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Discussing time and temporality in care work is becoming more central as societies with growing proportions of older persons with care needs strive to arrange cost-effective eldercare. As resources become scarcer, the efficiency of care work is emphasised, and care is increasingly sorted into cost-per-minute units. In our paper, we will analyse the different ways care professionals themselves describe their temporal experiences and practices concerning care interactions in long-term dementia care. Our data consists of semi-structured interviews with care professionals (n = 25) working in round-the-clock service housing in Finland. Using thematic content analysis to analyse the data, we show that, along with a holistic understanding of temporality, good dementia care necessitates understanding alterity, which is insufficiently regarded in linear or quantitative understandings of time. By using concepts of temporal duration (Bergson), crip time (Kafer) and dementia time (Yoshizaki-Gibbons), it is possible to understand another person's alter-temporal experience, into which care can aim to enter and towards which it can attune itself. We argue that a concept of attunement is needed to fully make sense of the ideal temporal practices of dementia care. Our analysis presents attunement as understanding dementia time, receptive practices, and expressive practices, and describes limitations of attunement as temporal discordance. [ABSTRACT FROM AUTHOR]

Polypharmacotherapy is an ever-increasing issue with an ageing patient population. Anticholinergic medications make up a large proportion of patient medication but cause significant side effects, contributing to well-documented issues within the older population and in hospital medicine. This review explores the documented impact of anticholinergic burden in older surgical patients on postoperative delirium, infection, length of stay and readmission, urinary retention, ileus and mortality. It also highlights the need for further high-quality research into anticholinergic burden management among older surgical patients to further impact practice and policy in the area. [ABSTRACT FROM AUTHOR]

Background: Research suggests that person‐centred care can be beneficially implemented and sustained, even though barriers remain that prevent uptake in clinical practice. Understanding barriers to person‐centred care seems important, as this has an impact on care practices and resident outcomes. Moreover, there is limited knowledge about nursing home managers' descriptions of barriers when leading person‐centred care. Objectives: To explore barriers to leading person‐centred care as narrated by nursing home managers. Methods: A descriptive qualitative design was used to collect data using individual interviews with 12 nursing home managers in highly person‐centred nursing homes. Data were analysed using content analysis. Results: Multi‐level barriers to leading person‐centred care were identified on the (1) person level, (2) team level and (3) organisational level. Placing professional and family considerations ahead of resident considerations was described as a barrier on the personal level (1). Also, staff's divergent care values, processes, and priorities together with turnover and low foundational knowledge were identified as barriers on the team level (2). On an organisational level (3), constrained finances, functional building design and group level rostering were identified as barriers. Conclusion: Multi‐level barriers influence nursing home managers' ability to lead and promote person‐centred care. Promoting the development of person‐centred practices requires efforts to eliminate barriers on person, team and organisational level. Implications for Practice: Identifying and overcoming barriers at various levels in nursing home care has the potential to promote person‐centred practices. This study can inform stakeholders and policymakers of challenges and complexities in person‐centred practices. Multi‐level strategies are needed to target challenges at person‐, team‐ and organisational level when striving to develop person‐centred care. [ABSTRACT FROM AUTHOR]

Background: Vision impairment can have an impact on cognition, health, and social function. Vision loss may be avoided if detected early and treated promptly. Eye health is a minor topic in general practice, but the ongoing relationship between doctor and patient has the potential to assist the patient in navigating the healthcare system and guaranteeing timely healthcare service delivery. Aim: To explore the attitudes of older members of the public (aged ≥60 years) towards navigating primary sector eye health care in Denmark, with a focus on optometrists, practising ophthalmologists (POs), and GPs. Design & setting: Qualitative study in Copenhagen, Denmark. Method: Focus group interviews were performed in the spring of 2022 with 21 older members of the public. Results: Older members of the public perceived optometrists and POs to be the most relevant health professionals to consult about eye health. Opportunities were identified for enhancing the function of general practice including detecting early signs of visual impairment, being in charge of further referrals, and managing issues affecting quality of life such as dry eyes. Conclusion: Older members of the public sought help from health professionals who are directly qualified to treat symptoms of vision impairment that patients are experiencing or expect to face in the near future. Participants identified a potential for GPs to address vision impairment. This included focusing on the patient’s general health and function, as well as potential comorbidities influencing treatment trajectories. The current denigration of general practice risks missing out on the potential benefits of robust engagement from general practice in eye health.

