Physiotherapists' moral distress: Mixed-method study reveals new insights.

BACKGROUND: Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of  professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists. RESEARCH QUESTION: What factors contribute to Moral distress among physiotherapists and how do they cope? OBJECTIVES: To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena. RESEARCH DESIGN: A 2017-2022 mixed-methods study: (1) Survey of 407 physiotherapists quantitatively testing a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis. PARTICIPANTS AND CONTEXT: Israeli physiotherapists from various occupational settings recruited via professional networks. ETHICAL CONSIDERATIONS: The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use. FINDINGS: Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress. DISCUSSION: Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors. CONCLUSIONS: Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies.

The effect of co-dependent (thinking in motion [TIM]) versus single-modality (CogniFit) interventions on cognition and gait among community-dwelling older adults with cognitive impairment: a randomized controlled study.

BACKGROUND: Cognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive impairment. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive impairment has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with "Thinking in Motion (TIM)," a co-dependent group intervention, among community-dwelling older adults with cognitive impairment. METHODS: Employing a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive impairment were randomly assigned to 8 weeks of thrice-weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome; and gait, under single- and dual-task conditions, as a secondary outcome. RESULTS: CogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p < .001, ηp2 = .283] but not for group [F (1, 44) = 0.001, p = .970]. No time X group interaction [F (1, 44) = 1.29, p = .261] was found. No changes in gait performance under single and dual-task performance were observed in both groups. CONCLUSIONS: The findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive impairment. Such investigations should be extended to include various populations and a broader set of outcome measurements. TRIAL REGISTRATION: ACTRN12616001543471. Date: 08/11/2016.

Ethics Review Boards for Research With Human Participants: Past, Present, and Future.

The debate around ethics review boards (IRBs) has assumed an increasingly central place in academic practice and discourse. In this article, we summarize a unique workshop (study-group) that convened at the University of Haifa, attended by 27 academics from around the globe, representing nine countries in four continents. The participants presented data and points of view, which served as the basis for an open, interdisciplinary discussion. The group developed a set of recommendations, including working toward a transition from a review system to an advisory and validation system; focusing on respectful research approach to participants, rather than "ethical" research; building a procedure that focuses on feedback, rather than the process itself; recognizing that a unified examination need not necessarily be standardized; and constructing a feedback procedure in which researchers can respond to the review of their research.

The Two-Track Model of Dementia Grief (TTM-DG): The theoretical and clinical significance of the continuing bond in sickness and in death.

Grief and mourning for family members caring for a dementia patient begin with the initial changes in the person's cognitive abilities, and intensify with the worsening of his or her condition. The aim of this article is to propose a Two-Track Model of Dementia Grief (TTM-DG). This model enlarges the theoretical, research and clinical lenses for dementia, and explores how the illness process as well as the bereavement responses after death stimulate the reworking of grief and mourning over the beloved family member. Based on the insights derived from the Two-Track Model of Loss and Bereavement and the Continuing Bonds paradigm, we propose that the clinical and research examination of dementia grief begin in life and continue after the death. The TTM - DG's Track I focuses on bio-psycho-social functioning and Track II focuses on the internalized psychological representation of the patient, the ongoing relational bond and the illness and death story. A case study illustrates how this combined perspective provides a comprehensive picture of the experience of grief for persons afflicted with dementia over the course of the disease trajectory. Future clinical and empirical research has an important role to play in the further development of this model.

Consumer Fraud: Older People's Perceptions and Experiences.

In view of the growing need to address the rights of older people as consumers, this study captures the perceptions and meanings that older people attribute to their experiences as older consumers, particularly regarding consumer fraud, using qualitative-phenomenological methodology based on semi-structured, open-ended interviews with 16 older consumers in Israel. The findings raise distinctive aspects of their experiences, including physical and cognitive characteristics of aging, social response to aging, and involvement of family members in decision making and support. The study concludes by offering several sociolegal policy recommendations for protecting older consumers, directed to them, their family members, professionals interacting with them, and the legal system.

