Factors influencing emotional support of older adults living in the community: a scoping review protocol.

BACKGROUND: Emotional support is key to improve older adults' subjective health, and psychological, social and emotional well-being. However, many older adults living in the community lack emotional support, increasing the risk for loneliness, depression, anxiety, potentially avoidable healthcare use and costs, and premature death. Multiple intersecting factors may influence emotional support of older adults in the community, but these are poorly understood. Studies have focused on specific populations (e.g., older adults with depression, cancer). Although relevant, these studies may not capture modifiable factors for the wider and more diverse population of older adults living in the community. Our scoping review will address these important gaps. We will identify and synthesize the evidence on factors that influence emotional support of older adults in the community. METHODS: We will use the Johanna Briggs Institute updated methodological guidance for the conduct of scoping reviews to guide our review process. We will search MEDLINE, EMBASE, APA Psycinfo, CINAHL, Dissertations and Theses Global, and Scopus from inception. We will include studies published in English, examining factors influencing emotional support of older adults residing in community, without restrictions on the study design or year of publication. We will also include gray literature (dissertations and reports). Two independent reviewers will conduct title, abstract, and full-text screening, as well as risk of bias assessment, using validated quality appraisal tools based on study designs. Discrepancies will be resolved by consensus. The primary reviewer will extract the data from all studies, and the second reviewer will check the extractions of all the studies. We will use descriptive statistics and narrative synthesis for analysis. Family/friend caregivers and older adults involved as an advisory group will help with explaining the findings in terms of whether associations observed reflect their experiences and reality. We will analyze the discussion and generate themes, and summarize in a narrative form. DISCUSSION: This scoping review may identify factors that could be modified or mitigated to improve emotional support provision for older adults residing in community. The knowledge will inform the development of tailored interventions directed to older adults and their caregivers. SYSTEMATIC REVIEW REGISTRATION: https://doi.org/10.17605/OSF.IO/4TAEB (associated project link: osf.io/6y48t).

Bladder and bowel preferences of patients at the end of life: a scoping review.

BACKGROUND: Following patient preferences at the end of life should improve outcomes of care, yet patient preferences regarding bladder and bowel care are not often accommodated, as they are not well known in the literature. AIMS: This scoping review sought to identify bladder and bowel care preferences of patients at the end of life in published literature. METHODS: Papers published in or after 1997 (in English) that focused on adult preferences for bladder and bowel care at the end of life were included. FINDINGS: Scant literature exists on preferences for bladder and bowel care for adult patients at end of life. Further investigation is warranted to arrive at a better understanding of preferences regarding bladder and bowel symptom management. CONCLUSIONS: Future research should explore if prioritising the symptoms caused by incontinence, among the many symptoms experienced at the end of life, could be achieved through careful questioning and development of a standardised tool focused on improving patient care and incorporating patient preferences for care.

Connection between competence, usability, environment and risk of falls in elderly adults / Relação entre competência, usabilidade, ambiente e risco de quedas em idosos / Relación entre competencia, usabilidad, entorno y riesgo de caídas en el adulto mayor

Objective: to determine connections between competence, usability, environment and risk of falls in elderly adults. Method: correlational descriptive study, 123 elderly adults, both male and female, aged 70 years and older were included. Data was collected via the Tinetti Scale, CESD-7 Scale, Montreal Cognitive Assessment, Usability Questionnaire on Housing and Housing Enabler; and sociodemographic and health background certificate data. For data analysis, descriptive and inferential statistics were used, multivariate linear and logistic regression models were adjusted. Results: 42.0% of the elderly adults had presented with falls, with a higher prevalence in women, and in the group of 70-75 years. The physical environment of the house, gait, and usability were set as risk factors for falls. A negative relationship between usability and depressive symptoms, cognitive health, balance, gait, the social and physical environment was found, p <0.05; and a strong positive correlation between walking and balance, p <0.05. Conclusion: this study helps to better understand the phenomenon of falling, to find a connection between usability with the risk of falls, and other variables.

Objetivo: determinar a relação entre competência, usabilidade e ambiente com risco de quedas em idosos. Método: estudo descritivo correlacional, incluindo 123 homens e mulheres idosos de 70 anos para mais. Os dados foram coletados com os instrumentos Escala de Tinetti, Escala CESD-7, Avaliação Cognitiva Montreal, Questionário de Usabilidade na Moradia e Housing Enabler; e um instrumento de coleta de dados para antecedentes sociodemográficos e de saúde. Para a análise dos dados, foi utilizada estatística descritiva e inferencial, em que foram ajustados modelos lineares multivariados e de regressão logística. Resultados: 42,0% dos idosos apresentaram quedas, sendo maior a prevalência nas mulheres e no grupo de 70-75 anos. Como risco de quedas, foram encontrados o ambiente físico da moradia, caminhada e usabilidade. Encontrou-se relação negativa entre usabilidade com sintomas depressivos, saúde cognitiva, equilíbrio, caminhada, ambiente social e físico p<0,05; e forte correlação positiva entre caminhada e equilíbrio p<0,05. Conclusão: o estudo contribui para melhor compreensão formal do fenômeno das quedas ao encontrar relação entre a usabilidade com o risco de quedas, e com outras variáveis que se relacionam com as quedas.

