Patient/ Family Involvement

Introduction: Community-based care such as adult day services (ADS) are preferred by people with dementia. ADS offers the opportunity to support the health and social needs of their clients and provide respite to family members, contributing to a stable care situation at home. The psychological needs of humans according to the self-determination-theory (SDT) (autonomy, competence, and relatedness) can be fulfilled by leisure activities and thus improve well-being and quality of life. The implementation of leisure activities that reflect individual preferences support active participation, preserve autonomy, improve satisfaction with care and consequently can be understood as a core aspect of person-centered care. However, it is currently unknown how people receiving ADS understand leisure and which leisure activities they prefer.

Method: To gain insight, a qualitative design was chosen. We conducted semi-structure interviews with 15 people receiving ADS in Germany. Participants were recruited from three different ADS in one state in Germany. Interviews were recorded, transcribed verbatim and analyzed using reflexive thematic analysis and categories of the SDT.

Results: The results show that over 90 % of participants were diagnosed with dementia and we identified two different themes. The first theme, the sweet bitter symphony, emphasizes the positive (sweet tones: autonomy, competence, and relatedness) and negative (bitter tones: incompetence, unrelatedness, and heteronomy) sensations and feelings that shape interviewees’ understanding of leisure. The second theme, young, wild & free!, describes the different preferred leisure activities. 

Conclusion: The results indicate the importance of preference-based service design in ADS to meet clients’ psychological needs and thus provide person-centered care to improve well-being and quality of life. These results can be used to develop an item-based assessment tool to assess the preferences of people with care needs regarding leisure activities in ADS.

Introduction

NHS England is committed to the expansion of virtual wards, necessitating patient engagement with home care technology. Literature suggests there is a technology adoption lag among older populations. We investigated if this lag was evident in geriatric virtual ward patients.

Methods

Data from three NHS trusts using a virtual care  platform (March 2021-August 2023) were aggregated to assess differences in perceived ease of use, technology adoption style, and measures of adherence. All patients received the Telehealth Usability Questionnaire Ease of Use (EOU) subsection (higher scores indicate higher EOU). Patients completed surveys via tablet, wore monitoring devices, and took blood pressure readings. We dichotomized age (<75 vs. 75+) and used Fisher’s exact and Wilcoxon-Mann-Whitney tests.

Results

Of 857 patients, 36.9% were geriatric (mean age 81.5 years). The younger group (mean age 59.1 years) had 541 patients. Gender was evenly split between age groups (p=0.62). Median EOU scores were 5.5 (geriatric) and 6.2 (younger) (p<0.001). Geriatric patients were more likely to avoid or delay technology adoption (82% vs. 56% in younger patients, p<0.001). Geriatric patients had higher adherence to the wearable device (median 95.3%) compared to younger patients (93.3%, p<0.001). Blood pressure (median 81.6%) and survey adherence (median 83.3%) did not significantly differ between groups (p=0.076, p=0.0501).

Conclusions

Despite perceptions and literature suggesting older patients are less comfortable with technology, our findings demonstrate high engagement in virtual ward technology. While differences exist in technology adoption and EOU scores, geriatric patients exhibit equal or higher adherence to remote monitoring tasks. These results challenge stereotypes and underscore the importance of incorporating technology in geriatric care.

Background Osteoporosis is a global health concern that is likely to increase with a rapidly ageing world population. It affects one in three women and one in five men over the age of 50. Although there is a large body of qualitative research exploring the experience of living with osteoporosis, far fewer studies have focused on men. We aim to explore the meaning making processes of men with osteoporosis. Methods We interviewed 13 White British men aged 63 to 94 with an osteoporotic vertebral fracture We used the six stages of reflexive thematic analysis: familiarisation with the data; coding ; generating initial themes; developing and reviewing themes through discussion; refining and naming themes; writing up. Results We developed six themes giving insight into the existential losses of men with osteoporosis: there has been a step changed coming; I am no longer what I once was; the change in me is de-meaning; I want to know where I am heading; I want to know why this happened to me; I want to know what’s wrong and how to fix it? We describe moral narratives used in defence of self. Conclusions Our findings highlight the challenge of deciphering the symptoms of osteoporosis and age-related changes. We also see the impact on self and a struggle to repair self. Healthcare providers are in a unique and privileged position to accompany their patients at points of Existential Crisis. As such, they attend to the repair of both identity and body. This comes with an ethical responsibility and has implications for clinical education. Health professionals should feel equipped to be alongside people facing existential losses. Qualitative Research and can give valuable insight into the phenomenology of illness and contribute to improvements in care pathways.

