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The transition to adult health care (HCT, Health Care Transition), is the purposeful, planned movement of patients from paediatric to adult services. For the adolescent living with obesity (ALwO), the HCT represents a crucial window for effective intervention that can help improve body weight, adiposopathy, and metabolic complications. Nevertheless, no transition guidelines, models, and tools have been developed for these patients. The present statement of the Italian Society of Obesity examines the critical transition of ALwO from paediatric to adult healthcare. It synthesises current knowledge and identifies gaps in HCT of ALwO. Drawing on successful practices and evidence-based interventions worldwide, the paper explores challenges, including disparities and barriers, while advocating for patient and family involvement. Additionally, it discusses barriers and perspectives within the Italian health care scenario. The need for specialised training for healthcare providers and the impact of transition on healthcare policies are also addressed. The conclusions underscore the significance of well-managed transitions. The SIO recognises that without proper support during this transition, ALwOs risk facing a gap in healthcare delivery, exacerbating their condition, and increasing the likelihood of complications. Addressing this gap requires concerted efforts to develop effective transition models, enhance healthcare provider awareness, and ensure equitable access to care for all individuals affected by obesity. The document concludes by outlining avenues for future research and improvement. [ABSTRACT FROM AUTHOR]

The demand for care homes appears to be emerging as a key future trend in response to the burgeoning population of older adults, with the need for care provision increasing accordingly. Life quality, happiness and well-being are important factors associated with the care of older residents. This qualitative study explores how older adults moving into care homes view their life quality, from their own perspectives, in two quite different cultural contexts, Chinese and Danish. Older care residents in Shanghai and Denmark participated in the study by means of semi-structured and in-depth interviews. An interpretive phenomenological analysis approach was used for data analysis. Four interrelated themes were identified: positive transfer; positive environment; positive capability and positive experience. The findings demonstrated that older adults considered their quality of life as the result of a dynamic process. Their pursuit of a harmonious status, centered on "change" as the core value, which encompassed both the simplicities and complexities of life. Both older adult groups cared more about their emotional wellbeing, which focused mainly on positive emotions being stimulated while negative emotions were shunned. In the situations when they were "harmonized" by society systems, there was an important emotional thread which continued throughout their whole life that was strongly associated with life quality which was the relationship with family members – be it in the past, present or future. [ABSTRACT FROM AUTHOR]

Intergenerational practice, where children and older adults come together for shared activities, has grown in popularity in many Western countries. However, research about intergenerational practice, particularly in the UK, is limited. This paper reports on the findings from an exploratory case study about a small intergenerational project between a maintained nursery school and a residential care home for older adults with dementia in the South-East of England. The methodology was informed by a narrative dialogic approach drawing on the work of Bakhtin. Data was collected using naturalistic observations of children's weekly visits to the care home and qualitative interviews with nursery school practitioners. The analysis explores how meaningful interactions were created between the children, the older adults, and the nursery school practitioners. Our findings suggest that singing, unstructured moments, continuity, context (open spaces/flexible sessions), and objects contribute to meaningful interactions between young children and older adults. The ability to be flexible and "go with the moment" were identified as key skills for practitioners supporting children and older adults. We conclude that intergenerational projects afford benefits not just for children and older adults, but also for practitioners in the form of "emotional rewards". The importance of re-establishing intergenerational practice is recognised, as well as the ways in which barriers created by social distancing might safely be addressed through the use of outdoor spaces and digital technologies. [ABSTRACT FROM AUTHOR]

