ABSTRACT FROM AUTHOR]

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An introduction is presented in which the editor discusses various topics within the issue, including the National Health and Aging Trends Study (NHATS), the care of people with dementia, and the trajectories of paid and family care hours of people living with dementia.

Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems. [ABSTRACT FROM AUTHOR]

An ageing population and increased longevity means that long term care will become progressively more expensive. In 2009 the Government published a Green Paper on future funding options and a White Paper in 2010. This article considers the role of private finance products under the 'Partnership' option. It finds that few households are able to pay for LTC based on income and savings but the number increases if housing assets are included. We show that products can be devised for a range of circumstances, although state support would need to continue. We propose a simplified means testing system based on a combination of income and assets. [ABSTRACT FROM AUTHOR]

Aged care monitoring devices (ACMDs) enable older adults to live independently at home. But to do so, ACMDs collect and share older adults' personal information with others, potentially raising privacy concerns. This paper presents a detailed account of the different privacy problems in ACMDs that concern older adults. We report findings from interviews and a focus group conducted with older adults who are ageing in place. Using Daniel Solove's privacy taxonomy to categorize privacy concerns, our analysis suggests that older adults are concerned about the potential for ACMDs to give rise to six problems: surveillance, secondary use of data, breach of confidentiality, disclosure, decisional interference and disturbing others. Other findings indicate that participants are worried about their ability to impose control over collection and management of their personal details and are willing to only accept privacy trade-offs during emergencies. We provide recommendations for ACMD developers and future directions to address findings from this research. [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]

Robots are increasingly appearing as a potential answer to the 'care crisis' facing a number of countries. Although it is anticipated that many positives will flow from the application of these technologies, they are also likely to generate unexpected consequences and risks. This paper explores the use of robots within disability and aged care settings in the Australian and New Zealand contexts. Informed by thirty-five semi-structured interviews with a range of stakeholders, the paper explores why this area is so difficult to govern examining areas identified as generating tensions around the use of robots in care settings. In each of these areas some respondents saw the introduction of robots to be relatively straightforward applications that do not require extensive structures of governance. Others, however, viewed these applications as having potentially greater implications and the need to govern for these over the longer term. The three areas of tension that we explore in this paper relate to independence and surveillance, the re-shaping of human interaction and who can care. These tensions illustrate some of the problems involved in governing robots in a care service context and some of the potentially difficult issues that governments will need to resolve if these technologies are to be effective. We conclude the paper arguing what is needed is a responsive regulation approach to help resolve some of the complexities and tensions in overseeing these technologies. [ABSTRACT FROM AUTHOR]

Introduction Caregiving work in 'residential care homes for the elderly' (RCHEs) has long been devalued as 'dirty work', which contributes to RCHE's acute shortages of health care staff in Hong Kong. This study aims to unearth the voice of the RCHEs workers by delineating their insider perspectives of RCHE work. Method Adopting the Photovoice method, a participatory methodology, 30 RCHEs care workers (i.e. Registered Nurses, Enrolled Nurses, Health Workers, and Personal Care Workers) were invited to take photos that showcase their perspectives of doing aged care work. Two in-depth interviews were conducted with each research participant before and after the photo-taking procedure. Thematic analysis is then conducted to analyse the visual and verbal data. Results Findings show that RCHEs care workers perceive and revitalize the nature and meaning of their work in four ways: conducting 'dirty tasks' to help the elderly; valuing and engaging in long-term relationships; learning in work; and cultural meaning of working with the elderly. Contrary to public devaluation, RCHE care workers normalize the delivery of 'dirty tasks' (i.e. handling human excreta and wounds) as being helpful to both the elderly and the family members. Besides the routine caring tasks on paper, care workers highlight that they spend a lot of unrecognized labor to build rapport and provide emotional support to the elderly and their family members in their work. They also report that learning and self-development are an important part of residential care work, both in terms of professional knowledge and personal growth. Taking care of the elderly also conveys positive cultural meanings in Chinese society. Conclusion Policy, professional and educational initiatives of geriatric care primarily emphasize the delivery of clinical tasks (caring for), while undermining the emotional and relational aspects of aged care work. The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China. (UGC/FDS16/M12/20). [ABSTRACT FROM AUTHOR]

