A systematic review of health state utility values for older people with acute myeloid leukaemia.

PURPOSE: Older people with acute myeloid leukaemia (AML) have a poor prognosis, reduced health-related quality of life (HRQoL) and require substantial healthcare resources. The objectives of this systematic review were to determine what health state utility values (HSUVs) are reported in the literature that can be used in economic evaluations of interventions for older people with AML, identify research gaps, and discuss directions for future research. METHODS: The following databases were searched for studies published from inception until Feb 2023: PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, and EconLit. Studies were included if they reported on HSUVs of people with AML >60 years, or HRQoL data that could be mapped to HSUVs using currently published algorithms. RESULTS: Of 532 studies identified, 7 met inclusion (4 full studies and 3 conference abstracts). Twenty-eight potentially eligible studies were excluded as they did not report HRQoL measures in sufficient detail to be mapped to utility values. Included studies reported on health states of newly diagnosed disease (n=4 studies), intensive therapy (n=1 study), controlled remission (n=3 studies), and relapsed or refractory disease (n=2 studies). No studies reported on low intensity therapy or supportive care health states. Utility values were largely reported via the EuroQol and ranged from 0.535 (intensive therapy) to 0.834 (controlled remission). CONCLUSION: There are gaps in knowledge on HSUVs for older people with AML, particularly for certain treatment-related health states. Future articles should publish comprehensive HRQoL outcomes to enable use in economic evaluation.

Unveiling the dynamics of older person care: a qualitative exploration of the intersection between formal and Informal Caregiving from the perspectives of registered nurses in Greece.

In the evolving landscape of older person care, the imperative to explore holistic approaches persists, especially in regions with distinct societal norms around informal caregiving. The deeply ingrained tradition of familial caregiving, often led by female family members, has historically compensated for healthcare system gaps in less integrated systems. Hence, societal expectations may affect registered nurses' experiences and impact the quality of care for older persons. This study aims to describe the meaning of caring for older persons in care settings in Greece. Ten in-depth interviews with registered nurses in older person care settings underwent qualitative thematic analysis. Four themes emerged from the analysis: (i) Living and bonding with older people as a basis for caring, (ii) Caring as a double-faced fulfillment, (iii) A sense of insufficiency in the caring relationship, and (iv) The encounter of existential issues creating loneliness. This research provides insights into the meaning of caring for older persons, highlighting the experiences of the closest professional caregivers of older individuals. A specific capture of the entanglement of cultural norms, societal expectations, and their impact on professional caregivers' experiences may contribute to quality care provision in systems rooted in familial caregiving traditions.

Measuring patients' medical treatment preferences in advance care planning: development and validation of the Treat-Me-ACP instrument - a secondary analysis of a cluster-randomized controlled trial.

BACKGROUND: Advance Care Planning interventions should be evaluated as broadly as possible to gain a holistic understanding of the Advance Care Planning process. However, validated early stage outcome instruments are lacking. Therefore, the Treatment-Preference-Measure-Advance Care Planning (Treat-Me-ACP) instrument was developed and validated as part of the cluster-randomized controlled trial STADPLAN (Study on Advance Care Planning in care-dependent community-dwelling older persons) to assess the effects of Advance Care Planning interventions on patients' medical treatment preferences. METHODS: The design of Treat-Me-ACP is based on the Emanuel Medical Directive and the Life Support Preferences Questionnaires. Using a multi-stage team approach a preliminary version of the Treat-Me-ACP was developed and pre-tested. The pre-tested instrument consists of one global medical care goal-item, five hypothetical scenarios with five hypothetical treatments, and one how would you feel-item within each scenario. A total of five scenario preference scores and five treatment preference scores can be formed. This version was subsequently applied to a subsample of the STADPLAN project (n = 80) to assess patient's preferences at baseline (T0) and at 12-month follow-up (T2). The further validation steps were based on this subsample and included: (1) acceptance by using completion rate and frequencies of missing data, (2) internal consistency by using Cronbach's α to test whether it was possible to create preference scores by scenario and treatment, (3) concurrent validation examining the association between the global medical care goal-item and the preference scores and the association between the how would you feel-items and the scenario preference scores, and (4) responsiveness of the instrument to changes in preferences for life-sustaining treatments by comparing preference scores from T0 to T2 between study groups. RESULTS: Acceptance of the instrument was high. Results of concurrent validation indicate that the five scenarios represent the global medical care goal well. The preference scores showed an average tendency for decreasing preferences for life-sustaining treatments across all scales for the intervention group during study follow-up. CONCLUSIONS: The Treat-Me-ACP can be used to evaluate the dynamics of patients' medical treatment preferences in Advance Care Planning. It has been validated for care-dependent community-dwelling older persons and can be used as an additional outcome measure in evaluating the effectiveness of ACP interventions. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00016886 on 04/06/2019.

