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GPs' perspectives on preventive care for older people: a focus group study
- Authors:
- DREWES Yvonne M., et al
- Journal article citation:
- British Journal of General Practice, 62(604), November 2012, pp.582-583.
- Publisher:
- Royal College of General Practitioners
The aims of preventive care for older people may differ from the traditional targets of preventing diseases or injuries and include the maintenance of independence and wellbeing. This qualitative study explored Dutch GPs' perspectives on preventive care for older people in six focus groups involving a total of 37 GPs. Whether or not to implement preventive care for older people depends on the patient's individual level of vitality, as perceived by the GP. For older people with a high level of vitality, GPs confine their role to standardised disease-oriented prevention on a patient's request. It is when the vitality levels in older people fall that the scope of preventive care shifts from prevention of disease to prevention of functional decline. For older, vulnerable people, GPs expect most benefit from a proactive, individualised approach, enabling them to live as independently as possible. Based on these responses, a conceptual model for preventive care for different groups of older people was developed. It focuses on five main dimensions: aim of care (prevention of disease versus prevention of functional decline), concept of care (disease model versus functional model), initiator (older persons themselves versus GP), target groups (people with requests versus specified risk groups), and content of preventive care (mainly cardiovascular risk management versus functional decline).
Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature
- Authors:
- ZECEVIC Aleksandra A., et al
- Journal article citation:
- Gerontologist, 46(3), June 2006, pp.367-376.
- Publisher:
- Oxford University Press
The purpose of this Canadian study was (a) to obtain information about the perceptions held by seniors and health care providers concerning what constitutes a fall and potential reasons for falling, and (b) to compare these perceptions to the research literature. As part of a larger telephone survey, interviewers asked 477 community-dwelling seniors to define a fall and to provide reasons for falling. In addition, 31 health care providers from the community were interviewed on the same topics. In order to capture patterns in conceptualized thinking, content analysis was used to develop codes and categories for a fall definition and reasons for falling. Selected articles were reviewed in order to obtain a comprehensive overview of fall definitions currently used in the research and prevention literature. The results found that a fall had different meanings for different groups. Seniors and health care providers focused mainly on antecedents and consequences of falling, whereas researchers described the fall event itself. There were substantial differences between the reasons for falling as reported by seniors and the risk factors as identified in the research literature. The authors conclude that if not provided with an appropriate definition, seniors can interpret the meaning of a fall in many different ways. This has the potential to reduce the validity in studies comparing fallers to nonfallers. Research reports and prevention programs should always provide an operational definition of a fall. In communication between health care providers and seniors, an appropriate definition increases the possibility for early detection of seniors in greater need of care and services.
Physicians' perspectives on caring for cognitively impaired elders
- Authors:
- ADAMS Wendy L., et al
- Journal article citation:
- Gerontologist, 45(2), April 2005, pp.231-239.
- Publisher:
- Oxford University Press
This study aims to develop an in-depth understanding of the issues important to primary care physicians in providing care to cognitively impaired elders. In-depth interviews were conducted with 20 primary care physicians in the USA. Text coded as "cognitive impairment" was retrieved and analyzed by use of grounded theory analysis techniques. A patient's impaired ability to provide an accurate history and to participate in self-care hindered the usual process of care, often resulting in greater medical uncertainty and feelings of inadequacy and frustration for the physician. Shifting the goal of care from "curing" the patient's illness to "caring" for the patient's quality of life was also problematic. The doctor–patient relationship changed dramatically as others became involved in care, often with attendant ethical dilemmas related to patient autonomy and the locus of decision making. Many physicians described a deep sense of loss and grief as the personhood of patients faded. The increased complexity and prominent social and emotional issues were difficult to manage in the context of the current model of practice.
Provider and LGBT Individuals’ perspectives on LGBT issues in long-term care: a systematic review
- Authors:
- CACERES Billy A., et al
- Journal article citation:
- Gerontologist, 60(3), 2020, p.e169–e183.