Background Having positive intimate, sexual and relational experiences is an important issue for older adults in care settings, yet little is known on the extent to which nursing staff and care workers have received education or training in addressing and meeting these needs among older residents. This scoping review aimed to identify and examine what education and training resources exist to assist nursing staff and care workers to meet their residents' needs in this area. Methods and analysis Using the Arksey and O'Malley framework, we systematically searched papers and grey literature to identify education interventions and resources that aimed to facilitate care home staff to meet their residents' sexuality, intimacy and relational needs. Results Eleven studies (one dissertation) and three education resources met the inclusion criteria; most were conducted in the USA and Australia. Across the studies and resources identified, the education content was mixed and the methodology, presentation, design and duration varied widely. The focus of the education interventions and resources was to increase knowledge and improve and/or change attitudes towards the: (i) sexual expression of older people living in residential aged care, (ii) sexuality and ageing and (iii) expression of sexuality in people with dementia. Conclusion Few education interventions and training resources were identified. The findings suggest that education interventions can improve knowledge and/or change care staff attitudes, in the short-term, towards older people's sexuality, intimacy and relational needs in care home settings, which can lead to facilitating staff to enhance person-centred care in this area of need. [ABSTRACT FROM AUTHOR]

This paper studies the causal effect of the voluntary contributions of labour to local services, in the form of voluntary provision of daily care to the elderly, on elderly mortality. To identify the causal effect, I exploit the earthquake that occurred in mid-western Japan in 1995 as a natural experiment inducing exogenous variation in the level of contributions. Based on a comparison of mortality between the municipalities that recorded little or no loss of life due to the earthquake but experienced a sharp increase in the level of contributions, and the nearby municipalities that were not hit by the earthquake, I find that the voluntary provision of daily care to the elderly significantly reduced elderly mortality. A series of robustness checks and falsification exercises are conducted to confirm that the results are not driven by the direct effects of the earthquake. [ABSTRACT FROM AUTHOR]

This year we are celebrating Socio-Economic Review (SER)'s 20th anniversary. The first of the two scrutinizes policymakers in the USA, while the second focuses on the general public in Europe. Subsequently, two historical papers shed light on market design and the role of economic ideas in the establishment of the California electricity and the Dutch healthcare markets, respectively. [Extracted from the article]

Introduction: In contrast to other medical specialties, trainees in Geriatrics have historically provided an increased contribution to clinical workload in General Internal Medicine and a reduced output of academic achievements. More recently, development of non-clinical skills has been recognised to have similar importance to clinical skills and the South East (SE) London Geriatrics Training Programme has thus supported trainees in applications for Out of Programme (OOP) opportunities to optimise career progression. Methods: Doctors who had undertaken specialist registrar training in the SE London Geriatrics Training Programme at any time between 2011 and 2019 were sent a questionnaire to assess whether they had completed time OOP and whether they had been awarded research grants, published papers in peer-reviewed journals, had abstracts accepted for presentation at conferences, and/or published book chapters during their training programme. Chisquared and Wilcoxon rank-sum tests were used to compare data between registrars who had completed time OOP and those who had not taken time OOP. Results: 77 (24 male; 53 female) registrars completed training in the SE London Geriatrics Training Programme between 2011 and 2019. 71 registrars (92%) completed the questionnaire, of whom 31 (44%) completed time OOP. In total, registrars were awarded 15 research grants, published 86 papers in peer-reviewed journals, had abstracts accepted for 184 conference presentations and published 20 book chapters. A notably increased proportion of registrars who took time OOP had an output of research grants, papers published in peer reviewed journals, abstracts accepted for presentation at conferences and/or book chapters respectively compared with registrars who had not taken time OOP (23% vs 5% ; 61% vs 23%; 84% vs 33%; 45% vs 5%). This equated to a combined academic output in 94% of registrars who completed time OOP compared with 48% who did not (p <0.001). Conclusions: A very strong association existed between registrars in Geriatrics taking time OOP and academic achievement substantiating the training programme’s aspiration to support development of non-clinical skills that may be helpful to trainees in their future careers. It would be worthwhile further work being undertaken in this area in other regions. [ABSTRACT FROM AUTHOR]

