Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study.

BACKGROUND: Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data. OBJECTIVE: This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions. METHODS: Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes. RESULTS: During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use. CONCLUSIONS: Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.

The ageing surgeon: a qualitative study of expert opinions on assuring performance and supporting safe career transitions among older surgeons.

BACKGROUND: Unlike some other safety critical professions, there is no mandatory age of retirement for doctors, including surgeons. Medical regulators in Australia are implementing additional checks on doctors from the age of 70. We describe expert opinions on assuring performance and supporting career transitions among older surgeons. METHODS: In this qualitative study, experts in four countries were purposively selected for their expertise in surgical governance. Experts responded to interviews (Australia, New Zealand and UK) or a survey (Canada). A tiered framework of interventions was developed by integrating findings with previous literature and responsive regulation theory. RESULTS: 52 experts participated. Participants valued the contribution of senior surgeons, while acknowledging that age-related changes can affect performance. Participants perceived that identity, relationships and finances influence retirement decisions. Experts were divided on the need for age-specific testing, with some favouring whole-of-career approaches to assuring safe care. A lack of validated tools for assessing performance of older surgeons was highlighted. Participants identified three options for addressing performance concerns-remediate, restrict or retire-and emphasised the need for co-ordinated and timely responses. CONCLUSION: Experts perceive the need for a staged approach to assessing the performance of older surgeons and tailoring interventions. Most older surgeons are seen to make decisions around career transitions with self-awareness and concern for patient safety. Some older surgeons may benefit from additional guidance and support from employers and professional colleges. A few poorly performing older surgeons, who are recalcitrant or lack insight, require regulatory action to protect patient safety. Developing robust processes to assess performance, remediate deficits and adjust scopes of practice could help to support safe career transitions at any age.

Spillover effects of a husband's retirement on a woman's health: Evidence from urban China.

Despite an increasing number of studies measuring the effect of retirement on individual well-being, research on spillover effects of one spouse's retirement on another spouse's well-being is limited. If such an effect exists but is not considered, it would result in an underestimation of the total retirement effect. This article examines the effect a man's retirement has on his wife's mental and physical health. Using data from the China Health and Retirement Longitudinal Survey (CHARLS), I exploit the large increase in the probability of retirement at the legal retirement age for urban male wage earners in China as a natural experiment. I implement a fuzzy regression discontinuity design to compare the health outcomes of women whose husbands recently retired with those whose husbands are close to retiring. Findings indicate that the retirement of her spouse improves a woman's physical and mental well-being, most likely by increasing the frequency of her social interactions and exercise.

Macro-level determinants of post-retirement health and health inequalities: A multilevel analysis of 18 European countries.

Poor health after retirement may have an important economic and societal impact and may be affected by macro-level factors. Our aim was to examine whether macro-level factors are associated with health and educational differences in health in recent retirees. We used data covering 18 European countries from the Survey on Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) on 8867 respondents who had been retired less than 5 years. We performed multi-level linear regression analyses to examine whether social expenditure in nine policy areas, minimum pension replacement rates, and unemployment replacement rates explained cross-country differences in post-retirement self-rated health (SRH) and educational inequalities in SRH. In both men and women, a higher total expenditure as well as higher expenditures on health, old age, housing, and 'other social policy areas' (non-categorical cash benefits to low-income households and other social services) were associated with better SRH. Cross-level interactions showed that in the presence of a higher old age expenditure, a higher unemployment expenditure, and a higher total expenditure, the absolute educational inequalities in post-retirement SRH were smaller than with lower expenditures in these areas, in both men and women. We found the same effect in women only for a higher expenditure on health as well as a higher minimum pension replacement rate. A higher expenditure on survivors pensions, a lower expenditure on family, and a higher unemployment replacement rate had this effect in men only. This study showed that social expenditure and replacement rates were associated with post-retirement health and health inequalities.

Retirement, job satisfaction and attitudes towards mandatory accreditation: a Danish survey study in general practice.

