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Background: China's government has invested a great deal of resources to improve the coverage rate of community care facilities for the elderly. However, the facilities that have been built are underutilized. Methods: Referring to the Anderson model, a framework for analyzing the utilization of community care facilities for the elderly was constructed. Descriptive statistics on survey data from 17 communities demonstrated the status of the utilization, and binary logistic regression analysis examined the influencing factors of the utilization. Results: Built community care facilities for the elderly are underutilized and there are significant differences in the influencing factors of the utilization between daily care facilities, medical care facilities, recreation facilities, and spiritual comfort facilities. Conclusions: The main reasons for the underutilization can be delineated as follows: (1) The demand for community care facilities is outstripped by the supply, resulting in a surplus; (2) Complex constraints on demand for facilities due to insufficient enabling resources; (3) Inadequacy of community care facilities in meeting expectations. (4) High substitutability of community care facilities; (5) Bureaucratic pressure hindering facility development. To address the underutilization of community care facilities, it is recommended to clarify the community responsibility boundaries for elderly care and the role that the market plays in community care facilities for the elderly. [ABSTRACT FROM AUTHOR]

Background: The growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients' needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints. Methods: An ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis. Results: Staff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient's formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient's home. Conclusion: The loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff's emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care. [ABSTRACT FROM AUTHOR]

This study utilized nationally approved data from the 2022 Long-Term Care Survey of Korea to examine the factors associated with career disruptions and employment status among family caregivers of home-based care recipients. Descriptive statistics, chi-square tests, one-way ANOVA, and multinomial logistic regression analysis were employed to address the research questions. The results indicated that 19.39% of family caregivers of home-based care recipients experienced career disruptions due to informal caregiving. Demographic factors such as gender, age of family caregivers, and their relationship with care recipients predicted their employment status. Gender was a significant explanatory factor, as daughters/daughters-in-law were more likely to be in insecure employment positions than sons. Lower household income and older age were also associated with employment insecurity. Recommendations include coverage expansion, family support programs, and pension credit for family caregivers to meet the needs of care recipients and their families. [ABSTRACT FROM AUTHOR]

Abstract Background China’s government has invested a great deal of resources to improve the coverage rate of community care facilities for the elderly. However, the facilities that have been built are underutilized. Methods Referring to the Anderson model, a framework for analyzing the utilization of community care facilities for the elderly was constructed. Descriptive statistics on survey data from 17 communities demonstrated the status of the utilization, and binary logistic regression analysis examined the influencing factors of the utilization. Results Built community care facilities for the elderly are underutilized and there are significant differences in the influencing factors of the utilization between daily care facilities, medical care facilities, recreation facilities, and spiritual comfort facilities. Conclusions The main reasons for the underutilization can be delineated as follows: (1) The demand for community care facilities is outstripped by the supply, resulting in a surplus; (2) Complex constraints on demand for facilities due to insufficient enabling resources; (3) Inadequacy of community care facilities in meeting expectations. (4) High substitutability of community care facilities; (5) Bureaucratic pressure hindering facility development. To address the underutilization of community care facilities, it is recommended to clarify the community responsibility boundaries for elderly care and the role that the market plays in community care facilities for the elderly.

Abstract Background The growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients’ needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints. Methods An ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis. Results Staff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient’s formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient’s home. Conclusion The loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff’s emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care.

Abstract Background Home-based care may cover anything from 24-hour support for people with a disability, to short-term post-discharge care, or to periodic assistance with simple tasks such as domestic aid for frail older people. The process can be complex and time-consuming and requires coordination between the individual, their family caregivers, and healthcare providers. Receiving care at home can also lead to social isolation as older people may have limited opportunities for social interaction. This study aimed to investigate older people’s experience and related factors while receiving home-based long-term care services. Methods A qualitative study was used. Face-to-face individual interviews were conducted with people who were receiving nursing care in their homes (N = 17) and analyzed through thematic analysis. Results Analysis of interview data resulted in the identification of three major themes that captured participants’ personal experiences regarding long-term care in the home: (1) Challenges faced by older people receiving long-term care at home; (2) The impact of home care services on people’s social well-being; and (3) Older people’s contradictory emotions regarding care delivery. Conclusions Findings of the study revealed that the most important and challenging factors in home care from the perspective of older people were social well-being, religious needs, and physical needs. They considered the nurses who provided these services as family members and the most significant helpers in their daily activities. Participants expressed a desire for more services in the future.

Abstract Background This study explored risk perception characteristics and influencing factors among informal caregivers of functionally dependent elderly individuals at home, aiming to improve caregivers’ caregiving risk perception and coping abilities and ultimately enhance the quality of life for these individuals. Methods We used purposive sampling to select 22 informal caregivers from a community in Zhengzhou City, Henan Province, China, between March and September 2023 and conducted face-to-face semi-structured in-depth interviews. The data were analyzed using Colaizzi’s seven-step analysis method. Results We extracted two themes, caregiving risk perception characteristics and caregiving risk perception associated factors, and eight sub-themes, perceived risk possibility, perceived risk anticipation, perceived severity of consequences, past caregiving experiences, health literacy, psychological status, caregiving burden, and family social support. Conclusion There were differences in how informal caregivers perceived the risks associated with caring for functionally dependent elderly individuals at home, which various factors could influence. It was essential to provide training that covered the knowledge and skills needed for caregiving, improve caregivers’ awareness of safety risks, and establish a correct perception of caregiving risks. The government must construct and refine a comprehensive framework for caregiver respite services. Simultaneously, healthcare professionals should proactively undertake health education endeavors to augment the recognition of care safety risks among informal caregivers, thereby cultivating an accurate awareness of care risk perception.

This study utilized nationally approved data from the 2022 Long-Term Care Survey of Korea to examine the factors associated with career disruptions and employment status among family caregivers of home-based care recipients. Descriptive statistics, chi-square tests, one-way ANOVA, and multinomial logistic regression analysis were employed to address the research questions. The results indicated that 19.39% of family caregivers of home-based care recipients experienced career disruptions due to informal caregiving. Demographic factors such as gender, age of family caregivers, and their relationship with care recipients predicted their employment status. Gender was a significant explanatory factor, as daughters/daughters-in-law were more likely to be in insecure employment positions than sons. Lower household income and older age were also associated with employment insecurity. Recommendations include coverage expansion, family support programs, and pension credit for family caregivers to meet the needs of care recipients and their families.

Abstract Background Older people receiving home-based care (HBC) often face barriers to access preventive oral health care (OHC) and dental treatments. Leading to deterioration of their oral healthcare. It is further deteriorated by factors such as increasing burden of systemic diseases, medicinal side effects, limited mobility, financial constraints and lack of professional OHC at home. Older people also struggle to maintain necessary daily oral hygiene, leading to malnutrition, weight loss, and a risk of a further health degradation. This cross-sectional survey aimed to investigate the oral health-related quality of life (OHRQoL) and their associated factors in HBC recipients. Methods 5,280 older people (≥ 60 years) living in Hamburg, who were in need of care and insured with statutory health insurance DAK-Gesundheit received the questionnaire, which included the German version of the Oral Health Impact Profile (OHIP G-14) and, the EQ-5D health-related quality of life (HRQoL) measure as well as further questions regarding the extent of informal social support, subjective oral health status, oral health behaviour, subjective cognitive status, and socio-demographic variables. Results The participants (n = 1,622) had a median age of 83.2 years, with 72.0% of the sample being female. Nearly two thirds of the sample reported that their independence or abilities were significantly impaired (care level 2). Regarding oral health impacts, 40.0% of the participants reported experiencing at least one of the fourteen possible prevalent impacts of the OHIP-G14 fairly often or very often. A multivariate regression model on the severity of oral health impacts revealed, that a better HRQoL, a positive perception of one’s own dental status, fewer visits to dental practices, and no need for support in OHC were associated with better OHRQoL. Conversely, respondents with a negative perception of their oral health status, more frequent visits to a dental practice, a need for support in OHC, and subjective memory impairment showed poorer OHRQoL. Conclusions The results highlight the risk for poor oral health among older people in HBC. We conclude that there is an urgent need to prioritise oral health, especially as poor oral health can further compromise the systemic wellbeing of these already care dependent population.

