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During the COVID-19 pandemic, the media provided daily coverage of this unprecedented crisis in the history of the 21st century. Some topics, such as how the virus affected older adults, were widely covered. The way in which COVID-19 was documented evoked a ‘tragedy’ narrative through consistent reporting about the suffering it was causing and the deleterious consequences it had on specific populations, including residents of long-term care homes (LTC). This article explores how reports on COVID-19 in LTC homes in a national newspaper (The Globe and Mail) fuelled a tragedy discourse that modulated the value of life of older adults living in those environments. We used critical discourse analysis and analysed 74 articles focusing on older persons residing in LTC homes in two Canadian provinces (Quebec and Ontario) during COVID-19. This article offers a brief overview of the notion of tragedy and how the discourse of tragedy is intertwined with humanitarian crises, life and death, and the value of life. Our findings revealed the construction of three types of tragedies that shape our societal values around life and death in LTC: the tragedy of the threat to life, the tragedy of the unfortunate (old, vulnerable and lacking in agency) and, finally, the tragedy of historical neglect and abandonment. Our findings suggest that the nature of reporting on life and death in LTC homes during the COVID-19 pandemic provoked a sense of fear and pity for a passive other. Re-thinking what gets reported in the media, including whose voice is represented/missing and how tragedy narratives are balanced with contesting stories, could elicit more sentiments of solidarity and action rather than reinforce pity, distancing and immobilisation.
Epidemiology studies how regularly diseases occur in different groups of people and why – hence its pivotal role in planning the distribution of resources. This chapter focuses on the epidemiology of mental illnesses in older people in acute hospitals and highlights the role of the liaison psychiatrist and other mental health professionals in bridging the gap between physical and mental disorders. By outlining the intricate connection between the two, it explains why careful consideration and a high index of suspicion are needed when assessing older persons in the acute hospital. Emphasis is placed on the importance of viewing ageing as a normal biological and social construct rather than a problematic disease process to which a figurative cut-off point can be applied. The chapter gives prominence to the mammoth social and economic burden of mental disorders, borne by all in society.
The chapter has subsections on important epidemiological terminologies, life expectancy, the prevalence of common psychiatric disorders in acute general hospitals (including emergency departments), and the influence of COVID-19 on the prevalence of mental disorders in older persons. It sounds a clarion call to challenge current practice, work synergistically with all stakeholders, and embrace change if a crisis is to be averted.
This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH.
Design:
A longitudinal whole-of-population record linkage study was conducted (2014–2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data.
Setting:
Australia’s most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review.
Participants:
Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older.
Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall.
Conclusions:
CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.
Undernutrition in elders remains under-detected, under-treated, and under-resourced and leads to further weight loss, increased infections, and delay in recovery from illness as well as increased hospital admissions and length of stay. The reports of the findings were fragmented and inconsistent in Ethiopia. Therefore, the main objective of this meta-analysis was to estimate the pooled prevalence of undernutrition and its association with dietary diversity among older persons in Ethiopia. Online databases (Medline, PubMed, Scopus, and Science Direct), Google, Google Scholar, and other grey literature were used to search articles until the date of publication. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The random effect model was used to estimate the pooled prevalence; whereas subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity using Stata version 14.0 software. Out of 522 studies accessed, 14 met our criteria and were included in the study. A total of 7218 older people (aged above 60 years old) were included in the study. The pooled proportion of undernutrition among older persons in Ethiopia was 20⋅6 % (95 % CI 17⋅3, 23⋅8). Elders who consumed low dietary diversity scores were strongly associated with undernutrition among older persons. Therefore, promoting appropriate intervention strategies for elders to improve dietary diversity practices and nutritional status is crucial.
The restrictive measures taken by nursing homes during the COVID-19 outbreak in 2020 (e.g., quarantine) may have been important stressors for which residents needed resilience to safeguard their well-being. Based on 30 semi-structured interviews with nursing home residents and close relatives, this study explored the lived experiences with respect to the restrictive measures. The data were collected in psychogeriatric, somatic, and mixed wards in The Netherlands and Flanders, Belgium. The restrictive measures were important stressors for residents, indicated by feelings of loneliness, sadness, and powerlessness. To deal with these measures, residents used various resources, which were determined by factors in the individual (e.g., health), interactional (e.g., possibilities for social interactions) and contextual (e.g. nursing home policy) domains. Because the lived experiences with respect to the restrictive measures seemed to relate to the resilience of nursing home residents, it is crucial to reinforce resources in the individual, interactional, and contextual domains.
The aim is to identify important factors for immigrants’ health and well-being and for their use (or non-use) of primary health care (PHC) and other non-specialised services, and for possible ways that PHC can support healthy ageing of immigrants.
