'I like to feel needed, you know?': a qualitative examination of sense of purpose in older care home residents.

OBJECTIVES: To explore older care home residents' experiences of maintaining a sense of purpose in life: a core component of psychological wellbeing. METHODS: Fifteen residents (9 female; 6 male), aged 60-95 years, from four care homes, were interviewed about their sense of purpose. Interview transcripts were analysed using inductive thematic analysis. RESULTS: Theme 1 ('Experiencing Loss') comprises two sub-themes that describe the impact of age-related losses on residents' sense of purpose (sub-theme 1) and the different responses that participants had to these losses (sub-theme 2). Theme 2 ('The Protective Effects of Social Connections') describes how social relationships could provide a sense of purpose, as well as the difficulties participants experienced in forming these relationships. Finally, theme 3 ('The Roles of Activities') describes the types of activities that could help residents to maintain a sense of purpose. CONCLUSION: Care home residents experience losses and barriers that make it more difficult to maintain a sense of purpose. However, with appropriate support and opportunities, residents are able to engage in activities and relationships that provide a sense of purpose. To support residents' mental health and wellbeing, care homes should offer varied opportunities for residents to engage in purposeful activities.

Assessment of non-directed computer-use behaviours in the home can indicate early cognitive impairment: A proof of principle longitudinal study.

OBJECTIVES: Computer-use behaviours can provide useful information about an individual's cognitive and functional abilities. However, little research has evaluated unaided and non-directed home computer-use. In this proof of principle study, we explored whether computer-use behaviours recorded during routine home computer-use i) could discriminate between individuals with subjective cognitive decline (SCD) and individuals with mild cognitive impairment (MCI); ii) were associated with cognitive and functional scores; and iii) changed over time. METHODS: Thirty-two participants with SCD (n = 18) or MCI (n = 14) (mean age = 72.53 years; female n = 19) participated in a longitudinal study in which their in-home computer-use behaviour was passively recorded over 7-9 months. Cognitive and functional assessments were completed at three time points: baseline; mid-point (4.5 months); and end point (month 7 to 9). RESULTS: Individuals with MCI had significantly slower keystroke speed and spent less time on the computer than individuals with SCD. More time spent on the computer was associated with better task switching abilities. Faster keystroke speed was associated with better visual attention, recall, recognition, task inhibition, and task switching. No significant change in computer-use behaviour was detected over the study period. CONCLUSION: Passive monitoring of computer-use behaviour shows potential as an indicator of cognitive abilities, and can differentiate between people with SCD and MCI. Future studies should attempt to monitor computer-use behaviours over a longer time period to capture the onset of cognitive decline, and thus could inform timely therapeutic interventions.Supplemental data for this article can be accessed online at http://dx.doi.org/10.1080/13607863.2022.2036946.

'It's just incredible the difference it has made': family carers' experiences of a specialist Lewy body dementia Admiral Nurse service.

BACKGROUND: Lewy body dementia (LBD) is characterised by a complex array of symptoms. Being a family carer of someone with LBD can be challenging, and is associated with high levels of stress, depression and anxiety. Admiral Nursing services support family carers of people with dementia in the UK by providing tailored information, advice and therapeutic support. Recently, the Admiral Nurse model has been adapted to the needs of more specific populations, including the introduction of a new, specialist LBD Admiral Nurse. OBJECTIVE: to explore family carers' experiences of the LBD Admiral Nurse service. METHODS: fourteen family carers of people with LBD were interviewed about their experiences of the LBD Admiral Nurse service. Interview transcripts were analysed using thematic analysis. RESULTS: four themes were identified: theme 1 described how participants valued the LBD Admiral Nurse's specialist expertise, which contrasted with the lack of knowledge they encountered in other services. In theme 2, participants described how the practical, tailored support provided by the LBD Admiral Nurse enabled them to better manage a variety of caring-related challenges. Theme 3 captured the emotional benefits that participants gained from being able to talk to someone who understood their situation. In theme 4, participants explained how the reliability of the LBD Admiral Nurse's support helped them feel supported in their role. CONCLUSIONS: the specialist knowledge and expertise of the LBD Admiral Nurse enabled family carers to better support the people they cared for, and to relieve some of the emotional stress associated with caring.

