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Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail
- Authors:
- LOIZEAU Andrea J., et al
- Journal article citation:
- Age and Ageing, 48(1), 2019, pp.67-74.
- Publisher:
- Oxford University Press
Background: Fact Boxes are decision support tools that can inform about treatment effects. Objectives: To test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia. Design: Randomized controlled trial. Setting: Swiss-German region of Switzerland. Subjects: Two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118). Intervention: Two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month). Methods: Participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments. Results: Participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = −8.35, 95% Confidence Interval (CI), −12.43, −4.28) and artificial hydration (b = −6.02, 95% CI, −9.84, −2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration. Conclusions: Fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers. (Publisher abstract)
How groups of nursing home residents respond to “the CRDL”: a pilot study
- Authors:
- LUYTEN Tom, et al
- Journal article citation:
- Journal of Enabling Technologies, 12(4), 2018, pp.145-154.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to describe whether and how groups of nursing home residents respond to the interactive device “the CRDL”. The CRDL can translate touches between people into sounds. It recognises the type of touch and adjusts the produced sound accordingly. Design/methodology/approach: This was as an observational explorative study. Responses were coded and analysed using an existing theoretical framework. Findings: The CRDL creates an atmosphere of playfulness and curiosity. It lowers the threshold to touch, provides an incentive to touch and encourages experimentation with different types of touches on arms and hands. The sounds the CRDL produces sometimes trigger memories and provide themes to start and support conversation. Involving a (large) group of nursing home residents to interact with the CRDL is challenging. Research limitations/implications: In order to more fully understand the potential of the CRDL, its use should be studied in different group and individual sessions and the effects of tailored content, adjusted to individual preferences and/or stages of cognition should be explored. Finally, the effects of using the CRDL on the general wellbeing of nursing home residents should be studied. Practical implications: The CRDL can help caregivers to use touch to make contact with (groups of their) residents. A session should be guided by an experienced caregiver. Some familiarisation and practice with the CRDL are recommended and a quiet environment is advised. Originality/value: This paper demonstrates the potential of interactive objects, such as the CRDL, in the nursing home. (Publisher abstract)
Involvement of Japanese care managers and social workers in advance care planning
- Authors:
- HIRAKAWA Yoshihisa, et al
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 14(4), 2018, pp.315-321.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
Successful advance care planning relies heavily on effective communication between the elderly and their families, care managers, and social workers. However, care managers and social workers are often not adequately prepared to conduct such discussion. The aim of the present study was to identify the specific challenges facing Japanese care managers and social workers when involvement in advance care planning. Two focus group discussions were held between August and November 2017, involving eleven care managers and three social workers employed at two long-term care facilities actively pursuing advance care planning initiatives. Four main themes were identified, through content analysis, as barriers and facilitators: client readiness, communication, variation-rich client individuality, and difficult-to-explain end-of-life options. This study revealed the importance of building rapport with the residents and their families in order to assess their readiness to discuss care options and preferences. Obstacles included lack of medical knowledge of care managers and social workers. Study findings suggested that a multi-disciplinary team, facilitated by care managers and social workers, was fundamental to achieving the goals of advance care planning. (Publisher abstract)
Communication technology adoption among older adult veterans: the interplay of social and cognitive factors
- Authors:
- LEONE Cristina, et al
- Journal article citation:
- Aging and Mental Health, 22(12), 2018, pp.1666-1677.
- Publisher:
- Taylor and Francis
Objectives: InTouch is an electronic communication platform designed to be accessible by computer-naive seniors. The present study explored the process of adoption and use of the application by seniors with and without mild cognitive impairment (MCI) through the lens of Social Cognitive Theory (SCT). Method: The authors studied adoption and use of InTouch for social communication over a 12-week period in a 475-bed Veteran's care facility at Sunnybrook Health Sciences Centre in Toronto, Canada. Eleven older adult veterans participated, six of whom had MCI, as indicated by their Montreal Cognitive Assessment score. Veterans were partnered with volunteers, each was provided with an iPad with the InTouch application. Qualitative data were collected through interviews, field notes, and direct observation. Quantitative data were collected from data logging of the software and medical charts. Data types and sources were triangulated and examined through the lens of SCT. Results: A total of 2361 messages (102 videos, 359 audios, 417 photos, 1438 texts) were sent by 10 of the 11 veterans over the 12-week study period. There was no apparent difference in extent of adoption or use, between participants with and without MCI. Participants used various resources and techniques to learn, provided that they felt motivated to connect with others using the app. Conclusion: This pilot illustrates both the accessibility of InTouch and the promise of using extrinsic motivators such as social bonding to promote learning in institutionalized older adults with and without cognitive impairment, whose intrinsic motivation and self-efficacy may well be suffering. (Edited publisher abstract)
‘They must help if the doctor gives them to you’: a qualitative study of the older person’s lived experience of medication-related problems
- Authors:
- PAREKH Nikesh, et al
- Journal article citation:
- Age and Ageing, 48(1), 2019, pp.147-151.
