Search results for ‘Subject term:"older people"’ Sort:
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Shared decision-making preferences in mental health: does age matter? A systematic review
- Authors:
- BURNS Lauren, DA SILVA Ana L., JOHN Ann
- Journal article citation:
- Journal of Mental Health, 30(5), 2021, pp.634-645.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Background: Research to date suggests older adults prefer a passive involvement in the clinical decision-making process; however, the empirical evidence underlying this claim in the mental health context is yet to be reviewed systematically. Aims: To understand whether older adults desire involvement in mental health-related clinical decisions. Method: A systematic review was conducted to identify primary research that explored mental-health decision-making preferences of people with a mean age of over 55 from January 1990 through to December 2018. Results: Three independent studies of varying design and quality were included. Study settings were in the USA, Germany, and the UK. A preference for shared decision-making was seen in two studies, while a preference for active decision-making was identified in one. Conclusions: In contrast to other reviews on clinical decision-making, this review focused on mental health-related decisions of older adults. The evidence suggests older adults desire involvement in mental health-related clinical decisions. Given the political drive to empower patients and the need to ensure evidence-based clinical practice, more high-quality research regarding the shared decision-making preferences and outcomes of older adults with mental ill-health is needed. (Edited publisher abstract)
A systematic review of older adults’ request for or attitude toward euthanasia or assisted-suicide
- Authors:
- DRANSART Dolores Angela Castelli, et al
- Journal article citation:
- Aging and Mental Health, 25(3), 2021, pp.420-430.
- Publisher:
- Taylor and Francis
Objectives: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. Method: The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. Results: This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. Conclusion: Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions. (Edited publisher abstract)
What do we know about the application of the Mental Capacity Act (2005) in healthcare practice regarding decision-making for frail and older people? A systematic literature review
- Authors:
- HINSLIFF-SMITH Kathryn, et al
- Journal article citation:
- Health and Social Care in the Community, 25(2), 2017, pp.295-308.
- Publisher:
- Wiley
In England and Wales, decision-making in cases of uncertain mental capacity is regulated by the Mental Capacity Act 2005. The Act provides a legal framework for decision-making for adults (16 and over) who are shown to lack capacity and where best interest decisions need to be made on their behalf. Frail older people with cognitive impairments represent a growing demographic sector across England and Wales for whom the protective principles of the Act have great relevance, as they become increasingly dependent on the care of others. However, while the Act articulates core principles, applying the Act in everyday healthcare contexts raises challenges for care providers in terms of interpretation and application. This paper presents a review of the published evidence documenting the use of the Act in healthcare practice, with particular reference to frail older people. The aim was to identify, review and critically evaluate published empirical studies concerned with the implementation and application of the Act in healthcare settings. A systematic approach was undertaken with pre-determined exclusion and inclusion criteria applied across five electronic bibliographic databases combined with a manual search of specific journals. This review reports on 38 empirical sources which met the inclusion criteria published between 2005 and 2013. From the 38 sources, three descriptive themes were identified: knowledge and understanding, implementation and tensions in applying the Act, and alternative perspectives of the Act. There is a need for improved knowledge and conceptualisation to enable successful incorporation of the Act into everyday care provision. Inconsistencies in the application of the Act are apparent across a variety of care settings. This review suggest staff need more opportunities to engage, learn and implement the Act, in order for it to have greater resonance to their individual practice and ultimately benefit patient care. (Publisher abstract)
Older people's conceptualization of abuse: a systematic review
- Authors:
- KILLICK Campbell, et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 27(2), 2015, pp.100-120.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This systematic literature review aims to identify and synthesize empirical research findings relating to older people’s conceptualization of abuse. In so doing, it attempts to answer four key questions: does the term 'abuse' have meaning for older people?; how do older people understand the concept of abuse?; are such understandings similar across populations and locations?; and how do older people’s conceptualizations of abuse compare with those of other groups, including carers and professionals? A total of eight databases were searched using agreed-upon criteria, and the results were assessed for relevance. These were Ageinfo, Applied Social Sciences Index and Abstracts (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, Medline, Psychinfo, Social Care Online, Social Services Abstracts (SSA), and Social Sciences Citation Index (SSCI). Fifteen studies were included, the majority of which were based in America (n = 7) or Canada (n = 4). The findings are discussed under the themes of caregiving, domestic violence, society, abusive acts, and thresholds. The impact of ageing and disempowerment was also a major theme in the studies, and highlights the importance of empowering the individual within any protection process. (Edited publisher abstract)
Professional decision making on elder abuse: systematic narrative review
- Authors:
- KILLICK Campbell, TAYLOR Brian J.