A scoping review of education and training resources supporting care home staff in facilitating residents' sexuality, intimacy and relational needs.

BACKGROUND: Having positive intimate, sexual and relational experiences is an important issue for older adults in care settings, yet little is known on the extent to which nursing staff and care workers have received education or training in addressing and meeting these needs among older residents. This scoping review aimed to identify and examine what education and training resources exist to assist nursing staff and care workers to meet their residents' needs in this area. METHODS AND ANALYSIS: Using the Arksey and O'Malley framework, we systematically searched papers and grey literature to identify education interventions and resources that aimed to facilitate care home staff to meet their residents' sexuality, intimacy and relational needs. RESULTS: Eleven studies (one dissertation) and three education resources met the inclusion criteria; most were conducted in the USA and Australia. Across the studies and resources identified, the education content was mixed and the methodology, presentation, design and duration varied widely. The focus of the education interventions and resources was to increase knowledge and improve and/or change attitudes towards the: (i) sexual expression of older people living in residential aged care, (ii) sexuality and ageing and (iii) expression of sexuality in people with dementia. CONCLUSION: Few education interventions and training resources were identified. The findings suggest that education interventions can improve knowledge and/or change care staff attitudes, in the short-term, towards older people's sexuality, intimacy and relational needs in care home settings, which can lead to facilitating staff to enhance person-centred care in this area of need.

Enhancing 'meaningfulness' of functional assessments: UK adaptation of the Amsterdam IADL questionnaire.

OBJECTIVE: Commonly used measures of instrumental activities of daily living (IADL) do not capture activities for a technologically advancing society. This study aimed to adapt the proxy/informant-based Amsterdam IADL Questionnaire (A-IADL-Q) for use in the UK and develop a self-report version. DESIGN: An iterative mixed method cross-cultural adaptation of the A-IADL-Q and the development of a self-report version involving a three-step design: (1) interviews and focus groups with lay and professional stakeholders to assess face and content validity; (2) a questionnaire to measure item relevance to older adults in the U.K.; (3) a pilot of the adapted questionnaire in people with cognitive impairment. SETTING: Community settings in the UK. PARTICIPANTS: One hundred and forty-eight participants took part across the three steps: (1) 14 dementia professionals; 8 people with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia due to Alzheimer's disease; and 6 relatives of people with MCI or dementia; (2) 92 older adults without cognitive impairment; and (3) 28 people with SCD or MCI. MEASUREMENTS: The cultural relevance and applicability of the A-IADL-Q scale items were assessed using a 6-point Likert scale. Cognitive and functional performance was measured using a battery of cognitive and functional measures. RESULTS: Iterative modifications to the scale resulted in a 55-item adapted version appropriate for UK use (A-IADL-Q-UK). Pilot data revealed that the new and revised items performed well. Four new items correlated with the weighted average score (Kendall's Tau -.388, -.445, -.497, -.569). An exploratory analysis of convergent validity found correlations in the expected direction with cognitive and functional measures. CONCLUSION: The A-IADL-Q-UK provides a measurement of functional decline for use in the UK that captures culturally relevant activities. A new self-report version has been developed and is ready for testing. Further evaluation of the A-IADL-Q-UK for construct validity is now needed.

Complex mediating effects of rumination facets between personality traits and depressive symptoms.