Nurse assistants' perception of caring for older persons who are dying in their own home : An interview study.

BACKGROUND: As the proportion of older persons in society increases, there is a growing trend towards providing end-of-life care in their homes. Palliative care is a complex and knowledge-demanding form of care, and nurse assistants are those who work closest to the older person at the end-of-life in their own homes. However, nurse assistants sometimes have low educational and insufficient levels of knowledge in palliative care, which can affect the quality of care they provide. Moreover, nurse assistants' experiences are relatively unexplored in this context. The purpose of the study was to illuminate nurse assistants' experiences in caring for dying older persons at home. METHOD: An empirical, qualitative interview study was conducted with 14 nurse assistants with experience of palliative care in homecare. The material was analyzed using thematic content analysis. RESULTS: From the nurse assistant's experiences, one main theme emerged: doing everything possible for the dying older person despite challenges. Moreover, three sub-themes emerged: making a difference at a crucial time, death awakens emotions, and balancing personal and professional relationships. The nurse assistants' saw their role primarily as relieving symptoms but also focusing on next of kin. The following are described as essential parts of their role: carrying out practical nursing tasks, focusing on the physical environment, working alone and seeking help from colleagues due to a physical distance to the other members of the multidisciplinary team. The nurse assistants experienced a lack of support as there was no structured guidance or debriefing available in difficult emotional situations. Furthermore, they disclosed that they were left alone to deal with their feelings. CONCLUSION: This study demonstrates that nurse assistants strive to provide comprehensive care for dying older persons despite facing obstacles from their working conditions and work organization. They lack supervision and education in palliative care, but they rely on their experience-based knowledge to a large extent and provide care according to the four cornerstones of palliative care.

Efficacy of Digital Dance on Brain Imagery, Cognition, and Health: Randomized Controlled Trial.

BACKGROUND: Multidomain interventions have demonstrable benefits for promoting healthy aging, but self-empowerment strategies to sustain long-term gains remain elusive. OBJECTIVE: This study evaluated the effects of digital somatosensory dance game participation on brain imagery changes as primary outcomes and other physical and mental health measures as secondary outcomes related to healthy aging. METHODS: Between August 31, 2020, and June 27, 2021, this randomized controlled trial recruited 60 eligible participants older than 55 years with no recent engagement in digital dance games. A computer-generated randomization sequence was used to allocate participants 1:1, without stratification, to an intervention group (n=30) who underwent digital somatosensory dance game training or a control group (n=30). An anonymized code masked the intervention allocations from the investigators, and individuals who assigned the interventions were not involved in analyzing the study data. The intervention entailed two 30-minute dance game sessions per week for 6 months, and the control group received healthy aging education. Primary outcomes were brain imagery changes. All variables were measured at baseline and the 6-month follow-up, and intervention effects were estimated using t tests with intention-to-treat analyses. RESULTS: Compared with the control group, intervention participants had significantly different brain imagery in the gray matter volume (GMV) of the left putamen (estimate 0.016, 95% CI 0.008 to 0.024; P<.001), GMV of the left pallidum (estimate 0.02, 95% CI 0.006 to 0.034; P=.004), and fractional amplitude of low frequency fluctuations of the left pallidum (estimate 0.262, 95% CI 0.084 to 0.439; P=.004). Additionally, the intervention group had different imagery in the cerebellum VI GMV (estimate 0.011, 95% CI 0.003 to 0.02; P=.01). The intervention group also had improved total Montreal Cognitive Assessment scores (estimate 1.2, 95% CI 0.27 to -2.13; P<.01), quality of life (estimate 7.08, 95% CI 2.35 to 11.82; P=.004), and time spent sitting on weekdays (estimate -1.96, 95% CI -3.33 to -0.60; P=.005). Furthermore, dance performance was significantly associated with cognitive performance (P=.003), health status (P=.14), resilience (P=.007), and demoralization (P<.001). CONCLUSIONS: Digital somatosensory dance game participation for 6 months was associated with brain imagery changes in multiple regions involving somatosensory, motor, visual, and attention functions, which were consistent with phenotypic improvements associated with healthy aging. TRIAL REGISTRATION: ClinicalTrials.gov NCT05411042; https://clinicaltrials.gov/study/NCT05411042.