Background:
Older persons are an increasing share of the immigrant population in the global north, frequently in contact with various forms of health services, (PHC services most of all. Consequently, PHC services are in a particularly unique position to support healthy ageing of immigrants.
Methods:
The position paper builds on five international, multi-professional and cross-disciplinary small group discussions as well as an international workshop early summer. During the discussions and the workshop, topics were arrived at as to factors related to the health situation of older immigrants, their needs, and health-seeking behaviour, and to how PHC professionals could support healthy ageing in immigrants. Those main topics in turn guided search for relevant research literature and informed the selection of the main research questions of this paper.
Findings:
Several factors, in addition to culture and cultural differences, are important to for PHC professionals and decision-makers to take into consideration in encounters with older immigrants. The socio-economic position of the older immigrant and close relatives, inter-generational relationships within the immigrant communities, country-specific factors in the host country like health care expenditure, and communication skills in health professionals are all examples of factors playing an important role regarding the health and health-seeking behaviour of older immigrants.
Little is known about the experiences of informal family care-giving for persons with ADRD in the context of Arab and Muslim communities. This paper offers fresh insight into the less-studied private sphere of the home, showing how families respond to the onset and long-term care of persons with Alzheimer's disease and related dementias (ADRD). It considers the extent to which sociocultural and religious influences are appropriated by family care-givers as coping mechanisms and motivators for care. Drawing upon interviews with 32 family care-givers for older persons living with ADRD in Qatar, findings reveal the intersectionality of the care-giving experience with various sociocultural, religious and emotional influences through seven emergent themes: (a) reasons and motivations for care-giving; (b) role of the extended family; (c) socio-demographic attributes of care-givers, their allocated responsibilities and how these intersect; (d) socio-religious attitudes towards care-giving of older persons; (e) social stigma; (f) personal knowledge of ADRD; and (g) coping mechanisms. The paper is concluded with key implications of these sociocultural insights for theory, policy and practice, which could inform Qatar's health and social care provision sector as well as other Arab and Muslim communities that share similar cultural and religious belief systems.
The coronavirus (COVID-19) pandemic and mandated physical distancing requirements significantly impacted volunteer programs for older persons with many long-standing programs either ceasing altogether or pivoting to connecting through virtual technologies. In this study, we collected qualitative interview data from 23 clients and 33 volunteers to investigate their experiences during the COVID-19 pandemic and the effects on the volunteer–client relationship. Three themes were identified: pandemic emotions, negotiating social interactions, and growing through the COVID-19 pandemic. These findings provide important insights into the experiences of hospice organizations and their volunteers and clients during the COVID 19 pandemic, further highlighting the importance of acknowledging both older persons’ vulnerability and their resilience, of building in compassionate community approaches to care, and of finding innovative ways to foster volunteer–client relationships during times when physical visiting is not possible.
The international community is moving towards the abolition of the death penalty but executions continue to lawful in a number of countries under certain circumstances where a crime of murder has been perpetrated at the issue of a fair trial. The mandatory death sentence is, however, always arbitrary. Those under 18 years of age at the time of the commission of the crime may not be lawfully sentenced to death and pregnant women may not be executed. The legality of executing persons with disabilities or older persons is also assessed. Finally, the death penalty in connection with an armed conflict is considered.
The elderly are especially vulnerable to abuse and neglect, and face, among others, an increasing risk of dementia as they age. While no one can halt the aging process, the special protection to which older persons are entitled enables them to live the remainder of their lives in dignity. In addition, the chapter addresses briefly the legality of execution of the death penalty on older persons as well as the legality of euthanasia. The chapter concludes with an analysis of the protection of older persons in situations of armed conflict.
The COVID-19 pandemic has required services to evolve quickly to continue routine care and telemedicine has been rapidly implemented to facilitate this. Older persons are at high risk of serious complications of COVID-19 and it is essential that their exposure to COVID-19 is minimized.
Objectives
Our aim was to assess staff and patient satisfaction with remote psychiatric assessments using mobile tablets in long-stay facilities.
Methods
Remote clinics using Skype video on mobile tablets were conducted with patients in long-stay facilities attending psychiatry in rural North-West Ireland between April and July 2020. At each review, a satisfaction survey was administered to the patient, their keyworker and the clinician. The patient/keyworker survey instrument had four yes/no statements and the clinician survey had four statements with 5-point likert scale responses (1=very low to 5=very high). Open feedback was also obtained for thematic analysis. Descriptive analyses were completed using SPSS software.
Results
23 patients (mean age 80.9yrs) were assessed in 10 long-stay facilities. All patients were agreeable to participating in video consultation although only 13 patients were able to respond to survey due to cognitive impairment. There was a 92.3% positive patient response (12/13) and 95.7% positive keyworker response (N=22/23) for all statements. The mean score on the assessor response ranged from 3.43 to 4.04 with the lowest rate for quality of transmission. The main themes identified were related to the quality of connection and sensory difficulties.
