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1.
J Cross Cult Gerontol ; 35(2): 133-153, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32409899

RESUMO

This paper explores perspectives of Inuit elders on the relationships between aging, health and place. Their views are important to consider in the context of a growing proportion and number of older people in Arctic communities, a new sociological condition. Developing policies and programs to promote healthy aging in Inuit communities is challenging as there is little known about the social and living conditions that promote healthy aging in the Arctic. In this study twenty Inuit aged between 50 to 86, from one community in Nunavut, participated to in-depth qualitative interviews. Themes discussed included aging and health, housing conditions, community conditions, land-based activities, medical and leisure travel outside of the community, and mobility and accessibility. Preliminary analyses of the qualitative data were validated in the community through a focus group with four participants and an interpreter. Interviews and the focus group transcripts were analysed using thematic content analyses and NVivo 12 qualitative data analysis program (QSR International Pty Ltd. 2017). Participants reported that spending time with children, having social support, living in houses adapted to aging health conditions, having access to community activities and services, and time spent on the land were the main resources supporting their health. Several factors limited the availability of these resources. These include: lack of accessibility to resources; structural factors impacting their availability; and natural and social changes in interpersonal relationships. Participants also stressed the importance of being able to grow old in their own community. Knowledge generated in this project contributes to policies and programs targeting housing and community conditions to support healthy aging, and aging in place, in Inuit Nunangat.


Assuntos
Envelhecimento/psicologia , Envelhecimento Saudável/psicologia , Vida Independente/psicologia , Inuítes/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nunavut , Pesquisa Qualitativa , Determinantes Sociais da Saúde , Apoio Social
3.
Soc Psychiatry Psychiatr Epidemiol ; 55(1): 1-14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31679047

RESUMO

PURPOSE: To build an evidence-informed theoretical model describing how to support people with dementia to live well or for longer at home. METHODS: We searched electronic databases to August 2018 for papers meeting predetermined inclusion criteria in two reviews that informed our model. We scoped literature for theoretical models of how to enable people with dementia to live at home independently, with good life quality or for longer. We systematically reviewed Randomised Controlled Trials (RCTs) reporting psychosocial intervention effects on time lived with dementia at home. Two researchers independently rated risk of bias. We developed our theoretical model through discussions with experts by personal, clinical and academic experiences, informed by this evidence base. RESULTS: Our scoping review included 52 studies. We divided models identified into: values and approaches (relational and recovery models; optimising environment and activities; family carer skills and support); care strategies (family carer-focused; needs and goal-based; self-management); and service models (case management; integrated; consumer-directed). The 11 RCTs included in our systematic review, all judged at low risk of bias, described only two interventions that increased time people with dementia lived in their own homes. These collectively encompassed all these components except for consumer-directed and integrated care. We developed and revised our model, using review evidence and expert consultation to define the final model. CONCLUSIONS: Our theoretical model describes values, care strategies and service models that can be used in the design of interventions to enable people with dementia to live well and for longer at home. TRIAL REGISTRATION: PROSPERO 2018 registration number: CRD42018099693 (scoping review). PROSPERO 2018 registration number: CRD42018099200 (RCT systematic review).


Assuntos
Administração de Caso , Demência/psicologia , Vida Independente/psicologia , Cuidadores/psicologia , Demência/terapia , Assistência Domiciliar , Humanos , Modelos Teóricos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Arch Phys Med Rehabil ; 101(1): 54-61, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-29407517