At some point in their life, adolescent patients with a congenital heart disease (CHD) transition from paediatric services to adult care facilities. The process is not without any risks, as it is often linked with a significantly progressive deterioration in adolescents' health and loss of follow-up. In fact, transition patients often encounter troubles in finding a care giver who is comfortable managing their condition, or in re-establishing trust with the new care provider. Planning the rules of transition is pivotal in preventing these risks. Unfortunately, the American and European guidelines on CHD provide just generic statements about transition. In a recently published worldwide inter-societies consensus document, a hybrid model of transition, which should be adapted for use in high- and low- resource settings, has been suggested. Currently, in literature there are a few models of transition for CHD patients, but they are by far local models and cannot be generalized to other regions or countries. This paper describes the Irish model for transition of care of CHD patients. Due to the peculiarity of the healthcare organization in the Republic of Ireland, which is centralized with one main referral centre for paediatric cardiology (in Dublin, with a few smaller satellite centres all around, according to the "hub and spoke" model) and one centre for adult with CHD (in Dublin), the model can be considered as a national one and the first to be released in the old continent. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to apply Cultural Lens Approach theory to data collected from third year nursing students related to an assignment undertaken during their month-long practicum placement in an aged residential care facility. We explore the extent to which a national vision of bi-culturalism and inclusivity is evident in students' quality improvement project topic selection and practice. Background: Aotearoa New Zealand is a nation of dual heritage, informed by the cultures of Māori as the indigenous tangata whenua (people of the land), and Pākehā, (European) settlers. All public sectors, including all higher education providers and the curricula they deliver, are required to incorporate and promote a contemporary, bi-cultural world-view. Methods: Stage one of the research reported in this paper involved a) document analysis of 93 students' quality improvement project reports; b) focus groups with 18 students; and c) an online questionnaire for 16 key stakeholders including aged care managers, clinical nurse leaders and student nurse educators. Stage two reviewed the above data through a five-step Cultural Lens Approach process to identify cultural biases and assumptions. Results: Qualitative analysis revealed students' increased professional confidence, improving communication and critical thinking skills. Responses as to development of cultural competence and cultural safety were mixed: a key barrier identified was that staff in the placement setting received minimal professional development to ensure appropriate tikanga (customary protocols and practice) for Māori residents was in place. Conclusion: Viewed through a cultural lens, a westernized concept of aged healthcare provision continues to prevail in most settings. Nursing students noted gaps between cultural learning and practice. [ABSTRACT FROM AUTHOR]

This trial represents the final stage of the CARESSES project which aimed to develop and evaluate a culturally competent artificial intelligent system embedded into social robots to support older adult wellbeing. A parallel group, single-blind randomised controlled trial was conducted across older adult care homes in England and Japan. Participants randomly allocated to the Experimental Group or Control Group 1 received a Pepper robot for up 18 h across 2 weeks. Two versions of the CARESSES artificial intelligence were tested: a fully culturally competent system (Experimental Group) and a more limited version (Control Group 1). Control Group 2 (Care As Usual) participants did not receive a robot. Quantitative outcomes of interest reported in the current paper were health-related quality of life (SF-36), loneliness (ULS-8), and perceptions of robotic cultural competence (CCATool-Robotics). Thirty-three residents completed all procedures. The difference in SF-36 Emotional Wellbeing scores between Experimental Group and Care As Usual participants over time was significant (F[1] = 6.614, sig =.019, ηp2 =.258), as was the comparison between Any Robot used and Care As Usual (F[1] = 5.128, sig =.031, ηp2 =.146). There were no significant changes in SF-36 physical health subscales. ULS-8 loneliness scores slightly improved among Experimental and Control Group 1 participants compared to Care As Usual participants, but this was not significant. This study brings new evidence which cautiously supports the value of culturally competent socially assistive robots in improving the psychological wellbeing of older adults residing in care settings. [ABSTRACT FROM AUTHOR]

Most studies on socially assistive robots (SARs) in elder care are conducted in care homes and recruit participants with some degree of cognitive impairment. The ethical dimension in these studies thus requires careful attention, suggesting that the researchers involved should be offered specific research ethics training. To meet this need in CARESSES—an international multidisciplinary project that aims to design and evaluate the first culturally competent SAR for the care of older adults—a research ethics training module for the project researchers was developed. The training module is largely based on case-based learning (CBL), a widely recognized approach to learning and instruction that is regarded as highly effective across multiple disciplines. In this paper, we argue that research ethics training should be offered to robotics investigators involved in research on SARs in elder care, and we provide an overview of the ethical issues involved in conducting research with SARs and older adults in care homes. Finally, we show how CBL can be used for research ethics training in this context. [ABSTRACT FROM AUTHOR]

Background: A large part of the long-term care is provided by non-professional caregivers, generally without any monetary payment but a value economic of time invested. The economic relevance of informal caregivers has been recognized in Spain; however, public provision may still be scarce. The objective of this paper is to estimate the economic burden associated with informal long-term care that should assume the families through a new concept of cost sharing that consider opportunity costs of time provided by informal caregivers. Methods: The study sample includes all dependent adults in Spain. Socioeconomic information and the number of hours of informal care was collected through the Spanish Disability and Dependency Survey. The terms of shadow and extended shadow cost sharing were defined as the difference between the maximum potential amount of money that families could receive for the provision of informal care and the amount that actually they received and the value of informal care time with respect to the amount received, respectively. Results: 53.87% of dependent persons received an economic benefit associated to informal care. The average weekly hours of care were 71.59 (92.62 without time restrictions). Shadow cost sharing amounted to, on average, two thirds, whereas the State financed the remaining third. In terms of extended shadow cost sharing, the State financed between 3% and 10% of informal care provided by caregivers. Conclusions: This study reveals the deficient support received for the provision of informal care in Spain. More than 90% of informal care time is not covered by the economic benefits that families receive from the State. [ABSTRACT FROM AUTHOR]