Expectations and Preferences for Digital Cessation Treatment: Multimethods Study Among Older Adults Who Smoke Cigarettes.

BACKGROUND: To address enduring age-related tobacco disparities, it is critical to promote cessation treatment among older adults (aged 65+ years). Digital health platforms offer opportunities for wide dissemination of evidence-based behavioral cessation support. However, existing digital cessation treatments are not tailored to unique aging-related needs and preferences, resulting in low uptake. Detailed information is needed about how to best adapt these treatments for this age group. OBJECTIVE: We aimed to collect detailed, hypothesis-generating information about expectations and preferences for cessation digital treatment among older adults who smoke cigarettes. METHODS: Semistructured interviews were conducted with adults aged 65+ years currently smoking or who had quit within the past month. Interviews included open-ended questions regarding prior experiences with digital health platforms and expectations and preferences for cessation treatment via various modalities (app-delivered, texting-based, or videoconferencing counseling). Interviews also elicited questions regarding digital modalities that integrated social components (app-delivered social forums and group videoconferencing counseling). Using an iterative, team-based approach, the thematic analysis identified meaningful themes. Interviews were supplemented with quantitative measures assessing sociodemographics, digital literacy, and physical health symptoms. RESULTS: Participants (12/20, 60% men; 15/20, 75% White; 4/20, 20% Black or African American; 1/20, 5% Asian) were currently smoking (17/20, 85%) or had recently quit (3/20, 15%). Thematic analysis identified 3 meaningful themes across all digital modalities: convenience, accessibility, and personalization. Expected benefits of digital platforms included convenient treatment access, without reliance on transportation. Participants preferred treatments to be personalized and deliver content or strategies beyond standard education. Most (17/20, 85%) were unfamiliar with cessation apps but found them appealing given the potential for offering a novel quitting strategy. App ease of use (eg, easy navigation) was preferred. Half (10/20, 50%) would try a texting-based intervention, with many preferring texting with a counselor rather than automated messaging. Most (17/20, 85%) would use videoconferencing and expected this modality to deliver better quality counseling than via telephone. Expected videoconferencing challenges included looking presentable onscreen, technological difficulties, and privacy or security. Videoconferencing was regarded as the most personalized digital treatment, yet benefits unique to app-delivered and texting-based treatments included anonymity and access to treatment 24/7. Participants expected integrating social components into digital treatment to be useful for quit success and social connection, yet were concerned about possible interpersonal challenges. CONCLUSIONS: Because a long history of quit attempts and familiarity with standard quitting advice is common among older adults who smoke cigarettes, digital platforms might offer appealing and novel strategies for cessation that are accessible and convenient. Overall, this population was open to trying digital cessation treatments and would prefer that these platforms prioritize ease of use and personalized content. These findings challenge the bias that older adults are uninterested or unwilling to engage with digital treatments for behavioral health.

Understanding the home environment of older adults living with dementia: A scoping review of assessment tools.

Rigorous assessments to better understand the person-environment interaction are essential to comprehend how neurocognitive disorders influence in-home functioning of older people living with dementia. No recent synthesis identifies validated instruments targeting the human (e.g. caregivers) and nonhuman (e.g. objects) elements of the home environment interacting with this population and used with the perspective of aging in place. Consequently, following Arksey and O'Malley's (2005) scoping review method, 2,182 articles were identified in six databases and in gray literature. Two reviewers independently selected 23 relevant articles describing 19 validated assessment tools targeting elements of the home interacting with older people with dementia, namely: nonhuman environment (n = 13), human environment (n = 3), and person-environment interaction (n = 3). This overview highlights the scarcity of tools addressing the human environment and the person-environment interaction to foster sustainable at-home living for older people with neurocognitive disorders, demonstrating the need to incorporate new evidence-based, holistic methods into dementia home care.