RESUMO

OBJECTIVE: To assess the responsiveness of the Traumatic Brain Injury-Quality of Life (TBI-QOL) measurement system. DESIGN: Participants completed the 20 TBI-QOL item banks and the Participation Assessment with Recombined Tools-Objective (PART-O) Productivity Subscale at baseline and 6-month follow-up assessments. Participants were categorized into 4 groups (increased productivity, unchanged productivity, and decreased productivity) based on PART-O Productivity scores. Paired sample t tests were used to compare TBI-QOL scores at baseline and 6 months, and standardized response means and Cohen's d were computed to estimate effect sizes. SETTING: Three traumatic brain injury (TBI) Model Systems rehabilitation centers in the United States. PARTICIPANTS: Two hundred one community-dwelling adults with TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 20 TBI-QOL item banks. RESULTS: As expected, given that there was no intervention, group mean TBI-QOL subdomain scores for the entire sample showed no change or small improvement over the 6-month study period. At the follow-up assessment, 72 participants reported increased productivity, 71 reported decreased productivity, and 58 reported the same level of productivity as they had 6 months prior. When compared with participants who reported unchanged or decreased productivity, participants who reported increased productivity on the PART-O subscale had clinically meaningful (d≥0.30) improvements on 7 TBI-QOL measures. The largest improvement was in the Independence subdomain (mean change, 7.06; df=0.84), with differences also observed in the Mobility, Positive Affect and Well-Being, Resilience, Grief/Loss, Ability to Participate, and Satisfaction with Participation subdomains. CONCLUSIONS: The 20 TBI-QOL item banks demonstrate responsiveness to change and measurement stability in a community-dwelling sample. Researchers may use the TBI-QOL to detect changes in HRQOL after a clinical intervention and clinicians may use it in their daily practices to monitor patient recovery.


Assuntos
Lesões Encefálicas Traumáticas/psicologia , Avaliação da Deficiência , Eficiência , Vida Independente/psicologia , Qualidade de Vida/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Estados Unidos
5.
Arch Phys Med Rehabil ; 101(1): 62-71, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-28527644

RESUMO

OBJECTIVE: To determine the factor structure of the Traumatic Brain Injury-Quality of Life (TBI-QOL) measurement system. DESIGN: Observational. SETTING: 3 TBI Model Systems rehabilitation centers. PARTICIPANTS: Twenty TBI-QOL item banks were administered to a sample of community-dwelling adults with TBI (N=504) as part of a study of TBI classification. A subsample of participants (n=200) was randomly selected for exploratory factor analyses, while data from the remaining participants (n=304) were used for the confirmatory factor analysis. To examine a wide range of conceptual models, confirmatory factor analyses were conducted on a total of 16 models, ranging from 1 to 7 factors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Initial exploratory factor analysis yielded support for a 5-factor model (negative emotion, cognitive impairment, functioning and participation, positive emotion, pain). Confirmatory factor analysis results, however, indicated a 7-factor model including physical function, physical symptoms, cognition, negative emotion, positive emotion, sense of self, and social participation (model 16; robust fit statistics root mean square error of approximation =.063, standardized root mean square residual =.035, comparative fit index =.955, Tucker-Lewis Index =.943, Bayes Information Criterion =40059.44). CONCLUSIONS: The complex 7-factor model of the TBI-QOL provides a more nuanced framework for understanding health-related quality of life for persons with TBI than the commonly used 3-factor model including physical health, mental health, and social health.


Assuntos
Lesões Encefálicas Traumáticas/psicologia , Avaliação da Deficiência , Inquéritos e Questionários/normas , Adulto , Teorema de Bayes , Análise Fatorial , Feminino , Nível de Saúde , Humanos , Vida Independente/psicologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Desempenho Físico Funcional , Psicometria , Qualidade de Vida , Centros de Reabilitação , Comportamento Social
6.
Clin Interv Aging ; 14: 1985-1995, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31814713

RESUMO

Background: Older adults and care professionals advocate a more integrated and proactive care approach. This can be achieved by proactive outpatient assessment services that offer comprehensive geriatric assessments to better understand the needs of older adults and deliver person-centered and preventive care. However, the effects of these services are inconsistent. Increased involvement of the older adult during the assessment service could increase the effects on older adult's well-being. Methods: We studied the effect of an assessment service (Sage-atAge) for community-dwelling frail adults aged ≥65 years. After studying the local experiences, this service was adapted with the aim to increase participant involvement through individual goal setting and using motivational interviewing techniques by health-care professionals (Sage-atAge+). Within Sage-atAge+, when finishing the assessment, a "goal card" was written together with the older adult: a summary of the assessment, including goals and recommendations. We measured well-being with a composite endpoint consisting of health, psychological, quality of life, and social components. With regression analysis, we compared the effects of the Sage-atAge and Sage-atAge+ services on the well-being of participants. Results: In total, 453 older adults were eligible for analysis with a mean age of 77 (± 7.0) years of whom 62% were women. We found no significant difference in the change in well-being scores between the Sage-atAge+ service and the original Sage-atAge service (B, 0.037; 95% CI, -0.188 to 0.263). Also, no change in well-being scores was found even when selecting only those participants for the Sage-atAge+ group who received a goal card. Conclusion: Efforts to increase the involvement of older adults through motivational interviewing and goal setting showed no additional effect on well-being. Further research is needed to explore the relationship between increased participant involvement and well-being to further develop person-centered care for older adults.


