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Dominant cultural views and norms in Asia indicate that elder care should be met within the family. However, little is known about the migratory patterns of older adults seeking care in non‐institutional settings. This study investigates older adults' migration patterns and factors that affect their decisions to seek care in home‐based facilities. We employed an explanatory‐sequential approach, using two data sets: (1) Thai National Migration Surveys in Thailand for 2016, 2017, and 2018, and (2) in‐depth interviews with 20 older adults who migrated for care. Our findings indicate that elderly migration for care in home‐based settings is a strategy used by households to meet the care needs of older individuals. Age group, marital status, education, gender, health, family structure, family attachments, and the capacity of destination caregivers to provide care were significant factors influencing the likelihood of moving for care. The findings support the new economics of labor migration paradigm in minimizing the risk of households. Additionally, they demonstrate that an ecological framework can be expanded beyond their geographical boundaries through familial connections and the concept of aging in place. [ABSTRACT FROM AUTHOR]

This systematic review detected only limited positive effects of exercise on bone mineral density in older men. Further, based on the present literature, we were unable to suggest dedicated exercise prescriptions for this male cohort that might differ from recommendations based on studies with postmenopausal women. The primary aim of this systematic review was to determine the effect of exercise on bone mineral density (BMD) in healthy older men. A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement included only randomized or non-randomized controlled trials of exercise training ≥ 6 months with study groups of ≥ eight healthy men aged 50 years or older, not using bone-relevant pharmacological therapy, that determined BMD by dual-energy X-ray absorptiometry. We searched PubMed, Scopus, Web of Science, Cochrane, Science Direct, and Eric up to November 2016. Risk of bias was assessed using the PEDro scale. We identified eight trials with 789 participants (PEDro-score, mean value 6 of 10) which satisfied our eligibility criteria. Studies vary considerably with respect to type and composition of exercise. Study interventions of six trials were considered to be appropriate for successfully addressing BMD in this cohort. Between-group differences were not or not consistently reported by three studies. Three studies reported significant exercise effects on BMD for proximal femur; one of them determined significant differences between the exercise groups. None of the exercise trials determined significant BMD effects at the lumbar spine. Based on the present studies, there is only limited evidence for a favorable effect of exercise on BMD in men. More well-designed and sophisticated studies on BMD in healthy older men have to address this topic. Further, there is a need to define intervention quality standards and implement a universal scoring system that allows this pivotal determinant to be addressed much more intensively. [ABSTRACT FROM AUTHOR]

A 69-year-old morbidly obese man presented with hematuria caused by a large anterior wall bladder tumor. The mass was inaccessible for resection by standard means due to the patient's obesity and phallic length. A perineal urethrostomy was required to enable complete resection. This age-old technique is revisited for the benefit of this generation's urologists. [ABSTRACT FROM AUTHOR]

In this paper, we draw on narrative correspondence from older male spousal caregivers and interviews with care providers from the voluntary and statutory sectors to explore how older male carers in the UK cope with and experience care-giving, the forms of support they draw upon, and how this impacts on their sense of self and identity as older men. We also consider how (or if) gender plays a part in shaping the forms of formal care support extended to male carers. We conclude, that how older men construct and perform care-giving, and how the wider family and community respond to older men as carers, can impact on how they perform masculinity. This in turn can contribute to a decline in their social networks and opportunities for sociability, leading to increased loneliness and social isolation. Such insights are important if we are to enrich our knowledge of the challenges they face, the coping mechanisms they employ, and the extent to which their support needs are met in their caring role. What is known about the topic • Most unpaid care for older people is undertaken by women but amongst older carers this gender balance is changing. • Older men experience care-giving differently to women but research in this area is limited. [ABSTRACT FROM AUTHOR]