End-of-life conversations for the older person: A concept analysis.

AIM: The aim of this concept analysis is to seek clarity as to what end-of-life conversations involve by developing a clear working definition and using model cases to conceptualise the defining attributes of an end-of-life conversations with the older person. DESIGN: Walker and Avant's eight step approach to Concept Analysis. DATA SOURCES: Four databases were searched, including PubMed, CINAHL, PsycINFO, and Scopus. A total of 339 publications were identified with 30 papers meeting the inclusion criteria and put forward for the final conceptual analysis. RESULTS: The defining attributes associated with end-of life conversations included (1) an ongoing process of older person empowerment, (2) discussion's concerning values and preferences concerning end-of-life issues, and (3) maintaining an open dialogue between all concerned individuals. Antecedents were associated with the older person is their readiness to talk openly about death and dying. Consequences were identified as having a better understanding of what death and dying may mean to the older person in a more specific manner. CONCLUSIONS: End-of-life conversations are vital in understanding an individual's values and preferences at the end of life, and yet, the concept of the end-of-life conversation has not been well defined in the literature. End-of-life conversations with the older person encompass ongoing discussions and maintaining open dialogue around end-of-life care while developing strategies to promote individual empowerment in making informed choices. Using a conceptual model, aides in addressing aspects of end-of-life conversations and an acknowledgment of the dynamic process of end-of-life conversations.

Effects of empathy training on psychological concerns and empathy in caregivers of older people: A randomized, double-blind, crossover, clinical trial with follow-up.

OBJECTIVES: To investigate the effects of empathy training on psychological concerns and empathy in caregivers of older people. METHODS: A randomized, double-blind, crossover, clinical trial with follow-up was conducted online. Thirty paid and unpaid caregivers of older people from different regions of Brazil participated in an empathy training program. The caregivers answered a sociodemographic questionnaire and measures for the evaluation of empathy (affective and cognitive domains), burden, the impact of providing care as well as depressive symptoms and psychiatric symptoms before and immediately after training. Empathy and its domains were also assessed at three post-intervention follow-ups. RESULTS: Empathy training diminished levels of psychological concerns. Moreover, an increase was found in levels of cognitive empathy 15, 30 and 60 days after the intervention. CONCLUSIONS: Empathy training with a focus on cognitive empathy diminished psychological concerns in caregivers of older people and increased the levels of this ability over time. This intervention can be considered a coping strategy for negative impacts related to providing care. CLINICA LTRIAL REGISTRATION: RBR-8kjtfx3.

Review of recently published articles.

Aysha Mendes provides a synopsis and brief review of a selection of recently published research articles that are of interest to community nurses, highlighting key points to keep you up to date; a full reference is provided for those who wish to read the research in more detail.

Phase II clinical trial to study the safety and efficacy of combined S-1 + oxaliplatin therapy as neoadjuvant chemotherapy for locally advanced gastric cancer in older patients.

BACKGROUND: Gastrectomy with D2 dissection and adjuvant chemotherapy is the standard treatment for locally advanced gastric cancer (LAGC) in Asia. However, administering chemotherapy with sufficient intensity after gastrectomy is challenging. Several trials demonstrated the efficacy of neoadjuvant chemotherapy (NAC). However, limited studies explored the feasibility of NAC-SOX for older patients with LAGC. This phase II study (KSCC1801) evaluated the safety and efficacy of NAC-SOX in patients with LAGC aged ≥ 70 years. METHODS: Patients received three cycles of SOX130 (oxaliplatin 130 mg/m2 on day 1, oral S-1 40-60 mg twice daily for two weeks every three weeks) as NAC, followed by gastrectomy with lymph node dissection. The primary endpoint was the dose intensity (DI). The secondary endpoints were safety, R0 resection rate, pathological response rate (pRR), overall survival, and relapse-free survival. RESULTS: The median age of 26 enrolled patients was 74.5 years. The median DI in NAC-SOX130 was 97.2% for S-1 and 98.3% for oxaliplatin. Three cycles of NAC were administered in 25 patients (96.2%), of whom 24 (92.3%) underwent gastrectomy with lymphadenectomy. The R0 resection rate was 92.3% and the pRR (≥ grade 1b) was 62.5%. The major adverse events (≥ grade 3) were neutropenia (20.0%), thrombocytopenia (11.5%), anorexia (11.5%), nausea (7.7%), and hyponatremia (7.7%). Postoperative complications of abdominal infection, elevated blood amylase, and bacteremia occurred in one patient each. Severe diarrhea and dehydration caused one treatment-related death. CONCLUSIONS: NAC-SOX130 is a feasible therapy for older patients, although systemic management and careful monitoring of adverse events are necessary.

