Re-orientating health and nursing care: a qualitative study on indigenous conceptualisations of wellbeing.

BACKGROUND: Health systems often fail to address the wellbeing needs of older Indigenous populations; this is attributed to a lack of knowledge of Indigenous health systems arising from a privileging of dominant western biomedical epistemologies. In Aotearoa/New Zealand, there is a dearth of nursing knowledge relating to Maori, which negatively impacts on the provision of holistic nursing care. This research explores insights and perspectives of older Maori adult's (pakeke) perceptions of wellbeing so nurses can provide culturally responsive care and support the wellbeing of Indigenous New Zealanders. METHODS: An Indigenous kaupapa Maori methodology underpinned and directed this research project. Audio-recorded interviews were conducted face to face in participants' homes, marae (meeting house) and workplaces. Pakeke over the age of 55 participated in in-depth interviews. A total of 10 pakeke were interviewed and narratives were thematically analysed in accordance with meanings derived from Maori worldviews. RESULTS: Wellbeing was attributed to the holistic interconnection and balancing of whanau (wider family), whanaungatanga (social connectedness), hinengaro (mental and emotional wellbeing), taha tinana (physical wellbeing) and wairua (spirituality). CONCLUSION: The findings offer unique insights into how wellbeing is constructed for pakeke; the results are unique but consistent with international accounts of older Indigenous peoples. Pakeke wellbeing can be supported by acknowledging existing cultural and spiritual beliefs and peer-support initiatives. Nursing models of care should prioritise Indigenous ways of knowing; this research offers nursing-focused recommendations to improve care.

Adverse Perinatal Outcomes in COVID-19 Infected Pregnant Women: A Systematic Review and Meta-Analysis.

The impact of COVID-19 virus infection during pregnancy is still unclear. This systematic review and meta-analysis aimed to quantitatively pool the evidence on impact of COVID-19 infection on perinatal outcomes. Databases of Medline, Embase, and Cochrane library were searched using the keywords related to COVID-19 and perinatal outcomes from December 2019 to 30 June 2021. Observational studies comparing the perinatal outcomes of COVID-19 infection in pregnancy with a non-infected comparator were included. The screening process and quality assessment of the included studies were performed independently by two reviewers. Meta-analyses were used to pool the comparative dichotomous data on perinatal outcomes. The database search yielded 4049 results, 1254 of which were duplicates. We included a total of 21 observational studies that assessed the adverse perinatal outcomes with COVID-19 infection. The odds of maternal death (pooled OR: 7.05 [2.41-20.65]), preeclampsia (pooled OR: 1.39 [1.29-1.50]), cesarean delivery (pooled OR: 1.67 [1.29-2.15]), fetal distress (pooled OR: 1.66 [1.35-2.05]), preterm birth (pooled OR: 1.86 [1.34-2.58]), low birth weight (pooled OR: 1.69 [1.35-2.11]), stillbirth (pooled OR: 1.46 [1.16-1.85]), 5th minute Apgar score of less than 7 (pooled OR: 1.44 [1.11-1.86]) and admissions to neonatal intensive care unit (pooled OR: 2.12 [1.36-3.32]) were higher among COVID-19 infected pregnant women compared to non-infected pregnant women.

Holding on and letting go: Views about filial piety among adult children living in New Zealand.