Introduction: The Swiss Red Cross (SRC) is supporting local partners in Eastern Europe/CIS in developing services to allow elderly a dignified ageing in their homes. SRC promotes integrated medico-social home care services in agreement with the local partners, their strategies and capacities. "Help to self-help" is crucial besides the provision of good quality low cost services, accessible for people in need. In many post-Soviet countries, cooperation between Health and Social Ministries is rather weak. Access to health/social care services is a challenge for older people due to low pensions, lack of transportation means and low self-mobility. At policy level, the SRC facilitates the collaboration between health/social care policy makers and fosters exchange with advisory boards or working groups. At practical level, the SRC links medical and social care workers and puts a model of nurse-led care into practise. Objectives: - Strengthening health care systems and enabling access for all, - Engaging in advocacy for health and social inclusion, - creation of workplaces for nurses and new profession of home-helpers/care assistants Results: In all six SRC partner countries, SRC and parners gathered their experiences: The health and social needs and type of services to be provided needs to be confirmed by in depth surveys/assessments and to be demand-driven, with user- and provider integration. In all five countries, approx. 12'000 elderly, chronically ill persons are cared for by 60 home care centers[1] and authorities (local, national) are co-funding. The existing legal framework is an important factor when considering sustainability issues. Integrated medico-social home care services are nurse-led/managed services in close cooperation with General Practitioners and stationary public services. Many countries accept only medical doctor led services for reimbursement. Promoting nurse-led services requires a shift of paradigm and changes in legislative frameworks. This requires evidence based advocacy to withstand the strong doctor's lobby. The continuous training of home care staff is crucial, particular in quality of care, in dementia and palliative care issues. Countries lack legislation, regulations and guidelines in how to care for such persons. Home care staff often are the only persons taking care of patients, living alone, with dementia or being terminally ill. In 2013, the SRC and partners established their knowledge management group with all six partner countries. The aim was to analyse different home care models and define core areas for cooperation. To learn from each other bears many advantages. Successes in one country encourage others to work and advocate for positive approaches. Exchange also involved peertrainings, peer-coaching and peer-reviews as well as peer-evaluations, mainly in 2015-2016. Based on the exchange, once a year a meeting in one of the project countries including field visits and every 2nd month discussions in skype-meetings proved to be effective. Hence the SRC has a community of practice established for the knowledge-management group in Home Care, Active and Healthy Aging on its intranet. Uploading and screening of applications, reports, evaluations is a common practice nowadays in the network between the six countries. In order to compare outcomes and effects in Home Care the SRC introduced core-indicators for measuring of the Outcomes in all six project countries and elaborated as well a toolbox (result chain) for home care. Thus, all members (SRC delegates in the countries and partner organisations) are involved in Knowledge-Management and sharing. This approach used to satisfying, efficient, effective and improved the quality of the work enormously. Evidence of functioning of the Home care model: Before any activity is started, sound and serious data collection is needed with surveys/studies and scrutinizing the existing policies, strategies, road-maps in a given country related to community health and social services. Important in the work of the Swiss Red Cross as humanitarian organisation is the aspect of vulnerability. Thus, the vulnerability capacity assessment (VCA) is one tool measuring the scale of vulnerability in different areas (economic; social; health; mental; livelihood; water etc). Focus-group discussions, household surveys, needs studies etc are part of the assessment in cooperation with the partner organisation and very often Government agencies and other international or national NGO's in a chosen country. Thus Home Care services are not build up based on a "wish-list", but on evidences in the given country. Scalability and sustainability of the Home care model: In all six SRC countries in Europe/CIS, the partners are mostly the national, local Red Cross/Red Crescent Societies. In the West, RC/RC Societies often work auxiliary to Governments. This is not given in the countries where former socialist or autocratic systems were in place. Home based Care is a new issue in all these countries - thus before such model is adopted within the official health and social care system, SRC and partners have to extensively lobby and work evidence-based with operational research tools to show the gap in the public service provision, the need to have new quality, cost-efficient and effective care models for the growing parts of vulnerable populations not able to "pay-out-of pocket" and thus not having even access to basic services. 12'000 clients in 6 countries in 4 ½ years of work is a step forward in systems, that not think integrated and in interfaces and where health and social areas are strictly separated. Hence only in Moldova a small funding for "nurse led" home services are paid by the national Health Insurance Fund. In all other countries, either HIF is not existing (Semashko-system) or only doctor-led services are funded and thus, changing of mind-sets in people and across the cultures is needed - behaviour change needs time. Nurse-led services present a change in paradigm in all these countries and cultures. Thus, social authorities and family doctors/general practicioners, Policlinics/hospitals, specialist doctors ought to be step-bystep taken on board as partners. Not the competition on sometimes scarce funding in some countries should be the issue, but to build a case- and care-management and referral system. The aim is: The General Practitioners/Policlinics/Social Workers & the Home Care staff form one "Care" Team with one goal: to improve the health and well-being of the client; The information about the client is with all partners/stake-holders in the system (e.g. patient card); Functional up and down-referral system is developed within the state/public system In addition, to scale up, replicate and achieve sustainability changes in existing health/social care laws are needed (funding follows laws), regulations changed, new professions introduced e.g. Bulgaria: social care assistant (home helper); Bosnia/Herzegovina: care assistant. Quality standards for Home care centers and for a national minimal quality standard in Home care for Not-for-Profit-Organisations introduced; post-graduate trainings for nurses defined and accredited; volunteers found, trained and retained; paid services introduced i.e. multifunding approaches elaborated; benchmarking/costing study introduced etc. Taking all in mind, we may even speak of a partial reform in "Primary health care/Community health and social care". Before Governments are not ready to change for such new model scalability ought to be planned but the numbers of clients kept lower in order to not create new dependancies on external funding We know from "Community based home care provision" in Switzerland, Austria and Germany that for building such a service a minimum of 15-20 years of continuous processes is needed in a stable economic environment. [ABSTRACT FROM AUTHOR]