- Publisher:
- Oxford University Press
Objective: Medication-related problems (MRP) are common for older adults and can lead to harm. The older person’s perspective on MRP has been seldom reported in published literature. This study explored the lived experience of MRP in older adults with varying functional levels, focussing on the hospital discharge period. Design, setting, participants: This qualitative study was conducted in Brighton and Hove, UK. A purposive sample of 20 older people with experience of MRP, involving carers, took part in focus groups and semi-structured interviews. Data were thematically analysed using a ‘framework’ approach. Results: Four major themes associated with MRP were identified; (1) experience of the healthcare system, (2) practicalities of using medicines, (3) management of medication problems and (4) participant beliefs. Participants encountered problems in communication with healthcare professionals such as passive listening and paternalistic consultations. A conflict was acknowledged between participants’ implicit trust in the healthcare system and their negative experience of MRP. Participants felt vulnerable around hospital discharge, describing reduced capacity to comprehend information, pressured discharge circumstances and lack of integrated care in the community. Drug formulations, packaging and information leaflets were felt to be poorly tailored to the needs of older people. Conclusions: The lived experience of older people with MRP in this study was multifaceted and complex. Participants felt communication was poor around hospital discharge, and insufficient support with medicines was offered in the community when problems arose. Harm due to MRP might be reduced if the contributory factors described by patients inform clinical and policy-level intervention. (Publisher abstract)
Managing emotional and psychological distress in older people
- Author:
- CHAPMAN Felicity
- Journal article citation:
- Working with Older People, 22(4), 2018, pp.234-242.
- Publisher:
- Emerald
Purpose: Much has been written about helping those with dementia. But what about those for whom distress is not primarily related to a neurological cause and there is no psychiatric history? The purpose of this paper is to offer a guide for allied health professionals and family carers to manage distress in older people who are able to engage in language based communication and who are experiencing significant change or loss. Design/methodology/approach: This practice informed paper draws on the authors’ extensive experience working as a mental health social worker who specializes in work with older people in the community and in care, with family carers and in educating allied health professionals on how to manage presentations of distress in older people. Findings: Three foundational management strategies are discussed: understand the reason for distress, implement the C.A.R.E. Plan and maximize comfort in exploration and referral. Research limitations/implications: This viewpoint piece has not been substantiated through research and does not reflect training in the field of clinical geropsychology. Originality/value: The ideas in this paper are original and are practical solutions to common problems that can be faced by workers or family in close contact with older people. The information can be applied immediately to whatever setting is relevant for the reader and is written in easy to understand language. Furthermore, its aim is not only to increase skill and confidence for the reader but also to promote the emotional and psychological wellbeing of older people. (Publisher abstract)
Exploring health care workers’ perceptions and experiences of communication with ethnic minority elders
- Authors:
- LIKUPE Gloria, BAXTER Carol, JOGI Mohamed
- Journal article citation:
- Quality in Ageing and Older Adults, 19(3), 2018, pp.180-190.
- Publisher:
- Emerald
Purpose: There is a recognition in Europe and in the western world of a demographic shift in the ageing population. While the overall ageing of the general population is growing, the numbers of immigrants getting old in their host countries is also increasing, thereby increasing the racial and ethnic proportion of older people in these countries. This changing landscape calls for understanding of issues related to health care provision, policy and research regarding ethnic minorities. Communication is seen as a key factor in understanding the needs of ethnic minority elders (EMEs). The purpose of this paper is to explore health care workers’ (HCWs) perceptions and experiences of communication with EMEs. In this paper the term HCW includes qualified nurses and health care assistants. Design/methodology/approach: A descriptive qualitative study design using semi-structured interviews was employed. Ten HCWs, who had ethnic minorities in their care were individually interviewed to explore their perceptions and experiences of communication when caring for EMEs. Findings: Analysis of data revealed that in common with all older people, EMEs experience stereotyped attitudes and difficulties in communication. However, EMEs face particular challenges, including cultural differences, different language and stereotyping of care based on misunderstood needs of EMEs. Facilitators of communication included appropriate training of HCWs and appropriate use of interpreters. Research: limitations/implications: Only homes willing to take part in the study gave permission for their staff to be interviewed. In addition, the HCWs came from various settings. Therefore, views of staff in homes who did not give permission may not be represented. Practical implications: The diversity of older people needing care in nursing homes and the community calls for training in culturally competent communication for effective provision care provision for EMEs. Originality/value: Training of health care staff in culturally appropriate communication requires effective practice. (Publisher abstract)
Overcoming elderspeak: a qualitative study of three alternatives
- Author:
- CORWIN Anna I.