Tools to monitor implementation progress could facilitate scale-up of effective treatments. Most treatment for depression, a common and disabling condition, is provided in primary care settings. Collaborative Care Management (CoCM) is an evidence-based model for treating common mental health conditions, including depression, in this setting; yet, it is not widely implemented. The Stages of Implementation Completion (SIC) was adapted for CoCM and piloted in eight rural primary care clinics serving adults challenged by low-income status. The CoCM-SIC accurately assessed implementation effectiveness and detected site variations in performance, suggesting key implementation activities to aid future scale-ups of CoCM for diverse populations. [ABSTRACT FROM AUTHOR]

Although high income countries increasingly emphasize care at home, long-term residential care is and will remain the place where some of our most vulnerable live and work. Based on over 500 interviews with the entire range of actors in long-term residential care, intensive observations by interdisciplinary teams of at least 12 in 27 different sites in six countries and on background documents that take context into account, this paper explores tensions in long-term residential care. It argues that recognizing and balancing these tensions is critical to care and constitute promising practices. However, multiple pressures are shifting the balances in these tensions, with for-profit, chain ownership and the increasing pressure to emphasize clinical care among the most powerful forces. [ABSTRACT FROM AUTHOR]

Cleaning and cleaners make three main contributions to long-term residential care. While cleaning in hospitals has received considerable research attention, much less attention has been paid to connecting cleaning and cleaners with the specific nature of long-term care and resident needs. In this article we explore three critical contributions cleaning and cleaners make to the quality of care in nursing homes. This work is central to infection control. It is also important in maintaining the appearance of the home; in making it home-like, welcoming, and safe. Much less visible is the significant part cleaners play in supporting relational care. Based on ethnographic studies in six countries, we argue that the extent to which cleaners and cleaning promote quality care and worker health is related to the division of labour, team work, training, equipment, and some autonomy. [ABSTRACT FROM AUTHOR]

Changing resident and staff populations, along with political economic reforms, call for new insights into the kinds of skills needed to work in long-term residential care (LTRC). This paper explores the skills of three occupational groups in LTRC: direct care workers, nurses, and doctors. We highlight complexities and ambiguities that exist regarding the training, roles and responsibilities, and integration of these occupational groups, and consider how race and gender relations shape assumptions regarding the skills of different workers. This paper synthesizes presentations and discussions from a workshop titled ‘Skills for Long-term Residential Care,’ held in Toronto, Canada in May 2015. Presentations drew on ethnographic research in LTRC facilities across Canada, the United States, the United Kingdom, Norway, Sweden, and Germany, as well as the practical experience and knowledge of representatives from Canadian unions and professional organizations. We highlight conditions needed to ensure workers have the appropriate skills to care for an aging population, and raise questions to be addressed to develop a sustainable, highly skilled LTRC workforce. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined volunteer experiences in residential care and personal care homes (PCH) in one Canadian city. Topics discussed include influence of residential care on volunteers' subjective experiences since they believe they are filling an important gap, regulation by organizations of task involvement of informal and formal volunteers, and exclusion of volunteers from the care team in residential care facilities.

An introduction to the journal is presented in which the editor discusses various reports within the issue on topics including aging, long-term care, and residential care.

This article analyzes the effects of the presence of children on the time devoted to adult care. Using the 2002 Spanish Time Use Survey (STUS), we examine two possible effects of children: (i) a negative effect, the Substitution Effect, associated with active childcare, and (ii) a positive effect, the Presence Effect, associated with passive childcare. Our results show that both effects have significant impacts on the ways in which mothers devote time to adult care activities. We find that an additional child in the family, under age 18, reduces the probability of caregiving, the Substitution Effect, while the presence of children during adult care, the Presence Effect, increases the probability of caregiving. [ABSTRACT FROM AUTHOR]

The European Dementia Consensus Network (EDCON) is a special project of the Madariaga Foundation located in Brussels. The Madariaga Foundation seeks to facilitate collaboration between European countries and between the public and private sector. This paper will review the differences in the definitions of Severe Dementia and summarise the EDCON consensus on their implications for management. EDCON recommends that: - The attributes of the person suffering from dementia should be given as much attention (and are as important for care) as the severity of cognitive decline in dementia; - The dementia syndrome (particularly in it's severe form) is inadequately defined by criteria which only includes the domain of cognition; - Physical, legal, social and cultural factors defining the environment of patients and their families should be carefully examined and that the results of this examination should be used in conjunction with the results of the somatic and psychiatric assessment in planning care and placement of the patient; - patients with severe dementia should have access to palliative care; - family members should be included in the care plans for those with severe dementia who are in institutional care. [ABSTRACT FROM AUTHOR]