Background older patients aged ≥65 years constitute the majority of the National Emergency Laparotomy Audit (NELA) population. To better understand this group and inform future service changes, this paper aims to describe patient characteristics, outcomes and process measures across age cohorts and temporally in the 4-year period (2014–2017) since NELA was established. Methods patient-level data were populated from the NELA data set years 1–4 and linked with Office of National Statistics mortality data. Descriptive data were compared between groups delineated by age, NELA year and geriatrician review. Primary outcomes were 30- and 90-day mortality, length of stay (LOS) and discharge to care-home accommodation. Results in total, 93,415 NELA patients were included in the analysis. The median age was 67 years. Patients aged ≥65 years had higher 30-day (15.3 versus 4.9%, P  < 0.001) and 90-day mortality (20.4 versus 7.2%, P  < 0.001) rates, longer LOS (median 15.2 versus 11.3 days, P  < 0.001) and greater likelihood of discharge to care-home accommodation compared with younger patients (6.7 versus 1.9%, P  < 0.001). Mortality rate reduction over time was greater in older compared with younger patients. The proportion of older NELA patients seen by a geriatrician post-operatively increased over years 1–4 (8.5 to 16.5%, P  < 0.001). Post-operative geriatrician review was associated with reduced mortality (30-day odds ratio [OR] 0.38, confidence interval [CI] 0.35–0.42, P  < 0.001; 90-day OR 0.6, CI 0.56–0.65, P  < 0.001). Conclusions older NELA patients have poorer post-operative outcomes. The greatest reduction in mortality rates over time were observed in the oldest cohorts. This may be due to several interventions including increased perioperative geriatrician input. [ABSTRACT FROM AUTHOR]

This paper contributes to the ongoing refinement of citizenship as a feminist concept through the development of understandings of the relationship between economic and intimate citizenship in contemporary Europe. It draws on two cross-national research projects that each focus on a group of people who might be thought to be affected by particular processes of individualization: the economic “activation” of large numbers of women in increasingly deregulated labour markets, and the progressive detraditionalization of intimate life. The paper examines patterns of intimate life and citizenship that accompany employment in the elder care sector, and patterns of economic life and citizenship that accompany the experience of living outside the conventional family. It argues that there are significant and hitherto unrecognized tensions between “flexible” jobs and the ability of individuals to exercise agency as intimate citizens. It suggests that it is difficult to flourish as an intimate citizen without enjoying a degree of economic autonomy, and that economic autonomy is elusive for women working in the most deregulated sectors of the labour market. It also points to the important role that social policies play in mediating the relationship between intimate and economic citizenship. [ABSTRACT FROM PUBLISHER]

Introduction Constipation is a common and often overlooked problem with potentially serious consequences, including patient discomfort, urinary retention, delirium and bowel obstruction. These consequences can lead to prolonged hospital stay, increased healthcare costs and increased morbidity and mortality. Accurate stool chart documentation is an essential part of basic care that helps prevent this. The aim of the project was to increase daily stool chart documentation, including stool type, to 70% on a care of the elderly ward in a medium-sized district general hospital. Method We created a proforma to review each patients' stool chart from the previous 24 hours. Daily data was collected by measuring the number of correctly completed stool charts on the ward. Initial baseline data showed an average daily completion rate of 24%. We tested 3 separate interventions over a 6 week period using Plan-Do-Study-Act (PDSA) methodology: Intervention 1- Increase staff awareness about stool charts via email, posters and at handovers Intervention 2- Complete stool charts every time routine observations are performed Intervention 3- Complete online stool charts. Results All interventions led to an improvement in the average daily stool chart completion rate. Intervention 1 caused the most significant improvement with the average daily stool chart completion rate increasing to 77%. Intervention 2 was the least successful change, with an average daily stool chart completion rate of 39%. Intervention 3 had an average daily stool chart completion rate of 64%. Conclusion Simple interventions like staff education and prompts to help culture and behaviour change led to a significant improvement in stool chart documentation rates. Paper documentation (intervention 1) fared better than online documentation (intervention 3) most likely due to the former requiring fewer processes to complete. Intense monitoring and documentation (intervention 2) was unsuccessful and was perceived to be burdensome. [ABSTRACT FROM AUTHOR]