Background: There is limited information on prevalent and incident atrial fibrillation in Chinese. We aimed to investigate the prevalence, incidence, management and risks of atrial fibrillation in an elderly Chinese population. Methods: In a population-based prospective study in elderly (⩾60 years) Chinese, we performed cardiovascular health examinations including a 12-lead electrocardiogram at baseline in 3,922 participants and biennially during follow-up in 2,017 participants. We collected information on vital status during the whole follow-up period. Results: The baseline prevalence of atrial fibrillation was 2.0 % (n = 34) in 1718 men and 1.6 % (n = 36) in 2204 women. During a median 3.8 years of follow-up, the incidence rate of atrial fibrillation (n = 34) was 4.9 per 1000 person-years (95 % confidence interval [CI], 3.4-6.9). In univariate analysis, both the prevalence and incidence of atrial fibrillation were higher with age advancing (P < 0.0001) and in the presence of coronary heart disease (P ⩽ 0.02). Of the 104 prevalent and incident cases of atrial fibrillation, only 1 (1.0 %) received anticoagulant therapy (warfarin). These patients with atrial fibrillation, compared with those with sinus rhythm, had significantly higher risks of all-cause (n = 261, hazard ratio [HR] 1.87, 95 % CI, 1.09-3.20, P = 0.02), cardiovascular (n = 136, HR 3.78, 95 % CI 2.17-6.58, P < 0.0001) and stroke mortality (n = 44, HR 6.31, 95 % CI 2.81-14.19, P = 0.0003). Conclusions: Atrial fibrillation was relatively frequent in elderly Chinese, poorly managed and associated with higher risks of mortality. [ABSTRACT FROM AUTHOR]

Background: Home care is integral to enabling older adults to delay or avoid long-term care (LTC) admission. To date, there is little population-based data about gender differences in home care users and their subsequent outcomes. Our objectives were to quantify differences between women and men who used home care in Ontario, Canada and to determine if there were subsequent differences in LTC admission. Methods: This is a population-based retrospective cohort study. We identified all adults aged 76+ years living in Ontario and receiving home care on April 1, 2007 (baseline). Using the Resident Assessment Instrument - Home Care (RAI-HC) linked to other databases, we characterized the cohort by living condition, health and functioning, and identified all acute care and LTC use in the year following baseline. Results: The cohort consisted of 51,201 women and 20,102 men. Women were older, more likely to live alone, and more likely to rely on a child or child-in-law for caregiver support. Men most frequently identified a spouse as caregiver and their caregivers reported distress twice as often as women's caregivers. Men had higher rates of most chronic conditions and were more likely to experience impairment. Men were more likely to be admitted to hospital, to have longer stays in hospital, and to be admitted to LTC. Conclusions: Understanding who uses home care and why is critical to ensuring that these programs effectively reduce LTC use. We found that women outnumbered men but that men presented with higher levels of need. This detailed gender analysis highlights how needs differ between older women, men, and their respective caregivers. [ABSTRACT FROM AUTHOR]