This study investigates whether facets of rumination statistically mediate the relationships between Big Five personality traits and depressive symptoms. Self-reported personality traits and rumination were investigated as predictors of depressive symptoms in a cross-sectional sample of 3043 participants aged 18-60 years (68.8% female). Multiple regression analysis investigated which personality traits and rumination facets best explained variance in depressive symptoms. Structural equation modelling was used to determine whether facets of rumination mediated the relationships between personality traits and depressive symptoms. Multiple regression analysis found that variance in depressive symptoms was best explained by the personality traits neuroticism, extroversion, conscientiousness; and both facets of rumination, brooding and reflection. Structural equation modelling added that the effects of neuroticism, extroversion, conscientiousness and openness on depressive symptoms were statistically mediated by brooding; the effects of neuroticism, extroversion and openness to depressive symptoms were statistically mediated by reflection. Rumination facets statistically mediated the effects of various personality traits on depressive symptoms. These results provide insights into which individuals may be best suited to treatments for depression targeting rumination.

Moderating effects of age on relationships between attitudes to aging and well-being outcomes.

Objectives: More positive attitudes to aging are associated with better health and wellbeing outcomes. This study examined whether chronological age moderated relationships between attitudes to aging and wellbeing outcomes, and whether these relationships differ according to the specific attitudinal construct measured.Method: Participants were 911 adults aged 18-60 years (mean = 36.63 years). Attitudes to ageing were measured using the Malay Reactions to Ageing Questionnaire (M-RAQ), which focuses on respondents' anticipated reactions to being aged over 65 years, and the Malay Anxiety about Ageing Scale (M-AAS), which additionally captures respondents' fears and anxieties about current aging and older people. Wellbeing outcomes were measured using the Warwick- Edinburgh Mental Well-being Scale (WEMWBS) and the Satisfaction with Life Scale (SWLS).Results: More positive attitudes to ageing were associated with higher levels of wellbeing and life satisfaction after controlling for age, gender, education, and self-rated health. Age moderated the relationships between the M-AAS and wellbeing and life satisfaction, with stronger relationships in younger adults. No moderating effects of age were found for the M-RAQ.Conclusion: The difference in the moderating effects of age between measures suggests that the two attitudinal constructs captured by these two measures operate in different ways. In particular, the current emotional/anxiety components of attitudes to ageing may differentially affect wellbeing at different ages. This suggests that interventions aimed at the promotion of wellbeing through coping with aging-related anxieties might be particularly well-suited to younger adults, who may be less able to respond effectively to the anxieties they experience.

A systematic review of the impact of person-centred care interventions on the behaviour of staff working in dementia care.

AIM: To examine the content, focus, and effectiveness of person-centred care (PCC) interventions aimed at increasing staff PCC behaviour in health and social care settings for people with dementia. DESIGN: Systematic search and narrative synthesis of quantitative data. DATA SOURCES: PsychINFO, Medline, EMBASE, Web of knowledge, CINAHL, ASSIA, and BNI were searched from inception to 5 November 2016. REVIEW METHODS: All records retrieved were screened using predetermined eligibility criteria. Quality assessment was performed with the Effective Public Health Practice Project tool (EPHPP). RESULTS: A total of 4,367 records were screened and 33 studies examining the impact of PCC interventions were included. Eight different categories of PCC intervention were identified, with seven of these having at least some evidence to support their effectiveness in increasing staff PCC behaviour. CONCLUSION: The range of interventions and outcome measures identified in this review highlight different ways PCC behaviour can be demonstrated by staff and the range of interventions that can be used to enhance PCC staff behaviour. In future, more rigorously controlled research comparing the relative effectiveness of these interventions will support nursing facilities and staff to choose appropriate interventions to support them in enhancing PCC. IMPACT: This study addressed the health priority of increasing PCC for people with dementia. It found preliminary evidence that seven of the eight intervention types identified are effective at increasing staff PCC behaviour in health and social care settings for people with dementia.

A pilot and feasibility study of the effectiveness of care mapping on person-centred care in neurorehabilitation settings.