Lena-Karin Gustafsson,1 Els-Marie Anbacken,2 Gunnel Östlund,2 Anna Bondesson,1 Tina Pettersson,1 Viktoria Zander3 1Division of Caring Science, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden; 2Division of Social Work, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden; 3Division of Health and Welfare Technology, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, SwedenCorrespondence: Lena-Karin Gustafsson, Division of Caring Science, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden, Tel +46 70 7874420, Email lena-karin.gustafsson@mdu.seAim: This study aims to describe experiences of the implementation of a new integrated healthcare model for older adults with complex care needs due to multimorbidity, living at home, from a health and welfare personnel perspective. The goal was to diminish hospitalization and still carry out high quality care at home for older adults living with multimorbidity. The model was implemented by two organizations working in cooperation, the municipality, and the region that handles interprofessional social care and healthcare in people’s homes.Materials and Method: Open-ended group interviews with personnel were carried out, three of the group interviews pre-implementations of the model, and three of the group interviews post-implementation. The interviews were audiotaped and analysed according to the procedure of thematic analysis.Results: The quality of the integrated care model was based on care-chain cooperation, shared professionalism, and creating relations with the patient including closeness to next of kin, which was underlined by the participants. Unencumbered time gave the professionals the possibility to develop quality in integrated healthcare as part of integrated and person-centred care. The coproduction of education, research interviews and the follow-up meeting identified successes in diminishing hospitalization rates according to the participants’ experiences of the post-implementation interviews. An identified failure was, however, that shared professionalism was not developed over time, rather the different responsibilities were accentuated according to the information retrieved at the follow-up meeting.Conclusion: Quality aspects of the model were identified in the present study. However, when implementation of a new model is completed, the organizations always have their own interpretation of how to further understand the model in question.Plain language summary: The intention of the present study was to follow the process of working with a new model of providing care at home, thus preventing increased numbers of hospital readmissions, based on the professionals´ point of view of what quality care is for older adults with complex care needs due to multimorbidity, living in their own home. The professionals were interviewed in group settings on several occasions during the implementation.The result showed hopeful expectations expressed by the professionals before the new model was implemented, such as a hope for getting more time for high-quality care for the older adults with multimorbidity. During the teamwork, the conversation within the team members was praised as a key factor that included shared professionalism from professionals with different levels of education and focus on their work. According to the staff, unnecessary hospital stays were reduced, while the interprofessional care-chain cooperation was improved through the work of the integrated care team. For many team members, the positive difference in both work and care satisfaction was highlighted in comparison to regular home care as they were able to use their multi-disciplinary skills and support.Keywords: integrated-care model, multi-morbidity, interprofessional care, home-based care, person-centred integrated care

Background: Home-based care may cover anything from 24-hour support for people with a disability, to short-term post-discharge care, or to periodic assistance with simple tasks such as domestic aid for frail older people. The process can be complex and time-consuming and requires coordination between the individual, their family caregivers, and healthcare providers. Receiving care at home can also lead to social isolation as older people may have limited opportunities for social interaction. This study aimed to investigate older people's experience and related factors while receiving home-based long-term care services. Methods: A qualitative study was used. Face-to-face individual interviews were conducted with people who were receiving nursing care in their homes (N = 17) and analyzed through thematic analysis. Results: Analysis of interview data resulted in the identification of three major themes that captured participants' personal experiences regarding long-term care in the home: (1) Challenges faced by older people receiving long-term care at home; (2) The impact of home care services on people's social well-being; and (3) Older people's contradictory emotions regarding care delivery. Conclusions: Findings of the study revealed that the most important and challenging factors in home care from the perspective of older people were social well-being, religious needs, and physical needs. They considered the nurses who provided these services as family members and the most significant helpers in their daily activities. Participants expressed a desire for more services in the future. [ABSTRACT FROM AUTHOR]

Background: This study explored risk perception characteristics and influencing factors among informal caregivers of functionally dependent elderly individuals at home, aiming to improve caregivers' caregiving risk perception and coping abilities and ultimately enhance the quality of life for these individuals. Methods: We used purposive sampling to select 22 informal caregivers from a community in Zhengzhou City, Henan Province, China, between March and September 2023 and conducted face-to-face semi-structured in-depth interviews. The data were analyzed using Colaizzi's seven-step analysis method. Results: We extracted two themes, caregiving risk perception characteristics and caregiving risk perception associated factors, and eight sub-themes, perceived risk possibility, perceived risk anticipation, perceived severity of consequences, past caregiving experiences, health literacy, psychological status, caregiving burden, and family social support. Conclusion: There were differences in how informal caregivers perceived the risks associated with caring for functionally dependent elderly individuals at home, which various factors could influence. It was essential to provide training that covered the knowledge and skills needed for caregiving, improve caregivers' awareness of safety risks, and establish a correct perception of caregiving risks. The government must construct and refine a comprehensive framework for caregiver respite services. Simultaneously, healthcare professionals should proactively undertake health education endeavors to augment the recognition of care safety risks among informal caregivers, thereby cultivating an accurate awareness of care risk perception. [ABSTRACT FROM AUTHOR]

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Background: Older people receiving home-based care (HBC) often face barriers to access preventive oral health care (OHC) and dental treatments. Leading to deterioration of their oral healthcare. It is further deteriorated by factors such as increasing burden of systemic diseases, medicinal side effects, limited mobility, financial constraints and lack of professional OHC at home. Older people also struggle to maintain necessary daily oral hygiene, leading to malnutrition, weight loss, and a risk of a further health degradation. This cross-sectional survey aimed to investigate the oral health-related quality of life (OHRQoL) and their associated factors in HBC recipients. Methods: 5,280 older people (≥ 60 years) living in Hamburg, who were in need of care and insured with statutory health insurance DAK-Gesundheit received the questionnaire, which included the German version of the Oral Health Impact Profile (OHIP G-14) and, the EQ-5D health-related quality of life (HRQoL) measure as well as further questions regarding the extent of informal social support, subjective oral health status, oral health behaviour, subjective cognitive status, and socio-demographic variables. Results: The participants (n = 1,622) had a median age of 83.2 years, with 72.0% of the sample being female. Nearly two thirds of the sample reported that their independence or abilities were significantly impaired (care level 2). Regarding oral health impacts, 40.0% of the participants reported experiencing at least one of the fourteen possible prevalent impacts of the OHIP-G14 fairly often or very often. A multivariate regression model on the severity of oral health impacts revealed, that a better HRQoL, a positive perception of one's own dental status, fewer visits to dental practices, and no need for support in OHC were associated with better OHRQoL. Conversely, respondents with a negative perception of their oral health status, more frequent visits to a dental practice, a need for support in OHC, and subjective memory impairment showed poorer OHRQoL. Conclusions: The results highlight the risk for poor oral health among older people in HBC. We conclude that there is an urgent need to prioritise oral health, especially as poor oral health can further compromise the systemic wellbeing of these already care dependent population. [ABSTRACT FROM AUTHOR]

Background: Psychosocial interventions, crucial for recovery in patients with schizophrenia, have often been developed and tested in high income countries. We aimed at developing and validating home-based a booklet based psycho-social intervention with inputs from stakeholders: patients, families, and mental health professionals (MHP) for patients with schizophrenia and related disorders in low resource settings. Methods: We developed a preliminary version of psychosocial intervention booklets based on six themes derived from focus group discussions conducted with patients, families, and MHP. Initially, quantitative assessment of content validity was done by MHP on overall and Content Validity Index of individual items of the specific booklets, followed by in-depth interviews about their views. The booklets were modified based on their inputs. Further, pilot testing of manuals was done on the users - nine pairs of patients and caregivers followed by development of a final version of psycho-social intervention. Results: The percentage content validity of individual modules and overall booklets was ≥78.5% indicating good validity. Most MHP reported that the manuals were relevant and easy to use but were text-heavy, and lengthy. On pilot testing of modified manuals with patients and their family caregivers, majority (77.8%) of them found booklets useful and suggested that there should be separate booklets for both patients and caregivers for providing information and entering separate response for the activities, integrating helpful tips. Language should be simple. Finally, two sets of booklets (“info book” and “workbook”) named ‘Saksham’ (meaning empowered) were created with specific modules (viz., ‘Medicine adherence’, ‘Daily routine’, ‘Eating right’, ‘Physical activity’, ‘Physical health monitoring’, ‘Self-reliance’, and ‘Psychoeducation’) for patients and caregivers each, in two languages (Hindi and English). Conclusion: Booklets with modules for psychosocial interventions for patients with schizophrenia and their caregivers were developed after establishing content validity and pilot testing.

