Barriers and facilitators in providing care for patients with a migration background.

AIMS AND OBJECTIVES: The aim of this study was to identify the barriers and facilitators experienced by healthcare professionals while caring for patients with a migration background. BACKGROUND: People with a migration background often face several structural inequalities and barriers in terms of accessibility to, and affordability of, healthcare. In order to provide quality care for patients with a migration background, it is important to understand which barriers healthcare professionals experience that prevent them from providing care and which factors can facilitate this. DESIGN AND METHODS: Qualitative research following the COREQ criteria. A total of six focus groups (n = 37) and 12 individual interviews were conducted with a multidisciplinary sample: doctors, nurses, social workers, and occupational therapists. Nursing and medical students were also included. Thematic content analysis was used. RESULTS: Key findings suggest that the main barrier is that healthcare professionals regard people with a migration background as "the other". Healthcare professionals do not feel secure or competent to provide care for these "others." According to the healthcare professionals, the hospital structures-and, particularly, the managerial instances-appear to be only slightly supportive. Structural barriers at the level of the healthcare system, such as limited implementation of care coordination and austerity measures (time pressure or economic restrictions), were also perceived as barriers. Facilitators can be the healthcare professionals' attitude or the flexibility of the management. CONCLUSIONS: Healthcare professionals experience barriers in caring for people with a migration background. Othering plays a key role in building or maintaining several barriers. A multilevel approach is necessary to tackle these barriers and enable facilitators. RELEVANCE TO CLINICAL PRACTICE: Raising awareness about "othering" in the educational programs of students and healthcare professionals is essential. Also, deploying support mechanisms and valuing the competences of multicultural and multi-lingual healthcare professionals can help facilitate quality care for patients with a migrant background. PATIENT OR PUBLIC CONTRIBUTION: Patients, informal and formal caregivers participated in the study at several stages (e.g.: by involving them during the research design phase or providing feedback and input at specific moments across the study). In addition, community participants played a key role also during the research design and data analysis phases as well as by facilitating patients' recruitment.

Culturally Sensitive Care: Definitions, Perceptions, and Practices of Health Care Professionals.

INTRODUCTION: Research highlights that patients from ethnic minority groups often receive lower quality of care. This study contributes to the knowledge and understanding of culturally sensitive care and explores health care professionals' definitions and perceptions of this concept and how they deliver this in practice. METHOD: This qualitative study conducted a total of six focus groups (n = 34) and four in-depth interviews with six categories of health care professionals in Belgium. Thematic content analysis was used. RESULTS: The results indicate that the concept of culturally sensitive care is perceived quite narrowly. Professionals are likely to portray their own frame of reference and find it challenging to show empathy with patients with a different background. Othering (micro-racism by defining "the other") is a powerful example. DISCUSSION: The discussion reveals the significance of increasing cultural awareness and understanding, sensitizing about current narrow perceptions, and enhancing culturally sensitive care in the Belgian health care setting.

Elder Abuse Assessment Tools and Interventions for use in the Home Environment: a Scoping Review.

BACKGROUND AND AIM: Caregivers in the home environment have an important role in timely detecting and responding to abuse. The aim of this review was to provide insight into both the existing tools for the assessment of and interventions for elder abuse by formal and informal caregivers in the home environment, and to categorize them according to a public health perspective, into primary, secondary, tertiary or quaternary prevention. METHODS: We selected the assessment tools and interventions that can be used by caregivers in the home environment included in previous reviews by Gallione et al (2017) and Fearing et al (2017). To identify published studies after these reviews, a search was performed using PubMed, Cochrane Database, CINAHL and Web of Science. RESULTS: In total, fifteen assessment tools and twelve interventions were included. The number of assessment tools for elder abuse for use in the home environment is increasing; however, tools must be validated over different cultures and risk groups. In addition, the tools lack attention for the needs of vulnerable older persons such as persons with dementia. Existing interventions for caregivers in the home environment lack evidence for addressing elder abuse and do not address potential adverse effects (quaternary prevention). CONCLUSION: Assessment tools for elder abuse need further testing for validity and reliability for use by caregivers in the home environment. For interventions, meaningful outcome measures are needed. Important to note is that quaternary prevention requires more attention. This argues for taking into account perspectives of (abused) older persons and caregivers in the development of assessment tools and interventions protocols.

Frailty differences in older adults' use of informal and formal care.