Assuntos
Idoso Fragilizado/psicologia , Avaliação Geriátrica , Vida Independente/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Pessoal de Saúde , Humanos , Masculino , Qualidade de Vida
7.
BMC Public Health ; 19(1): 1612, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791301

RESUMO

BACKGROUND: The co-occurrence of two or more chronic medical conditions in an individual is defined as multimorbidity. Lifestyle factors, including poor dietary patterns, physical inactivity, tobacco use, and excessive alcohol consumption are key modifiable risk factors that play a role in the development of chronic medical conditions and potentially multimorbidity. The current study aimed to examine the level of physical activity among those with multimorbidity and its association with socio-demographic factors, clinical parameters, and health-related quality of life (HRQoL) among community-dwelling adults attending a primary care clinic in Singapore. METHODS: This cross-sectional study was conducted among patients with multimorbidity between August 2014 and June 2016. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) Short Form. HRQoL was measured using the EuroQol-5 Dimension (EQ-5D-3 L). Data on clinical parameters including hemoglobin A1c (HbA1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure were collected from patient records. Multivariable logistic regression analysis and linear regression were performed to determine the association between IPAQ and clinical health outcomes, as well as HRQoL measures, respectively. RESULTS: In all, 932 respondents with multimorbidity were recruited for the study. Of these, 500 (53.8%) had low physical activity, 325 (35.0%) had moderate physical activity, while 104 (11.2%) had high physical activity. Respondents who were insufficiently active had significantly higher odds of being overweight/ obese (OR: 1.5, 95% confidence interval [CI]: 1.1-1.9, p = 0.01) as compared to those who were sufficiently physically active. The multiple linear regression model revealed that insufficient activity level was negatively associated with EQ-5D index score (ß = - 0.05, p <  0.001) and the visual analogue scale (ß = - 4.4, p <  0.001) measuring HRQoL as compared to sufficient activity levels in respondents with multimorbidity. CONCLUSIONS: The low levels of physical activity among patients with multimorbidity, and its association with overweight status and poorer HRQoL emphasizes the importance of increasing physical activity in this population. Family physicians treating patients with chronic diseases need to continue encouraging and helping individuals to initiate and maintain appropriate physical activity levels.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Doença Crônica/psicologia , Grupos Étnicos/psicologia , Exercício Físico/psicologia , Qualidade de Vida , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/etnologia , Estudos Transversais , Feminino , Humanos , Vida Independente/psicologia , Estilo de Vida , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Multimorbidade , Análise Multivariada , Fatores de Risco , Singapura
8.
Nutrients ; 11(11)2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31694320

RESUMO

Awareness and knowledge of nutrient-dense foods are important for older adults to help them make dietary choices that support a food-first approach to healthy aging. This is especially important since age is a major risk factor for chronic disease and the proportion of older adults in North America is increasing. Beans can contribute to a food-first approach to healthy aging as they are nutrient-dense and can reduce the risk of chronic diseases. However, studies exploring awareness and knowledge of beans in older adults are lacking. Therefore, the aim of this study was to explore older adults' awareness of beans in relation to their nutrient content and role in chronic disease risk. Community-dwelling older adults (≥65 years old) were recruited and completed a validated researcher-administered questionnaire (n = 250), which was followed by 10 focus groups (n = 49). Results showed that the majority of older adults considered beans as a healthy food and thought consuming them could improve their health (99.2% and 98.0%, respectively); however, only 51.2% were bean consumers. While the majority (83.6%) of older adults were aware that a serving of beans is high in dietary fibre, bean consumers were significantly more likely to think that consuming beans could improve health areas related to dietary fibre including body weight management and constipation. Furthermore, most (84.8%) older adults thought consuming beans could improve heart health; however, bean consumers were significantly more likely to be aware that one serving of beans is low in nutrients relevant to heart health including total fat, saturated and trans fat as well as cholesterol. This research can help to inform healthcare professionals and public health agencies to create specific dietary strategies focusing on increasing older adults' awareness and knowledge of beans in relation to their nutrient profile and role in promoting health.