Dementia care mapping for neurorehabilitation (DCM-NR) is a tool designed to increase person-centred care (PCC) in neurorehabilitation settings. This paper reports pilot and feasibility testing of a cluster-randomized controlled trial assessing the effectiveness of DCM-NR at increasing PCC. Forty-one staff members, from four neurorehabilitation wards, were cluster-randomized to receive DCM-NR (experimental group) or care as usual (control). Measures of PCC, attitudes to people with brain injury, and PCC self-efficacy were taken at baseline and follow-up. The experimental group were also interviewed about their experiences of the trial. Twenty-nine participants completed the study. Participants generally found the intervention and trial to be acceptable. PCC was significantly higher in the experimental than the control group at follow-up, despite levels of exposure to the intervention being low. PCC self-efficacy increased in the control group, but not in the experimental group, perhaps reflecting an initial reduction in perceived competence following feedback. Neither group showed a change in attitudes to people with brain injury. The findings suggest that this cluster-randomized trial design is acceptable; that DCM-NR shows promise as a tool for increasing PCC; and highlight modifications to the protocol that could increase the success and theoretical value of a future large-scale study.

Barriers and facilitators to accessing psychological therapies for severe mental health difficulties in later life.

BACKGROUND: The number of people growing older with severe mental illness (SMI) is rising, reflecting societal trends towards an ageing population. Evidence suggests that older people are less likely to seek help, be referred for and receive psychological therapy compared with younger people, but past research has focused on those with mild to moderate mental health needs. AIMS: This research aims to identify the specific barriers faced by older people with SMI. METHOD: We interviewed 53 participants (22 service users with SMI aged over 50 years, 11 carers of people with SMI, and 20 health care professionals) about their views and experiences of accessing therapy for SMI in later life. RESULTS: Thematic analysis revealed five themes: organizational and resource issues; myths about therapy and attitudinal barriers; stigma; encouraging access to therapy; and meeting age-specific needs. CONCLUSIONS: Barriers faced by older people with SMI are not only age-related, but also reflect specific issues associated with having a SMI over many years. Improving awareness of the benefits of psychological therapies is important not only for older people with SMI themselves, but also for their carers and staff who work with them.

SLTs' conceptions about their own and parents' roles during intervention with preschool children.

BACKGROUND: Current research investigating collaboration between parents and speech and language therapists (SLTs) indicates that the SLT role is characterized by therapist-led practice. Co-working with parents of children with speech and language difficulties is less frequently described. In order to embrace co-working during intervention, the SLT role may need to be reframed, focusing on acquiring skills in the role of coach as well as the role of planning intervention and treating children. AIMS: To report (1) SLTs' conceptions about their own roles during intervention for pre-school children with speech and language difficulties; and (2) SLTs' conceptions of parents' roles during intervention. METHODS & PROCEDURES: A qualitative study used individual, semi-structured interviews with 12 SLTs working with pre-school children. Open-ended questions investigated SLTs' expectation of parents, experience of working with families, and the SLTs' conception of their roles during assessment, intervention and decision-making. Thematic network analysis was used to identify basic, organizational and global themes. RESULTS & OUTCOMES: SLTs had three conceptions about their own role during intervention: treating, planning and coaching. The roles of treating and planning were clearly formulated, but the conception of their role as coach was more implicit in their discourse. SLTs' conception of parents' roles focused on parents as implementers of activities and only occasionally as change agents. CONCLUSIONS & IMPLICATIONS: Collaboration that reflects co-working may necessitate changes in the conception about the role for both SLTs and parents. SLTs and parents may need to negotiate roles, with parents assuming learner and adaptor roles and SLTs adopting a coaching role to activate greater involvement of parents. Applying conceptual change theory offers new possibilities for understanding and enabling changes in SLTs' conception of roles, potentially initiating a deeper understanding of how to achieve co-working during speech and language intervention.

E-Textiles for Healthy Ageing.