BackgroundAs more Americans age in place, it is critical to understand care delivery in the home. However, data on the range of home-based services provided by Medicare is limited. We define a taxonomy of clinical care in the home funded through fee-for-service Medicare and methods to identify receipt of those services.MethodsWe analyzed Fee-for-service (FFS) Medicare claims data from a nationally-representative cohort of older adults, the National Health and Aging Trends Study (NHATS), to identify home-based clinical care. We included 6,664 NHATS enrollees age ≥ 70 and living in the community, observed an average of 3 times each on claims-linked NHATS surveys. We examined provider and service type of home-based clinical care to identify a taxonomy of 5 types: home-based medical care (physician, physician assistant, or nurse practitioner visits), home-based podiatry, skilled home health care (SHHC), hospice, and other fee-for-service (FFS) home-based care. We further characterized home-based clinical care by detailed care setting and visit types.ResultsFrom 2011-2016, 17.8%-20.8% of FFS Medicare beneficiaries age ≥ 70 received Medicare-funded home-based clinical care. SHHC was the most common service (12.8%-16.1%), followed by other FFS home-based care (5.5%-6.5%), home-based medical care (3.2%-3.9%), and hospice (2.6%-3.0%). Examination of the other-FFS home-based care revealed imaging/diagnostics and laboratory testing to be the most common service.ConclusionsWe define a taxonomy of clinical care provided in the home, serving 1 in 5 FFS Medicare beneficiaries. This approach can be used to identify and address research and clinical care gaps in home-based clinical care delivery.

Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear's Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses' actions and their moral responsibility to work towards the respect of patient's values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research. [ABSTRACT FROM AUTHOR]

Objective To use the Plan-Do-Check-Action(PDCA) cycle management model to reduce the number of nursing adverse events in home-based nursing of patients with indwelling gastric tubes. Methods A total of 14 patients who chose to have indwelling gastric tube at home from January to June of 2021 were enrolled. With the informed consent of the patient and his family, indwelling gastric tube placement was performed at home. The PDCA cycle management model was implemented for the home indwelling gastric tube nursing of patients. The occurrence of indwelling gastric tube-associated nursing adverse events and the nursing quality of nursing staff before and after the implementation of PDCA mode were compared. Results After implementation of the PDCA cycle management model, six indicators were regularly monitored daily: the number of nasal strips that were not measured for deep replacement of gastric tubes, residual volume before nasogastric feeding, gastric tube use for more than 28 days, self-extubation, no oral care and other nursing problems. After observation, the number of gastric tubes-associated nursing problems were significantly reduced, with as significant difference (P＜0. 01). Nursing staff had significant improvements in PDCA skills, team spirit, brain development, communication and coordination, activity confidence, responsibility in the PDCA cycle mode. Conclusion The use of PDCA cycle management mode in the home-based nursing of patients with indwelling gastric tubes can reduce the incidence of nursing adverse events, and effectively improve the nursing quality. (目的 运用PDCA循环管理模式减少留置胃管相关护理问题, 提升患者居家护理安全。方法 选取2021年1月—6月共14例接受居家护理的留置胃管患者为研究对象。在患者及其家属知情同意下, 于家中实施留置胃管。运用PDCA循环管理模式开展居家护理, 对比实施PDCA模式前和实施PDCA模式后留置胃管相关护理问题发生情况与护理人员的护理质量。结果 运用PDCA循环管理模式后, 每日定期观察6项指标: 未测量胃管深度更换鼻贴、鼻饲前未回抽检查残余量、胃管使用超过28 d、自行拔管、无口腔护理和其他护理问题的发生数量。实施PDCA循环管理模式后, 留置胃管相关护理问题较实施前减少, 差异有统计学意义(P＜0. 01), 护理人员PDCA循环工具、团队精神、脑力开发、沟通协调、活动信心, 责任荣誉感方面均较改善前有明显改善。结论 对于居家留置胃管患者, 运用PDCA循环管理模式能够减少留置胃管相关护理问题, 有效提升护理人员的护理质量。)

Objectives: The objectives of this study were to assess the knowledge and practice skills on home-based urinary catheter care among parents of under-five children with urinary catheter. Materials and Methods: This cross-sectional study was conducted from June 1, 2021, to September 11, 2021, in a tertiary hospital in north India. Purposive sampling was used to select 50 participants. Three instruments were employed for data collection after fulfilling sample criteria; for baseline information demographic tool, knowledge questionnaires, and a practice checklist. Data were analyzed using descriptive and inferential statistics. Results: On assessment of 50 participants, the majority of parents aged above 30 years (74%). Most of the participants were male (82%), graduated (38%), and working in the private sector (58%). Similarly, two-thirds of participants were residing in a nuclear family (64%) with a single child 32 (64%) and family income

This article summarized the family participatory nursing care in an elderly patient with congenital anomalies of urinary tract undergoing indwelling catheter placement. According to the nursing plan, targeted interventions were carried out. The designed health education program was provided to improve the knowledge and practice skills of primary caregivers, in order to prevent the catheter-associated complications. (本文总结1例老年尿道畸形留置尿管患者的家庭参与式护理体会。通过制定护理目标、护理计划、实施方案且对照护者进行有计划的培训和指导干预, 有效提高了照护者的理论知识、操作技能及执行力, 对预防留置尿管相关并发症起到积极作用。)