Aim:Aspirin resistance is recognized in different population. However, the prevalence and clinical events of aspirin resistance in elderly male patients with cardiovascular disease (CVD) have not been reported. Methods: We enrolled 304 elderly male patients with CVD receiving daily aspirin therapy (≥ 75 mg) more than 1 month. Platelet aggregation was measured by light transmission aggregometry (LTA) and thrombelastography platelet mapping assay (TEG). The median follow-up time was 1.8 years. The primary outcome was the composite of death, myocardial infarction, unstable angina, stroke and transient ischemic attack. Results: By LTA, 25 (8.2%) of elderly patients were aspirin resistant and 106 (34.9%) patients were semiresponders. According to TEG, 62 patients (20.4%) were found to be resistant to aspirin therapy. Of the 62 patients with aspirin resistance by TEG, 21 patients were aspirin resistant by LTA. Twenty-two of the 106 semiresponders by LTA were aspirin resistant by TEG. Patients with aspirin resistance or aspirin semiresponders were at increased risk of the composite outcome compared with aspirin-sensitive patients by LTA (18.3% vs 9.8%, Hazard ratio (HR) = 1.864, 95% confidence interval (CI): 1.046-3.324 p = 0.039). However, aspirin resistance was not associated with an increased risk of clinical vascular events compared to aspirin-sensitive patients by TEG (17.7% vs 10.9%, p = 0.452). In addition, Cox proportional hazard regression modeling demonstrated that aspirin resistance or semiresponders (HR = 3.050, 95% CI: 1.464-6.354, p = 0.003) and diabetes (HR = 2.055, 95% CI: 1.060-3.981, p = 0.033) were associated with major adverse long-term outcomes. Conclusions: Aspirin resistance or semiresponders, defined by LTA, are associated with an increased risk of adverse clinical events in elderly male patients with CVD. [ABSTRACT FROM AUTHOR]

Introduction: The idea of an Alzheimer's Cafe in North Wicklow developed when in the hospital we noted a lack of follow on support and education for people diagnosed with dementia and their carers. It was also noted that this was an increasing issue amongst our local population. Three Health and Social Care Professionals from St Columcille's Hospital attended training on Alzheimer's Cafe's in order to try and establish one in our locality. Practice Change Implemented: The Alzheimer's Cafe Bray promotes early diagnosis, reducing stigma, and caring for older people in their home environment by providing education, support and information in an accessible and community focused way. Aims and Theory of Change: The aim was to set up an Alzheimer's Café - a relaxed space where people with all types of dementia and their families/carers can come together for socialisation, education and support under a person-centred ethos and to promote resilience. The theory is that by "role-modelling positive language, accurate concepts, an accepting attitude, sensitive communication and warm interactions" (Jones 2010: 34) we can destigmatise dementia and provide support (National Dementia Strategy 2014) Targeted population and stakeholders: The targeted population is people with dementia in South Dublin and North Wicklow and those who care for them. The stakeholders are the hospital staff, the community support services, local politicians, people with dementia and those caring for them. Key stakeholders were invited to form a steering committee. Those who attended the first Alzheimer's Cafe were surveyed so the educational 'themes' set for the year reflected their needs thereby ensuring an age-friendly environment. Timeline: The first meeting of the steering committee was in November 2015 and we gave ourselves a lead in time of 6 months which we accomplished. Core tasks of fundraising; sourcing accommodation & equipment; marketing & communication and recruiting volunteers were assigned. Monthly progress meetings were held. Highlights: While the Alzheimer Cafe movement started in the Netherlands in 1997 and there are a number of them in Ireland at this stage; this integrated initiative between hospital and community is a new way to promote highly effective co-ordinated care. The innovation is that a team with knowledge, expertise and experience can provide the education necessary without having to outsource the educational piece. We provide support for people with dementia, their families/carers and in the process enhance working relationships and communication across services. 25 PwD and carers and 8 volunteers on average attend per month. 20 have returned to at least 7 out of 8 of our monthly Alzheimer's Cafe's. 100% of the people who attended and provided feedback in the early stages rated the AC as a 'very positive experience' with a 'warm, easy atmosphere'. In the most recent survey 94% of respondents now felt more comfortable discussing dementia. This supports families caring for older people and older people's care in the home environment. 100% of respondents stated the volunteers were 'approachable and friendly'. Sustainability: We are a group that meets monthly in an accessible and available location that is given to us free of charge. We receive donations of food from the hospital and money raised through fundraising. This ensures it is an achievable and sustainable piece of work that promotes positive ageing and dignity. Transferability: The Alzheimer's Cafe Bray and the Ireland East Hospital Group are of the opinion that this highly innovative way of developing a long-standing support service is highly transferable. In fact, the IEHG have created a target that our approach is replicated across all hospitals in this group by 2019. [ABSTRACT FROM AUTHOR]