Staff knowledge, attitudes and confidence levels for fall preventions in older person long-term care facilities: a cross-sectional study.

BACKGROUND: Falls are the most common health problem affecting older people in long-term care facilities (LTCFs), with well-recognised adverse psychological and physical resident outcomes, and high staff burden and financial cost. LTCF staff knowledge and skills can play a vital role in providing and promoting fall prevention care. METHODS: A descriptive cross-sectional survey study was conducted across 13 LTCF sites in the Southwest of Ireland; a sampling frame facilitated inclusion of a range of provider types and facility sizes. An existing questionnaire, based on fall prevention guidance, and examining staff knowledge, skills and attitudes, was distributed in physical and online formats. RESULT: The response rate was 15% (n = 155), predominantly healthcare assistants, staff nurses and senior nurses. Almost 90% expressed high confidence levels for delivering fall prevention interventions and being aware of how falls affect LTCFs. However, over half underestimated the fall rate in LTCFs, and only 60% had adequate knowledge. Longer experience in working with older people in healthcare services was associated with greater knowledge (p = .001) and confidence in fall prevention interventions (p = .01), while senior nurses had more knowledge than others (p = .01). LTCF staff had lowest knowledge about "identification systems for residents at high risk of falling", "keeping confused residents near nursing stations", "the effect of using antipsychotic medicine on falls", "using a toileting regimen" and "staff responsibility regarding fall prevention efforts". Despite their knowledge gaps, nearly 50% thought they had enough fall prevention training; their main preference for any further fall education training was face-to-face education. CONCLUSION: The results, with the caveat of a low response rate, show the need for interdisciplinary fall prevention training that is tailored to both the perceived learning needs and actual knowledge gap of LTCF staff and their preferences for learning delivery, as part of an overall approach to reducing fall-related adverse outcomes.

Staff's insights into fall prevention solutions in long-term care facilities: a cross-sectional study.

BACKGROUND: Falls are one of the most common and serious health issues in long-term care facilities (LTCFs), impacting not just residents, but staff and the healthcare system. This study aimed to explore LTCF staff's current practices around falls prevention, and their suggested solutions for better falls prevention. METHODS: In the southwest of Ireland, a descriptive cross-sectional study was conducted in 13 LTCF sites, across a range of provider types and facility sizes. A survey, measuring staff knowledge, skills and attitudes, was distributed in physical and online formats. Staff suggestions for prioritising fall and fall-related injury prevention activities, and current staff practices regarding fall incidents were also sought. Content analysis was used to analyse responses, mapping categories and subcategories to the refined theoretical domains framework (TDF) and to an existing fall prevention guideline. RESULTS: There were 155 respondents (15% response rate), from staff of the LTCFs. Environmental reviews and modifications (aligned to the TDF environmental context and resource domain) were the most common suggestions for preventing both falls and fall-related injuries. Other common suggestions for preventing falls were staff education, monitoring of residents, and using alarm/calling systems, while few staff members, across all roles, reported assessing residents, exercises, reviewing medications, and vitamin D supplements. For preventing fall-related injuries, suggestions included protective equipment, hip protectors and alarm/calling systems. Staff used a standardised approach when responding to a fall incident, with intensive and holistic post-fall control measures. HCAs focussed on transferring residents safely, while nurses of all grades focused more on post-fall assessment. Respondents believed that staff education, communication, increasing staffing levels and enhancing specialist care could support their practice. CONCLUSION: Noting the low response rate, the results suggest an awareness gap regarding some evidence-based, resident-focussed falls prevention solutions, such as pro-active fall-risk assessment, exercise, medication review, and Vitamin D supplements. These aspects should be included in future fall prevention education programmes in LTCFs.

Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review.

BACKGROUND: Falls are common among older people in long-term care facilities (LTCFs). Falls cause considerable morbidity, mortality and reduced quality of life. Of numerous interventional studies of fall prevention interventions in LTCFs, some reduced falls. However, there are challenges to implementing these interventions in real-world (non-trial) clinical practice, and the implementation techniques may be crucial to successful translation. This systematic review thus aimed to synthesise the evidence on implementation strategies, implementation outcomes and clinical outcomes included in fall prevention intervention studies. METHODS: A systematic search of six electronic databases (PubMed, CINAHL, EMBASE, PsycINFO, SCOPUS, Web of Science) and eight grey literature databases was conducted, involving papers published during 2001-2021, in English or Arabic, targeting original empirical studies of fall prevention interventions (experimental and quasi-experimental). Two seminal implementation frameworks guided the categorisation of implementation strategies and outcomes: the Expert Recommendations for Implementing Change (ERIC) Taxonomy and the Implementation Outcomes Framework. Four ERIC sub-categories and three additional implementation strategies were created to clarify overlapping definitions and reflect the implementation approach. Two independent researchers completed title/abstract and full-text screening, quality appraisal assessment, data abstraction and coding of the implementation strategies and outcomes. A narrative synthesis was performed to analyse results. RESULTS: Four thousand three hundred ninety-seven potential papers were identified; 31 papers were included, describing 27 different fall prevention studies. These studies used 39 implementation strategies (3-17 per study). Educational and training strategies were used in almost all (n = 26), followed by evaluative strategies (n = 20) and developing stakeholders' interrelationships (n = 20). Within educational and training strategies, education outreach/meetings (n = 17), distributing educational materials (n = 17) and developing educational materials (n = 13) were the most common, with 36 strategies coded to the ERIC taxonomy. Three strategies were added to allow coding of once-off training, dynamic education and ongoing medical consultation. Among the 15 studies reporting implementation outcomes, fidelity was the most common (n = 8). CONCLUSION: This is the first study to comprehensively identify the implementation strategies used in falls prevention interventions in LTCFs. Education is the most common implementation strategy used in this setting. This review highlighted that there was poor reporting of the implementation strategies, limited assessment of implementation outcomes, and there was no discernible pattern of implementation strategies used in effective interventions, which should be improved and clearly defined. TRIAL REGISTRATION: This systematic review was registered on the PROSPERO database; registration number: CRD42021239604.

A diarized journey: an interpretative phenomenological analysis of the older person's lived experience of a hip or knee replacement within a fast-track programme.

BACKGROUND: For the older person living with end-stage hip or knee osteoarthritis, a hip or knee replacement can be a traumatic event, influencing the physical, physiological, psychological, social and economic facets of daily living. This interpretative phenomenological study aimed to reveal and interpret the daily lived experiences of the older person before, during and after a primary total hip or knee replacement surgery in a fast-track programme in South Africa. METHODS: A qualitative interpretive phenomenological study, collecting data through solicited diaries and reflexive member validation interviews from seven participants aged 65-75 years, who underwent a primary elective hip or knee replacement surgery. The surgical fast-track process and data collection process happened simultaneously. Data collection from the solicited diary started before surgery, continued during the surgery process and finished six weeks after surgery and this was followed with reflexive member validation interviews. Interpretative phenomenological analysis was used throughout the three phases of the fast-track programme. RESULTS: Three superordinate themes developed during the three phases of surgery: "The holistic impact of pain on daily quality of life", "Finding ways to cope", and "Transition between independence and dependence and back". Although former research confirms the physical impact of osteoarthritis on the older person and the success of fast-track programmes for subsequent hip and knee replacements, this study contributes to the holistic impact of the surgery on participants' daily lives. The diarized journey of individuals through the psychological, psychosocial, physical, professional, and spiritual experience are described and interpreted in this study. CONCLUSIONS: Across the solicited diaries, it was clear that pain as catalyst impacted the daily activities of the individual physically, psychologically, and psychosocially. Pain was subjectively present at different intensities during all the phases of the replacement surgery, impairing mobilization and triggering roller-coaster emotions. In order to cope with physical and emotional difficulties while preparing and adjusting to the environment, participants reflected on social support, physical and professional support, and spirituality. Throughout the preparation, hospitalization and the recovery process, the transition between independence, dependence, and back to independence was significant, reinforcing the individual's determination to recover.