The ageing population has grown quickly in the last half century with increased longevity and declining birth rate. This presents challenges to health services and the wider society. This review paper considers different aspects (e.g., physical, mental, and social well-being) of healthy ageing and how health devices can help people to monitor health conditions, treat diseases and promote social interactions. Existing technologies for addressing non-physical (e.g., Alzheimer's, loneliness) and physical (e.g., stroke, bedsores, and fall) related challenges are presented together with the drivers and constraints of using e-textiles for these applications. E-textiles provide a platform that enables unobtrusive and ubiquitous deployment of sensors and actuators for healthy ageing applications. However, constraints remain on battery, integration, data accuracy, manufacturing, durability, ethics/privacy issues, and regulations. These challenges can only effectively be met by interdisciplinary teams sharing expertise and methods, and involving end users and other key stakeholders at an early stage in the research.

Are mothers less likely to breastfeed in harsh environments? Physical environmental quality and breastfeeding in the Born in Bradford study.

We use the United Kingdom's Born in Bradford study to investigate whether women in lower quality environments are less likely to breastfeed. We use measures of physical environmental quality (water disinfectant by-products [DBPs], air pollution, passive cigarette smoke, and household condition) alongside socio-economic indicators, to explore in detail how different exposures influence breastfeeding. Drawing on evolutionary life history theory, we predict that lower environmental quality will be associated with lower odds of initiating, and higher hazards of stopping, breastfeeding. As low physical environmental quality may increase the risk of adverse birth outcomes, which may in turn affect breastfeeding chances, we also test for mediation by gestational age, birthweight, head circumference, and abdominal circumference. Our sample is composed of mothers who gave birth at the Bradford Royal Infirmary in West Yorkshire between March 2007 and December 2010 for whom breastfeeding initiation data was available. Analyses were stratified by the two largest ethnic groups: White British (n = 3,951) and Pakistani-origin (n = 4,411) mothers. After controlling for socio-economic position, Pakistani-origin mothers had lower chances of initiating and higher chances of stopping breastfeeding with increased water DBP exposure (e.g., OR for 0.03-0.61 vs. <0.02 µg/day dibromochloromethane exposure 0.70 [0.58-0.83], HR 1.16 [0.99-1.36]), greater air pollution exposure predicted lower chances of initiation for both ethnic groups (e.g., OR for 10 µg/m3 increase in nitrogen dioxide 0.81 [0.66-0.99] for White British mothers and 0.79 [0.67-0.94] for Pakistani-origin mothers) but also a reduced hazard of stopping breastfeeding for White British mothers (HR 0.65 [0.52-0.80]), and exposure to household damp/mould predicted higher chances of breastfeeding initiation amongst White British mothers (OR 1.66 [1.11-2.47]). We found no evidence that physical environmental quality effects on breastfeeding were mediated through birth outcomes amongst Pakistani-origin mothers and only weak evidence (p < 0.10) amongst White British mothers (exposure to passive cigarette smoke was associated with having lower birthweight infants who were in turn less likely to be breastfed whereas greater air pollution exposure was associated with longer gestations and in turn reduced hazards of stopping breastfeeding). Overall, our findings suggest that there is differential susceptibility to environmental exposures according to ethnicity. Although the water DBP results for Pakistani-origin mothers and air pollution-initiation results for both ethnic groups support our hypothesis that mothers exhibit reduced breastfeeding in poorer quality environments, several physical environmental quality indicators showed null or positive associations with breastfeeding outcomes. We consider physiological explanations for our findings and their implications for life history theory and public health policy.

Openness, inclusion and transparency in the practice of public involvement in research: A reflective exercise to develop best practice recommendations.