Assuntos
Doença Crônica/psicologia , Dieta Saudável/psicologia , Fabaceae , Preferências Alimentares/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Idoso , Idoso de 80 Anos ou mais , Conscientização , Feminino , Humanos , Vida Independente/psicologia , Masculino , América do Norte , Valor Nutritivo
9.
J Nerv Ment Dis ; 207(12): 1012-1018, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31703035

RESUMO

The objective of the present study was to measure the very long-term outcome in community-dwelling patients with a diagnosis of psychosis and to search for possible correlations of outcome with clinical factors. The sample included 55 psychotic patients with at least 15 years of disease duration (M = 32.1 years). For the estimation of the outcome, the Health of the Nations Outcome Scale and the Clinical Global Impression Scale were used. A total of 34.5% of the patients had a good outcome, whereas 27.3% had poor outcome. Outcome was found to be correlated to symptoms, and it was significantly worse in patients living with other severely mentally ill family members. In our study, outcome was good in more than a third of patients. Both symptoms and social functioning were associated with outcome. This study may have some implications for mental healthcare delivery.


Assuntos
Vida Independente/psicologia , Vida Independente/tendências , População Rural/tendências , Esquizofrenia/epidemiologia , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Grécia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esquizofrenia/diagnóstico , Fatores de Tempo , Resultado do Tratamento
10.
Artigo em Inglês | MEDLINE | ID: mdl-31766451

RESUMO

Neighborhoods within age-friendly cities and communities are an important factor in shaping the everyday lives of older adults. Yet, less is known about how neighborhoods experiencing change influence the ability to age in place. One type of rapid neighborhood change occurring across major cities nationally and globally is gentrification, a process whereby the culture of an existing neighborhood changes through the influx of more affluent residents and businesses. Few studies have considered the impact of gentrification on older adults, who are among the most vulnerable to economic and social pressures that often accompany gentrification. The current study explores one consequence of gentrification, indirect displacement. While gentrification-induced displacement can refer to the physical (e.g., direct) displacement of residents moving out of a neighborhood due to rising housing costs, it also references the replacement of the unique character and social identity of a neighborhood (e.g., indirect displacement). We examine perceptions of the latter, characterized by perceived cultural shifts and housing concerns among adults aging in place in a gentrifying neighborhood in New York City. The implications of indirect displacement for displacement risk and aging precarity are discussed as potential threats to aging in place in age-friendly cities.


Assuntos
Envelhecimento/psicologia , Vida Independente/psicologia , Características de Residência , Afro-Americanos/psicologia , Idoso , Idoso de 80 Anos ou mais , Cidades , Feminino , Grupos Focais , Habitação , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Qualidade de Vida , Mudança Social
11.
Acta Med Indones ; 51(3): 220-229, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31699945

RESUMO

BACKGROUND: there are differences in factors associated with frailty syndrome in elderly population. The aim of this research was to determine frailty status (fit, pre-frail and frail) and to identify factors associated with physical frailty in urban community-dwelling elderly women. METHODS: a cross-sectional study of community-dwelling women aged 60 years and older was conducted in West and Central Jakarta regions, Indonesia, from July until September 2017. The Cardiovascular Health Study (CHS) score was used to determine frailty status (fit/ pre-frail/ frail). Chi-Square Test and logistic regression analysis were used to determine association between independent variables and physical frailty. RESULTS: there were 325 female subjects with a median age of 67 (60-94) years; 95.7% had income below the Provincial Minimum Income of DKI Jakarta in 2017 (<3.3 million IDR≈238 USD/month), and 92.6% had a level of education ≤9 years. Subjects were classified into this following groups: fit (12.6%), pre-frail (63.4%) and frail (24%). Factors associated with physical frailty were age above 70 years old with OR 5.27, lower Barthel Index for Activities of Daily Living (B-ADL) with OR 2.85, depressive symptoms with OR 6.79, and Euro Quality of Life-5 Dimensions (EQ-5D) index with OR 1.96. CONCLUSION: elderly women in the urban community with low socioeconomic status were classified as fit (12.6%), pre-frail (63.4%) and frail (24%). Factors associated with physical frailty were age above 70 years old, depressive symptoms, lower functional status and health-related quality of life index.