Background: Clinically significant pharmacokinetic and pharmacodynamic changes occurring with age make older patients more prone to the consequences of inappropriate prescribing. The combination of higher use of medicines resulting from a higher disease burden with suboptimal treatment monitoring results in a higher risk of unwanted drug effects from sometimes inappropriate choice of drugs, doses and durations of treatment. Pharmacy services are increasingly being targeted to minimize the overall number of unnecessary and potential harmful medicines. Objective: To investigate the impact of a pharmacist-led medication review on quality of prescribing by a healthcare professional team consisting of a general practitioner (GP), care home staff and a pharmacist. Methods: This observational study compared outcome measurements before and after a pharmacist-led review of medications for patients under the care of a healthcare professional team consisting of a GP, care home staff and pharmacist. The procedure for conducting and recording the medication review consisted of the preparation of a patient medication profile, which combined the patient's medical records with his or her complete prescription record (current and previous [last 3 years] medication history) and pharmaceutical record (electronic journal entries for the patient over the same period). Laboratory values were evaluated in clinical context. Recommendations for the pharmaceutical plan were discussed at a conference involving the clinical pharmacist and other healthcare team members. Patients were recruited for medication review over the 12-month period 1 April 2003 to 1 April 2004. Medication appropriateness was assessed by an independent panel of clinical pharmacists using the Medication Appropriateness Index (MAI). Results: A total of 54 patients were eligible according to the inclusion criteria, of whom 24 were subsequently excluded for various reasons; thus, 30 patients were eligible for assessment on the MAI. There was a statistically significant difference between overall pre- and post-intervention summed MAI scores (p = 0.013). The pharmacist identified 115 drug-related problems, and the total number of accepted recommendations was 78 (67.8%). Use of a medication review as an intervention by a clinical pharmacist was associated with an improvement in appropriateness of prescribing. Conclusion: This study provides evidence supporting the formal integration of a clinical pharmacist into the healthcare team with the aim of improving prescribing appropriateness for institutionalized elderly Dutch patients. Overall MAI scores for all long-term medications used by a group of elderly patients improved significantly after a pharmacist-led medication review. This is an important finding because quality of prescribing is assuming increasing importance as a means of preventing avoidable medication-related harm. [ABSTRACT FROM AUTHOR]

Abstract  In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. [ABSTRACT FROM AUTHOR]

The creation of a safe and healthy environment, the establishment of an atmosphere of trust, and the use of a residential treatment group as a powerful force in order to achieve behavior modification of its individual group members-these are the intentions that moved me to undertake the challenge of adopting a peer group methodology, originally designed for work with delinquent adolescents, to a younger, more emotionally disturbed population. I did so during my affiliation with ILEX (International Learning Exchange in Social Education) and the Edgewood Children’s Center in San Francisco 1999/2000. The following article will present how I introduced and established this group methodology, “Positive Group Interaction” (PGI), to my residence unit in the course of a year as the basis of that unit’s approach to working with its children. All observations are based on the specific group setting I worked in. [ABSTRACT FROM AUTHOR]

This paper examines recent developments in elder care homes and changing attitudes toward institutional care in the Tianjin area of China. Based on research conducted at 12 sites, this study compares two types of elder care homes which are competing in the growing Chinese market for institutional elder care: ones characterized as government-owned and others described as "non-government-owned." Findings suggest that, despite rapid growth in the elder care home industry in China, the market is tilted toward the former government-owned elder care homes that still enjoy institutional and bureaucratic advantages in funding, staffing, and insurance. The research also examines the changing connotations of cultural norm in parent care. Traditional attitudes against placing parents in elder care homes are changing; some adult children as well as elders are starting to express acceptance of institutional elder care. The authors argue that institutional care for aging parents is likely to become a major option for parent care as adult children become increasingly unavailable due to the one-child policy, the need to work, and perhaps distant residence. [ABSTRACT FROM AUTHOR]