(1) Background: Pneumonia stands as a prevalent infectious disease globally, contributing significantly to mortality and morbidity rates. In Taiwan, pneumonia ranks as the third leading cause of death, particularly affecting the elderly population (92%). This study aims to investigate factors associated with community-acquired pneumonia (CAP) among elderly individuals receiving home-based care. (2) Methods: Conducted between January 2018 and December 2019, this retrospective study involved a medical chart review of elderly patients under home-based care. A multiple logistic regression model was employed to identify factors associated with CAP in this demographic. (3) Results: Analysis encompassed 220 elderly patients with an average age of 82.0 ± 1.1 years. Eighty-five patients (38.6%) were hospitalized for CAP. Predominant diagnoses included cancer (32.3%), stroke (24.5%), and dementia (23.6%). Significant predictors of CAP for elderly patients under home-based care included male gender (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.95–8.60, p < 0.001), presence of a nasogastric (NG) tube (OR = 8.85, 95% CI: 3.64–21.56, p < 0.001), and a borderline negative association with the use of proton pump inhibitors (PPIs) (OR = 0.37, 95% CI: 0.13–1.02, p = 0.0546). End-of-life care indicators for these patients with CAP included an increased number of hospital admission days in the last month of life (OR = 1.13, 95% CI: 1.08–1.18, p < 0.001) and a higher likelihood of hospital death (OR = 3.59, 95% CI: 1.51–8.55, p = 0.004). (4) Conclusions: In the current study, significant predictors of CAP among elderly patients receiving home-based care included the presence of an NG tube and male gender, while the use of PPIs was borderline inversely associated with the risk of CAP. Notably, more admission days in the last month of life and death in the hospital were found to be associated with end-of-life care for this group. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to assess the knowledge and practice skills on home-based urinary catheter care among parents of under-five children with urinary catheter. Materials and Methods: This cross-sectional study was conducted from June 1, 2021, to September 11, 2021, in a tertiary hospital in north India. Purposive sampling was used to select 50 participants. Three instruments were employed for data collection after fulfilling sample criteria; for baseline information demographic tool, knowledge questionnaires, and a practice checklist. Data were analyzed using descriptive and inferential statistics. Results: On assessment of 50 participants, the majority of parents aged above 30 years (74%). Most of the participants were male (82%), graduated (38%), and working in the private sector (58%). Similarly, two-thirds of participants were residing in a nuclear family (64%) with a single child 32 (64%) and family income <5000 rupees per month (60%). The mean score of knowledge was 1.94 ± 0.81 and that of practice skills was 1.98 ± 0.85 on home-based care. Regression analysis showed that knowledge of parents was significantly associated with qualification (ß: 1.821, P = 0.002). Similarly, association of practice skills of parents with gender (ß: 1.235, P = 0.050) and qualification (ß: 1.889, P = 0.00) was significant. Conclusion: The general findings of our study showed that parents' education and occupation played a significant role in a child's care. Parental education and catheter care skills positively affect the child and reduce readmission rates. [ABSTRACT FROM AUTHOR]

Background: Palliative Care (PC) was a core component of Primary Health Care services during the World Health Assembly Resolution, 2014. The study aims to develop a Comprehensive Palliative Care Model (CPCM) for patients with life-threatening conditions compliant with the local context and unmet needs. Materials and Methods: A mixed-methods approach will be adopted for the three-phased study in two districts of Telangana. Phase I, a literature review, will be performed to explore globally available PC models, followed by an on-ground observational study. Phase II will address the gaps in existing models while identifying the unmet needs of the patients and caregivers. The outcome of the above phases will help develop a CPCM in Phase III. The developed model will be validated using the Delphi technique. Results: The expected outcomes of the study are a) Phase-I: Details of the PC models available globally and locally, b) Phase-II: Availability of essential resources in the Health and Wellness Centers (HWCs), Knowledge and Attitude of the PC team, Barriers to provide PC, Unmet needs, and c) Phase-III: CPCM model Conclusion: The study attempts to provide a holistic PC model, considering the health system, patients, and caregivers and offering policy suggestions to the state.

Abstract Background The COVID-19 pandemic has made devastating impacts on public health and global economy. While most people experience mild symptoms, it is highly transmissible and deadly in at-risk populations. Telemedicine has the potential to prevent hospitalization and provide remote care. Methods This retrospective study included 336 people with COVID-19, among which 141 (42%) and 195 (58%) were in Delta and Omicron dominant groups, respectively. Patients were confirmed to have COVID-19 by PCR or rapid test and were cared for via telemedicine. Severe cases were hospitalized for more intensive treatment. Results The majority of individuals recovered at home (97.02%), while 2.98% required hospitalization. All hospital admissions were in Delta dominant group. No deaths were reported. Delta dominant group was more likely to develop loss of taste and smell, decreased appetite and need longer treatment time than those in Omicron dominant group. Conclusions Telemedicine is a safe measure to provide at-home care for people with COVID-19 infections caused by both Delta and Omicron variants. Trial registration This study was approved by the Institutional Review Board Committee of University of Medicine and Pharmacy at Ho Chi Minh City (IRB No: 22115–DHYD).

Objective To evaluate the application effect of home-based exercise therapy in community-dwelling elderly patients with mild cognitive impairment (MCI) and depression. Methods From January 2021 to December 2022, 60 community-dwelling elderly patients with MCI and depression who were screened at medical institutions were randomly divided into the control group and the intervention group. According to the basic requirements of national public health service, community medical staff carried out group follow-up once every quarter, and patients were intervened by general lifestyle interventions and health education for 6 months. On the basis of routine interventions, the intervention group received home-based exercise therapy for 6 months. The Geriatric Depression Scale(GDS), The Montreal Cognitive Assessment (MoCA), Brathel Index (BI) for Activity of Daily Living were adopted for effectiveness assessment of exercise therapy on cognitive function, depression level and daily living ability of patients. Results After 6 months of intervention, the score ofGDS in the intervention group was lower than that in the control group, with a significant difference (P＜0. 01); The total score of MoCA and subscale scores of Visuospatial/Executive, Attention, Language, Abstraction, Delayed recall and Orientation in the intervention group were higher than those in the control group (P＜0. 01); The score of BI in the intervention group was higher than that in the control group, with a significant difference (P＜0. 01). Conclusion Home-based exercise therapy can alleviate the depressive symptoms, improve the cognitive function and activity of daily living among community-dwelling elderly patients with MCI and depression (目的 探讨以家庭为基础的运动疗法对社区老年轻度认知障碍(MCI)伴抑郁患者的影响。方法 选取2021年1月—2022年12月, 经医疗机构筛查并居住在上海市奉贤区社区的60名MCI伴抑郁症状的患者, 随机分为对照组和干预组。对照组依据国家基本公共卫生服务要求, 由课题组成员在相应社区每季度开展团体讲座, 普及MCI相关健康教育知识, 饮食、运动等生活方式, 干预6个月; 干预组在对照组的基础上, 增加了以家庭为基础的运动疗法, 干预6个月。对比两组患者老年抑郁量表(GDS)、蒙特利尔认知评估量表(MoCA)和Barthel指数评定量表(BI)得分情况。结果 干预后, 干预组GDS量表评分低于对照组, 差异有统计学意义(P＜0. 01); 干预组MoCA量表视空间与执行能力、注意力、语言功能、抽象思维、延迟回忆和定向力维度评分以及总分高于对照组, 差异有统计学意义(P＜0. 01); 干预组患者BI量表评分较对照组提高, 差异有统计学意义(P＜0. 01)。结论 以家庭为基础的运动疗法可以缓解社区老年MCI伴抑郁患者的抑郁症状, 改善认知功能, 提高日常生活能力, 并延缓MCI病情进展。)

Home-based primary care (HBPC) is a clinical practice that is being increasingly utilized for the homebound older adult population. As the age demographics in the United States shift over time, these programs will need to be expanded to accommodate the growing aging population. This narrative review aims to compile studies on the benefits of HBPC from the perspective of homebound older adult patients, caregivers, and the health care providers who practice HBPC. Studies were identified through PubMed, Web of Science, and Google Scholar, and a total of 10 papers were included in this review. Identified benefits of HBPC for homebound older adult patients included improved relationships, peace of mind, goal attainment, improved access to care, and avoidance of hospitalization. Benefits for caregivers included providing emotional support, informational support, and easing logistical challenges. Benefits for providers included improved patient care by addressing social determinants of health, improved rapport with patients, and improved provider wellness and attitude. The main limitation of this review is the lack of adequate research on this topic, specifically from the perspective of providers other than resident physicians and nurse practitioners such as nurses and community health workers. As the U.S. population of older adults continues to grow over the coming decades, the need for more home-based medicine should not be seen as a burden but rather as an opportunity to transform and humanize the way medicine is practiced.

Abstract Objective During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. Methods Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an ‘early hospital discharge’ program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. Results Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff’s qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. Conclusions We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care.