OBJECTIVES: This study aims to analyse the associations between general practitioner (GP) retirement, job satisfaction and attitudes towards a mandatory accreditation scheme. External interventions such as mandatory accreditation schemes may be perceived negatively by GPs, causing early retirement from practice. In Denmark, almost half of the GPs had negative attitudes prior to the implementation of a mandatory accreditation scheme, constituting a possible risk of early practice retirement. SETTING: In January 2015 all 3,404 Danish GPs were invited to participate in a survey on attitudes towards a forthcoming mandatory accreditation programme. PARTICIPANTS: 1,906 GPs (56%) answered the questionnaire. In total, 391 (11%) retired from practice in the following period from 1 January 2015 to 31 January 2017. Of these, 193 GPs (49%) answered the questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was GP retirement. Labour union data on practice retirement were linked with data from the questionnaire survey on job satisfaction and attitudes prior to implementation of mandatory accreditation. Logistic regression analyses were used to determine the associations between practice retirement and job satisfaction and attitudes towards accreditation. RESULTS: Practice retirement was associated with job dissatisfaction (OR: 2.5, 95% CI 1.6 to 3.7). Retirement was not associated with any of the other surveyed attitudinal variables. Retirement rate was relatively high in the accreditation start-up period. CONCLUSION: Practice retirement was associated with job dissatisfaction but not to a priori attitudes towards an upcoming mandatory accreditation programme. However, the retirement rate was relatively high in the start-up period of the accreditation programme. Future research should evaluate the effects of external interventions on preterm retirement from general practice. TRIAL REGISTRATION NUMBER: NCT02762240.

Cross-national health comparisons using the Rasch model: findings from the 2012 US Health and Retirement Study and the 2012 Mexican Health and Aging Study.

PURPOSE: Cross-national comparisons of patterns of population aging have emerged as comparable national micro-data have become available. This study creates a metric using Rasch analysis and determines the health of American and Mexican older adult populations. METHODS: Secondary data analysis using representative samples aged 50 and older from 2012 U.S. Health and Retirement Study (n = 20,554); 2012 Mexican Health and Aging Study (n = 14,448). We developed a function measurement scale using Rasch analysis of 22 daily tasks and physical function questions. We tested psychometrics of the scale including factor analysis, fit statistics, internal consistency, and item difficulty. We investigated differences in function using multiple linear regression controlling for demographics. Lastly, we conducted subgroup analyses for chronic conditions. RESULTS: The created common metric demonstrated a unidimensional structure with good item fit, an acceptable precision (person reliability = 0.78), and an item difficulty hierarchy. The American adults appeared less functional than adults in Mexico (ß = - 0.26, p < 0.0001) and across two chronic conditions (arthritis, ß = - 0.36; lung problems, ß = - 0.62; all p < 0.05). However, American adults with stroke were more functional than Mexican adults (ß = 0.46, p = 0.047). CONCLUSIONS: The Rasch model indicates that Mexican adults were more functional than Americans at the population level and across two chronic conditions (arthritis and lung problems). Future studies would need to elucidate other factors affecting the function differences between the two countries.

The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points.

BACKGROUND: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known. OBJECTIVE: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions. METHODS: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested. RESULTS: A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times. CONCLUSIONS: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions.

Gender differences in retirement planning: A longitudinal study among Spanish Registered Nurses.

BACKGROUND: Consistent patterns of gender differences in retirement planning behaviours have been shown but little is known about these behaviours among nurses. AIMS: To analyse the antecedents of the behaviours to prepare for retirement in nurses older than 55 and to identify differences as a function of gender. METHODS: A two-wave longitudinal study with Spanish nurses (n = 132). RESULTS: Statistically significant gender differences were revealed. Specifically, paths from financial knowledge to public protection and self-insurance as well as paths from goals clarity to public protection all differed by gender. CONCLUSIONS: Patterns of retirement planning differentiated by gender apparently continue to emerge. IMPLICATIONS FOR NURSING MANAGEMENT: The study adds evidence showing that female nurses continue to rely on public protection as a solid support for their retirement. Despite their greater awareness of the importance of health care and social relations, savings and finance are more neglected by female nurses. Intervention should be aimed at fostering financial literacy of the entire nursing population, but particularly, the access of women to this training. Secondly, given that the differences persist, advance planning of social actions to protect those who will be living alone and economically helpless in old age.

Retirement planning and work-related variables in Chinese older nurses: A cross-sectional study.