Ageism: can a museum exhibit make a difference?

Ageism is a key challenge to today's aging societies. "Dialogue with Time" is an original Israeli interactive museum exhibit that aims to change negative ageist attitudes by creating a meaningful and stereotype-breaking encounter between visitors and old age. The objective of this study was to examine whether the exhibition reduces ageist attitudes among its visitors. The study employed a comparative pre-post structure with a comparison group. A closed-answer questionnaire was supplied to 100 participants in the experimental group, visitors to the "Dialogue with Time" exhibit, and to 100 participants in the control group. Participants were asked to complete the questionnaire before entering the exhibits and again after experiencing them. Changes in the level of ageism were measured using the Farboni Scale of Ageism. A significant reduction in ageism attitudes was shown in the experimental group when comparing before and after the visit, t(91) = 11.75, p = 0.001, with a good effect size of Cohen's d = 0.50, whereas in the control group there was no significant change, t(76) = 0.05, p = 0.95, and a weak effect size of Cohen's d = 0.00. The findings indicate that combating ageism can also be sustained by means of museum exhibits. We recommend that museums and other similar public institutions (e.g. art galleries, exhibition halls) use public spaces to advance multigenerational exposure to positive images of aging.

Building Bridges between Gerontology and Elder Law.

BACKGROUND: Academics have long called for greater interaction between gerontologists and legal scholars. However, prior studies have suggested that disciplinary borders remain a barrier to such interaction, hampering gerontology's ability to function as a truly multi- or interdisciplinary field. OBJECTIVE: This study was designed to understand the nature of current interactions between legal scholars and gerontologists, and to identify opportunities to advance scientific dialogue and cooperation between the two. METHODS: Semi-structured, open-ended interviews with 27 participants (12 elder law scholars, 15 gerontologists) were conducted by phone, recorded, and analyzed by an interdisciplinary team. RESULTS: Both elder law scholars and gerontologists indicate that their field would benefit from research collaboration and cross-disciplinary teaching with the other field, but the fields remain distinct with little cross-disciplinary learning. Participants identified a series of opportunities, however, for increasing such learning and collaboration. CONCLUSIONS: The authors identify ways gerontologists can be encouraged to integrate elder law into their teaching and research, and suggest how this integration could enhance understanding of the aging experience.

The meanings of the unlicensed assistive personnel role in nursing homes: A triadic job analysis perspective.

AIM: This study described and analyzed how older residents, professional nurses and unlicensed assistive personnel (UAP) perceive the meaning and content of the job carried out by UAP in nursing homes (NHs), as a basis for job analysis. BACKGROUND: Increasing numbers of NH beds and financial restraints have led UAP to become a significant part of the long-term care service system, yet in numerous contexts, the UAP job remains misunderstood and underexplored. METHOD: The research employed a qualitative phenomenological methodology. Data were collected from 50 semi-structured in-depth interviews with 18 UAP, 15 certified nurses and 17 older NH residents. RESULTS: We identified six content dimensions in the participants' descriptions regarding the meanings of the roles and duties of the UAP: (a) care for the physical environment, (b) bodily-physical care, (c) psycho-social interpersonal care, (d) professional hierarchy and boundaries, (e) UAP personal traits and (f) UAP skills, or the need for training and professional education. CONCLUSIONS: Future job definition and formal regulation of UAP should place more focus on the personal characteristics of UAP, as a prerequisite to enter the job. IMPLICATIONS FOR NURSING MANAGEMENT: The study takes a step forward toward better defining the professional boundaries delineating the meaning of the UAP position.

Gender, aging, and the economics of "active aging": Setting a new research agenda.

The world is aging, and the percentages of older people are on a dramatic ascent. This dramatic demographic aging of human society is not gender neutral; it is mostly about older women. One of the key policy approaches to address the aging revolution is known as "active aging," crystalized by the WHO in 2002 by three pillars: participation, health, and security. The active aging policy has financial and economic aspects and affects both men and women. However, as argued in this article, a gender-based approach has not been adopted within the existing active aging framework. Therefore, a new gender-specific research agenda is needed, one that focuses on an interrelation between gender and different economic aspects of "active aging" from international, comparative, cultural, and longitudinal perspectives.