This paper assesses the challenges and the benefits of 2 methodological approaches for improving the study of transnational mobilities of older adults: mixed methods and inclusiveness. The first approach refers to a mixed-methods research design based on surveys and qualitative interviews. We share our experience of conducting a "fully mixed-concurrent-equal-status-design" research project, for which we collected data through quantitative surveys on transnational practices of people aged 55+. Furthermore, we conducted semistructured interviews with adults aged 64+ living or who have lived in Switzerland and spend part of the year in Spain. The second approach relates to the use of an inclusive sample diversified in terms of nationality and migration backgrounds. The inclusive design affects the formulation of questions asked to all participants (and the response options provided in the survey), as well as decisions related to language choices and translations. These elements have to be considered to ensure that older adults from different backgrounds feel included. In a research project on transnational mobility of older adults, conducting an inclusive plus mixed-methods research project pushes researchers to find strategies to balance research objectives with available resources. Maximizing the research team's methodological background appears to be a suitable approach to address different population groups while working within a budget. [ABSTRACT FROM AUTHOR]

The phrase 'not safe for discharge home' is often heard in relation to an older person in hospital, commonly due to functional limitations or risk of falls. But it remains unclear how such a standard of safety should be set in this context, or who should set it. In addition, labelling someone 'unsafe' to return to their own home has significant practical and ethical implications. After briefly exploring these issues, this Commentary suggests that a holistic approach and shared decision-making is required in this setting. Instead of simply declaring someone safe or unsafe for discharge home, specific 'safety concerns' (or 'hazards') should be identified and addressed as able. Ongoing specific concerns can then be discussed in conjunction with a patient's values and perceived benefits of returning home, in comparison with potential pros and cons of other discharge options. Overall, this paper suggests that paying attention to our words and values can enhance discharge planning and person-centred care. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. PA interventions for community-dwelling older adults are often delivered by healthcare professionals, fitness instructors or trained members of a research team. Innovative approaches are needed to ensure that these interventions are practical and sustainable.This systematic review explores the effectiveness of volunteer-led PA interventions in improving health outcomes for community-dwelling older people. Methods: Following PRISMA recommendations, five databases (MEDLINE, Embase, CINAHL, PEDro, Cochrane library) were systematically searched until May 2019, for studies using trained volunteers to deliver PA interventions for community-dwelling older people aged ≥ 65 years, reporting on participant outcomes. Meta-analysis was not conducted due to included study heterogeneity. Results: Twelve papers (eight studies including three randomised controlled trials (RCTs)) were included in the review; five papers reported different outcomes from the same RCT. Intervention settings included community exercise groups (n=4), home (n=2) and care homes (n=2). All eight studies included strength and balance exercises and frequency of PA ranged from once daily to weekly sessions. The three RCTs showed improvement in grip strength, nutritional and frailty status, and reduction in fear of falling, among 39 older adults (mean age 83 years) who received a physical training and nutritional intervention; improvement in grip strength and activity of daily living scores among 56 nursing home older adults (mean age 78 years) who received resistance exercise training; and a significantly higher proportion of older adults (n = 193, 9% improvement vs 0.5% in the control group) achieved the recommended target of 150 minutes of moderate vigorous PA per week using the Falls Management Exercise intervention. Two studies compared volunteer and health professional-delivered PA interventions and reported that both interventions were equally effective in reducing fear of falls and improving quality of life. Two quasi-experimental studies reported improvement in functional outcomes including functional reach, timed up and go test, and chair stand. A large prospective cohort study (n = 1620) reported a reduction in disability among older adults who received volunteer-led exercise compared to control, with a hazard ratio of 0.73 (95% CI 0.62-0.86) for development of disability. Conclusions: Trained volunteers can lead PA interventions among community-dwelling older adults with some evidence of improved health outcomes including nutritional, functional and frailty status. [ABSTRACT FROM AUTHOR]