Mirkka Söderman, Anna Bondesson, Tina Pettersson, Lena-Karin Gustafsson Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, SwedenCorrespondence: Mirkka Söderman, School of Health, Care and Social Welfare, Box 325, Eskilstuna, 631 05, Sweden, Tel +46 16153433, Email mirkka.soderman@mdu.seBackground: Reablement as a concept includes a health-promoting perspective with the goal of strengthening health and the ability to perform and participate in daily activities, a broader perspective than in general home care and rehabilitation. Reablement interventions have shown to be both more effective and to a greater extent improve the function and health-related quality of life of older persons when compared to traditional home-based care. Success factors for intensive-home-rehabilitation (IHR), an intervention based on the reablement concept, have been described earlier; however, there is a lack of knowledge about why some persons do not recover despite receiving IHR.Aim: The aim was to shed light on the older persons’ conditions during IHR from the perspective of the rehabilitation team members and to describe obstacles to recovery.Methods: Qualitative analysis of health and care records of persons (65+) who received IHR (n=19) performed by an interprofessional team.Results: The analysis revealed various problematic situations, dilemmas, that occurred in the older persons’ lives during IHR, as well as their consequences and the strategies employed by the older persons as a result. IHR aspects perceived as successful by the older persons also emerged, as well as differences in experiences of the physical and mental aspects of the IHR. Analysis also revealed reasons why the IHR might be experienced as broadly successful.Conclusion: The older persons seemed to be satisfied with IHR and achieved their goals; however, some seemed to need more time to reach their goals. Background factors such as having additional diagnoses and living alone might affect the rehabilitation process.Implication for Practice: The study provides knowledge regarding the importance of IHR for the recovery process for the increasing numbers of older persons, which might also be useful in other patient groups requiring otherwise long-term rehabilitation and recovery such as after covid-19 infection.Keywords: home-based care, intensive-home-rehabilitation, interprofessional team, older persons, reablement, recovery, rehabilitation process

Background: The COVID-19 pandemic has made devastating impacts on public health and global economy. While most people experience mild symptoms, it is highly transmissible and deadly in at-risk populations. Telemedicine has the potential to prevent hospitalization and provide remote care. Methods: This retrospective study included 336 people with COVID-19, among which 141 (42%) and 195 (58%) were in Delta and Omicron dominant groups, respectively. Patients were confirmed to have COVID-19 by PCR or rapid test and were cared for via telemedicine. Severe cases were hospitalized for more intensive treatment. Results: The majority of individuals recovered at home (97.02%), while 2.98% required hospitalization. All hospital admissions were in Delta dominant group. No deaths were reported. Delta dominant group was more likely to develop loss of taste and smell, decreased appetite and need longer treatment time than those in Omicron dominant group. Conclusions: Telemedicine is a safe measure to provide at-home care for people with COVID-19 infections caused by both Delta and Omicron variants. Trial registration: This study was approved by the Institutional Review Board Committee of University of Medicine and Pharmacy at Ho Chi Minh City (IRB No: 22115–DHYD). [ABSTRACT FROM AUTHOR]

Objective: During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. Methods: Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an 'early hospital discharge' program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. Results: Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff's qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. Conclusions: We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care. [ABSTRACT FROM AUTHOR]

Background and aims: Diabetes is a metabolic disorder associated with many complications; caregivers' self-efficacy is essential for sustained home management. The study aimed to find out the effects of nursing intervention programs on caregivers' selfefficacy regarding adhering to home-based management of child to type1 diabetes mellitus. Methods: A quasi-experimental study design on home-based nursing intervention was conducted and recruited 60 caregivers who took homecare for their diabetes type 1. The systematic sampling method was used to select the participants Who were divided into two groups (30 in an intervention group and 30 in a control group) and who were registered at the Gulan General Hospital in Akre / Duhok city of Iraqi Kurdistan region. Verbal consent was obtained. starting from 3rd of January to the end of 5th September 2022. The home-based lesions were adopted for 5 months, Mann-Whitney U test, and TTest ware used to identify the comparison between the variables. A p-value of = 0.05, considered statistically significant. Results: There is no significant association between the control and study groups at the pretest before conducting the intervention program, while after conducting a homebased program for the intervention group, the results show that there was a highly significant difference between the pre and post test, the result reflects and successful program to change the self-efficacy of the caregivers from intervention, and it means a provided compared with the control group (non-intervention group), at a p-value of = 0.05. Conclusion: The results show that the caregivers who participated in the program (Intervention group), were successfully adapted to the self-efficacy program. Applying the program to a wider range of caregivers, to adhere to the caregivers and improve their self -efficacy toward home-based management of type 1 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Objectives To examine factors contributing to delaying care home admission; and compare the rates of care home admission and cost consequence between two government subsidised programmes, Veterans' Affairs Community Nursing (VCN) and Home Care Package (HCP). Methods Our national, population-based retrospective cohort study and cost analysis used existing, de-identified veterans' claims databases (2010–19) and the Registry of Senior Australians Historical Cohort (2010–17), plus aggregate programme expenditure data. This involved 21,636 VCN clients (20,980 aged 65–100 years), and an age- and sex-matched HCP cohort (N  = 20,980). Results Service factors associated with lower risk of care home admission in the VCN cohort were periodic (versus continuous) service delivery (HR 0.27 [95%CI, 0.24–0.31] for ≤18 months; HR 0.89 [95%CI, 0.84–0.95] for >18 months), and majority care delivered by registered nurses (versus personal care workers) (HR 0.86 [95%CI, 0.75–0.99] for ≤18 months; HR 0.91 [95%CI, 0.85–0.98] for >18 months). In the matched cohorts, the time to care home admission for VCN clients (median 28 months, IQR 14–42) was higher than for HCP clients (14, IQR 6–27). Within 5 years of service access, 57.6% (95%CI, 56.9–58.4) of HCP clients and 26.6% (95%CI, 26.0–27.2) of VCN clients had care home admission. The estimated cost saving for VCN recipients compared to HCP recipients over 5 years for relevant government providers was over A$1 billion. Conclusions Compared to an HCP model, individuals receiving VCN services remained at home longer, with potentially significant cost savings. This new understanding suggests timely opportunity for many countries' efforts to enhance community-based care services. [ABSTRACT FROM AUTHOR]

ObjectivesApproximately 7.5 million US adults are homebound or have difficulty accessing office-based primary care. Home-based primary care (HBPC) provides such patients access to longitudinal medical care at home. The purpose of this study was to describe the challenges and adaptations by HBPC practices made during the first surge of the COVID-19 pandemic.DesignMixed-methods national survey.Setting and participantsHBPC practices identified as members of the American Academy of Homecare Medicine (AAHCM) or participants of Home-Centered Care Institute (HCCI) training programs.MethodsOnline survey regarding practice responses to COVID-19 surges, COVID-19 testing, the use of telemedicine, practice challenges due to COVID-19, and adaptations to address these challenges. Descriptive statistics and t tests described frequency distributions of nominal and categorical data; qualitative content analysis was used to summarize responses to the open-ended questions.ResultsSeventy-nine practices across 29 states were included in the final analyses. Eighty-five percent of practices continued to provide in-person care and nearly half cared for COVID-19 patients. Most practices pivoted to new use of video visits (76.3%). The most common challenges were as follows: patient lack of familiarity with telemedicine (81.9%), patient anxiety (77.8%), clinician anxiety (69.4%), technical difficulties reaching patients (66.7%), and supply shortages including masks, gown, and disinfecting materials (55.6%). Top adaptive strategies included using telemedicine (95.8%), reducing in-person visits (81.9%), providing resources for patients (52.8%), and staff training in PPE use and COVID testing (52.8%).Conclusions and implicationsHBPC practices experienced a wide array of COVID-19-related challenges. Most continued to see patients in the home, augmented visits with telemedicine and creatively adapted to the challenges. An increased recognition of the need for in-home care by health systems who observed its critical role in caring for fragile older adults may serve as a silver lining to the otherwise dark sky of the COVID-19 pandemic.