Assuntos
Idoso Fragilizado/psicologia , Fragilidade/epidemiologia , Vida Independente/psicologia , Qualidade de Vida/psicologia , Classe Social , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Depressão/complicações , Feminino , Avaliação Geriátrica , Humanos , Indonésia/epidemiologia , Modelos Logísticos , Pessoa de Meia-Idade , População Urbana
12.
Rev Bras Enferm ; 72(6): 1715-1722, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644765

RESUMO

OBJECTIVE: to evaluate, in emergency hospital service and at home, the functional independence of elderly people who fell. METHOD: longitudinal study with 151 elderly. Functional Independence Measure (FIM) was used. Statistical tests were performed with univariate and bivariate analysis. RESULTS: mean of total FIM value in the hospital was 70.4; and at home 84.3 (p <0.001). Independence was lower in the motor domain, in "self-care", "mobility" and "locomotion" dimensions, in the two evaluations (p <0.001). Dependence reduced from 97.3% elderly in the hospital to 82.8% at home (p <0.001). There was a negative correlation between total FIM and age, number of medications, number of diseases and hospitalization time in both evaluations. Femoral and hip fractures were associated with lower total FIM values (p <0.001). CONCLUSION: the elderly had less independence in the hospital compared to at home, with greater impairment in the motor domain and "self-care", "mobility" and "locomotion" dimensions, in the two moments evaluated.


Assuntos
Acidentes por Quedas , Atividades Cotidianas/classificação , Vida Independente/psicologia , Desempenho Físico Funcional , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Seguimentos , Humanos , Vida Independente/normas , Vida Independente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
13.
Rev Epidemiol Sante Publique ; 67(6): 403-412, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31495459

RESUMO

BACKGROUND: The increase in life expectancy and the aging of the population have a significant impact on the informal care provided by caregivers. Protecting caregivers against excessive burden has become a public health priority. The majority of studies target only those providing care for dependent elderly people. The aim of this study was to describe the characteristics of informal caregivers of non-dependent elderly persons, their difficulties and their level of burden. METHODS: A cross-sectional study was conducted among 876 dyads: elderly people (over 70 years of age, non-dependent, living at home and having requested assistance from CARSAT South-East) and their caregivers. Two questionnaires were administered: one for the elderly (including the Frailty Group Iso-Resource Evaluation) and one for caregivers (including the Mini-Zarit Scale). A multi-component analysis and a logistic regression were performed. RESULTS: The elderly were mainly women (77.6%) with a mean age of 82.2±5.8 years and most were frail (94.7%). Most of the caregivers were women (64.5%) with a mean age of 62.7±13.7 years. The multi-component analysis showed three categories of caregivers: spouses, children and others. Among them, spouses performed the most tasks (4.8±2.6) and had the greatest burden. Caregivers in the "others" category were the least burdened and were the least impacted in their daily life. The children category caregivers were divided into two subgroups: those with characteristics similar to "others" caregivers and those with characteristics similar to "spouse" caregivers. Heavy burden was related to greater impact on daily life, poor relationships with the elderly and caregivers' difficulties in performing their role. CONCLUSION: This study confirms the heterogeneous nature of informal caregiver profiles. It also shows that the characteristic features and the burden of these caregivers are similar whether the elderly person is dependent or non-dependent but frail.