Psychiatric service delivery for older people in hospital and residential aged care: An updated systematic review.

OBJECTIVE: To review studies reporting on the effectiveness of psychiatry service delivery for older people and people with dementia in hospital and residential aged care. METHODS: A systematic search of four databases was conducted to obtain peer-reviewed literature reporting original research published since June 2004 evaluating a psychiatry service for older people (aged 60 years and over) or people with dementia in inpatient or residential aged care settings. RESULTS: From the 38 included studies, there was consistent low-to-moderate quality evidence supporting the effectiveness of inpatient older persons' mental health wards (n = 14) on neuropsychiatric symptoms, mood, anxiety and quality of life. Inpatient consultation/liaison old age psychiatry services (n = 9) were not associated with improved depression, quality of life or mortality in high-quality randomised studies. However, low-quality evidence demonstrated improved patient satisfaction with care and reduced carer stress. The highest quality studies demonstrated no effect of psychiatric in-reach services to residential aged care (n = 9) on neuropsychiatric symptoms but a significant reduction in depressive symptoms among people with dementia. There was low-quality evidence that long-stay intermediate care wards (n = 6) were associated with reduced risk for dangerous behavioural incidents and reduced costs compared to residential aged care facilities. There was no effect of these units on neuropsychiatric symptoms or carer stress. CONCLUSIONS AND IMPLICATIONS: The scarcity of high-quality studies examining the effectiveness of old age psychiatry services leaves providers and policy-makers to rely on low-quality evidence when designing services. Future research should consider carefully which outcomes to include, given that staff skill and confidence, length of stay, recommendation uptake, patient- and family-reported experiences, and negative outcomes (i.e. injuries, property damage) are as important as clinical outcomes.

Home care nursing practice for older persons with heart failure living at home.

AIMS AND OBJECTIVES: To enhance knowledge of how older people with heart failure, living at home, manage their illness with the support of their family caregivers and home care nursing services. BACKGROUND: Heart failure monitoring and self-care have been important means of reducing the serious impact of heart failure. Drawing on theories of practice as enacted and conceptualising service users and their family caregivers as active, the idea of attunement was used to explore how home care nurses work in supporting them. DESIGN: Ethnographic case study. METHOD: Data collection involved home visits and interviews (10 home care users, 10 caregivers, five home care team leaders). Data were field-notes and transcribed interviews. Themes were deductively developed from the findings, informed by the theoretical background, using content analysis. The COREQ checklist was used. FINDINGS: Three themes were developed from the data: (1) Practices of attunement in relations, (2) Becoming among difficulties and (3) Off track-difficult to attune around self-care. CONCLUSIONS: The findings reflect the complexity of heart failure monitoring at home, showing how, in addition to self-care measures, users are supported by an array of informal and formal care. The caregiving situation is shaped by relations among participants and involves making oneself available to the situation. We suggest a stance of attunement for home care nurses, which demands tact and calls for interest, engagement and openness. RELEVANCE TO CLINICAL PRACTICE: Study findings caution against limiting heart failure monitoring to circumscribed tasks, instead calling for a holistic understanding of what may be helpful for users. Home care nurses need time to attune with users living with heart failure and their caregivers to prevent exacerbations and promote well-being. NO PATIENT OR PUBLIC CONTRIBUTION: Although patients were not formally involved in study design ethnography favours their voice.

The five aspects mealtime environment observation instrument for assessing mealtime environments in nursing homes: Development and validation.