Background: Many older adults with serious illness who depend on others for care have symptoms that are difficult to manage. Supporting caregivers in symptom assessment (SA) may reduce suffering. Objective: Pilot an SA-Toolkit for caregivers to assess older adults' symptoms at home. Design: Pilot study. Setting/Subjects: English-speaking patients ≥65 years of age and their caregivers from a home-based geriatrics program in San Francisco. Measurements: With multiple stakeholder input, we created a SA-Toolkit consisting of illustrations depicting symptoms, validated Faces Scale, and easy-to-use tracking system with phone numbers of family/friends/clinicians. At baseline and one week, we assessed change in patients' symptoms and caregivers' self-efficacy with SA (5-point scale) using Wilcoxon signed-rank tests. We assessed acceptability at one week. Results: Eleven patient/caregiver dyads participated in the study. Patients were 84.7 years old (SD 5.7), 81.8% women, 27.3% non-white. From baseline to one week, mean number of symptoms decreased (3.7 [1.5] to 2.6 [1.8], p = 0.03). Specifically, patients with pain decreased from 63.6% to 36.4%, anxiety 54.6% to 18.2%, depression 45.5% to 27.3%, and loneliness 36.4% to 18.2%. Caregiver self-efficacy increased (4.6 [0.3] to 4.8 [0.3], p = 0.09). Patients found the symptom illustrations easy to use (8.7 on 10-point scale), but the Faces Scale less so (7.3/10) because it provided "too many choices." Caregivers liked the SA-Toolkit because it was easy to use; nearly all (10/11, 90%) would recommend it to others. Conclusions: The SA-Toolkit resulted in decreased symptom burden among patients and higher caregiver self-efficacy in SA. The SA-Toolkit is acceptable and may help reduce suffering in frail, older patients.

ObjectivesTo explore and analyze the influencing factors of depression in older adults living at home, so as to propose suggestions for improving the quality of older adults living at home.MethodsWe conducted a cross-sectional study on 498 older adults living at home based on questionnaire survey on the general information, daily living ability, health status, and care perception (including self-care, care for cohabitants, and care for non-cohabitants) of older adults living at home, as well as their willingness to help each other, and analyzed the influencing factors of depression among older adults living at home.ResultsThe results showed a willingness to help older adults, self-care, and total activities of daily living (ADL), health status was an influential factor for depression in older adults (p

Abstract Background As more Americans age in place, it is critical to understand care delivery in the home. However, data on the range of home-based services provided by Medicare is limited. We define a taxonomy of clinical care in the home funded through fee-for-service Medicare and methods to identify receipt of those services. Methods We analyzed Fee-for-service (FFS) Medicare claims data from a nationally-representative cohort of older adults, the National Health and Aging Trends Study (NHATS), to identify home-based clinical care. We included 6,664 NHATS enrollees age ≥ 70 and living in the community, observed an average of 3 times each on claims-linked NHATS surveys. We examined provider and service type of home-based clinical care to identify a taxonomy of 5 types: home-based medical care (physician, physician assistant, or nurse practitioner visits), home-based podiatry, skilled home health care (SHHC), hospice, and other fee-for-service (FFS) home-based care. We further characterized home-based clinical care by detailed care setting and visit types. Results From 2011–2016, 17.8%-20.8% of FFS Medicare beneficiaries age ≥ 70 received Medicare-funded home-based clinical care. SHHC was the most common service (12.8%-16.1%), followed by other FFS home-based care (5.5%-6.5%), home-based medical care (3.2%-3.9%), and hospice (2.6%-3.0%). Examination of the other-FFS home-based care revealed imaging/diagnostics and laboratory testing to be the most common service. Conclusions We define a taxonomy of clinical care provided in the home, serving 1 in 5 FFS Medicare beneficiaries. This approach can be used to identify and address research and clinical care gaps in home-based clinical care delivery.

With the rapid advancement of the population aging, how to precisely meet the needs of the elderly has become an urgent problem. The paper focuses on the current situation and problems of elderly care in China, typical elderly care service models at home and abroad, and the development of domestic elderly care models, with a view to laying the theoretical foundation for constructing a better service model that meets the diversified and personalized service needs of the elderly in China. (随着人口老龄化态势的迅速发展, 如何精准满足老年人的养老需求成为亟待解决的民生问题。本文重点总结了我国老年人的养老现状和问题、国内外典型的养老模式以及现阶段国内养老模式的发展状况, 以期为构建更加符合我国老年人多元化、个性化服务需求的养老模式奠定理论基础。)

Abstract Background A rapid increase in community transmission of COVID-19 across the country overwhelmed Uganda’s health care system. In response, the Ministry of Health adopted the home-based care strategy for COVID-19 patients with mild-to-moderate disease. We determined the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care during the second wave in Kapelebyong district, in eastern Uganda. Methods We conducted a sequential explanatory mixed-methods study. We first collected quantitative data using an interviewer-administered questionnaire to determine characteristics and treatment outcomes of COVID-19 patients under home-based care. Cured at home was coded as 1 (considered a good outcome) while being admitted to a health facility and/or dying were coded as 0 (considered poor outcomes). Thereafter, we conducted 11 in-depth interviews to explore the experiences of COVID-19 patients under home-based care. Multivariable logistic regression was used to assess factors associated with poor treatment outcomes using Stata v.15.0. Thematic content analysis was used to explore lived experiences of COVID-19 patients under home-based care using NVivo 12.0.0 Results A total of 303 study participants were included. The mean age ± standard deviation of participants was 32.2 years ± 19.9. Majority of the participants [96.0% (289/303)] cured at home, 3.3% (10/303) were admitted to a health facility and 0.7% (2/303) died. Patients above 60 years of age had 17.4 times the odds of having poor treatment outcomes compared to those below 60 years of age (adjusted odds ratio (AOR): 17.4; 95% CI: 2.2–137.6). Patients who spent more than one month under home-based care had 15.3 times the odds of having poor treatment outcomes compared to those that spent less than one month (AOR: 15.3; 95% CI: 1.6–145.7). From the qualitative interviews, participants identified stigma, fear, anxiety, rejection, not being followed up by health workers and economic loss as negative experiences encountered during home-based care. Positive lived experiences included closeness to friends and family, more freedom, and easy access to food. Conclusion Home-based care of COVID-19 was operational in eastern Uganda. Older age (> 60 years) and prolonged illness (> 1 months) were associated with poor treatment outcomes. Social support was an impetus for home-based care.

Abstract Background There is a growing interest to support extended independent living of people with dementia (PwD) via unobtrusive monitoring (UM) technologies which allow caregivers to remotely monitor lifestyle, health, and safety of PwD. However, these solutions will only be viable if developers obtain a clear picture of how to create value for all relevant stakeholders involved and achieve successful implementation. The aim of this study was therefore to explore the value proposition of UM technology in home-based dementia care and preconditions for successful implementation from a multi-stakeholder perspective. Methods We conducted an expert-informed survey among potential stakeholders (n = 25) to identify key stakeholders for UM technology in home-based dementia care. Subsequently, focus groups and semi-structured interviews were conducted among 5 key stakeholder groups (n = 24) including informal caregivers (n = 5), home care professionals (n = 5), PwD (n = 4), directors and managers within home care (n = 4), and policy advisors within the aged care and health insurance sector (n = 6). The sessions addressed the value proposition- and business model canvas and were analyzed using thematic analysis. Results Stakeholders agreed that UM technology should provide gains such as objective surveillance, timely interventions, and prevention of unnecessary control visits, whereas pains mainly included information overload, unplannable care due to real-time monitoring, and less human interaction. The overall design-oriented need referred to clear situation classifications including urgent care (fall- and wandering detection), non-urgent care (deviations in eating, drinking, sleeping), and future care (risk predictions). Most important preconditions for successful implementation of UM technology included inter-organizational collaboration, a shared vision on re-shaping existing care processes, integrated care ICT infrastructures, clear eligibility criteria for end-users, and flexible care reimbursement systems. Conclusions Our findings can guide the value-driven development and implementation of UM technology for home-based dementia care. Stakeholder values were mostly aligned, although stakeholders all had their own perspective on what UM technology should accomplish. Besides, our study highlights the complexity of implementing novel UM technology in home-based dementia care. To achieve successful implementation, organizational and financial preconditions, as well as digital data exchange between home care organizations, will be important.