Introduction

Physical activity (PA) and replete nutritional status are key to maintaining independence and improving frailty status among frail older adults. We aimed to evaluate the feasibility and acceptability of training volunteers to deliver a remote intervention, comprising exercise, behaviour change, and nutrition support, to older people with frailty after a hospital stay.

Methods

Volunteers were trained to deliver a 3-month, multimodal intervention to frail (Clinical Frailty Status ≥5) adults ≥65 years after hospital discharge, using telephone, or online support. Feasibility was assessed by determining the number of volunteers recruited, trained, and retained; participant recruitment; and intervention adherence. Interviews were conducted with 16 older adults, 1 carer, and 5 volunteers to explore intervention acceptability. Secondary outcomes included physical function, appetite, well-being, quality of life, anxiety and depression, self-efficacy, and PA. Outcomes were measured and compared at baseline, post-intervention, and follow-up (3-months). Interviews were transcribed verbatim and analysed using thematic analysis.

Results

Five volunteers (mean age 16, 3 female) completed training, and 3 (60%) were retained at the end of the study. Twenty-seven older adults (mean age 80 years, 15 female) signed up to the intervention (10 online;13 telephone). Seventeen completed the intervention. Participants attended 75% (IQR 38-92) online sessions, and 80% (IQR 68.5-94.5) telephone support. Self-reported total PA (p = .006), quality of life (p = .04), and appetite (p = .03) improved significantly post-intervention, with a non-significant decrease at follow-up. The intervention was safe and acceptable to volunteers, and older adults with frailty. Key barriers were lack of social support, and exercise discomfort. The online group was a positive vicarious experience, and telephone calls provided reassurance and monitoring to socially isolated older adults.

Conclusion

Volunteers can safely deliver a remote multimodal intervention for frail older adults discharged from hospital with training and support from a health practitioner.

Introduction:

The aging population has increased the demand for family caregivers, who often suffer from psychological distress, especially compassion fatigue. This systematic review and meta-analysis evaluate the effectiveness of web-based compassion interventions in improving the mental well-being of family caregivers.

Methods:

MEDLINE, Embase, PsycINFO, Web of Science, Cochrane Library, and Proquest were searched from database inception until manuscript submission date. Eligible studies included family caregivers participating in web-based compassionate interventions with reported mental wellness indicators, such as self-compassion. Two independent researchers conducted a literature review, extracted data, and assessed the quality of each study using the Risk of Bias 2 tool. Random effects meta-analysis was performed to pool the data, followed by subgroup analyses, sensitivity analyses and Egger's tests.

Results:

Out of 1095 studies evaluated, eight randomized controlled trials (encompassing 1978 participants) were included, with 75% exhibiting low risk of bias and high-quality evidence. Meta-analysis results indicated positive effects of web-based compassion interventions on family caregivers' self-compassion (SMD = 0.33, 95% CI 0.08 to 0.58, P = 0.009) and mindfulness (SMD = 0.46, 95% CI 0.03 to 0.90, P = 0.04). These interventions also demonstrated a positive impact on reducing stress (SMD: -0.32, 95% CI -0.59 to -0.04, P = 0.02) and anxiety (SMD: -0.28, 95% CI -0.47 to -0.09, P = 0.003). Subgroup analyses highlighted superior self-compassion outcomes for caregivers supporting individuals with mental illness and cancer compared to those caring for individuals with Alzheimer's disease. Interventions lasting ≥ 8 weeks were the most common and effective.

