Engaging older adults in clinical communication is an essential aspect of high-quality elder care, patient safety and satisfaction in hospitals and GP clinics. However, the factors that influence ...older adults' participation during their appointments with health professionals from the older patient's perspective remain under-investigated. We aimed to fill this knowledge gap by reviewing research articles that have examined older patients' involvement in clinical communication. In doing so, we hope to assist healthcare professionals and institutions in developing new strategies to improve older patients' participation and engagement in clinical communication. A systematic review of nine databases was conducted for studies reporting identified influences on older patients' participation in clinical communication published from 2010. These studies were then subjected to thematic analysis for stratification. Twenty-one articles with a total of 36,797 participants were included and highlighted three major themes that influenced older patients' participation in the clinical communication. The first theme identified includes accessibility to appointments, support, health information and person-centred care, highlighting that access to appointments, person centred care and health information significantly influences clinical communication participation. Relevant and understandable healthcare information identified that communication factors i.e. tailored health information, health literacy and patient language barriers, and communication impairments influences older patients' participation. Older Patient perceptions of HCP credibility and trustworthiness highlighted how patient's perceptions of health professionals influence their willingness to participate in clinical communications. This review demonstrates that there are several factors that contribute to insufficient or no participation of older patients in clinical communication in hospitals and GP clinics. These include accessibility to relevant and understandable health information, and the perceived health professional credibility and trustworthiness. Identifying ways to address these factors may improve patient participation, doctor-patient collaboration and overall health outcomes for older patients.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A global catastrophe-the COVID-19 pandemic-appears to have two-dimensional health consequences for older adults: high risk of being infected and psychological distress. There is limited evidence on ...how the pandemic has impacted the life and coping of older adults who are culturally and linguistically diverse (CALD), women in particular. This study explored the COVID-19 risk perception and coping strategies of older CALD women in South Australia.
A mixed-methods research design was employed, involving a 31-items coping and emergency preparation scale for survey and semi-structured interviews with participants. The older CALD women were approached through 11 multicultural NGOs. One hundred and nine women participants from 28 CALD communities completed the online surveys; 25 of them agreed to a telephone interview and provided their contact details. 15 older CALD women ultimately participated in interviews.
Mean sum-score of dread risk, unknown risk, and fear (M: 43.5; SD: 4.9) indicated that the participants were somewhat anxious and worried. Mean sum-score of coping (M: 79.8; SD: 9.3) reported their compliance with expert advice and disinfection practices but accessing health information (M: 2.8; SD 1.4) and tendency to minimize anxiety (M: 2.1; SD: 1.2) were below neutral. Significant variations were found in coping in terms of age, meaning that the women aged 75 years and older were less likely to cope with the pandemic (P = 0.01). Emergency preparation differed based on the participants' residence and occupation status. The deductive-inductive thematic analysis of interview data was framed around three priori themes: risks of being affected, emotional and behavioral coping, and emergency preparation and access to services.
Evidence shows a fear among the older CALD women with an endeavor to cope and prepare for emergency situations. This suggests the requirements for interventions that improve coping and reduce the risk of stress among them.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Quality of dementia care improves with a personalized approach to aged care, and knowledge of the disease process and unique care needs of residents with dementia. A personalized model of care can ...have a significant impact on the overall organizational culture in aged care homes. However, the dimensions of personalized aged care relating to dementia often remain under-managed. We aim to explore the factors that shape the dimensions of personalized dementia care in rural nursing homes using qualitative data of a mixed-method 'Harmony in the Bush' dementia study. The study participants included clinical managers, registered nurses, enrolled nurses and care workers from five rural aged care homes in Queensland and South Australia. One hundred and four staff participated in 65 semi-structured interviews and 20 focus groups at three phases: post-intervention, one-month follow-up and three-months follow-up. A multidimensional model of nursing home care quality developed by Rantz et al. (1998) was used in data coding and analysis of the factors. Three key themes including seven dimensions emerged from the findings: resident and family resident and family centeredness, and assessment and care planning; staff staff education and training, staff-resident interaction and work-life balance; and organization leadership and organizational culture, and physical environment and safety. A lack of consideration of family members views by management and staff, together with poorly integrated, holistic care plan, limited resources and absence of ongoing education for staff, resulted in an ineffective implementation of personalized dementia care. Understanding the dimensions and associated factors may assist in interpreting the multidimensional aspects of personalized approach in dementia care. Staff training on person-centered approach, assessment and plan, and building relationships among and between staff and residents are essential to improve the quality of care residents receive.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The physical health and conditions of elderly people are challenged by the adverse effects of seasonal variations in sub-tropical countries, including Bangladesh. Research to date does not feature ...the risk of seasonal changes for primary healthcare infrastructures and practices in supporting elderly women’s care, especially in rural areas. This study aims to identify the health effects of seasonal variations that place increased risk of symptoms and diseases on rural elderly women, and to explore the determinants associated with the women’s use of healthcare locally. Using a mixed-methods approach, audio-recorded semi-structured interviews including a short survey with sixty-five rural elderly women and eleven healthcare professionals were conducted. Quantitative data were analyzed in SPSS, and a thematic analysis of the qualitative data was facilitated by NVivo. Self-reported health history by rural elderly women identified the prevalence of three major seasonal symptoms: headache (28/43.1%), digestive disorder (27/41.5%), and physical pain (27/41.5%). The prevalence of three symptoms such as nausea, headache and digestive disorder varied significantly (p < 0.05) across the study villages. Of the women, the age group (60-70 years) recorded the highest number of cases (20), followed by age group (71-80 years/15), where the number of cases significantly varied across three seasons (p = 0.021). While 78.5% and 55.4% reported one and two symptoms/diseases respectively, the community clinic visits differed significantly (p = 0.011) among the seasons. The utilization of primary healthcare was low, and marginalization in using healthcare was underpinned by the health system, the poor living conditions of the women, and their reluctance to seek treatment. The findings suggest a need for policy solutions in promoting preventive measures and treatments by strengthening local clinics and on-going health education and training of staff and elderly women.