AIM: To explore the situation of older nurses approaching retirement with regard to their retirement planning, and the relationship of their retirement planning behaviour with the job environment and job satisfaction under their current employment arrangements and other work-related variables. BACKGROUND: Nurse shortage has become a global phenomenon that can be alleviated by retaining older nurses in service. The Chinese government proposed the "Incremental Delay Retirement Age Policy." However, older nurses face delayed retirement but lack retirement plans. METHOD: A cross-sectional questionnaire survey was conducted among a convenience sample of older retiring nurses (n = 152; 84.92% response rate) recruited from every department of four large general hospitals in Changchun, Jilin Province from June to August 2016. RESULT: The majority of the respondents presented poor retirement planning (n = 122, 80.3%). The independent variables of information exchange with patients, teamwork and personal growth and development explained approximately 16.6% of the variance in retirement planning. Nurse-patient communication and personal growth and development can promote retirement planning, but teamwork is negatively related to retirement planning. CONCLUSION: Retirement planning by Chinese older nurses is related to certain work-related variables. However, many other work-related variables were not associated with retirement planning and require further research. Overall, Chinese older retiring nurses must improve their retirement planning practices.

Meeting the Late-Career Needs of Faculty Transitioning Through Retirement: One Institution's Approach.

PROBLEM: Medical school faculty are aging, but few academic health centers are adequately prepared with policies, programs, and resources (PPR) to assist late-career faculty. The authors sought to examine cultural barriers to successful retirement and create alignment between individual and institutional needs and tasks through PPR that embrace the contributions of senior faculty while enabling retirement transitions at the University of Massachusetts Medical School, 2013-2017. APPROACH: Faculty 50 or older were surveyed, programs at other institutions and from the literature (multiple fields) were reviewed, and senior faculty and leaders, including retired faculty, were engaged to develop and implement PPR. Cultural barriers were found to be significant, and a multipronged, multiyear strategy to address these barriers, which sequentially added PPR to support faculty, was put in place. A comprehensive framework of sequenced PPR was developed to address the needs and tasks of late-career transitions within three distinct phases: pre-retirement, retirement, and post-retirement. OUTCOMES: This sequential introduction approach has led to important outcomes for all three of the retirement phases, including reduction of cultural barriers, a policy that has been useful in assessing viability of proposed phased retirement plans, transparent and realistic discussions about financial issues, and consideration of roles that retired faculty can provide. NEXT STEPS: The authors are tracking the issues mentioned in consultations and efficacy of succession planning, and will be resurveying faculty to further refine their work. This framework approach could serve as a template for other academic health centers to address late-career faculty development.

Longitudinal associations of experiences of adversity and socioeconomic disadvantage during childhood with labour force participation and exit in later adulthood.

The Extending Working Lives (EWL) agenda seeks to sustain employment up to and beyond traditional retirement ages. This study examined the potential role of childhood factors in shaping labour force participation and exit among older adults, with a view to informing proactive interventions early in the life-course to enhance individuals' future capacity for extending their working lives. Childhood adversity and socioeconomic disadvantage have previously been linked to ill-health across the life-span and sickness benefit in early adulthood. This study builds upon previous research by examining associations between childhood adversity and self-reported labour force participation among older adults (aged 55). Data was from the National Child Development Study - a prospective cohort of all English, Scottish, & Welsh births in one week in 1958. There was evidence for associations between childhood adversity and increased risk of permanent sickness at 55 years - which were largely sustained after adjustment for educational disengagement and adulthood factors (mental/physical health, qualifications, socioeconomic disadvantage). Specifically, children who were abused or neglected were more likely to be permanently sick at 55 years. In addition, among males, those in care, those experiencing illness in the home, and those experiencing two or more childhood adversities were more likely to be permanently sick at 55 years. Childhood factors were also associated with part-time employment and retirement at 55 years. Severe childhood adversities may represent important distal predictors of labour force exit at 55 years, particularly via permanent sickness. Notably, some adversities show associations among males only, which may inform interventions designed to extend working lives.

Older women public sector workers in Ireland: Decisions about retirement timing.

Older women workers' decision making around retirement is increasingly important given the increasing involvement of older women in paid employment. This article explores influences on the retirement decision making of older women workers in Ireland. It is based on a case study of 57 interviews with women in the Irish civil service exploring work-life decision making. It finds that retirement choices vary according to initial socioeconomic resources and/or life-course trajectories and are particularly affected by gendered caring norms, employment policy, job tenure, and place in organizational hierarchies. Those women with interrupted careers and low pay have fewer choices around retirement timing.

Nurse administrators' intentions and considerations in recruiting inactive nurses.