CONTEXT: Reflective accounts of public involvement in research (PI) are important for helping researchers plan and deliver more effective PI activities. In particular, there is a need to address power differentials between team members that can prohibit effective and meaningful involvement. OBJECTIVE: To critically reflect on the PI practices that underpinned our research project on intimacy and sexuality in care homes, to develop a series of recommendations for improving future PI activities. SETTING: The research team comprised five academics from nursing, public health, sociology and psychology, and two members of the public with experience of sex education, and lesbian, gay, bisexual and trans issues in older populations. In order to address power differentials within the group, we developed an approach to PI practice that was grounded in values of openness, inclusion and transparency. METHOD: Reflective commentaries on the strengths and weaknesses of the team's approach to PI were gathered through interviews and open-ended questionnaires with research team members. These views were collated and discussed at a workshop comprising research team members and an additional member of the public to generate recommendations for future PI practice. RESULTS: A number of strengths and limitations of our approach to PI were identified. Clear recommendations for improving PI practice were developed for three broad areas of identified difficulty: (i) communication within and between meetings; (ii) the roles and responsibilities of team members; and (iii) PI resources and productivity. DISCUSSION AND CONCLUSION: These recommendations add to the developing body of guidance for conducting effective PI.

The challenges and opportunities in researching intimacy and sexuality in care homes accommodating older people: a feasibility study.

AIM: To explore the challenges of conducting research on sexuality and intimacy among older care home residents. BACKGROUND: Sexuality and intimacy are neglected in care policies and practices. DESIGN: Qualitative analytical study drawing on poststructuralist theorizing. METHODS: Semi-structured interviews were conducted with residents and spouses (n = 6) and care staff (n = 16) in two care homes in Northwest England in 2014. The sample was obtained through a network of 'research-ready' care homes. Thematic analysis was used to make sense of narratives with the aid of NVivo10. RESULTS: Participant responses highlight the workings of ageist erotophobic discourse that undergirds the assumption of residents (and old people generally) as postsexual. This materialized in reservations about the research ranging from opposition on moral grounds to doubts about its feasibility given the age-group concerned. However, residents and care home staff can also draw on counter-discourses that resist/challenge ageist erotophobic thinking, which materialized in methodological and ethical recommendations. CONCLUSION: Participants generally agreed with the principle of the research and made recommendations that could counter/resist ageist erotophobic governance and guide researchers on sampling, style of questioning and communicating with (prospective) study participants on a sensitive subject.

Sexuality and intimacy among care home residents.

Discussing sexuality and intimacy with older people can be problematic, so it is not uncommon that their needs go unrecognised. This article identifies barriers to addressing sexuality and intimacy needs, and outlines some simple strategies to raise awareness of them among older care home residents and staff, thereby facilitating a discussion to enable such needs to be met.

Knockdown of both mitochondrial isocitrate dehydrogenase enzymes in pancreatic beta cells inhibits insulin secretion.

BACKGROUND: There are three isocitrate dehydrogenases (IDHs) in the pancreatic insulin cell; IDH1 (cytosolic) and IDH2 (mitochondrial) use NADP(H). IDH3 is mitochondrial, uses NAD(H) and was believed to be the IDH that supports the citric acid cycle. METHODS: With shRNAs targeting mRNAs for these enzymes we generated cell lines from INS-1 832/13 cells with severe (80%-90%) knockdown of the mitochondrial IDHs separately and together in the same cell line. RESULTS: With knockdown of both mitochondrial IDH's mRNA, enzyme activity and protein level, (but not with knockdown of only one mitochondrial IDH) glucose- and BCH (an allosteric activator of glutamate dehydrogenase)-plus-glutamine-stimulated insulin release were inhibited. Cellular levels of citrate, α-ketoglutarate, malate and ATP were altered in patterns consistent with blockage at the mitochondrial IDH reactions. We were able to generate only 50% knockdown of Idh1 mRNA in multiple cell lines (without inhibition of insulin release) possibly because greater knockdown of IDH1 was not compatible with cell line survival. CONCLUSIONS: The mitochondrial IDHs are redundant for insulin secretion. When both enzymes are severely knocked down, their low activities (possibly assisted by transport of IDH products and other metabolic intermediates from the cytosol into mitochondria) are sufficient for cell growth, but inadequate for insulin secretion when the requirement for intermediates is certainly more rapid. The results also indicate that IDH2 can support the citric acid cycle. GENERAL SIGNIFICANCE: As almost all mammalian cells possess substantial amounts of all three IDH enzymes, the biological principles suggested by these results are probably extrapolatable to many tissues.