AIMS AND OBJECTIVES: The study aimed to explore the perspectives of adult children about late-life living and care arrangements for their ageing immigrant parents living in New Zealand. BACKGROUND: Older immigrants' well-being is closely associated with filial relations and is often reliant on families as a main source of social, financial and emotional support. Research among migrant Asian adults has reported mixed findings regarding intergenerational perspectives of filial practices. DESIGN: Qualitative design using focused ethnographic lens. METHODS: Semi-structured individual interviews were undertaken with 45 adult children of older immigrants living in New Zealand to explore their views about filial piety. The CoREQ checklist was used in reporting methods and findings. RESULTS: Two major themes were identified in this study of adult children's view of filial piety and late-life care for their ageing parents. The first theme, 'holding on-reconfiguring values', referred to a process described by the participants as upholding the core values and cultural familial expectations, looking after their ageing parents, yet modifying the ways in which they provide care. The second major theme 'letting go-reconfigured expectations', described participants' views of aged care for themselves, which meant they no longer held traditional values that needed to be enacted by their children. CONCLUSIONS: Adult children from immigrant families were positioned as intermediaries of these shifting values of their own and within younger generations. The adult children's shift of thinking and acceptance of reconfigured expression of filial duties impact care and living arrangements of older people from immigrant and culturally diverse backgrounds, which also influences health and well-being in later life. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals including nurses working in the ageing and aged care sector need to accommodate the changing generational perspectives about filial piety to cater to the unique late-life care requirements and health needs of older people and their families.

Social connectedness and self-perceived health of older adults in New Zealand.

The objective of this research was to explore social connectedness and associations with self-perceived health amongst older adults in New Zealand at a population level. The data for this analysis were derived from the 2016 Health and Lifestyle Survey, a nationally representative survey administered via face-to-face interviews. The findings from this analysis of 1,374 respondents, all of whom were over the age of 55 years, highlight that being female, belonging to older age groups (above 70 years), being employed full-time or part-time, connecting online with known people, considering cultural connections to be important and not feeling isolated from others are significantly and positively associated with positive self-perceived health. The findings underscore the resilience potential of older adults and importance of social connectedness for positive health and well-being. In addition, the findings reveal target areas that would benefit by intervention and support by health professionals and policy makers.

Cardiovascular disease risk prediction in older people: a qualitative study.

BACKGROUND: Despite cardiovascular disease (CVD) risk prediction equations becoming more widely available for people aged ≥75 years, views of older people on CVD risk assessment are unknown. AIM: To explore older people's views on CVD risk prediction and its assessment. DESIGN AND SETTING: Qualitative study of community-dwelling older people in New Zealand. METHOD: A diverse group of older people was purposively recruited. Semi-structured interviews and focus groups were conducted, transcribed verbatim, and thematically analysed. RESULTS: Thirty-nine participants (mean age 74 years) of Maori, Pacific, South Asian, and European ethnicities participated in one of 26 interviews or one of three focus groups. Three key themes emerged: poor knowledge and understanding of CVD and its risk assessment; acceptability and perceived benefit of knowing and receiving advice on managing personal CVD risk; and distinguishing between CVD outcomes - stroke and heart attack are not the same. Most participants did not understand CVD terms, but were familiar with the terms 'heart attack' and 'stroke', and understood lifestyle risk factors for these events. Participants valued CVD outcomes differently, fearing stroke and disability - which might adversely affect independence and quality of life - but were less concerned about a heart attack, which was perceived as causing less disability or swifter death. These findings and preferences were similar across ethnic groups. All but two participants wanted to know their CVD risk, how to manage it, and distinguish between CVD outcomes. Those who did not wish to know perceived this as something only their God could decide. CONCLUSION: To inform clinical decision making for older people, consideration of an individual's wish to know their risk is important, and risk prediction tools should provide separate event types rather than just composite outcomes.

Tai chi and yoga in residential aged care: Perspectives of participants: A qualitative study.