Age limitation for organ transplantation: the Israeli example.

In 2013 the Israeli Ministry of Health appointed a public committee to examine the policy of placing an age limitation on candidates listed for organ transplantation. The committee rejected the use of an age limit criterion for listing candidates for transplantation and recommended to abolish it. However, opinions differed regarding the use of recipients' age in shaping a fair organ allocation policy. The committee's recommendations were adopted and put into force as of April 2014. This article unfolds the committee deliberations on accommodating values of formal equality for optimising the use of organ transplantation.

The legal appearances of dementia in court rulings: mapping the terrain.

BACKGROUND: Individuals with dementia may appear before the court in different roles: as victims, as witnesses, and as those standing up for their rights. While there is growing interest in the rights of older persons with dementia, relatively little empirical data exists regarding their actual interactions in courts. Therefore, the goal of this study was to empirically map this legal terrain. METHODS: This study used a descriptive quantitative method. A computerized search of a national legal database limited to the period 2004-2014 and a screening process for the results were used to establish a sample of 280 court rulings that directly addressed dementia. All cases were analyzed and categorized into the following four criteria groups: characteristics of the person with dementia; characteristics of the legal procedure; the legal substance of the case; and the legal outcome. RESULTS: The majority of cases involved a single, very-elderly (i.e. over 80 years) woman, living in the community, with unspecified dementia. The majority of cases were heard and decided in lower level courts, addressing a broad range of primarily non-criminal legal issues. Finally, in the majority of non-criminal cases, the person with dementia was found to be legally capable, whereas in the majority of criminal cases, the person with dementia was found incapable. CONCLUSIONS: The legal needs and rights of persons with dementia are much broader than issues of legal capacity or social protection. Deeper knowledge and more research is needed in order to fully understand the contexts in which dementia is constructed under the law.

Alzheimer's disease and the law: positive and negative consequences of structural stigma and labeling in the legal system.

OBJECTIVE: To explore the meaning and consequences of labeling on structural stigma in the context of Alzheimer's disease (AD) in the legal system. METHOD: This qualitative study was made up of three focus groups including social workers and lawyers (n = 26). Participants were asked to report their experience in circumstances in which persons with AD and their family members engage with the legal system. Thematic analysis using the constant comparative method was used. RESULTS: The discussions in the focus groups raised two overall themes. (1) The significance of the medical diagnostic labeling of AD in the legal system and (2) the consequences of labeling of AD within the legal system. This last theme included four sub-themes: (a) negative consequences of labeling; (b) reasons associated with negative consequences of labeling; (c) positive consequences of labeling; and (d) reasons associated with positive consequences of labeling. CONCLUSION: Findings of the study provide a first foundation for future research on the meaning and consequences of labeling in legal cases involving persons with AD. They suggest that increasing judges' knowledge about AD and reforming the existing 'status-based' legal capacity legislation might benefit by limiting the legal weight given today to the medical diagnosis.

Exploring the Objective and Perceived Environmental Attributes of Older Adults' Neighborhood Walking Routes: A Mixed Methods Analysis.

Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults' local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.

The Human Right to Leisure in Old Age: Reinforcement of the Rights of an Aging Population.

The right to leisure is recognized as a human right under the 1948 United Nations Universal Declaration of Human Rights. The actual meaning and material content of this human right is subject to debate. The aim of this study is to examine the extent and the context to which this human right is specifically recognized with regard to older persons. Methodologically, this study textually analyzed 17 different international older persons' human rights documents. The findings reveal that in the majority of these documents there is no reference to the right to leisure. In the remaining documents, the right to leisure is mostly referred to indirectly or in a narrow legal construction. These findings support the notion that despite the growing body of knowledge regarding the importance of meaningful leisure in old age-and its empowering and anti-ageist nature-this knowledge has not transformed into a legal human rights discourse.