Assuntos
Cuidadores , Comportamento de Ajuda , Vida Independente , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Efeitos Psicossociais da Doença , Estudos Transversais , Avaliação da Deficiência , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Fragilidade/enfermagem , Fragilidade/psicologia , Avaliação Geriátrica , Humanos , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Autonomia Pessoal , Qualidade de Vida , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia
14.
PLoS One ; 14(9): e0222887, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539403

RESUMO

OBJECTIVES: Social isolation is a particular problem among older people and social participation may reduce future isolation. However, it is unclear which types of activities and which level of participation are effective. This study examines the relationship between social participation and isolation among Japanese older people by employing a 3-year longitudinal study. METHODS: A mail survey was sent to 3,518 community-dwelling older people in an urban area in 2014 (baseline: BL). We then conducted follow-up mail survey on respondents who were non-isolated at BL in 2017 (follow-up: FL), with isolation being defined as being in contact with others less than once a week. An analysis was carried out on 1,070 subjects (398 men and 672 women). Social participation is defined by participation in group activities (community, senior club, hobbies, sports, volunteering, politics, industry, and religion). A logistic regression analysis was conducted to determine the association between the types of social participation and the number of organization types at BL, and isolation at FL. RESULTS: At FL, 75 men (18.8%) and 59 women (8.8%) were considered to be isolated. Among the men, participation in a hobby group and sports group both significantly reduced the degree of isolation. Moreover, participation in two organizations and three or more organizations significantly lowered the risk of isolation when compared to non-participants. Among women, there were no significant associations among particular types of social activities and isolation. On the other hand, participation in one organization and three or more organizations significantly reduced their isolation when compared to non-participants. There was a significant linear trend between the number of types of organizations and isolation, regardless of gender. CONCLUSIONS: Participation in social activities reduces future isolation in older people. Encouraging participation in social activities could help reduce negative health outcomes associated with social isolation later in life.


Assuntos
Vida Independente/psicologia , Comportamento Social , Isolamento Social/psicologia , Participação Social/psicologia , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Feminino , Nível de Saúde , Humanos , Japão , Estudos Longitudinais , Masculino , Ajustamento Social
15.
J Aging Stud ; 50: 100793, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31526491

RESUMO

Most older persons (age 65 and over) in the United States occupy suburban residential areas. Distinguishing where the older population lives is important because critics argue that the built environments of their suburban communities make it difficult for them to age in place successfully, that is, to have healthy, independent, active, and enjoyable lives. They point to their low population and building densities, long distances separating their residences from services, amenities, and commercial areas, and few transit and walking options. Consequently, when the mobility limitations of older residents prevent them from safely driving their vehicles, they have difficulties reaching destinations outside their homes (mobility behaviors) to satisfy their discretionary and obligatory needs. This paper questions this suburban bashing. It argues that future cohorts of older people, especially women, will be more able to drive, cars will be technologically safer and easier to operate, and ride-sharing options will be more available. More suburbs will also have mixed-use and pedestrian-accessible built environments reducing the need for vehicular travel. Most importantly, the information, activities, goods, services, and care required by older people to age in place will be delivered to their dwellings. Home sharing, home care, internet connectivity, e-commerce, social media, smart homes, telemedicine and robotic technologies will make the mobility or out-of-home behaviors of older residents less necessary. The paper introduces the constructs of connectivity options and connectivity behaviors to encompass these expanded travel and in-home delivery strategies. These new ways of connecting with their environments will result in more self-reliant older persons who are less constrained by their mobility limitations. These conclusions offer insights for planners and policymakers seeking to make their suburban communities more age-friendly. They must keep pace with the changing ways that older people will access their environments if they are to improve the quality of their lives and help them to age in place successfully.