Objective assessment of attention in delirium: a narrative review.

OBJECTIVE: Inattention is a core feature of delirium, and valid assessment of attention is central to diagnosis. Methods of measuring attention in delirium can be divided into two broad categories: (i) objective neuropsychological testing; and (ii) subjective grading of behaviour during interview and clinical examination. Here, we review and critically evaluate studies of objective neuropsychological testing of attention in delirium. We examine the implications of these studies for delirium detection and monitoring in clinical practice and research, and how these studies inform understanding of the nature of attentional deficits in delirium. METHODS: Searches of MEDLINE and ISI Web of Knowledge databases were performed to identify studies in which objective tests of attention had been administered to patients with delirium, who had been diagnosed using DSM or ICD criteria. RESULTS: Sixteen publications were identified. The attention tests administered in these studies were grouped into the following categories: measures of attention span, vigilance tests, other pen-and-paper tests (e.g. Trail Making Test) and computerised tests of speeded reaction, vigilance and sustained attention. Patients with delirium showed deficits on all tasks, although most tasks were not considered pure measures of attention. Five papers provided data on differential diagnosis from dementia. Cancellation tests, spatial span tests and computerised tests of sustained attention discriminated delirium from dementia. Five studies presented reliability or validity statistics. CONCLUSIONS: The existing evidence base on objective assessment of attention in delirium is small. Objective testing of attention is underdeveloped but shows considerable promise in clinical practice and research.

"Something we can all share": Exploring the social significance of food insecurity for young people in KwaZulu-Natal, South Africa.

Food insecurity remains a pressing global issue and South Africa continues to face socioeconomic inequalities that make securing food a challenge for many young people. To address this challenge, we need better understanding of the social context of food and its importance in driving perceptions and behaviours about food and its scarcity. In this study, we examine the meaning of food for young people living in urban informal settlements and rural villages in KwaZulu-Natal, and investigate how they exert agency in the face of food insecurity. We use qualitative data from 17 photo/video elicitation interviews conducted from December 2020-January 2021 with young people experiencing food insecurity. The sample consisted of 9 women and 8 men who were part of the Siyaphambili Youth ("Youth Moving Forward") project. Data were analysed using thematic analysis. Themes included the challenges young people face in securing food and money for food. However, in exploring young people's agency, food also plays a critical role in shaping their identities and social networks. Relevant themes included the use of food as a means of bonding with others; solidifying relationships; and as a signifier of social status and gender roles. Despite the challenges of food insecurity, young people demonstrated resilience and agency, utilising social and gendered coping strategies to secure food and to maintain their social networks. Our study contributes to the understanding of food insecurity amongst young people in South Africa and highlights the need for a comprehensive and culturally sensitive approach to addressing this issue. We argue that interventions aimed at addressing food insecurity should prioritise the empowerment of local communities and consider the sociocultural and gendered context of food in their design and implementation.

Enablers and Barriers to Hearing aid Use in People Living With Dementia.

Hearing loss is highly prevalent in dementia; however, people with dementia are less likely to use hearing aids consistently than people with intact cognition are. This qualitative study is the first of its kind to explore factors that influence hearing aid use from the perspective of community-living people with mild to moderate dementia and their care partners. Eleven UK-based dyads from the European SENSE-Cog Randomized Controlled Trial of a sensory intervention for people with dementia completed semi-structured interviews based on the Theoretical Domains Framework (TDF). Our findings suggest that the TDF domains environmental context and resources, behavioral regulation, reinforcement, and social influences are of greatest relevance to hearing aid use in dementia. Within these domains, we identified a range of factors that may influence the target behavior of hearing aid use. The findings suggest that adoption of multifaceted, flexible intervention approaches may support hearing aid use in dementia.