- Publisher:
- Oxford University Press
Discrimination toward the lesbian, gay, bisexual and transgender (LGBT) population has raised concerns about the type of long-term services and supports (LTSS) that will be available to them as they age. To understand the unique needs of aging LGBT populations, the study sought to synthesize and critique the evidence related to LTSS providers and LGBT individuals’ perspectives of LGBT issues in LTSS in the United States. Research Design and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of the literature was conducted. The Crowe Critical Appraisal Tool was used to appraise the quality of the included studies. Results: Nineteen studies met inclusion criteria. Seven studies that examined the perspectives of LTSS providers identified two themes, including that they lack knowledge and training on LGBT health issues and generally report negative attitudes toward same-sex relations among older adults. In addition, 12 studies that examined the perspectives of LGBT individuals found that they (i) are concerned about LTSS planning, (ii) fear discrimination from providers in LTSS, and (iii) identify several strategies for improving care of LGBT older adults receiving LTSS. Discussion and Implications: This systematic review highlights the importance for LTSS providers to receive training in LGBT health and be reflective of potential biases toward the LGBT population. LGBT individuals identified concerns related to LTSS planning and fear of discrimination from LTSS providers. LGBT individuals also identified a need for increased training of providers to improve the care of LGBT older adults in LTSS. (Edited publisher abstract)
Volunteering with older people in a care home
- Authors:
- TINKER Anthea, et al
- Journal article citation:
- Working with Older People, 21(4), 2017, pp.229-235.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to investigate the influence that volunteering before medical school with older people in a care home has on the perceptions of older people. Design/methodology/approach: Eight medical students answered an anonymous questionnaire relating to their experiences of volunteering in a care home before medical school. This was combined with an analysis of the relevant literature. Findings: All the students had initially volunteered to enhance their CV for medical school. After volunteering, they had a greater realisation of the variety of older people. They also gained a number of transferable skills related to communicating with older people, especially those with cognitive impairment. The greatest learning experience was around the issues to do with dementia. Research limitations/implications: The research is based on eight students although they were from different areas. Practical implications: It would be beneficial if care homes could be more proactive in encouraging prospective medical students to volunteer. Medical schools could also provide clearer advice or take a more active stance such as encouraging prospective students to volunteer with older people. Further research should be with a larger sample to gain insight into varying perspectives. It would also be useful to conduct research into older adults’ attitudes towards the contribution of potential medical students to their own lives and to the home. Social implications: Volunteering before medical school should be encouraged as it will enhance the chances of getting a place as well as being an eye opening experience and equip them with lifelong skills. (Publisher abstract)
Caring for older people living alone with dementia: healthcare professionals’ experiences
- Authors:
- DE WITT Lorna, PLOEG Jenny
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 15(2), 2016, pp.221-238.
- Publisher:
- Sage
Older adults living alone with dementia are at greater risk of placement in long-term care homes compared with those living with others. Healthcare professionals have vital roles in supporting them to continue living in the community. Yet, little is known about how healthcare professionals fulfill these roles and what their experiences are like. The study purpose was to describe health care professionals’ experiences of caring for older people with dementia living alone. Using a qualitative descriptive approach and qualitative content analysis method, 15 healthcare professionals were interviewed in Ontario, Canada. The overall theme of the findings, doing the best that they could for them, involved discussing sensitive care issues with what professionals viewed as gentle realism. Walking the tightrope expressed tensions in meeting professional responsibilities. Constraints (my hands are tied) and boundaries (it’s not my job, it’s not my decision) described perceived limitations on professional roles. Effects of the emotional struggle involved in working with these older people were lessened by believing that they did the right thing. The findings have implications for what could be done better for older people with dementia living alone, through integration of person-centred/relationship-centred principles in education programmes, community agency policies, a national dementia care strategy, and culture change in community care. (Edited publisher abstract)
A survey of older peoples’ attitudes towards advance care planning
- Authors:
- MUSA Irfana, et al
- Journal article citation:
- Age and Ageing, 44(3), 2015, pp.371-376.