The paper, '"Who Wants to Know all this Stuff?!": Understanding Older Adults' Privacy Concerns in Aged Care Monitoring Devices', by Sami Alkhatib, Ryan Kelly, Jenny Waycott, George Buchanan, Marthie Grobler and Shuo Wang, published in Interacting with Computers (November 2021), explores the use of care technology and the privacy concerns of older people. [ABSTRACT FROM AUTHOR]

Objectives: Because End of life (EOL) is becoming an increasingly long life stage, this paper aims to describe the delineation of EOL by reviewing studies which examine (a) terminal decline (TD), the timing of change in slope of decline in specific abilities; and (b) trajectories of decline in areas such as function, health care expenditures, and well-being according to cause of death. Methods: Studies were identified through Google Scholar, PsycNET, and PubMed. Results: TD was identified in diverse domains. Most findings focused on decline of cognitive abilities, and they reported this to occur 3-7 years prior to death. TD in wellbeing was found to begin 3-5 years prior to death. Trajectories by cause of death generally examined sudden death, terminal illness, organ failure, and frailty, and findings described differences in costs, function, and wellbeing, though examining a shorter predeath period than the TD literature. Discussion: Further research is needed to combine methods of investigation in order to assist the health care system in personalizing services to the trajectories of decline, and in enabling caregivers to prepare for the EOL experience. [ABSTRACT FROM AUTHOR]

Rapid population ageing has dramatically increased the social and economic cost of elderly care. As a consequence of the search for cost effectiveness/reduction we observe a convergence in how the care market is organised: all countries are moving towards home care, private provision and cash transfers. The aim of this paper is twofold. It is argued that the way in which elderly care is provided and financed may entail considerable differences in the creation of a formal care market. National employment models in turn shape the features of the care labour market, affecting both the quantity and quality of care labour supply, the extent of the care labour shortage, and the degree of dependence on migrant carers. This paper presents a comparative analysis of various European country models of elderly care to show how these two factors combine to shape the characteristics of elderly care regimes, and their differing capacity to meet increasing demand for care either by using native workers or, alternatively, by turning to immigrant workers in order to cope with labour shortages. [ABSTRACT FROM AUTHOR]

This paper draws on the evaluation of the impact of the English National Service Framework for Older People (NSFOP) on the experiences and expectations of older people, four years into its ten-year programme. The NSFOP focuses on achieving cultural changes so that older people and their carers are treated with respect, dignity and fairness. The evaluation took a mixed methods consultation approach in ten localities. This paper focuses on what was said by older people, their carers and in voluntary sector groups about social workers' roles and activities. The data suggest that they find social workers' roles unclear and variable. They appreciate a person-centred approach, informed about older people's needs in a confusing social care system. Their perceptions tally with those of social workers that the tasks of care management can be reductionist, but older people also desire specialist knowledge combined with a relationship that is 'on their side'. Social workers' roles in rationing support and means-testing did not seem to promote such models. At a time of rising expectations about the skills of social workers and of changes to social work roles in England and Scotland, this study provides one of the few examples of information directly gathered from older people themselves. [ABSTRACT FROM AUTHOR]