Objetivo: determinar la relación de la competencia, usabilidad y del entorno con el riesgo de caídas en el adulto mayor. Método: estudio descriptivo correlacional, se incluyeron 123 adultos mayores hombres y mujeres de 70 años y más. Los datos fueron recolectados con los instrumentos Escala de Tinetti, Escala CESD-7, Evaluación Cognitiva Montreal, Cuestionario de Usabilidad en la Vivienda y Housing Enabler; y una cédula de datos para antecedentes sociodemográficos y de salud. Para el análisis de datos se utilizó una estadística descriptiva e inferencial, en donde se ajustaron modelos lineales multivariados y de regresión logística. Resultados: el 42,0% de los adultos mayores había presentado caídas, con una mayor prevalencia en las mujeres y en el grupo de 70-75 años. El entorno físico de la vivienda, marcha y usabilidad se establecieron como riesgos de caída. Se encontró una relación negativa entre la usabilidad y los síntomas depresivos, la salud cognitiva, el equilibrio, la marcha, el entorno social y físico p<0,05; y una fuerte correlación positiva entre la marcha y el equilibrio p<0,05. Conclusión: el estudio contribuye a comprender mejor el fenómeno de las caídas al encontrar relación entre la usabilidad con el riesgo de caída, y con otras variables.

Chemotherapy at home: keeping patients in their "natural habitat".

Escalating cancer rates and an increase in the complexity and duration of chemotherapy regimens have brought the issue of cancer treatment at home to the forefront. For the participants of this study, home chemotherapy was offered as a potential treatment choice. Ten patients who accepted home chemotherapy were interviewed using the methodology of interpretive description. They shared their experiences of receiving chemotherapy at home, and identified home as being a "natural habitat" in which they were better able to adapt to their circumstances. Patients were able to redistribute their resources including time, energy, and finances in ways that were meaningful to them. They felt the care provided was enhanced and they were more receptive to teaching. Lastly, participants viewed themselves as being less ill and better able to cope with their treatments. Given the results of this study and other research available, chemotherapy at home should be considered an option for patients with cancer.

Lower urinary tract symptoms in older adults undergoing hip arthroplasty: a feasibility study.

PURPOSE: We undertook a feasibility study to explore the prevalence of preoperative and postoperative lower urinary tract symptoms (LUTS) in older adults undergoing elective hip arthroplasty and to determine whether a larger prospective study was warranted. METHOD: Subjects awaiting elective hip arthroplasty were recruited preoperatively from an orthopedic office and preadmission clinic at 1 university-affiliated hospital. LUTS and related quality of life were measured prehospitalization and 6 weeks postoperatively using the American Urological Association Symptom Index and quality-of-life score. Postvoid residual urine and the 24-hour pad test were used to assess bladder emptying and continence status. RESULTS: Sixteen participants (9 males, 7 females, mean age 74 years) completed the study. Preoperatively, 15 participants reported at least 1 symptom and none had discussed these with a healthcare professional. The most common LUTS were nocturia, frequency, and urgency. Postoperatively, all reported symptoms, with 8 (53%) experiencing increased symptoms with a negative impact on quality of life for 3. Recruitment was a major barrier in conducting the study and would need to be taken into account in further studies of the topic. CONCLUSION: Despite recruitment issues, we suggest larger studies of LUTS in older adults undergoing surgery are warranted to further understand potential problems and risks in transition from hospital to home. Future studies should include identification of potential reasons for increased LUTS, including urinary tract infection.

Pharmacotherapeutics in older adults.

The process of aging influences both pharmacodynamics and pharmacokinetics. In addition to this, the issue of the increased incidence of chronic diseases as the age of people and the effects of medications in older adults becomes very complex. This article will review the influence of the aging process on the absorption, distribution, metabolism, and excretion of drugs. Specific concerns of older adults, including drug groups and side effects of concern, drug-induced geriatric syndromes, and medication adherence, are also discussed.

Diabetes-associated bladder dysfunction in the older adult (CE).

Diabetic cystopathy is a chronic complication of diabetes with a classic triad of symptoms: decreased bladder sensation, increased bladder capacity, and impaired detrusor contractility. This article discusses age- and diabetes-related changes that affect lower urinary tract function. The article also reviews bladder function in the older adult diabetic, explores bladder dysfunction prevention, and suggests management strategies for diabetic cystopathy. Little research has been published to date to guide practice in this area, and opportunities exist for nursing research to fill the gap in knowledge.