- Publisher:
- Oxford University Press
Background: Advance care planning (ACP) is a process to establish an individual's preference for care in the future; few UK studies have been conducted to ascertain public attitudes towards ACP. Objective: The aim of this study was to assess the attitudes of older people in East Midlands through the development and administration of a survey. Design: The survey questionnaire was developed on the basis of a literature review, exploratory focus groups with older adults and expert advisor input. The final questions were then re-tested with lay volunteers. Setting: Thirteen general practices were enrolled to send out surveys to potential participants aged 65 or older. There were no additional inclusion or exclusion criteria for participants. Methods: Simple descriptive statistics were used to describe the responses and regression analyses were used to evaluate which items predicted responses to key outcomes. Results: Of the 5,375 (34%) community-dwelling older peoples, 1,823 returned questionnaires. Seventeen per cent of respondents had prepared an ACP document; of whom, 4% had completed an Advance Decision to Refuse Treatment (ADRT). Five per cent of respondents stated that they had been offered an opportunity to talk about ACP. Predictors of completing an ACP document included: being offered the opportunity to discuss ACP, older age, better physical function and male gender. Levels of trust were higher for families than for professionals. One-third of the respondents would be interested in talking about ACP if sessions were available. Conclusion: Although a third of the respondents were in favour of discussing ACP if the opportunity was available with their GP, only a relative minority (17%) had actively engaged. Preferences were for informal discussions with family rather than professionals. (Edited publisher abstract)
A question of behaviours: why delivering care integration and managing acute demand depends as much on changing behaviour as new systems and structures
- Author:
- KHALDI Alex
- Publisher:
- IMPOWER
- Publication year:
- 2013
- Pagination:
- 40
- Place of publication:
- London
A behavioural insight specialist at iMPOWER highlights the importance of behaviours, attitudes and motivations alongside structures and systems as we integrate care. This report considers two connected challenges: the increasing dependency on acute settings and urgent care, particularly for older people; and the positive agenda to integrate care in home and community settings. It is based on a survey of 200 older people in Sandwell. West Midlands, a review of the relevant literature, a friends and family survey, a survey of more than 600 GPs, and interviews of leaders and managers in the care and health services. Evidence from the survey suggests that structural ‘big system’ change alone will not work, as 56% of the GPs think that their relationship with social care is poor or very poor, and less than half of the older people (46%) have the confidence to know how to access the health and social care system. Therefore, the priority must be to shift the focus of care to the most appropriate level, where the benefits of changing behaviour would be: being able to manage demand better; avoiding costs and saving money; improving outcomes and performance; and changing the patient and user experience. (Edited publisher abstract)
Home visits for frail older people: a qualitative study on the needs and preferences of frail older people and their informal caregivers
- Authors:
- KEMPEN Janneke A. L. van, et al
- Journal article citation:
- British Journal of General Practice, 62(601), August 2012, pp.417-418.
- Publisher:
- Royal College of General Practitioners
Despite continuing interest from professionals in home visits for older people, reports on older people's needs and preferences for such visits are scarce. This qualitative study investigated the views and needs of 11 community-dwelling older people living in the area of Nijmegen, the Netherlands, concerning home visits. Most participants felt home visits would give older people the personal attention they used to receive from GPs. Most stated that this would give them more trust in GPs. Participants stated that trust was one of the most important factors in a good patient-professional relationship. Further, participants preferred home visits to focus on the psychosocial context of the patient. They stated that more knowledge of the psychosocial context and a good patient-professional relationship would enable the professional to provide better and more patient-centred care. The authors concluded that future studies on home visits should involve patients in the development of home visiting programmes.
Imagined futures and communities: older lesbian and gay people’s narratives on health and aged care
- Author:
- HUGHES Mark
- Journal article citation:
- Journal of Gay and Lesbian Social Services, 20(1/2), 2008, pp.167-186.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The experiences of older lesbian and gay men’s experiences and expectations of Australian health and aged care service delivery are explored on the basis of 14 in-depth interviews that were analysed according to principles of narrative research. This included an analysis of the socio-linguistic properties of narratives as well as a wider socio-cultural analysis of the meanings expressed by them. The themes that emerged focused on personal identities and imagined communities (i.e. the gay community, the retirement community), the real neighbourhoods in which participants lived, experiences with heath and care services, experiences with gay and lesbian community groups and organisations, and experiences with friendship networks. The findings suggest a complex relationship between identity and community in the lives of older lesbians and gay men. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).