- Journal article citation:
- Gerontologist, 58(4), 2018, pp.724-729.
- Publisher:
- Oxford University Press
Purpose: This study identifies genres of communication that avoid the features of elderspeak and successfully engage cognitively or physically affected older adults in rich communicative interaction. Design and Methods: The study examined 100 hr of audio- and video-recorded interaction between older Catholic nuns and their caregivers. The data were collected as part of a 7-year study on the linguistic and communicative factors that contribute to successful ageing in a Catholic convent infirmary. Data analysed in this article were selected from the corpus based on 2 criteria: (a) the interaction was absent of elderspeak and (b) the interaction was between a communicatively or cognitively impaired older adult and a caregiver. Results: Linguistic analysis of the interactions revealed 3 alternatives to elderspeak that maintain lexically and grammatically rich communication while maintaining minimal opportunity for communicative failure or breakdown. These include: (a) offered and requested blessings, (b) jokes, and (c) narratives. Implications: These 3 communicative strategies offer examples of lexically and grammatically complex ways to communicate with older adults who have little other opportunity for similarly complex interaction and may reduce resistiveness to care, and linguistic isolation, which has been linked to cognitive decline. (Edited publisher abstract)
Pain assessment in the older population: what the literature says
- Authors:
- SCHOFIELD Pat, ABDULLA Aza
- Journal article citation:
- Age and Ageing, 47(3), 2018, p.324–327.
- Publisher:
- Oxford University Press
Assessment of pain in the older adult presents a number of challenges, especially related to communication. This commentary summarises the revised evidence-based Guidelines on the Assessment of Pain in Older Adults which have been developed by the British Pain Society and British Geriatrics Society. The guideline summarises the pain assessment tools that have been developed and validated for use in the older population. Recommendations are made for use of specific tools in older people and in those with dementia. The need for education and training of health care professionals is emphasised. Gaps in the evidence are identified as subjects for future research. It is hoped that the guideline will improve recognition of pain in older people, and help to drive the future research agenda. (Edited publisher abstract)
Daily crying prevalence and associated factors in older adult persons living in nursing homes: findings from a regional study
- Authors:
- PALESE Alvisa, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(1), 2018, p.e85–e93.
- Publisher:
- Wiley
Objectives: The study aims to evaluate the prevalence of nursing home (NH) resident crying and associated factors at the individual and NH levels. Design: A regional retrospective study design has been used. Participants and setting: A total of 8875 residents, living in 105 NHs, were included. Measurements: The occurrence of an episode of crying on at least a daily basis in the last month was the dependent variable; independent variables were set at individual and at the NH levels as reported in the Val.Graf regional database. Results: A total of 1,443 (16.3%) residents reported daily episodes of crying over the last month. Several individual variables were significantly associated with crying; female gender (odds ratio [OR] 2.535, 95% confidence interval [CI] 2.069–3.107); sad, pained or worried facial expressions (OR 1.885, 95% CI 1.785–2.021); negative thoughts (OR 1.650, 95% CI 1.508–1.804); unrealistic fears (OR 1.410, 95% CI 1.295–1.534); anger with self or others (OR 1.141, 95% CI 1.043–1.248); repetitive anxious complaints/concerns (OR 1.136, 95% CI 1.045–1.235); clinical instability (OR 1.186, 95% CI 1.018–1.381); pain (OR 1.183, 95% CI 1.058–1.323); night restlessness (OR 1.180, 95% CI 1.100–1.267); communication problems (OR 1.169, 95% CI 1.051–1.300); and cognitive impairment (OR 1.086, 95% CI 1.019–1.156); all increased the likelihood of crying. Conversely, sociability (OR 0.866, 95% CI 0.805–0.932) and being involved in social based activities (OR 0.882, 95% CI 0.811–0.960) were protective against crying. However, the previously mentioned variables have explained only 35.9% of variance in daily crying. Conclusions: Around one out of six residents living in NH cries on a daily basis, and the reasons are also at the individual level. Residents seem to cry for attachment and clinical needs and to express stress and unhappiness; more research is needed, aiming at discovering other factors associated with resident's daily crying. (Publisher abstract)