OBJECTIVES: This study examines different combinations of informal and formal care use of older adults and investigates whether these combinations differ in terms of need for care (physical and psychological frailty) and enabling factors for informal and formal care use (social and environmental frailty). METHODS: Using cross-sectional data from the Belgian Ageing Studies (survey, N = 38,066 community-dwelling older adults), Latent Class Analysis (LCA) is used to identify combinations of informal and formal care use. Bivariate analyses are used to explore the relationship between the different combinations of care use and frailty. RESULTS: Latent Class Analysis (LCA) identified 8 different types of care use, which vary in combinations of informal and formal caregivers. Older adults who are more likely to combine care from family and care from all types of formal caregivers are more physically, psychologically and environmentally frail than expected. Older adults who are more likely to receive care only from nuclear family, or only from formal caregivers are more socially frail than expected. CONCLUSIONS: Older adults with a higher need for care are more likely to receive care from different types of informal and formal caregivers. High environmental frailty and low social frailty are related with the use of care from different types of informal and formal caregivers. This study confirms that informal care can act as substitute for formal care. However, this substitute relationship becomes a complementary relationship in frail older adults. Policymakers should take into account that frailty in older adults affects the use of informal and formal care.

CFAI-Plus: Adding cognitive frailty as a new domain to the comprehensive frailty assessment instrument.

OBJECTIVES: Cognitive frailty is characterized by the presence of cognitive impairment in exclusion of dementia. In line with other frailty domains, cognitive frailty is associated with negative outcomes. The Comprehensive Frailty Assessment Instrument (CFAI) measures 4 domains of frailty, namely physical, psychological, social, and environmental frailty. The absence of cognitive frailty is a limitation. METHOD: An expert panel selected 6 questions from the Informant Questionnaire on Cognitive Decline that were, together with the CFAI and the Montreal cognitive assessment administered to 355 older community dwelling adults (mean age = 77). RESULTS: After multivariate analysis, 2 questions were excluded. All the questions from the original CFAI were implemented in a principal component analysis together with the 4 cognitive questions, showing that the 4 cognitive questions all load on 1 factor, representing the cognitive domain of frailty. By adding the cognitive domain to the CFAI, the reliability of the adapted CFAI (CFAI-Plus), remains good (Cronbach's alpha: .767). CONCLUSIONS: This study showed that cognitive frailty can be added to the CFAI without affecting its good psychometric properties. In the future, the CFAI-Plus needs to be validated in an independent cohort, and the interaction with the other frailty domains needs to be studied.

Relationships between the perceived neighborhood social environment and walking for transportation among older adults.

Ecological models state that physical activity (PA) behaviors can be explained by the interplay between individuals and their surrounding physical and social environment. However, the majority of research on PA-environment relationships has focused upon the physical environment. The purpose of the current study was to investigate the relationship between the perceived social environment and older adults' walking for transportation, while adjusting for individual and perceived physical environmental factors. Questionnaires were used to collect data on walking for transportation, individual, perceived physical and social environmental factors in 50,986 Flemish older adults (≥65 years) in the period of 2004-2010. Multilevel logistic regression analyses were applied to examine the relationships between perceived social environmental factors and the odds of daily walking for transportation. The final models showed significant positive relationships for frequency of contacts with neighbors, neighbors' social support, too many immigrants residing in the neighborhood, neighborhood involvement, participation, and volunteering. These results emphasize the need for including social environmental factors in future studies examining correlates of older adults' physical activity. Current findings suggest that projects stimulating interpersonal relationships, place attachment, and formal community engagement might promote walking for transportation among older adults. Future research should try to further disentangle the complex (inter)relationships and causal mechanisms between older individuals, their environments, and their walking for transportation behavior.

Developing age-friendly cities: case studies from Brussels and Manchester and implications for policy and practice.

Developing environments responsive to the aspirations of older people has become a major concern for social and public policy. Policies and programs directed at achieving "age-friendly" communities are considered to require a wide range of interventions, including actions at the level of the social and physical environment. This article compares the age-friendly approaches of two European cities, Brussels and Manchester, with a particular focus on policies and initiatives that promote active aging in an urban context. The article examines, first, the demographic, social, and multicultural contexts of Brussels and Manchester; second, the way in which both cities became members of the World Health Organization Global Network of Age-Friendly Cities and Communities; third, similarities and differences in the age-friendly approaches and actions adopted by both cities; and fourth, opportunities and barriers to the implementation of age-friendly policies. The article concludes by discussing the key elements and resources needed to develop age-friendly cities.

Relationships of individual, social, and physical environmental factors with older adults' television viewing time.