Background: Depression is common in old age and is associated with disability, increased mortality, and impairment from physical diseases. Aim: To estimate the prevalence of depression among older patients in Norwegian general practice, to evaluate the extent they talk about it during their consultation, whether it was previously known or suspected by their GP, and how frequently patients with depression visit their GP. Design & setting: Cross-sectional study among patients and GPs at 18 primary care clinics in the south of Norway. Method: Patients aged ≥65 years who visited their GP were asked to complete the Patient Health Questionnaire-9 (PHQ-9). The GPs reported what kind of issues the patient presented at the consultation, if a current depression was known, and the consultation frequency. Results: Forty-four (11.4%) of 383 patients reported moderate or severe depressive symptoms (PHQ9 ≥10). Among the cases with data from both patient and GP (n = 369), 38 patients (10.3%) reported moderately depressive symptoms. Of these, only 12 (31.6%) mentioned psychological problems to their GP during their consultation; 12 (31.6%) with previous depression were neither known to the GP nor suspected of currently having depression; and 67.6% of them visited their GP ≥5 times a year. Conclusion: Older patients tend to speak little of their depression to the GP. Almost one in three older patients with moderate depressive symptoms were unrecognised by their GP. Older patients who frequently visit the GP should be suspected of potentially having mental health problems. [ABSTRACT FROM AUTHOR]

Background: Depression is common in old age and is associated with disability, increased mortality, and impairment from physical diseases. Aim: To estimate the prevalence of depression among older patients in Norwegian general practice, to evaluate the extent they talk about it during their consultation, whether it was previously known or suspected by their GP, and how frequently patients with depression visit their GP. Design & setting: Cross-sectional study among patients and GPs at 18 primary care clinics in the south of Norway. Method: Patients aged ≥65 years who visited their GP were asked to complete the Patient Health Questionnaire-9 (PHQ-9). The GPs reported what kind of issues the patient presented at the consultation, if a current depression was known, and the consultation frequency. Results: Forty-four (11.4%) of 383 patients reported moderate or severe depressive symptoms (PHQ-9 ≥10). Among the cases with data from both patient and GP (n = 369), 38 patients (10.3%) reported moderately depressive symptoms. Of these, only 12 (31.6%) mentioned psychological problems to their GP during their consultation; 12 (31.6%) with previous depression were neither known to the GP nor suspected of currently having depression; and 67.6% of them visited their GP ≥5 times a year. Conclusion: Older patients tend to speak little of their depression to the GP. Almost one in three older patients with moderate depressive symptoms were unrecognised by their GP. Older patients who frequently visit the GP should be suspected of potentially having mental health problems.

Background: Emergency Departments (ED) can be crowded places and not ideal environments for Residential Aged Care Facilities (RACF) residents awaiting assessment. Assessment and care planning may be made available via telehealth thereby avoiding unnecessary transfer to ED, without compromising the quality of care for the older person. Telehealth is attractive addition to improving healthcare decision‐making in RACFs. Objectives: The aim of this scoping review is to explore the evidence around the use of telehealth and whether it influences the decision to transfer residents of RACF to ED. Methods: All peer reviewed literature that focused on RACFs, decision‐making and assessment of residents using telehealth in real time, was included. All study designs, pilot studies and some systematic reviews were considered. Databases Medline, Embase and CINAHL were used in this search in June 2022. Search terms were a combination of the population: RACF residents, decision‐making and assessments using telehealth, and or transfer to the ED. The search was assisted by a senior university research academic librarian/information specialist and reviewed by senior researchers. The PRISMA‐ScR guidelines were used to report this study. Results: Of the 124 articles initially identified, 31 were eligible for inclusion for synthesis. The date range of the included studies was 2001 to 2022, with 15 published in the last five years. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Conclusion: This scoping review has mapped evidence that telehealth has been widely used in multiple settings. The association between the use of telehealth with improved clinical outcomes highlights its potential utility in enhancing care delivery for an older population in RACFs. Telehealth has shown that it can improve the decision‐making for residents in RACFS, but more robust research designs are needed. Implications for practice: Using video/telehealth appears to improve RACF staff access to expert clinicians who can then assess and jointly plan care/management that can be provided in the resident's home. Knowledge and skills of RACF staff appear to be improved through joint assessment and decision‐making with the use of video/telehealth access to expert clinicians. [ABSTRACT FROM AUTHOR]