Conclusions
Video consultations using mobile tablets offer an acceptable form of remote psychiatry assessment for older persons in long-stay facilities.
Older persons with parkinsonism (PWP) are at high risk for hospitalization and adverse outcomes. Few effective strategies exist to prevent Emergency Department (ED) visits and hospitalization. The interdisciplinary Geriatrics Clinic for Parkinson’s (“our clinic”) was founded to address the complexity of parkinsonism in older patients, supported by a pharmacist-led telephone intervention (TI) service. Our primary objective was to study whether TI could avert ED visits in older PWP.
Methods:
Using a prospective, observational cohort, we collected data from all calls in 2016, including who initiated and reasons for the calls, patient demographics, number of comorbidities and medications, diagnoses, duration of disease, and intervention provided. Calls with intention to visit ED were classified as “crisis calls”. Outcome of whether patients visited ED was collected within 1 week, and user satisfaction by anonymous survey within 3 weeks.
Results:
We received 337 calls concerning 114 patients, of which 82 (24%) were “crisis calls”. Eighty-one percent of calls were initiated by caregivers. Ninety-three percent of “crisis calls” resolved without ED visit after TI. The main reasons for “crisis calls” were non-motor symptoms (NMS) (39%), adverse drug effects (ADE) (29%), and motor symptoms (18%). Ninety-seven percent of callers were satisfied with the TI.
Conclusion:
Pharmacist-led TI in a Geriatrics Clinic for Parkinson’s was effective in preventing ED visits in a population of older PWP, with high user satisfaction. Most calls were initiated by caregivers. Main reasons for crisis calls were NMS and ADE. These factors should be considered in care planning for older PWP.
The World Health Organization defines ageism as “stereotyping, prejudice, and discrimination towards people based on their age” (WHO, 2018). Ageist beliefs and stereotypes are expressed in cultural and media representations, institutional and governmental policies, and social practices that may limit people’s access to the resources necessary to lead healthy and productive lives, such as employment opportunities, housing choices, and health services. Under these circumstances, older persons are more vulnerable to social exclusion, political disempowerment, income insecurity, financial exploitation, homelessness, violence, and abuse leading to human rights violations such as the right to the highest attainable standard of physical and mental health. This chapter examines how these violations impact older persons from a social psychological perspective through a selective literature review focused on ageism issues, including the impact of ageism on how old age is defined as a social category in various societies; how older persons are portrayed in culture and media; and how they are differently perceived and treated as migrants, patients, and workers. Possible best practices to reduce or eliminate ageism globally are also discussed.
The Coronavirus Disease 2019 (COVID-19) has accounted for more than 25 000 cases in Ireland with approximately 28% of the clusters in nursing homes as of June 2020. The older population is the most vulnerable to serious complications from this illness and over 90% of deaths due to COVID-19 to date have been in patients over the age of 65. Continuing to provide routine care within nursing homes in these challenging times is an essential part of ensuring that presentations to hospitals for non-essential reasons are minimized. In this article, we describe a project being undertaken by a rural Psychiatry of Old Age Service in the northwest of Ireland. We aim to provide ordinary care in extraordinary times by using mobile tablets within the nursing homes and long-stay facilities in our region for remote video consultations during the COVID-19 crisis.
As cash increasingly becomes an essential part of humanitarian assistance, it is critical that practitioners are aware of, and work to mitigate, exposure to protection risks among the most vulnerable recipients. This article presents findings from qualitative research exploring protection risks and barriers that arise in cash programming for internally displaced persons at high risk of violence and exploitation in Cameroon and Afghanistan. The authors conclude with recommendations for mainstreaming global protection principles into cash programmes, as well as key considerations for designing and implementing cash programmes in ways that minimize existing risks of harm and avoid creating new ones.
Physical frailty and depressive symptoms are reciprocally related in community-based studies, but its prognostic impact on depressive disorder remains unknown.
Methods:
A cohort of 378 older persons (≥ 60 years) suffering from a depressive disorder (DSM-IV criteria) was reassessed at two-year follow-up. Depressive symptom severity was assessed every six months with the Inventory of Depressive Symptomatology, including a mood, motivational, and somatic subscale. Frailty was assessed according to the physical frailty phenotype at the baseline examination.
Results:
For each additional frailty component, the odds of non-remission was 1.24 [95% CI = 1.01–1.52] (P = 040). Linear mixed models showed that only improvement of the motivational (P < 001) subscale and the somatic subscale (P = 003) of the IDS over time were dependent on the frailty severity.