New Labour's project of modernization has involved the promotion of interlocking ideas about active citizenship and new modes of democratic engagement combining to produce what has described as 'participative governance'. Concerns about legitimacy, a 'democratic deficit' and the need to shift power and responsibility to the 'citizen' have led to the emergence of a range of new deliberative for a and democratic processes. This has led to debates about how to ensure that social diversity can be represented in the decision-making process. A challenge has been how to engage with the issues of an ageing population and represent older people in all their diversity. In recent years, there have been growing calls to extend advocacy rights to older people living in residential care. Mostly, this has been to ensure that as consumers, they have a fuller say in how their service is run. Older care home residents are service users but, as persons, should not be reduced to this role only; they are also citizens in the broadest sense and should not be cut adrift from debates at the national, local and community levels on issues that concern them. This paper examines how the moves to bring older people into deliberative democratic processes have tended to focus on those in their 'Third Age'. Those in institutional settings, being in the 'Fourth Age', occupy a much more marginal position. This effective disenfranchisement is yet another reason why, for many, the move into residential care—a difficult transition for a variety of reasons—becomes regarded as the 'last refuge'. It contributes to the sense of loss of identity, lowering of self-esteem and a reduced sense of personhood. This article accepts that there should be more effective involvement of care home residents in decision making about their personal care. However, there are dangers in adopting a too narrowly consumerist approach. This can reinforce a reductionist view of care home residents simply as 'service users'—a form of 'othering' in itself. As citizens and members of a wider community, they should be included in consultations about any community and wider political debates that affect them. Such a proposal implies a widening and deepening of advocacy services available to this group. As most older people in residential care are there following the intervention of a social care professional, then ensuring that they have access to advocacy must surely be a key task. This paper argues that this is frustrated by the lack of suitable services. Without a significant investment by the Government in independent advocacy services, not only is the social work task with one of social care's core client groups rendered impossible, but the Government cannot deliver on its own agenda of empowerment, active citizenship and inclusion. [ABSTRACT FROM AUTHOR]

This paper reports case study research that set out to identify what care managers do during independent care home closures. Little research has focused on the way in which care homes for older people are closed in England, or what those involved think about the process. This paper reports the activities and views of care managers directly involved in helping older people relocate from care homes that were closed by their owners. During such closures, residents and their families have no choice but to move, usually to a deadline, and with little control over the process. Care managers have a responsibility to help arrange alternative care for those current residents who are publicly funded, and to offer information and support to those funding their own care (the 'self-funded'). Closure related activities could involve considerable staff time. Care management arrangements, including the organization of teams and provision of needs assessments, varied across authorities. The care managers described drawing on emotional counselling and inter-personal skills, as well as practitioner knowledge and experience, particularly when offering support and advice about finding appropriate new homes. Tensions between aims, constraints on their actions and views of good practice are identified. [ABSTRACT FROM AUTHOR]

Geriatric medicine is the clinical specialty that focuses upon the care of older people—especially those with frailty (a state of increased vulnerability). In hospital, older people living with frailty are at high risk of developing a range of unpleasant outcomes such as delirium, falls, fractures, pressure sores and death. Comprehensive geriatric assessment is a form of holistic care that incorporates a specific set of clinical competencies that are able to reduce these adverse outcomes. Over the years, geriatric medicine has moved from being more of a community-based service towards a more acute specialty—encroaching now upon emergency department care. The challenge now is to work out how best to deliver geriatric care across the whole hospital (older people with frailty are not just cared for in geriatric wards!). The themed collection published on the Age & Ageing journal website outlines key articles that are attempting to develop solutions to this challenging conundrum. We hope that you enjoy reading them. [ABSTRACT FROM AUTHOR]

Older patients, suffering from numerous diseases and taking multiple medications are the rule rather than the exception in primary care. A manifold of medical conditions are often associated with poor outcomes, and their multiple medications raise additional risks of polypharmacy. Such patients account for most healthcare expenditures. Effective approaches are needed to manage such complex patients in primary care. The paper will discuss different models of care as well as major health care challenges in the management of multimorbidity in primary care with focus on interactions (disease-disease, treatment-treatment, and treatment-disease) extrapolated from (disease specific) guidelines and the feasibility to apply these guidelines for and with patients who have multimorbidity. [ABSTRACT FROM AUTHOR]