Introduction: The aging population within the Republic of Ireland is increasing exponentially to approximately 20,000 per year. As a result there is an increase in frail older persons living within the community with increased risks of emergency department (ED) presentations and hospital admissions. Better co-ordinated care with targeted specific interventions can assist with admission avoidance and unplanned hospital admission and is seen as key to supporting patients at home. The use of virtual wards have increased in popularity in providing a framework for risk stratification and supporting integration of care across primary and acute settings Practice change implementation: In January 2015 a community virtual ward was implemented within North Dublin operating on a traffic light system of red (high risk), amber (moderate risk), green (low risk). A number of assessment tools reviewing frailty, function, cognition and risk of a hospital admission were used to determine overall risk and response to interventions overtime. Targeted population and key stakeholders: The model of care focused on older persons > 65 average age 81.6 years (SD + 5.7 years) living at home with 2 or more co-morbidities and evidence of clinical or functional decline within a 30 day time frame. Key stakeholders included the clinical case manager older persons, primary care services, older persons services, acute hospital specialist gerontology as well as the Day Hospital, the ED, frailty intervention therapy team (FITT), hospital bed management, Royal College of Surgeons Ireland, School of Nursing and Midwifery, Nursing and Midwifery Planning and Development Unit (North Dublin) Timeline: The initiative is ongoing with plans to expand due to the development of an integrated care team within North Dublin. Outcomes: A total 85 patients have been through the community virtual ward with evidence of a significant reduction in the median unplanned hospital admissions (1, IQR 0-1) in comparison to the number of unplanned hospital admissions prior to CVW interventions (0, IWR-0-0, z=4.79, P=0.001). ED presentations were also reduced (ED presentations pre median 1= IQR 0.2 ED presentations post median 0, IQR 0-1 z=4.52, P= <0.001) which is statistically significant. Sustainability: The model is sustainable as it focuses on care in the home supporting the expansion of an integrated care team working across primary and secondary care. Transferability: As it focuses on integration of care including risk stratification, timely service mobilisation and monitoring the model is transferable to areas such as palliative care, disabilities and mental health Conclusion: The CVW offers solution to integrated care for older persons with complex care needs in supporting patients at home during critical periods of illness and functional decline. [ABSTRACT FROM AUTHOR]