Assuntos
Vida Independente/psicologia , Acesso à Internet/estatística & dados numéricos , Limitação da Mobilidade , Características de Residência/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Nível de Saúde , Serviços de Assistência Domiciliar/tendências , Humanos , Acesso à Internet/tendências , Masculino , População Suburbana/estatística & dados numéricos , Telemedicina/métodos , Telemedicina/estatística & dados numéricos , Estados Unidos/epidemiologia , Caminhada
16.
Health Soc Care Community ; 27(6): 1438-1450, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31368621

RESUMO

Reablement - or restorative care - is a central feature of many western governments' approaches to supporting and enabling older people to stay in their own homes and minimise demand for social care. Existing evidence supports this approach although further research is required to strengthen the certainty of conclusions being drawn. In countries where reablement has been rolled out nationally, an additional research priority - to develop an evidence base on models of delivery - is emerging. This paper reports a prospective cohort study of individuals referred to three English social care reablement services, each representing a different model of service delivery. Outcomes included healthcare- and social care-related quality of life, functioning, mental health and resource use (service costs, informal carer time, out-of-pocket costs). In contrast with the majority of other studies, self-report measures were the predominant source of outcomes and resource use data. Furthermore, no previous evaluation has used a global measure of mental health. Outcomes data were collected on entry to the service, discharge and 6 months post discharge. A number of challenges were encountered during the study and insufficient individuals were recruited in two research sites to allow a comparison of service models. Findings from descriptive analyses of outcomes align with previous studies and positive changes were observed across all outcome domains. Improvements observed at discharge were, for most, retained at 6 months follow-up. Patterns of change in functional ability point to the importance of assessing functioning in terms of basic and extended activities of daily living. Findings from the economic evaluation highlight the importance of collecting data on informal carer time and also demonstrate the viability of collecting resource use data direct from service users. The study demonstrates challenges, and value, of including self-report outcome and resource use measures in evaluations of reablement.


Assuntos
Atividades Cotidianas/psicologia , Serviços de Saúde Comunitária/métodos , Serviços de Assistência Domiciliar/organização & administração , Vida Independente/psicologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Programas Governamentais/organização & administração , Humanos , Estudos Prospectivos
17.
Int J Qual Stud Health Well-being ; 14(1): 1658333, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31451098

RESUMO

Purpose: Government strategies are putting increasing emphasis on sustaining the capacity of older persons to continue living independently in their own homes to ease strain on aged care services. The aim of this study was to understand the experiences and strategies that older people utilize to remain living at home from their own perspective. Methods: A grounded theory methodology was used to explore the actions and strategies used by persons over the age of 65 to enable them to remain living in their own homes. Data were collected from 21 women and men in three focus group discussions and 10 in-depth semi-structured interviews. Results: The data revealed that the central process participants used to hold momentum and sustain living at home involves a circular process in which older people acknowledge change and make ongoing evaluations and decisions about ageing at home. Conclusion: These findings have implications for informing policy and service provision by identifying appropriate resources and services to promote successful ageing at home.


Assuntos
Serviços de Saúde para Idosos/organização & administração , Envelhecimento Saudável/psicologia , Serviços de Assistência Domiciliar/organização & administração , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Grupos Focais , Teoria Fundamentada , Humanos , Masculino
18.
Int J Med Inform ; 130: 103950, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31446357

RESUMO

INTRODUCTION: The development of health information and communication technologies (HICTs) could modify the quality and cost of healthcare services delivered to an aging population. However, the acceptance of HICTs - a prerequisite for users to benefit from them - remains a challenge. This population-based study aimed to 1) explore the acceptance of HICTs by community-dwelling older adults as well as the factors associated to the overall acceptance/refusal of HICTs; 2) identify the factors associated with confidentiality (i.e., access to data allowed to physicians only versus to all caregivers) in the subgroup of older adults willing to accept HICTs. METHODS: A total of 3195 community-dwelling 69-83 year-old members of the Lausanne cohort 65+ were included. In 2017, participants filled out a 9-item questionnaire to assess their acceptance of HICTs ("yes without reluctance"; "yes but with reluctance"; "no"). A bivariate analysis was conducted to examine gender and age differences in the acceptance of HICTs. A multivariable logistic regression was performed to model 1) accepting all or rejecting all HICTs items; 2) willing to share HICTs items with physicians only versus all caregivers. RESULTS: The answer "acceptance without reluctance" ranged from 26.4% to 70.4% across HICTs and was the most frequent answer to six out of nine HICT items. For every HICT item, the acceptance rate decreased across age categories in women. Overall, 20.2% accepted all the HICTs without reluctance and 9.9% rejected them all. Older age and a lower level of education were significantly associated with both accepting all HICTs without reluctance (OR = 0.78 and OR = 0.65, respectively) and rejecting all HICTs (OR = 1.54 and OR = 2.89, respectively). Women and participants with health vulnerability (depressive symptoms, difficulty in activities of daily living (ADLs)) were less likely to accept data accessibility to non-physicians. CONCLUSION: Acceptance of HICTs was relatively high. To deploy HICTs in the older population, demographic, socioeconomic and health profiles, alongside confidentiality concerns, should be considered.