- Journal article citation:
- Journal of Elder Abuse and Neglect, 21(3), July 2009, pp.211-238.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Nine bibliographic databases were searched for studies on professional decision making regarding abuse of older people. The findings of the 19 articles meeting the inclusion criteria were synthesised using a structured narrative approach. Common themes identified were abuse factors, situational factors, and broader contextual factors. Abuse factors relating to risk levels and client vulnerability were central; age, gender, and health status were considered as key indicators of vulnerability. The opinion of adult protection workers about the potential effectiveness of their intervention was a factor in deciding about responding to alleged or suspected abuse. Professionals struggled with complex ethical dilemmas created by elder abuse, particularly when the victim did not want an investigation. A structured approach to narrative synthesis of a diverse range of studies retrieved through an explicit search and inclusion process provided a useful summary of key issues for practice and identified gaps in the research literature.
Advance directive decision making among independent community-dwelling older adults
- Authors:
- SESSANNA Loralee, JEZEWSKI Mary A.
- Journal article citation:
- Journal of Applied Gerontology, 27(4), 2008, pp.486-510.
- Publisher:
- Sage
This review of US literature finds that advance directive decision making has predominantly been explore among Caucasian women aged 65 or older and possessing a high school level education who are living independently in the community. While generally willing to discuss the issues, numerous barriers to advance directive discussion and completion remain both among older adults themselves and their health care providers. Research gaps include a lack of studies of men, older people from minority ethnic and cultural groups, and older people with lower levels of education. Replication of existing studies is also needed to strengthen the evidence base in this area.
The nature of decision-making in people living with dementia: a systematic review
- Authors:
- BHATT Jem, et al
- Journal article citation:
- Aging and Mental Health, 24(3), 2020, pp.363-373.
- Publisher:
- Taylor and Francis
Objective: The objectives of this systematic review were to: 1) understand how people living with dementia are involved in making decisions; 2) explore the different decisional styles and domains of decision-making that people living with dementia experience and 3) identify what influences the level of decisional involvement of people living with dementia. Methods: A systematic review of literature identified studies from Medline, PsycINFO, HAPI and CINAHL databases. Search terms related to decision-making and dementia. Qualitative and quantitative research designs were included. Appraisal of included studies was done using quality ratings. All studies focused on how decision-making took place. Extracted findings were synthesised narratively with concept mapping, conceptualisation and an exploration of connections between studies to develop an overall model of decision-making involvement. Results: Fifteen studies fully met the eligibility criteria (thirteen qualitative and two quantitative). All studies had moderate (n = 10) to high (n = 5) quality ratings. Participants were predominantly people living with dementia (n = 13), Parkinson’s disease and stroke. The model of decision-making encompasses four decisional styles (managed autonomy, mutual, reductive and delegated) determined by different degrees of involvement from the person living with dementia and their supporter. The decisional style implemented was influenced by the presence or absence of background (the Freedom of Choice framework) and contextual factors (risk, relationships and resources). Conclusion: Decision-making in dementia is complex and influenced by many factors beyond cognitive impairment alone. This review indicates that decision-making in dementia takes place through decisional styles, determined by unique levels of involvement from people living with dementia and their carers. (Publisher abstract)
Is there an “optimal time” to move to a care home for a person with dementia? A systematic review of the literature
- Authors:
- COLE Laura, SAMSI Kritika, MANTHORPE Jill
- Journal article citation:
- International Psychogeriatrics, 30(11), 2018, pp.1649-1670.