This paper explores optimal taxation of market purchases of an elderly care service, which can also be produced in the home. Home production cannot be taxed. If children discount parents' utility relative to their own utilities, an intergenerational externality arises in the family. When home production of the service is significant, the optimal tax rate on market purchases should be: (i) high, if the service and leisure are complements and the externality is strong, (ii) low, if they are substitutes, irrespective of the degree of the externality. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate changes in the oral healthcare of adults with learning disability after transference from long stay hospital care to community-based care. SUBJECTS: Adults with learning disability who were former residents of a single long stay hospital and who had been resettled into the community during the period April 1995 to April 1998. DESIGN: Structured questionnaire with a covering letter sent to community-based carers. Hospital notes were reviewed to assess oral healthcare received as in-patients. RESULTS: There was a 68% response rate to the questionnaire from community-based carers with details obtained from 106 out of a possible 157 subjects. As residents in the hospital, all subjects were examined regularly by a dentist - yearly for edentulous and six-monthly for dentate individuals. However, attendance patterns were less regular as residents in the community. In the community, individuals were also less likely to receive operative dental treatment. Although oral hygiene regimes were generally on a daily basis only 37% of the subjects and/or their carers had received oral health education from dental professionals in the community. CONCLUSION: Changes from institutional living to community-based housing for adults with learning disability may be associated with changes in dental attendance and treatment patterns. [ABSTRACT FROM AUTHOR]

In 1986, the traditional psychiatric hospital where 70% of Amsterdam's intramural treatment took place, was closed down. The progress of two groups of longstay patients was followed by longitudinal cohort research for five years after their transferral to new small-scale facilities in Amsterdam. The ADL-functioning of the most severely handicapped clients improved and their psychiatric symptoms decreased, while no improvement was seen in the functioning of the more independent and less handicapped clients. Now, thirteen years after closure of the old hospital, the use of the psychiatric facilities by these clients is being evaluated. This evaluation makes clear that the improvement of the severely disabled patients depends on the intensity of care given. Apparently, the improvement in the new facilities is no guarantee for a further development into a less care-intensive environment. The less handicapped and more independent clients, however, could more easily be transferred to less care-intensive facilities. [ABSTRACT FROM AUTHOR]

: As many as 40% of hip fractures occur in institutions for the elderly. Several studies have demonstrated a higher age-adjusted incidence of hip fractures in urban areas compared with rural areas. To assess whether this difference could be due to a preferential location of institutions for the elderly in urban areas, we compared the incidence of hip fractures over a 5-year period in urban versus rural areas, as defined according to the population density (urban >15 inhabitants/ha2). We then determined the age-adjusted incidence of hip fractures in institutional-dwelling elderly and home-dwelling elderly. Hip fracture incidence was 100.0/100 000 (150.5 in women and 43.8 in men) in urban areas, and 71.0/100 000 (107.2 in women and 32.8 in men) in rural areas (p<0.001). When only those patients living in their own homes were analyzed, the incidence was 66.7/100 000 (94.6 in women and 35.7 in men) in urban regions and 36.8/100 000 (49.6 in women and 23.4 in men) in rural areas (p<0.001), a difference of even greater magnitude than when both home-dwelling and institutional-dwelling residents were considered together. In a logistic regression model including age class, gender, urban or rural areas and institutionalization for inhabitants 65 years of age and older, urban residents have a 31% significantly (p<0.001) higher incidence of hip fracture compared with rural residents; women have a 79% significantly (p<0.001) higher incidence of hip fracture compared with men; and institutional-dwelling elderly have a 351% significantly (p<0.001) higher incidence of hip fracture compared with home-dwelling elderly. These results confirm the existence of a higher age-adjusted incidence of hip fractures in urban compared with rural areas. Since this difference is increased when patients living at home were analyzed separately, it indicates that the difference between urban and rural areas is not due to a preferential urban location of institutions for the elderly. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the letter to the editor "Care for all" by Dr. Korada that was published in volume 206 of the journal.

OBJECTIVE:To investigate changes in the oral healthcare of adults with learning disability after transference from long stay hospital care to community-based care. SUBJECTS:Adults with learning disability who were former residents of a single long stay hospital and who had been resettled into the community during the period April1995 to April 1998. DESIGN:Structured questionnaire with a covering letter sent to community-based carers. Hospital notes were reviewed to assess oral healthcare received as in-patients. RESULTS:There was a 68% response rate to the questionnaire from community-based carers with details obtained from 106 out of a possible 157 subjects. As residents in the hospital, all subjects were examined regularly by a dentist - yearly for edentulous and six-monthly for dentate individuals. However, attendance patterns were less regular as residents in the community. In the community, individuals were also less likely to receive operative dental treatment. Although oral hygiene regimes were generally on a daily basis only 37% of the subjects and/or their carers had received oral health education from dental professionals in the community. CONCLUSION:Changes from institutional living to community-based housing for adults with learning disability may be associated with changes in dental attendance and treatment patterns. [ABSTRACT FROM AUTHOR]