Background: Alcohol and tobacco use could cause health problems in older adults. Older adults who become in need of 24/7 care due to physical and/or neurological disabilities may need to move to a Residential Care Facility (RCF). RCFs aim to provide person‐centred care (PCC) to enhance quality of life (QoL) of residents. Objectives: This study aims to explore perspectives of residents on alcohol and tobacco use, which is essential to provide PCC. Methods: A qualitative research design was chosen, and semi‐structured interviews were conducted. Residents who use alcohol and/or tobacco and those who do not use these substances were purposively selected in two organisations on two types of units: psychogeriatric units and units providing care for residents with mainly physical disabilities. The results were analysed using thematic analysis. Results: Thematic analysis resulted in five themes: Current use and self‐reflection, knowledge and attitudes, addiction or habit, policies and availability, dependency versus autonomy. Conclusion: Residents in this study value their autonomy regarding alcohol and tobacco use. They experience dependency on their (in)formal caregivers to use these substances and acknowledge that their use could cause a nuisance to others, challenging the ability of caregivers to implement PCC. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health and safety risks for all. Implications for practice: This study could help care professionals to become aware of the habits and wishes of residents regarding alcohol and tobacco use and to discuss the possibilities and limitations within RCFs. [ABSTRACT FROM AUTHOR]

Background: The 'Your Care Needs You' (YCNY) intervention aims to increase the safety and experience of transitions for older people through greater patient involvement during the hospital stay. Methods: A cluster randomised controlled feasibility trial was conducted on NHS inpatient wards (clusters) where ≥ 40% of patients were routinely ≥ 75 years. Wards were randomised to YCNY or usual care using an unequal allocation ratio (3:2). We aimed to recruit up to 20 patients per ward. Follow-up included routine data collection and questionnaires at 5-, 30-, and 90-days post-discharge. Eligible patients were ≥ 75 years, discharged home, stayed overnight on participating wards, and could read and understand English. The trial assessed the feasibility of delivering YCNY and the trial methodology through recruitment rates, outcome completion rates, and a qualitative evaluation. The accuracy of using routinely coded data for the primary outcome in the definitive trial was assessed by extracting discharge information for up to ten nonindividual consenting patients per ward. Results: Ten wards were randomised (6 intervention, 4 control). One ward withdrew, and two wards were unable to deliver the intervention. Seven-hundred twenty-one patients were successfully screened, and 161 were recruited (95 intervention, 66 control). The patient post-discharge attrition rate was 17.4% (n = 28). Primary outcome data were gathered for 91.9% of participants with 75.2% and 59.0% providing secondary outcome data at 5 and 30 days post-discharge respectively. Item completion within questionnaires was generally high. Post-discharge follow-up was terminated early due to the COVID-19 pandemic affecting 90-day response rates (16.8%). Data from 88 nonindividual consenting patients identified an error rate of 15% when using routinely coded data for the primary outcome. No unexpected serious adverse events were identified. Most patients viewed YCNY favourably. Staff agreed with it in principle, but ward pressures and organisational contexts hampered implementation. There was a need to sustain engagement, provide clarity on roles and responsibilities, and account for fluctuations in patients' health, capacity, and preferences. Conclusions: If implementation challenges can be overcome, YCNY represents a step towards involving older people as partners in their care to improve the safety and experience of their transitions from hospital to home. Trial registration: ISRCTN: 51154948. [ABSTRACT FROM AUTHOR]

Introduction: During the COVID-19 pandemic, older people in Sweden's residential care facilities and home care services experienced high mortality rates. Prior to the pandemic, the care of older people in Sweden was challenged by organisational and regulatory changes, an ageing population and insufficient increases in staff numbers. These issues led to high staff turnover, increased workloads, stress, burnout and a perceived inability to provide satisfactory care. The pandemic brought about increased job strain, stress, anxiety, depression and post-traumatic stress disorder among the staff who cared for older people. The aim of this study was therefore to focus on assistant nurses and care aides' experiences of their work environments when caring for older people during the pandemic in Sweden., Methods: The data were collected through four focus groups interviews and analysed using qualitative content analysis., Results: The results showed that the care staff had to navigate organisational and ethical challenges in poor and unsafe work environments. They lacked supportive leadership in their respective organisations, were neither valued, seen nor heard and were treated as 'plain doers'. During the pandemic, they were unable to protect or communicate easily with the older people in their care, which had harsh consequences., Conclusion: According to the participants, the pandemic left them, their working conditions and this part of the care system in a worse situation than before the pandemic. The pandemic thus revealed more unsustainable and unethical working conditions for the staff than before it, including the vulnerability of the older people in their care., Implications for Practice: The findings highlights the need of policies that ensure adequate training and instruction on medical issues, for managers responsible for overseeing the care of older people. There are also a need of provision of sufficient support for care staff and health care professionals during crises. The findings also underscore the need of feasible and efficient strategies do disseminate care information and address the psychosocial needs of older people., (© 2024 The Author(s). International Journal of Older People Nursing published by John Wiley & Sons Ltd.)