Background Everyday 2591 elderly people die due to injury worldwide. The complications and consequences of injury is different and worse than that of other age-groups. Yet little is known about the injury scenario of elderly population of Bangladesh. This paper aim to describe the epidemiology of geriatric injury of Bangladesh which will help policy-makers to undertake interventions for this vulnerable-group. Methods Bangladesh Health and Injury Survey 2016, a nationwide cross-sectional survey was carried out among 299,216 residents to identify the injury-related mortality and morbidity. Injury data among the population aged 60-years and above was extracted and analyzed for this study. Results Injury was found to cause 3.9% of the total deaths among elderly population of Bangladesh. Mortality and morbidity rate due to injury was found 157 (95%CI 112- 216) per 100,000 elderly populations and 129 (95%CI 124-133) per 1000 elderly population respectively. Fatality rate was 182.6 among urban population and 147 among rural population. Fall was identified as the leading cause of injury deaths and morbidity. It caused 47.2% of all fatality followed by Transport-injury (19.4%) and Suicide (13.9%). Among all fatally injured, 72.2% victims received treatment from health-service providers and among these 58.3% (n = 21) went to registered doctors. Conclusions Fall is the leading cause of injury related mortality and morbidity among elderly of Bangladesh. A significant amount of deaths also occurred due to RTI and suicide. Further in-depth research and interventions are needed to minimize the preventable burden of fatality and morbidity among this vulnerable-group. Key messages Elderly, Injury, Epidemiology, Bangladesh [ABSTRACT FROM AUTHOR]

Recent evidence about the extent of caring for older people by older people themselves, and about the importance of spouse care, has challenged existing debates about gender and care. Male caters, particularly older husbands, have been 'discovered'. This paper attempts to reconceptualize the debate about gender and caring to take account of these developments, particularly to develop an understanding of the caring activities of older male eaters and to elaborate the implications for community care policy. The evidence suggests there are circumstances where men accept the obligation to care, undertake intimate personal care, and derive identity and reward from their caring work, driven by similar motives and experiencing similar struggles as women. Rather than seeking maximum distinction between the motives and experiences of women and men carers, the paper suggests that one important way to promote non-sexist community care is to explore the conditions where men's caring is undertaken and how it can be understood and developed. [ABSTRACT FROM AUTHOR]

Previous cross-national research suggests that women may be less likely to prefer family-based support to older adults and more likely to prefer government-based support compared to men. Guided by theories of gendered paid and unpaid labor, social network resources and strain, and global inequality, this paper investigates whether a gender gap in attitudes exists and, if so, whether it can be explained by characteristics of family, work, social networks and roles, and national context. Analyzing data from two cross-sectional International Social Survey Programme samples (2001, N = 23,360; 2012, N = 16,558) and aggregate nation-level data sources across 20 nations, the authors use multilevel modeling to predict four measures of attitudes toward family-based and/or government-based support. We find evidence of a small gender gap in attitudes. Overall, women are less likely to agree that children have a duty, more likely to say the government should definitely be responsible, and more likely to prefer that the government pay for care instead of the family/individual compared to men. Family resources, social support, occupational insecurity, and role strain are each associated with attitudes in the theorized directions, but only partially explain the gender gap in attitudes. Finally, attitudes toward older adult support vary predictably by national cultural, political, and economic measures, but the gender gap in attitudes varies cross-nationally and is likely limited to specific contexts. We discuss these findings in light of measurement options, gendered patterns of care cross-nationally, and global disparities in formal resources for caregiving. [ABSTRACT FROM AUTHOR]

The General Medical Council (GMC) provides a core curriculum for all medical degrees in the UK. However, these guidelines do not provide in-depth, specific learning outcomes for the various medical specialties. Recognising our ageing population, the British Geriatrics Society in 2013 published their own supplementary guidelines to encourage and further direct teaching on Gerontology and Geriatric Medicine in medical school curricula. Although teaching on Geriatric Medicine, a sub-discipline of Gerontology, has reassuringly increased in UK medical schools, there are convincing arguments for greater emphasis to be placed on the teaching of another sub-discipline: Social Gerontology. Considering the skills and knowledge likely to be gained from the teaching of Social Gerontology, in this paper we argue for the greater universal adoption of its teaching. This would help ensure that the doctors of tomorrow are better equipped to manage more successfully and holistically the growing cohort of older patients. [ABSTRACT FROM AUTHOR]