Conclusions:

Web-based compassion interventions benefit family caregivers by enhancing self-compassion, mindfulness, and reducing anxiety and stress. More well-designed studies are suggested for future clinical applications.

Introduction

People from ethnic minorities are 1.5 times less likely to use digital technology. Within Brighton and Hove, 2021 Census reports that 26.1% described themselves as non-White-British categorised as other White (11.5%), Mixed Race (4.8%), Asian (3.7%), Black (2.0%), Chinese (1.1%), Arab (1.1%), and Other (2.0%). The aim of the project was to understand the lived experience of older ethnic minority adults in Brighton and Hove with digital technology, and how this experience affects their potential engagement with research.

Methods

Older people from ethnic minorities were identified through Brighton and Hove Health Watch, Bridging Change, Sussex Interpreting Services, and Black and Minority Ethnic Partnership. Using a mixed-methods approach, focus group and one-to-one meetings were held with 22 people, exploring their digital literacy, using a Likert scale, and preferences for research engagement using digital means. Meetings were transcribed and thematic analysis was undertaken.

Results

The group average age was 71.6 years. Six identified as male, 16 as female, and confidence with digital technology averaged 3/5 (5 representing high confidence). Variation of digital skills was observed, with older age and language barriers limiting digital access. Digital technology was used for social, transactional and health purposes (booking GP appointments, receiving test results, and GP consultations). Trust and confidence in the research team enhanced the group’s likelihood to engage digitally. Explaining the research in their own language would be an incentive. Younger family members can help explain digital elements. Offering choice of digital alongside traditional methods was important. There was a preference for initial research conversations to be in person. Willingness to engage is higher when the research topic is common in their community or they are personally affected.

Conclusions

Older people from ethnic minorities in Brighton and Hove are willing to engage in research using digital means if tailored to their social circumstances.

Introduction: Clinical decision making for older adults with multimorbidity can be complex and demanding. When facing complex decision-making, patients may experience decisional conflicts, leading to low treatment adherence, adverse health outcomes, and increased utilization of health services, etc. To address these issues, patient decision aids (DAs) have been developed and utilized in the decision-making process to facilitate informed decisions. The aim of this study is to identify DAs developed for patients with multimorbidity and assess their quality.

Method: We searched full-text papers on nine databases. Any article utilizing a DA for patients with multimorbidity was eligible and DAs for making medical decisions at any point were eligible. We used the International Patient Decision Aid Standards (IPDAS) checklist to assess the quality of DAs.

Results： In total, ten articles including six DAs were included. Two DAs targeted for the older patients with multimorbidity. Most DAs didn’t focus on specific treatment choices but rather aimed at improving the overall quality of life for patients with multimorbidity. The targets of these DAs are including setting goals about health care, preparing for conversation with doctors and taking ownership for the decisions. IPDAS checklist revealed that only one DA met all qualifying criteria and provided comprehensive choice. Three DAs were deemed to have poor quality due to their failure to provide the pros and cons of decisions. The quality of the remaining DAs was difficult to judge due to incomplete versions.

Conclusions: DAs for patients with multimorbidity were few and had poor quality. Designing DAs for this patient population presents challenges given the complex nature of multimorbidity and its lack of specific treatment options. Future development should focus on adhering to the IPDAS checklist, provide more information and possibility, and aim at improving the quality of life for patients with multimorbidity.

Introduction

Fall-related injuries such as fractures are on the rise as the older adult population grows in New Brunswick, Canada. These injuries can lead to hospitalization and transitions in care that are complicated for patients and families. The objective was to investigate the impact of patient navigators (PNs) working alongside the healthcare team on patient and family experiences, as compared to the usual standard of care (SOC), for adults aged 65 and older admitted with a fracture to an Orthopedic Unit at one hospital in New Brunswick.