AIMS AND OBJECTIVES: This qualitative study examined the appropriateness and acceptability of 14-week modified tai chi and yoga programmes in an Australian residential aged care (RAC) setting by exploring experiences and perspectives of frail older residents and staff participants. BACKGROUND: Older persons in RAC have limited opportunities for physical activity. Tai chi and yoga are mindfulness-based exercise interventions that have been used to promote physical and psychological health of older adults in community settings. While research on tai chi and yoga interventions in community settings is promising, there is limited research regarding the interventions' appropriateness and acceptability for frail older residents in residential care settings in Australia. DESIGN: Descriptive and qualitative component of a mixed-methods study. METHODS: All residents who participated in the modified yoga and tai chi interventions and staff who supported them were invited. A total of 19 individuals comprising 16 residents and three staff members participated in three focus group interviews. The interviews were audio-recorded, transcribed and analysed thematically using a qualitative descriptive approach. RESULTS: Nine themes that reflected the uniqueness of the programmes' mind-body approach are presented: (a) novel, new and exciting; (b) smoothness, rhythm and flow; (c) slow and mindful; (d) gentle but rewarding; (e) moving whole body; (f) perceived benefits; (g) worthwhile; (h) feeling alive; and (i) calming and relaxing. CONCLUSIONS: The modified programmes of tai chi and yoga was acceptable, appropriate, enjoyable and helpful. Both tai chi and yoga appear to provide appropriate physical exercise and opportunities for older persons to enhance their quality of life through interaction of physical, emotional and intellectual wellness domains. RELEVANCE TO CLINICAL PRACTICE: The 14-week modified programmes of tai chi and yoga could be applied to frail older RAC population to promote health and active ageing.

The influence of tai chi and yoga on balance and falls in a residential care setting: A randomised controlled trial.

Abstract Falls amongst older people is a global public health concern. Whilst falling is not a typical feature of ageing, older people are more likely to fall. Fall injuries amongst older people are a leading cause of death and disability. Many older people do not do regular exercise so that they lose muscle tone, strength, and flexibility which affect balance and predispose them to falls. The management of falls in residential care settings is a major concern with strategies for prevention and monitoring a focus in this setting. Yoga and tai chi have shown potential to improve balance and prevent falls in older adults. They also have potential to improve pain and quality of life. The aim of this study was to determine the feasibility of conducting a three-arm randomised controlled trial (RCT) with frail older people in a residential care setting to test the hypothesis that a 14-week modified tai chi or yoga programme is more effective than usual care activity in improving balance function, quality of life, pain experience and in reducing number of falls. There were no statistically significant differences between the three groups in the occurrence of falls. Yoga demonstrated a slight decrease in fall incidence; quality of life improved for the tai chi group. Only the yoga group experienced a reduction in average pain scores though not statistically significant. The findings of the study suggest it is possible to safely implement modified yoga and tai chi in a residential care setting and evaluate this using RCT design. They show positive changes to balance, pain and quality of life and a high level of interest through attendance amongst the older participants. The results support offering tai chi and yoga to older people who are frail and dependent with physical and cognitive limitations.

The influence of tai chi and yoga on balance and falls in a residential care setting: a randomised controlled trial.

Abstract Falls amongst older people is a global public health concern. Whilst falling is not a typical feature of ageing, older people are more likely to fall. Fall injuries amongst older people are a leading cause of death and disability. Many older people do not do regular exercise so that they lose muscle tone, strength, and flexibility which affect balance and predispose them to falls. The management of falls in residential care settings is a major concern with strategies for prevention and monitoring a focus in this setting. Yoga and tai chi have shown potential to improve balance and prevent falls in older adults. They also have potential to improve pain and quality of life. The aim of this study was to determine the feasibility of conducting a 3-arm RCT with frail older people in a residential care setting to test the hypothesis that a 14 week modified tai chi or yoga program is more effective than usual care activity in improving balance function, quality of life, pain experience and in reducing number of falls. There were no statistically significant differences between the three groups in the occurrence of falls. Yoga demonstrated a slight decrease in fall incidence; quality of life improved for the tai chi group. Only the yoga group experienced a reduction in average pain scores though not statistically significant. The findings of the study suggest it is possible to safely implement modified yoga and tai chi in a residential care setting and evaluate this using RCT design. They show positive changes to balance, pain and quality of life and a high level of interest through attendance amongst the older participants. The results support offering tai chi and yoga to older people who are frail and dependent with physical and cognitive limitations.