- Publisher:
- Cambridge Journals
Background: There is limited evidence regarding how the decision evolves about whether and when it is best for a person with dementia to move to a care home. The factors leading to the timing of the decision remain particularly unclear. This systematic review of existing literature aims to gain an understanding of the decision-making timing and process to distinguish the drivers of these decisions, and to identify if there is an “optimal” or best time (if any) for a person with dementia to move to a care home. Methods: Six English language electronic databases were searched up to the end of 2016, along with included papers’ reference lists. Papers were screened against the inclusion criteria and rated for quality. Extracted data were thematically analysed. Results: The review identified 16 relevant papers. Seven themes were identified: (1) what happened before the move; (2) planning for the move, (3) weighing up the decision, (4) lack of support, (5) drivers of the decision, (6) emotional significance of the move, and (7) continued reflection on the decision. “Time” of the move was largely absent from much of the literature, although inferences were made. Overall, the decision-making process appeared to be cyclic, with family carers constantly re-evaluating when might be the time to make the move with some continuing to reflect on this even subsequently. Conclusions: Further research is required to understand the “optimal” or best time (if any) for when a person with dementia moves to a care home, and how to determine when someone is ready to move. (Edited publisher abstract)
Use of quality information in decision-making about health and social care services: a systematic review
- Authors:
- TURNPENNY Agnes, BEADLE-BROWN Julie
- Journal article citation:
- Health and Social Care in the Community, 23(4), 2015, pp.349-361.
- Publisher:
- Wiley
User choice and personalisation have been at the centre of health and social care policies in many countries. Exercising choice can be especially challenging for people with long-term conditions (LTC) or disabilities. Information about the quality, cost and availability of services is central to user choice. This study used systematic review methods to synthesise evidence in three main areas: (i) how people with LTC or disabilities and their family carers find and access information about the quality of services; (ii) how quality information is used in decision-making; and (iii) what type of quality information is most useful. Quality information was defined broadly and could include formal quality reports (e.g. inspection reports, report cards, etc.), information about the characteristics of a service or provider (e.g. number and qualifications of staff, facilities, etc.) and informal reports about quality (e.g. personal experience, etc.). Literature searches were carried out using electronic databases in January 2012. Thirteen papers reporting findings from empirical studies published between 2001 and 2012 were included in the review. The majority of papers (n = 9) had a qualitative design. The analysis highlighted the use of multiple sources of information in decision-making about services and in particular the importance of informal sources and extended social networks in accessing information. There is limited awareness and use of ‘official’ and online information sources. Service users or family carers place greater emphasis on general information and structural indicators. Clinical or quality-of-life outcomes are often difficult to interpret and apply. Trust emerged a key issue in relation to quality information. Experiential and subjective information is highly valued and trusted. Various barriers to the effective use of quality information in making choices about services are identified. Implications for policy and future research are discussed. (Publisher abstract)
Cognitive behavioral therapies in older adults with depression and cognitive deficits: a systematic review
- Authors:
- SIMON Sharon Sanz, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(3), 2015, pp.223-233.
- Publisher:
- Wiley
Objectives: Systematic review to investigate the effectiveness of cognitive behavioural therapies (CBTs) in improving depressive symptoms, disability, and cognition in older adults with depression and cognitive deficits. Design: Systematic searches for articles published between 1994 and February 2014 were conducted on MEDLINE/Pubmed, PsycINFO, and SCIELO. Studies included information about benefits after CBTs to older adults with depression and cognitive deficits. Results: Cognitive behavioural therapy focused on problem solving is the main approach studied, having better effectiveness than supportive therapy in randomised clinical trials. Significant improvements in mood and disability were consistent, although evidence of changes in cognitive measures is controversial, less studied, and limited. Nevertheless, improvements in executive functions, processing speed, and changes in patients' perspectives of problem solving skills, such as generating alternatives and decision-making, were described. Also, it would be necessary that future studies more often evaluate cognitive status of depressed elders, as well as cognitive changes after psychotherapy. It should be emphasized that there is a lack of studies in this field, and more approaches in CBTs need to be investigated to this population. Conclusion: Older adults with depression and cognitive deficits can benefit from CBTs. Improvements in mood and disability are more consistent than changes in cognition, which are little studied after CBTs. It is necessary more studies in the field, as well as, to investigate more approaches in CBTs to older adults with depression and cognitive deficits (Edited publisher abstract)