Introduction: (comprising context and problem statement) A national two year practice development programme took place in the Republic of Ireland from 2007 to 2010. The programme was commissioned to support staff to implement a framework for person-centred nursing practice-centred practice in residential settings for older persons. Eighteen sites took part in the programme and staff and managers from a variety of disciplines used a personcentred framework and practice development model to develop their practice. Since the programme finished there is evidence that this work sustained and in some places continued to grow. The Health Service Executive in Ireland (HSE) now wishes to extend this programme to all services incrementally using the same methodology so that care and practices can be more fully integrated from a workplace culture perspective. Short description of practice change implemented: Process and outcome evaluation demonstrated improvements in practice and workplace culture for staff and improvements in care experiences for residents. A number of validated tools were used, both process and outcome that engaged residents and staff. Evidence indicated increased choice for residents and more meaningful relationships between them and staff to name but two. There was for example evidence of changes in workplace culture with improvement to quality of communication and support between staff, greater role satisfaction, improved staffing and resources, and greater commitment to the setting. Aim and theory of change: The overall aims of the programme were to: implement a framework for person-centred practice for older people across multiple settings in Ireland, through a collaborative facilitation model and to carry out an evaluation of the processes and outcomes. The programme drew on numerous principles from different yet complementary theories and approaches: emancipatory practice development, co-operative inquiry and a specific personcentred nursing framework. Targeted population and stakeholders: Eighteen residential units for older people were involved in this programme. Along with residents in targeted sites, staff groups represented different areas within the units and grades i.e. Nurse Mangers, Staff Nurses, Health Care Assistants, Housekeeping, Catering and Administration staff. Timeline: An initial two year programme took place 2007 - 2010. The HSE will now replicate this programme by introducing a further three year national programme to develop cultures of person-centredness system wide which commences in February 2017. Highlights: (innovation, Impact and outcomes) This is an innovative methodology and programme that has been replicated in many different settings internationally such as New South Wales, Netherlands, Norway, Malta, UK, and others. Using this methodology and framework staff were facilitated to critically explore their practice and Comments on sustainability: For long term sustainability it is vital that practice development activities contribute to the professional and personal development of staff and managers. The development of staff key facilitation and practice development knowledge and skills enabled staff to work effectively with colleagues to changes their workplace culture. Comments on transferability: This programme has transferability to any care setting demonstrated in the variety of settings it has been introduces in for example in the New South Wales programme Essentials of Care The focus is on developing cultures of personcentredness that supports person-centred practices. Conclusions: (comprising key findings) The HSE had demonstrated considerable impact on care experiences for both service users and staff through the introduction of this programme in older persons' residential services. [ABSTRACT FROM AUTHOR]

Introduction: Multimorbidity is often combined with functional limitations among older adults. It is therefore important to ensure the built and social environment encourages older adults to safely age while maintaining independence. Previous findings have focused on the impact of the built environment as a barrier to an active lifestyle, but not specific to accessing community-based health and social care (CHSC). We propose to investigate the impact of patient and caregiver limitations on accessing care, including the impact of the built environment. Methods: Secondary thematic coding analysis was undertaken with 53 patient and 38 informal caregiver interviews from communities in Canada and New Zealand. Reported findings are from a broader research program titled, Implementing integrated Care for Older Adults with Complex Health needs (iCOACH). Older complex seniors were recruited for participation from a community primary healthcare team if they were greater than 50 years of age, and managing ongoing chronic conditions. Caregivers were unpaid informal carers of older adults. A specific thematic code about unmet need was extensively reviewed for examples related to the built environment and access to care. Results: Functional limitations hindered self-management at home as well as accessing CHSC. Attributes of the physical environment at home impacted the use of assistive devices, and impaired the ability to leave the home. Physical barriers within the social environment included the inability to use public transportation, access community programs, and conduct daily living tasks. Consequences from not being able to access supports included greater financial strain, social isolation, poor safety at home, lack of independence, and greater caregiver strain. Older adults appeared to be less impacted by access barriers when living in supportive housing settings, where on-site staff were available to provide direct support, or initiate referrals for additional services. Discussions: Experiences of older adults and informal caregivers highlighted access to care issues specific to the immediate and external physical environment, and examples of when support was efficiently provided. When considering how to best deliver services to people with complex care needs and their caregivers, it is important to consider how those services can be accessed. Conclusions: When services cannot be easily accessed, patients and caregivers may make critical trade-offs. To maintain independence and safety, it is important to design services which consider the adaptations and supports that are required to support older adults both at home, as well as the environment they have to navigate to access care. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 51-year-old man with type 2 diabetes mellitus and hypertension, admitted to the hospital for not taken insulin for several days. The patient has underwent a medical examination which revealed the patient has tachypnea, tachycardia and jaundice and was diagnosed with emphysermatous pyelonephritis. The hospital suggested the patient should underwent a medical therapy, medical treatment and surgical management for the rare life-threatening disease.