Assuntos
Vida Independente/psicologia , Tecnologia da Informação/estatística & dados numéricos , Informática Médica/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância da População , Inquéritos e Questionários
19.
BMC Geriatr ; 19(1): 208, 2019 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382887

RESUMO

BACKGROUND: The rate of aging in Korea is extremely fast compared to major countries. We examined the key demands of community-dwelling older adults with regard to Connected Active Space technology, which provides tailored assistance with daily living performance through robotic services. METHODS: This study is based on a mixed-method design, through a quantitative survey (n = 234) first phase, followed by a qualitative study with focus group interviews (n = 23) to explore the needs and acceptance of community-dwelling aged people concerning the application of robot technology in their daily lives. RESULTS: The scores concerning the need for and acceptance of robot services to assist daily living performance were high, at 7.2 and 7.9 out of 10 points, respectively. Further, for both needs and acceptance, timely reaction to emergency situations, early detection of emergency situations, help to locate objects, assistance with mobility, and assistance in memory recall were prioritized (in that order). In a thematic analysis of qualitative data from three focus-group interviews, a 'mismatch between desires and functional capacity' was the core characteristic of living as an older person and 'being a friend and helper' was the most desired trait of a robot service. CONCLUSION: Although most of the participants lived independently, they regularly experienced difficulties regarding buying products, transportation, using phones, and preparing meals. If appropriate assistance technology is developed, this population can maintain its independence. Thus, it is necessary to address main needs, including detecting and addressing emergency situations, locating objects, assisting mobility and memory recall, and assisting with daily living performance. New robot services that can be tailored to the functions or abilities of the elderly must be developed based on individually collected information.


Assuntos
Atividades Cotidianas/psicologia , Necessidades e Demandas de Serviços de Saúde , Vida Independente/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Robótica/métodos , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Feminino , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Vida Independente/tendências , Masculino , Pesquisa Qualitativa , República da Coreia/epidemiologia , Robótica/tendências
20.
BMC Psychiatry ; 19(1): 242, 2019 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382945

RESUMO

BACKGROUND: To date no study has compared more specifically the psychotropic medication treatment patterns for patients with schizophrenia living in community between rural and urban areas. This study examined the rural-urban differences of the use of psychotropic drugs among community-dwelling individuals with schizophrenia in China. METHOD: Data on 993 community-dwelling patients with schizophrenia (n = 479 in rural area and n = 514 urban area) were collected by interviews during 2013-2014, and 2015-2016 according to the diagnosis of DSM-IV or ICD-10. Data on patients' socio-demographic and clinical characteristics, prescriptions of psychotropic drugs were collected using a standardized protocol and data acquisition procedure. RESULTS: Multivariate analyses revealed that in comparison with the rural counterparts, the patients from the urban area were significantly more frequently prescribed antipsychotic polypharmacy, clozapine, and benzodiazepines, but the patients from the rural area had more frequently prescribed anticholinergics. CONCLUSIONS: Substantial variations in psychotropic medication treatment patterns for patients with schizophrenia living in community were found between rural and urban areas in China. Common use of antipsychotic polypharmacy, clozapine and benzodiazepines in urban area, and anticholinergics in rural area need to be further addressed.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Psicotrópicos/uso terapêutico , População Rural/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , População Urbana/estatística & dados numéricos , Adulto , Benzodiazepinas/uso terapêutico , China , Clozapina/uso terapêutico , Demografia , Feminino , Humanos , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Polimedicação , Padrões de Prática Médica/estatística & dados numéricos
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