AIMS: To understand nurse administrators' intentions and considerations in recruiting inactive nurses and to examine predictors of intent to recruit. BACKGROUND: Few studies have provided insight into employer intentions and considerations in recruiting inactive nurses. METHODS: A census survey collected data from 392 nurse administrators via a mailing method. RESULTS: Overall, 89.0% of nurse administrators were willing to recruit inactive nurses. Stepwise regression analysis revealed that the only predictor of nurse administrators' intention to recruit was nurse turnover rate at the hospital. Nurse administrators perceived the most important recruiting considerations were inactive nurses' cooperation with alternating shifts, health status and nursing licence. The most frequent reasons for not recruiting were an inactive nurse's lack of understanding of the medical environment and poor nursing competence. CONCLUSIONS: Most hospital nurse administrators were willing to recruit inactive nurses. Inactive nurses who wish to return to work should be qualified, willing to work both day and night shifts, and in good health. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators can reduce the nursing shortage by recruiting inactive nurses. Re-entry preparation programmes should be implemented that will provide inactive nurses with knowledge of the current medical environment and the skills required to improve their nursing competence.

The aging psychiatrist: lessons from our colleagues in surgery and anaesthesia.

OBJECTIVES: The Royal Australasian College of Surgeons (RACS) has been innovative in developing core competencies, which provide a framework for assessing performance and a 'Code of Conduct', for the lifelong journey of all surgeons. The older surgeon may face significant challenges, having passed their peak, with a lower volume of cases, and potentially increased complications. They also face the challenges of retiring from active clinical practice with its logistical and psychological dilemmas. The RACS has, therefore, put in place several initiatives to deal with these dilemmas. CONCLUSIONS: The Senior Surgeons' Group, which conducts annual 'Building Towards Retirement' workshops, has been the driving force behind these initiatives. The group has a regular program in the RACS Annual Scientific Congress, including the multidisciplinary session 'The ageing specialist - challenges for regulators: hypothetical' which took place in 2014, and some of its members are part of a multidisciplinary team with an approach to adapting to ageing that encourages self-reflection and self-monitoring. It has also influenced the RACS Council to change the continuing professional development (CPD) regulations to include requirements for ageing surgeons regards health maintenance, peer reviews, and modified requirements to satisfy CPD completion. The RACS offers a variety of other opportunities for the ageing surgeon to remain active in college activities.

When should surgeons retire?

BACKGROUND: Retirement policies for surgeons differ worldwide. A range of normal human functional abilities decline as part of the ageing process. As life expectancy and their population increases, the performance ability of ageing surgeons is now a growing concern in relation to patient care. The aim was to explore the effects of ageing on surgeons' performance, and to identify current practical methods for transitioning surgeons out of practice at the appropriate time and age. METHODS: A narrative review was performed in MEDLINE using the terms 'ageing' and 'surgeon'. Additional articles were hand-picked. Modified PRISMA guidelines informed the selection of articles for inclusion. Articles were included only if they explored age-related changes in brain biology and the effect of ageing on surgeons' performance. RESULTS: The literature search yielded 1811 articles; of these, 36 articles were included in the final review. Wide variation in ability was observed across ageing individuals (both surgical and lay). Considerable variation in the effects of the surgeon's age on patient mortality and postoperative complications was noted. A lack of neuroimaging research exploring the ageing of surgeons' brains specifically, and lack of real markers available for measuring surgical performance, both hinder further investigation. Standard retirement policies in accordance with age-related surgical ability are lacking in most countries around the world. CONCLUSION: Competence should be assessed at an individual level, focusing on functional ability over chronological age; this should inform retirement policies for surgeons.

The ageing practitioner: ANZCA's recommendations.

OBJECTIVES: The aim is to present recommendations of the Australian and New Zealand College of Anaesthetists (ANZCA) with respect to practice implications for ageing specialists, together with brief discussion of effects of ageing on professional medical capabilities and recommendations on preparing to retire from medical practice. CONCLUSIONS: Practitioners should recognise that planning for retirement is part of good management of a medical career, and that the ageing process will inevitably compromise their ability to treat patients safely unless they retire at the appropriate time. Planning should include adequate financial preparation, and cultivation of interests and friends outside medicine. Practitioners should also realise that insight is likely to be compromised, so that they should seek colleagues who are trusted to advise them if/when they begin to lose competency. Lastly all practitioners should ensure that they consult a General Practitioner frequently, and that they have arranged all the proper legal instructions such as a Will, a Power of Attorney and an Advanced Health Directive.The ANZCA recommendations concerning ageing specialists have wide application to all medical specialties, not just for anaesthetists, and therefore all Medical Colleges should generate their own specific recommendations for ageing practitioners and the general effects of fatigue particularly for aged practitioners.