The Right to Health in Old Age: Israeli Professionals' and Older Persons' Perspectives.

OBJECTIVES: To develop a better understanding of the right to health in old age through the personal knowledge and experience of older persons and professionals in Israel. METHODS: A qualitative research method was adopted based on focus groups. Information was collected through four focus groups with 33 participants. RESULTS: Three main themes emerged: The first focused on the older persons' self-positioning vis-à-vis the health-care system. The second illustrated the verbal means chosen by the participants to situate the health-care system itself. The third elaborated on the institutional and cultural processes involved in upholding health rights in old age. DISCUSSION: Future discussions regarding conceptualization of the right to health in old age should relate to its human aspects, that is, communication and interaction, and the older person's knowledge, participation, and involvement in shaping the medical services that they receive.

The Legal System and Alzheimer's Disease: Social Workers and Lawyers' Perceptions and Experiences.

The expected increase in the number of people living with Alzheimer's disease (AD) worldwide will be accompanied by an increase in the number of cases involving persons with AD brought up to the courts. This study examined the perceptions and experiences of social workers and lawyers regarding these cases. Three focus groups including social workers and lawyers (n = 26) were conducted. Two main themes were raised by the participants: (a) the role of social workers and lawyers in court cases regarding AD, and (b) the need for improving legal encounters involving persons with AD. Similarities and differences were found in both professionals' interpretations of these shared themes. Results of this study emphasize the need for increasing the knowledge and interprofessional training provided to social workers and lawyers involved in legal cases dealing with issues involving persons with Alzheimer's disease.

Losing a Grandchild: The Mourning Experience of Grandparents in Israel.

The rise in life expectancy has placed grandparents at higher risk to experience losing a grandchild. The authors examined the ways grandparents experience the loss of a grandchild. Twelve grandparents were interviewed based on an interview guide and phenomenologically analyzed. Three main themes were found: the loss as a personal turning point; the significance of the ongoing relationships with the deceased; and the impact on one's beliefs and attitudes. The loss of a grandchild is characterized by a complex tension between two inter-related forces of distancing and becoming closer to the grandchild and his or her parent.

Older women with intellectual disability and the meaning of aging.

Aging with intellectual disability has become an important topic in light of the significant increase in life expectancy of this population. More specifically, the combination of gender, age, and intellectual disability raises unique social issues. The aim of this research was to capture and analyze the aging experience of women with intellectual disability from their own voice and viewpoint within the Israeli experience. A phenomenological qualitative method was used in this study. In-depth interviews were conducted with 19 women with mild-to-moderate intellectual disability. Four key themes arose from the interviews: (a) the importance of work and reluctance to retire, (b) ageism and the fear of getting old, (c) the importance of a significant partner in old age, and (d) today's positive self-perception. A meaningful aging process can be constructed within the context of gender and disability. It was manifested in this study as a disability-neutral experience. However, ageism and negative attitudes toward old age still need to be addressed.

Older Europeans and the European Court of Justice.

BACKGROUND: the European Court of Justice (ECJ) is considered by many to be the most important judicial institution of the European Union today. Despite the potential importance and relevance of the ECJ rulings to the lives and rights of older Europeans, no research has attempted to analyse or to study the ECJ rulings in this field. OBJECTIVE: to describe the ECJ case-law in the field of elder rights. METHODS: using a computerised search of the ECJ database, between the years 1994 and 2010, 123 cases directly dealing with legal rights of older persons were analysed. RESULTS: on average, only 1-2% of the annual ECJ case-load addresses rights of older persons. Unlike the clear trend in the increase of the total ECJ case load, there was no similar trend of increase in the number of cases directly involving older persons' rights. However, in the majority of the elder-rights cases, the ECJ decision was in support of the older person's rights. CONCLUSIONS: the ECJ can potentially serve as an important protector of rights of older Europeans, if and to the extent that these cases reach its jurisdiction.