AIMS AND OBJECTIVES: To further develop and validate the Mealtime instrument, an observational instrument for assessing mealtime environments in nursing homes originating from the theoretical framework: Five Aspects Meal Model (FAMM). METHODOLOGICAL DESIGN AND JUSTIFICATION: A mealtime experience is significant for a sense of well-being. In nursing homes, residents' personal preferences, combined with their diagnoses and different stages of illness, influence their mealtime experience and provide a complexity that has been found difficult to assess. Using FAMM, a theoretical framework as its base, this study, attempts to look at different parts of the mealtime environment. FAMM structures the mealtime environment in to five aspects: room, meeting, product, management control system and atmosphere. This study's design includes instrument development and validation. ETHICAL ISSUES AND APPROVAL: This study has been approved by the Swedish Ethical Review Authority (dnr 2019-05477). DESIGN: Methodological study. RESEARCH METHOD: An existing instrument, the Mealtime instrument with FAMM as a theoretical framework, was used as a foundation for the development of the Five Aspects Mealtime Environment Observation Instrument (FAME-OI). Content validity index (CVI) was used to validate FAME-OI. RESULTS: FAME-OI's item-CVI, scale-CVI and modified Kappa displayed high validity. Changes were made in its structure and phrasing. These developments resulted in having a distinct structure in FAME-OI, in reference to FAMM. CONCLUSION: FAME-OI is applicable for clinical use in nursing homes and in research; however, adjustments may be needed before its use in other health care facilities.

Experiences of dignity: Age at onset of serious illness matters.

BACKGROUND: Preserving persons' dignity is integral to nursing. More research is needed to explore how a diversity of patients, particularly those that experience illness from a young age, experience dignity. AIM: Describe the characteristics of dignity for persons living with serious illness. RESEARCH DESIGN: Using a secondary data set of twenty audio-recorded interviews, a thematic content analysis was conducted to identify characteristics of dignity. The research team employed van Gennip et al.'s, 2013 "Model of Dignity in Illness" (1) to create a codebook, which the authors utilized to independently code twenty narrative interview transcripts. PARTICIPANTS AND RESEARCH CONTEXT: Twenty persons living with serious illness of heart failure and/or dialysis-dependent renal failure who were admitted in an acute care hospital. ETHICAL CONSIDERATIONS: This study was approved on August 26, 2019, by the Colorado Multiple Institutional Review Board (COMIRB) IRB Protocol #19-1874. FINDINGS: Early-onset participants expressed markedly different dignity concerns than late-onset participants. In the individual domain, early-onset participants felt that their illness was "normal"; they did not experience the "healthy person to patient" transition described by older onset participants. In the relational domain, early-onset participants expressed that their relationships had already integrated their illness while late-onset participants felt that their illness harmed many of their relationships. In the societal domain, early-onset participants described dignity concerns related to how society impacted their ability to financially support themselves during their illness. DISCUSSION: Differences in the dignity experience of early-onset and late-onset participants are informed by Erikson's "Model of Development" and by Aranda and Jones feminist critique of dignity in healthcare. CONCLUSIONS: Persons with early-onset illness experience dignity differently. Awareness of the importance of work and financial independence to the experience of dignity for seriously ill patients may enhance persons' dignity experience.

Ethical issues in long-term care settings: Care workers' lived experiences.

BACKGROUND: Professional care workers face ethical issues in long-term care settings (LTCS) for older adults. They need to be independent and responsible, despite limited resources, a shortage of skilled professionals, global and societal changes, and the negative reputation of LTCS work. RESEARCH AIM: Our aim was to describe the care workers' lived experiences of ethical issues. The findings can be used to gain new perspectives and to guide decision-making to improve the quality of care, occupational well-being and nursing education. RESEARCH DESIGN: Focus group interviews were analyzed using a hermeneutic-phenomenological method. The analysis comprised three steps: naïve reading, structural analysis, and comprehensive understanding. PARTICIPANTS AND RESEARCH CONTEXT: We randomly sampled LTCS service providers in Finland and 53 care workers with different educational backgrounds from seven organizations participated in focus group interviews in 2021. ETHICAL CONSIDERATIONS: This was a sensitive study, which was connected to the participants' individual views of the world, professional ethics and social and health care legislation. The participants' provided informed consent and their anonymity was guaranteed. FINDINGS: Care workers spoke about their lived experiences of ethical issues in an emotional way, using practical examples. They talked about how they were experts at caring and advocating for residents, balanced the responsibilities of their different roles, and defended their work to the wider society. The care workers said that ethical aspects of their work were too difficult to solve on their own. There were elements of their working environment and practices that caused unnecessary strain and they needed the commitment of managers, organizations, and society to solve ethical issues in LTCS. CONCLUSIONS: Ethical issues were related to the well-being of both residents and care workers and reflected both internal and external pressures. Some issues could not be resolved by individuals and needed input from managers, organizations, and society.