Methods

A concurrent embedded mixed methods design, in which the quantitative randomized control trial had an embedded qualitative component. The results for the family caregiver qualitative component, which used an interpretive description approach, are presented.

Results

Semi-structured interviews were conducted and thematically analyzed for 15 family caregivers (8 PN group, 7 SOC group). The SOC caregivers, six women and one man, had a mean age of 64.6 years (SD=6.9 years). The mean age of the 8 women in the PN group was 61.3 years (SD=10.1). All participants in both SOC and PN groups self reported their ethnicity as white. Thematic analysis found that SOC group caregivers discussed patients relying on support from family and friends throughout their care journey, whereas caregivers in the PN group predominantly discussed finding PNs supportive and helpful. Both groups discussed the ongoing stress that they felt throughout the care journey of the patient for which they cared for; however, for the PN group this topic was less prevalent.

Conclusions

This study provides an understanding of the positive impacts a patient navigator can have on older adult inpatient care and transitions in care. Patient Navigators were shown to be helpful to families, particularly those of patients with higher care needs and fewer family supports.

Introduction:

Navigating dementia care is challenging, but patient navigation (PN) offers valuable support for this population. The "Navigating Dementia NB / Naviguer la démence NB" program piloted a PN program in New Brunswick, Canada, targeting people living with dementia (PLWD) and their carers. The program aimed to assist participants in navigating health and social care systems, matching their needs with available services.

Methods:

Navigating Dementia NB was co-developed by researchers, patient partners, and clinicians. This pilot program embedded six PNs in primary care clinics/centers across the province between July 2022 and July 2023.  Using a mixed methods approach, participant surveys and interviews were used to explore program benefits and recommendations for improvement. Focus groups were used to explore facilitators and barriers to program development and implementation.

Results:

There were 150 participants (PLWD and carer dyads) enrolled in the PN program who provided informed consent. Interviews were conducted with 36 PLWD and their carers. Focus groups were conducted with nine members of the research team and five patient navigators.  Program benefits included: emotional support from navigators, provision of relevant information, and facilitating connections to appropriate services. Recommendations for improvement included: the need for PLWD and their carers to have access earlier in the patient journey and the need to reassess provincial policies related to home care support. Facilitators for implementing a PN program included: providing appropriate staff training and leveraging established connections within the health and social systems.  Barriers included a compressed timeline and existing systemic issues to service access.

Conclusions:

The findings suggest that embedding PN for PLWD in community based primary care can be done.  The program was beneficial for PWLD and their carers. Future plans involve partnering with government to support the implementation and evaluation of a province-wide scale-up of the PN program for this population.

Introduction

The Frailty Network, initiated in November 2023, aims to enhance care for frail patients through multidisciplinary collaboration across acute and community settings. By fostering partnerships with Health and Social Care teams, GPs, district nurses, and third sector organisations, the Network strives to provide realistic and patient-centric improvements in Lanarkshire. The initiative focuses on proactive, personalised, and coordinated support to help frail older adults maintain independence and well-being.

Methods

The Frailty Network is supporting multiple teams to implement new pathways to streamline care and improve outcomes. The aim is to understand our systems and have a focus on the data impacting our older adults. Stakeholder Engagement Table was utilised to show project success so far. Quantitative methodology such as LOS, number of referrals will be used to show impact. With a progress / Driver Diagram to show Quality Improvement Journey thus far. As the Network is a large piece of work, many aims are long term.

Results

The implementation of the Frailty Network has resulted in notable improvements in communication, engagement, collaboration and innovation. There has been reduced LOS in the frailty wards, improved transfers to community hospitals and more pathways to keep people at home. There are structures now imbedded to encourage multi system working from all settings.

Conclusion

The Frailty Network's innovative design has begun to successfully improve care for frail older adults in Lanarkshire. The collaboration between acute and community teams, combined with proactive interventions and the use of digital technology, has started the journey to a more sustainable future. Continued focus on integrated leadership and shared goals will further refine and sustain these improvements, setting a gold standard for frailty care in the region. Further research is required to assess long-term impacts.