Abstract Background Most people with dementia live at home and are supported by informal carers. During the care trajectory, the creation of a stable care situation is a guiding principle of informal carers, who often manage complex care arrangements. A recently developed theory – ‘Stability of home-based care arrangements for people living with dementia' (SoCA-Dem) – conceptualises how such care arrangements develop over time, and it highlights the relevance of the dyadic relationship, carer role, and resources with regard to the continuation of home-based care throughout the course of dementia. To further explore these three concepts, and to provide feedback for a further refinement of SoCA-Dem theory, this study aims to gain a deeper understanding of (1) how informal carers perceive their dyadic relationship, their carer role, and the resources of the care arrangement, and (2) how these concepts are interrelated. Methods This study was a secondary data analysis of n = 11 problem-centred interviews. Data were interpreted by a thematic qualitative text analysis. Results The findings distinguished subthemes within the concepts and uncovered their interrelations. The kinship relation, living situation and character of the dyadic relationship shaped informal carers’ self-conception of the carer role. This influenced the integration of resources into the care arrangement. Conversely, the quantity and quality of informal and formal support resulted in a feeling of relief or overload in the carer role, that shaped the informal carers’ way of living their dyadic relationship. The respective forming of the concepts had a significant impact with regard to the perceived stability or instability of the care situation in the examined care arrangements. Conclusions This study provided valuable evidence for future research alignment and targeted refinement of the SoCA-Dem theory. Scholars should further explore the specifics of spousal versus parent–child-dyads to better understand the dyads' diverse strategies in the creation of stable home-based care arrangements. Furthermore, future research should focus on the complex dynamics of dyads, family networks, and service providers, and all actors’ perspectives should be integrated in SoCA-Dem theory. Based on this growing knowledge base, innovative care interventions and structures should be developed to support people with dementia and their informal carers in better living and caring in the place of their choice.

INTRODUCTION If a family is discharged from a hospital earlier after birth, close supervision by a skilled midwife is essential. The aim was to describe mothers' overall experience receiving postnatal care in a Swedish home-based midwifery care model. METHODS A descriptive qualitative study was conducted. Mothers meeting the inclusion criteria for a new home-based postnatal care model at a hospital in Stockholm, Sweden, were included. In total, 24 healthy mothers participated in a semi-structured telephone interview, averaging 58 minutes. Data were analyzed using thematic analysis, according to Braun and Clarke. RESULTS The main theme explored, 'The home-based postnatal care model facilitated a smooth succession into motherhood', is explained by the themes: 1) Mothers felt 'not left adrift' when cared for by the home-based postnatal midwives; 2) Professional midwives with authority guided the way into motherhood; and 3) The home, a safe and secure space for new mothers. CONCLUSIONS Mothers valued the well-structured home-based postnatal midwifery care. Important for mothers was to receive health checks, adequate information, and that midwives have a kind and individual approach to the families. Midwives play an important role for mothers in the early days after the birth of their baby. [ABSTRACT FROM AUTHOR]

BackgroundHome-and community-based integrated care has been developing rapidly in China in recent years. However, empirical research on the demand from older people is insufficient. Most studies have failed to identify or differentiate the heterogeneity of older people, resulting in poor understanding of their needs and fragmentation of services. This study seeks to identify latent classes of demand for home-and community-based integrated care among older Chinese adults and the predictors that differentiate these demands.MethodsFrom January to March 2021, a questionnaire was administered to older people (aged ≥60 years) in community-based service centers for older people in six districts of Changsha City, Hunan Province. Participants were selected through purposive and incidental sampling. Latent profile analysis was used to categorize older people’s demand for home-and community-based integrated care. By extending Andersen’s behavioral model of health service use, and running multinomial logistic regression analyses, we explored which factors influenced the latent classes of demand.ResultsA total of 382 older people were included in the analyses: 64.4% were women and 33.5% were aged 80–89. The demand from older people for home-and community-based integrated care was classified into four latent classes: high health and social interaction demand (30% – 115/382); high comprehensive demand (23% – 88/382); high care service demand (26% – 100/382), and high social participation and low care demand (21% – 79/382). Taking this last class as the reference group, the other three latent classes differed significantly in the factors of predisposition, enabling, need, and perception of aging.ConclusionThe demand from older people for home-and community-based integrated care is multifaceted and heterogeneous. Services for older people should be designed with different sub-models of integrated care.

(1) Background: Pneumonia stands as a prevalent infectious disease globally, contributing significantly to mortality and morbidity rates. In Taiwan, pneumonia ranks as the third leading cause of death, particularly affecting the elderly population (92%). This study aims to investigate factors associated with community-acquired pneumonia (CAP) among elderly individuals receiving home-based care. (2) Methods: Conducted between January 2018 and December 2019, this retrospective study involved a medical chart review of elderly patients under home-based care. A multiple logistic regression model was employed to identify factors associated with CAP in this demographic. (3) Results: Analysis encompassed 220 elderly patients with an average age of 82.0 ± 1.1 years. Eighty-five patients (38.6%) were hospitalized for CAP. Predominant diagnoses included cancer (32.3%), stroke (24.5%), and dementia (23.6%). Significant predictors of CAP for elderly patients under home-based care included male gender (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.95–8.60, p < 0.001), presence of a nasogastric (NG) tube (OR = 8.85, 95% CI: 3.64–21.56, p < 0.001), and a borderline negative association with the use of proton pump inhibitors (PPIs) (OR = 0.37, 95% CI: 0.13–1.02, p = 0.0546). End-of-life care indicators for these patients with CAP included an increased number of hospital admission days in the last month of life (OR = 1.13, 95% CI: 1.08–1.18, p < 0.001) and a higher likelihood of hospital death (OR = 3.59, 95% CI: 1.51–8.55, p = 0.004). (4) Conclusions: In the current study, significant predictors of CAP among elderly patients receiving home-based care included the presence of an NG tube and male gender, while the use of PPIs was borderline inversely associated with the risk of CAP. Notably, more admission days in the last month of life and death in the hospital were found to be associated with end-of-life care for this group.

Interpersonal difficulties are common among veterans with posttraumatic stress disorder (PTSD) and are associated with poorer treatment response. Treatment outcomes for PTSD, including relationship functioning, improve when partners are included and engaged in the therapy process. Cognitive-behavioral conjoint therapy for PTSD (CBCT) is a manualized 15-session intervention designed for couples in which one partner has PTSD. CBCT was developed specifically to treat PTSD, engage a partner in treatment, and improve interpersonal functioning. However, recent research suggests that an abbreviated CBCT protocol may lead to sufficient gains in PTSD and relationship functioning, and yield lower dropout rates. Likewise, many veterans report a preference for receiving psychological treatments through clinical videoteleconferencing (CVT) rather than traditional face-to-face modalities that require travel to VA clinics. This manuscript describes the development and implementation of a novel randomized controlled trial (RCT) that examines the efficacy of an abbreviated 8-session version of CBCT ("brief CBCT," or B-CBCT), and compares the efficacy of this intervention delivered via CVT to traditional in-person platforms. Veterans and their partners were randomized to receive B-CBCT in a traditional Veterans Affairs office-based setting (B-CBCT-Office), CBCT through CVT with the veteran and partner at home (B-CBCT-Home), or an in office-delivered, couple-based psychoeducation control condition (PTSD Family Education). This study is the first RCT designed to investigate the delivery of B-CBCT specifically to veterans with PTSD and their partners, as well as to examine the delivery of B-CBCT over a CVT modality; findings could increase access to care to veterans with PTSD and their partners.