Sedentary behaviors (involving prolonged sitting) can be associated detrimentally with health outcomes. Older adults, the most sedentary age group, are especially at risk due to their high levels of television viewing time. This study examined individual, social, and physical environmental correlates of older adults' television viewing. Data on daily television viewing time, plus individual, social, and physical environmental factors were collected from 50,986 noninstitutionalized older adults (≥ 65 years) in Flanders (Belgium). The results showed significant relationships between television viewing time and individual, social, and physical environmental factors. Subgroups at risk for high levels of television viewing were those who were functionally limited, less educated, widowed, and (semi)urban-dwelling older adults. Our findings illustrate a cross-sectional link between older adults' television viewing time and social composition of their neighborhood, formal participation, access to alternative activities, and safety from crime.

Social participation among older adults living in medium-sized cities in Belgium: the role of neighbourhood perceptions.

This study examines the associations between neighbourhood perceptions and social participation in a sample of older adults living in medium-sized cities in Flanders, Belgium. Strong evidence of the influence of place on older people's physical and mental health exists. However, the question of how neighbourhoods promote or hinder social participation remains under-explored in social gerontology. Using data generated from the Belgian Ageing Studies, a multivariate regression model (n = 1877) is tested, with personal characteristics, subjective neighbourhood assessments and objective city-level measures as independent variables, and two indicators of social participation as dependent variables: social activity and formal participation. Positive predictors included neighbourhood involvement, frequent contact with neighbours and availability of activities for older people. However, the predictive role of neighbourhood perceptions is stronger for formal participation than for social activity, which is explained more by individual characteristics. The article concludes by discussing the implications of the findings for research and practice pertaining to health promotion interventions.

The comprehensive frailty assessment instrument: development, validity and reliability.

Population aging forces governments to change their policy on elderly care. Older people, even if they are frail and disabled, are motivated to stay in their own homes and environment for as long as possible. Consequently, the early detection of frail older persons is appropriate to avoid adverse outcomes. Several instruments to detect frailty exist, but none use environmental indicators. This study addresses the development and psychometric properties of the Comprehensive Frailty Assessment Instrument (CFAI). This new self-reporting instrument includes physical, psychological, social and environmental domains. The CFAI showed good fit indices and a high reliability. The underlying structure of the CFAI demonstrates the multidisciplinary nature of frailty. Using the CFAI can stimulate nurses and other community healthcare providers toward a more holistic approach of frailty and can guide them to take appropriate interventions to prevent adverse outcomes such as disabilities or hospitalization.

Physical environmental factors related to walking and cycling in older adults: the Belgian aging studies.

BACKGROUND: Socio-ecological models emphasize the relationship between the physical environment and physical activity (PA). However, knowledge about this relationship in older adults is limited. Therefore, the present study aims to investigate the relationship between area of residence (urban, semi-urban or rural) and older adults' walking and cycling for transportation and recreation. Additionally, relationships between several physical environmental factors and walking and cycling and possible moderating effects of area of residence, age and gender were studied. METHODS: Data from 48,879 Flemish older adults collected in 2004-2010 through peer research were analyzed. Walking, cycling and environmental perceptions were assessed using self-administered questionnaires. The Study Service of the Flemish Government provided objective data on municipal characteristics. Multilevel logistic regression analyses were applied. RESULTS: Urban participants were more likely to walk daily for transportation compared to rural (OR = 1.43; 95% CI = 1.22, 1.67) and semi-urban participants (OR = 1.32; 95% CI = 1.13, 1.54). Urban participants were less likely to cycle daily for transportation compared to semi-urban participants (OR = 0.72; 95% CI = 0.56, 0.92). Area of residence was unrelated to weekly recreational walking/cycling. Perceived short distances to services (ORs ranging from 1.04 to 1.19) and satisfaction with public transport (ORs ranging from 1.07 to 1.13) were significantly positively related to all walking/cycling behaviors. Feelings of unsafety was negatively related to walking for transportation (OR = 0.93, 95% CI = 0.91, 0.95) and recreational walking/cycling (OR = 0.95, 95% CI = 0.92, 0.97). In females, it was also negatively related to cycling for transportation (OR = 0.94, 95% CI = 0.90, 0.98). CONCLUSIONS: Urban residents were more likely to walk for transportation daily compared to semi-urban and rural residents. Daily cycling for transportation was less prevalent among urban compared to semi-urban residents. Access to destinations appeared to be important for promoting both walking and cycling for transportation and recreation across all demographic subgroups. Additionaly, feelings of unsafety were associated with lower rates of walking for transportation and walking/cycling for recreation in all subgroups and cycling for transportation in females. No clear patterns emerged for other environmental factors.