Conclusions:
Physical frailty negatively impacts the course of late-life depression. Since only improvement of mood symptoms was independent of frailty severity, one may hypothesize that frailty and residual depression are easily mixed-up in psychiatric treatment.
The Chinese government encourages the promotion of community-based older people centres as a way to use space rationally, improve social inclusion and support older residents’ everyday lives. This exploratory study is the first to examine in depth the contradictory and consistent attitudes and suggestions of residents of different age groups for the design of an inclusive community-based centre for older and younger people in China. An integrative mixed-methods approach was used. In the quantitative phase, 270 older adults (⩾60 years) and 250 younger adults (<60 years) from Harbin were asked to complete questionnaires (older adults’ response rate = 87.0%; younger adults’ response rate = 87.2%). In the qualitative phase, seven focus group discussions (four groups of older adults, three groups of younger adults) were conducted. The findings indicate that older adults have a higher acceptance level of inclusive design and prefer to share spaces to improve intergenerational interactions than younger adults. Residents of all ages are more likely to share functional spaces related to health services, living services and physical exercise. Moreover, the study reveals some design suggestions: the location of the centre should be away from the residential area and integrated into a public community building; comprehensive services should be provided to older people and be accessible to the whole family; design should be barrier-free, and the climate and nearby spaces should be considered.
For a long time researchers have used photography for different purposes, in different ways and with different focus. Photovoice is a qualitative visual research method that refers to photographs taken by the participants themselves. It has been used with different age groups and populations. The use of photovoice in older populations requires its own study of approaches, techniques and challenges. In this article, we review existing studies using photovoice with older participants specifically, to consider its potential as a qualitative research method in the field of gerontology. We discuss advantages and limitations of the method in gerontological research and provide guidelines for future studies. Our results show that photovoice has been used to study a wide range of topics in older people, from health issues and the impact of environment on health and wellbeing, to leisure experiences of groups living with HIV/AIDS. Using photovoice helps researchers to capture live experiences and perceptions of older persons and conduct engaging, involving and empowering research facilitating interaction, reflection and connection of participants. However, conducting photovoice studies can be practically challenging, such as when addressing special needs of the participants, or ethical and other feasibility issues. To conclude, photovoice has great potential for being used in gerontological research, it can be altered to fit specific goals, divergent issues studied and different research contexts.
Social support networks for older persons have been related to health outcomes including differences in psychological wellbeing (PWB). However, the specifics of this relationship remain unclear especially in sub-Saharan Africa. This study investigates the (1) relationship between aspects of social support and PWB among older persons in Ghana and (2) the extent to which this relationship is moderated by their education levels and locational characteristics.
Method:
The study included 1,200 community-residing individuals aged 50 years and older who participated in an Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AHPWHB) conducted between July 2016 and February 2017. Logistic regression models evaluated the associations of social support and their interactions with education and locational variables in PWB.
Results:
Several aspects of meaningful social support: family/friends contacts ( β = 0.958, p < 0.05), couple focused ( β = 0.887, p < 0.001), emotional bonds ( β = 0.658, p < 0.005), attending social events ( β = 0.519, p < 0.001) and remittances from children ( β = 0.394, p < 0.005) significantly related to improved PWB in later life. These associations remained robust and largely strengthened after accounting for respondents’ background and health-related factors. Education and locational characteristics substantially influenced the associations between social support and PWB.
Conclusion:
These findings suggest that especially in terms of PWB, aspects of meaningful social support networks are critical elements in later life. Strengthening opportunities for closer interpersonal relations with older persons may enhance their mental health, quality of life and independence.
As more older persons opt to age in place, there is a growing trend to hire migrant workers as live-in caregivers to care for them. This raises the need to examine the quality of care they receive within this unique care setting. The objective of this pilot study was to establish the components of quality of care as provided by migrant live-in caregivers.
Methods:
We interviewed a convenience sample of older persons cared for by migrant live-in caregivers and their relatives. When relatives reported that older persons could not be interviewed due to advanced dementia, only relatives were interviewed. Overall, 72 older persons and 117 relatives were interviewed. We used the Quality of Care Questionnaire (QuCQ) developed for this study to examine the main components of quality of care in this population.
Results:
Factor analysis using older persons’ data revealed two factors. In the first factor, “caretaking,” items concerning provision of prompt care exhibited the highest loadings. Items measuring interpersonal aspects of the care dynamic had the highest loadings in the second factor, thus labeled “relationship.” The factor analysis based on relatives’ data yielded similarities and differences with the one based on older persons’ data. Yet, there were significant correlations between relative and older persons’ responses when using the older persons’ factor structure.
Conclusions:
According to older persons and relatives, quality of care depends on the extent to which older persons’ care-related needs, as well as social ones, are addressed. Appropriate evaluation of quality of care in the live-in setting is important for its improvement.