Background/Purpose: Hip fractures are associated with physical dysfunction, and poor quality of life in the elderly. Post-acute care (PAC) would facilitate functional recovery in patients with hip fractures after surgeries. Taiwan has proposed a nationwide PAC program for hip fractures since 2017, but little has been known about its effectiveness. Therefore, this study aimed to evaluate the efficacy and cost-effectiveness of the PAC program for hip fracture patients in Taiwan. Methods: This was a prospective study. Patients aged ≥ 65 years with hip fractures after surgeries were recruited and divided into home-based, hospital-based, and control groups. Outcome measures included pain, physical function (sit-to-stand test, Barthel Index [BI], and Harris hip score [HHS]), and quality of life (EuroQol instrument [EQ-5D]). Direct medical and non-medical costs were recorded. Cost-effectiveness ratio (CER) was calculated as the amount of New Taiwanese Dollars (NTDs) paid per BI and EQ-5D unit improvement. Results: Forty-one patients participated in this study, with 17, 12, and 12 in the home-based, hospital-based, and control groups, respectively. The home-based group showed significant improvements in BI and HHS compared to the controls (p = 0.018 and p = 0.029, respectively). The hospital-based group demonstrated significant improvement in EQ-5D compared to the controls (p = 0.015). The home-based PAC program demonstrated the best CER for BI (NTD 554) and EQ-5D (NTD 41948). Conclusion: Both PAC programs would significantly improve the physical function and quality of life in patients with hip fractures. However, the home-based PAC provided the best CER for BI and EQ-5D.

Objectives: The objectives of the study were to evaluate the perceptions and performance of terminally ill cancer patients regarding the quality of palliative care at different settings and to measure their quality of life (QOL) at the end of life. Material and Methods: This comparative, parallel and mixed method study was conducted at the Community Oncology Centre, Ahmedabad, among 68 terminally ill cancer patients as per inclusion criteria; who were receiving hospice (HS)-based and home (HO)-based palliative care under 2 months permitted by the Indian Council of Medical Research. In this parallel and mixed method study, qualitative findings were supplemented by quantitative data with both components executed simultaneously. Interview data were recorded by taking extensive notes during interviews along with an audio recording. Interviews were transcribed verbatim and a thematic approach was adopted. QoL questionnaire ('FACIT© System') was used for the assessment of QOL in terms of four dimensions. Data were analysed using the appropriate statistical test on Microsoft Excel. Results: The qualitative data (primary component) analysed under five themes -- staff behaviour, comfort and peace, enough and consistent care, nutrition and moral support, in the present study favours a HS-based setting more than a HO-based setting. Among all four subscale scores, physical well-being and emotional well-being subscale scores were statistically significantly associated with the place of palliative care. Functional Assessment of Cancer Therapy-General (FACT-G) total score was high among patients getting HO-based palliative (mean = 67.64) care than HS-based palliative care (mean = 56.56) and the difference between total FACT-G scores was statistically significant (unpaired t-test = 2.20, P = 0.03). Conclusion: Overall, with the primary component favouring HS care and higher scores obtained in HO-based patients, the present study advocates the necessity for palliative services to expand their coverage regardless of whether they are provided at HS or HO, as it has improved the QOL of cancer patients significantly. [ABSTRACT FROM AUTHOR]

Background: A rapid increase in community transmission of COVID-19 across the country overwhelmed Uganda's health care system. In response, the Ministry of Health adopted the home-based care strategy for COVID-19 patients with mild-to-moderate disease. We determined the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care during the second wave in Kapelebyong district, in eastern Uganda. Methods: We conducted a sequential explanatory mixed-methods study. We first collected quantitative data using an interviewer-administered questionnaire to determine characteristics and treatment outcomes of COVID-19 patients under home-based care. Cured at home was coded as 1 (considered a good outcome) while being admitted to a health facility and/or dying were coded as 0 (considered poor outcomes). Thereafter, we conducted 11 in-depth interviews to explore the experiences of COVID-19 patients under home-based care. Multivariable logistic regression was used to assess factors associated with poor treatment outcomes using Stata v.15.0. Thematic content analysis was used to explore lived experiences of COVID-19 patients under home-based care using NVivo 12.0.0 Results: A total of 303 study participants were included. The mean age ± standard deviation of participants was 32.2 years ± 19.9. Majority of the participants [96.0% (289/303)] cured at home, 3.3% (10/303) were admitted to a health facility and 0.7% (2/303) died. Patients above 60 years of age had 17.4 times the odds of having poor treatment outcomes compared to those below 60 years of age (adjusted odds ratio (AOR): 17.4; 95% CI: 2.2–137.6). Patients who spent more than one month under home-based care had 15.3 times the odds of having poor treatment outcomes compared to those that spent less than one month (AOR: 15.3; 95% CI: 1.6–145.7). From the qualitative interviews, participants identified stigma, fear, anxiety, rejection, not being followed up by health workers and economic loss as negative experiences encountered during home-based care. Positive lived experiences included closeness to friends and family, more freedom, and easy access to food. Conclusion: Home-based care of COVID-19 was operational in eastern Uganda. Older age (> 60 years) and prolonged illness (> 1 months) were associated with poor treatment outcomes. Social support was an impetus for home-based care. [ABSTRACT FROM AUTHOR]

Abstract Objective The purpose of this study is to describe the experiences of home-based care providers (HBCP) in providing care to older adults during the pandemic in order to inform future disaster planning, including during pandemics. Design Qualitative inquiry using an abductive analytic approach. Setting and participants Home-based care providers in COVID-19 hotspots. Methods Telephone interviews were conducted with 27 participants (administrators, registered nurses and other members of the allied healthcare team), who provided in-home care during the pandemic in Medicare-certified home health agencies. Interviews focused on eliciting experiences from HBCP on challenges and successes in providing home-based care to older adults, including barriers to care and strategies employed to keep patients, and providers, safe in their homes during the pandemic. Results Data was distilled into four major themes that have potential policy and practice impact. These included disrupted aging-in-place resources, preparedness actions contributing to readiness for the pandemic, limited adaptability in administrative needs during the pandemic and challenges with unclear messaging from public health officials. Conclusions Home-based care plays an essential role in maintaining the health of older adults in disaster contexts, including pandemics. Innovative solutions, informed by policy that generate evidence-based best practices to support HBCP are needed to reduce barriers and increase protective factors, in order to maintain continuity of care for this vulnerable population during disruptive events.

Background: Dementia is a neurocognitive disorder that contributes to a high caregiver burden. This article describes caregivers' experiences in providing care at home for persons with dementia during the COVID-19 pandemic. The pandemic had brought the world to a standstill that no one alive had experienced before. Methods: Cross-sectional focus group discussion with 17 caregivers of persons living with Alzheimer's disease was conducted using video conferencing software. Results: The significant issues reported by the caregivers were changing routine, an increase in demanding behavior, an increase in the tendency of wandering behavior, increased frustration among caregivers, intolerance, and overall burden. However, some caregivers were also able to adapt to emerging situations and design a new set of daily living activities. Conclusion: Understanding caregiving experiences and guiding caregivers to build their resilience would prevent caregivers' burnout.

IntroductionA national consensus panel was convened to develop recommendations on future directions for home-based dementia care (HBDC).MethodsThe panel summarized advantages and challenges of shifting to HBDC as the nexus of care and developed consensus-based recommendations.ResultsThe panel developed five core recommendations: (1) HBDC should be considered the nexus of new dementia models, from diagnosis to end of life in dementia; (2) new payment models are needed to support HBDC and reward integration of care; (3) a diverse new workforce that spans the care continuum should be prepared urgently; (4) new technologies to promote communication, monitoring/safety, and symptoms management must be tested, integrated, and deployed; and (5) targeted dissemination efforts for HBDC must be employed.DiscussionHBDC represents a promising paradigm shift to improve care for those living with dementia and their family caregivers: these recommendations provide a framework to chart a course forward for HBDC.