Women in Indonesia’s civil service (n = 320) were surveyed about their career advancement. Analysis of variance identified differences in career progression, and post-hoc comparisons were tested ...using Fisher’s Least Significant Difference method. We found that family support and interpersonal relationships, paired with superior education to men, were critical to women’s successful leadership progression, especially through the echelon ranks. Qualitative results suggest that interpretations of hadith outweighed more contemporary textual readings, which required strategic maneuvering if women wanted to advance. This is because women’s own career aspirations required their ongoing loyalty to men and strategic maneuvering among filial, societal, and organizational constraints.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a ...person-centered, non-pharmacological dementia care model, 'Harmony in the Bush', based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia.
A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff's caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines.
Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency.
The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia.
Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458.
High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns ...for elderly residents with dementia in the 'Harmony in the Bush Dementia Study'. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention.
Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.
The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer's disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents' medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control.
Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data.
ANZCTR, ACTRN12618000263291 . Registered on 20th February 2018.
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Social determinants of health is a core cross-cutting approach of the World Health Organization to reduce health inequalities, and places an emphasis on aged care planning in rural areas of low- and ...lower-middle income countries including Bangladesh. The complex correlated health and social factors in Bangladesh interplay to shape the healthcare access of rural people. This impact is significant for rural elderly women in particular who have been shown to access healthcare in ways that are described as ‘socially determined’. This study aimed to explore how this cohort related their healthcare access to their living circumstances and provided insight into how their healthcare access needs can be addressed. This study was a critical social theoretical exploration from conversational interviews held over three months with 25 elderly women in rural Bangladesh. Two critical social constructs, ‘emancipation’ of Habermas and ‘recognition’ of Honneth, were used in the exploration and explanation of the influence of personal circumstances, society and system on rural elderly women’s healthcare access. The concept of ‘social determinants of healthcare access’ is defined from the physical, emotive, symbolic and imaginative experiences of these women. Interviewing the women provided information for exploration of the determinants that characterized their experiences into an overall construct of ‘The World is Not Mine’. This construct represented four themes focusing on the exclusion from healthcare, oppressive socioeconomic condition, marginalization in social relationships and personal characteristics that led the women to avoid or delay access to modern healthcare. This study confirms that the rural elderly women require adequate policy responses from the government, and also need multiple support systems to secure adequate access to healthcare. As healthcare services are often a reflection of community values and human rights concerns for the elderly, there is a need of recognition and respect of their voice by the family members, society and the healthcare system in planning and implementation of a prudent aged care policy for rural elderly women in Bangladesh.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Background: Coping with COVID-19 is a challenge for culturally and linguistically diverse (CALD) older adults. In Australia, little attention has been given to understanding associations between ...cultural contexts, health promotion, and socio-emotional and mental health challenges of older CALD adults during the COVID-19 pandemic. Therefore, we have collected data from older CALD adults to examine their COVID-19 risk perceptions and its association with their health precautions, behavioural dimensions and emergency preparation.
Methods: A cross-sectional survey was conducted in South Australia. The CALD population aged 60 years and above were approached through 11 South Australian multicultural NGOs.
Results: We provide the details of 155 older CALD South Australians' demographics, risk perceptions, health precautions (problem-and-emotion-focused), behavioural dimensions and emergency preparation. The explanatory variables included demographic characteristics (age, gender, education and ethnicity); and risk perception (cognitive likelihood of being affected and affective dimension fear and general concerns, and psychometric paradigm severity, controllability, and personal impact. The outcome measure variables were health precautions (problem-focused and emotion-focused), behavioral adaptions and emergency preparation.
Conclusions: This dataset may help the researchers who investigate multicultural health or aged care in the pandemic and or who may have interest to link with other datasets and secondary use of this primary dataset in order to develop culturally tailored pandemic-related response plan. The data set is available from
Harvard Dataverse.
Abstract
Although secondhand smoke (SHS) exposure is predominant in Bangladesh, the adverse effect of SHS exposure on health-related behaviors, such as sleep quality, have remained an ...under-investigated area of the country’s public health landscape. Therefore, the purpose of this study was to examine the association between SHS exposure and poor sleep quality among non-smoking university students in Bangladesh. A cross-sectional survey was carried out between May and September 2022. SHS exposure (main predictor variable) and other covariates (e.g., age, sex, etc.) were measured using a self-reported questionnaire and sleep quality (outcome variable) was measured via the Pittsburgh Sleep Quality Index. Multiple logistic regression models investigated the association between SHS exposure and poor sleep quality. The study included 390 students (mean age: 22 years, 53.8% male). Approximately 41.8% of the participants reported SHS exposure, and 50.5% had poor sleep quality. Students exposed to SHS were more likely to have poor sleep quality compared to their counterparts (AOR = 1.61; 95% CI 1.01, 2.58). Subgroup analysis revealed poor sleep quality was 2-times higher among male students exposed to SHS than those male students without SHS exposure (AOR = 2.03; 95% CI 1.05, 3.93). No association was found in female students. Findings from this study warrant increased awareness and public health initiatives on the implications of SHS on health behaviors, such as sleep quality, in non-smoking Bangladeshi university students.
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