Objective: Worldwide, older people are suffering from lumbar degenerative disease at an annual rate of 266 million. Although spine surgeries restore mobility, reduce pain and resolve neurological damage, these procedures can place older persons at high‐risk for medical complications due to multiple comorbid conditions that are often present in this population. However, the prevalence of complications occurring in older people prior to discharge is unknown. Postoperative medical complications lead to increased healthcare costs as well as pain and potential harm for the patient. Hence, this scoping review aimed to provide an overview of the current knowledge state regarding in‐hospital medical postoperative complications in older people (≥65 years) after elective spine surgery. Method: A scoping review was conducted following Arksey and O'Malley's framework. Four databases (PubMed, Cochrane, Scopus and CINAHL) were systematically searched. Inclusion criteria were medical complication(s) after elective spine surgery prior to discharge, age ≥65 years and English language. Co‐occurrence analysis was used to examine how often each complication was examined in the literature and how often the complications co‐occur. Results: Twenty‐six studies met inclusion criteria. The most frequently examined postoperative medical complications after spine surgery are delirium and urinary tract infection, followed by gastrointestinal and pulmonary embolus. Despite the list of in‐hospital medical complications, definitions or criteria for measurement of any identified complication were sparse and inconsistent. There is a lack of definition or instruments to comprehensively assess medical complications incurred by older people following spine surgery, including characteristics, classification methodology and temporality. To date, no research has been conducted on how older people experience or perceive a medical complication after elective spine surgery. Conclusion: The findings highlight the importance to develop comprehensive instruments to assess co‐occurrence of postoperative medical complications and design interventions to mitigate the negative impacts of medical complications incurred by older people after spine surgery. [ABSTRACT FROM AUTHOR]

Abstract Objectives This study aimed to evaluate the validity and reliability of the Persian version of Health of the Nation Outcome Scales for Elderly People (HoNOS65+) in Iran's elderly population. Methods The scale English version translated to Persian using a forward and backward translation method. The scale was filled for two elderly population groups (inpatient and outpatients) (N = 300). Simultaneously with HoNOS+65, the Clinical Global Impressions Scale (CGI) was completed. Two separate therapists were filled HoNOS+65 for thirty‐one patients (inter‐rater reliability test). In general, content validity, consistency, confirmatory factor analyses (CFA), convergent validity, and criterion validity were examined. Results Using exploratory factor analysis, three factors were extracted. Inter‐rater reliability in some items has a slight agreement. Content validity ratio (0.75) and index (0.90) were calculated for each item. Cronbach's alpha total score was 0.82. According to the largest modification indices, CFA showed satisfactory fit indices. The convergent validity between HoNOS +65 and CGI was (r = 0/71, sig = 0.000). Finally, the optimal cut‐off point was achieved 13. Sensitivity and specificity for the HoNOS +65 were 88.89% and 81.16%, respectively, with the Youden index of 0.7005. Conclusion The Persian version of HoNOS65+ has high reliability, validity, specificity, and sensitivity in multidimensional assessment of Iranian geriatric mental health.

Objectives: The proportion of older people in the population is increasing rapidly. Along with this comes an increase in the number of people requiring assistance in daily living, including oral care. Swedish law stipulates that care personnel who work with older people should be offered oral health education every year. The aim of this study was to investigate oral health care beliefs among such personnel. Methods: A questionnaire study was conducted among 2167 personnel providing care to older people at special accommodation sites and in home care. Data were collected using the Nursing Dental Coping Beliefs Scale. Descriptive statistics were calculated and logistic regression analysis was performed. Results: Personnel working in home care had lower odds of having an internal locus of control than those working in special accommodation, and personnel with less than 10 years of working experience had lower odds than their more experienced counterparts. Men had higher odds of having an external locus of control than women. Conclusions: It seems important to ensure that home care personnel and less experienced personnel attend oral care educational sessions, and to encourage male staff to focus on oral care work. [ABSTRACT FROM AUTHOR]

Abstract Aim The aim was to investigate assistant nurses’ perceptions of how working with national quality registries affected their work situation in care of older people. Design Qualitative interview study. Methods Sixteen semi‐structured interviews were conducted at four special housing units in Sweden, and a conventional content analysis, with elements of thematic analysis, was applied. Results The introduction of national quality registries contributed to role clarifications and the development of new formal work procedures in terms of documentation and arenas and routines for communication. The increased systematics and effectiveness gained from these changes had a perceived positive effect on the work situation, workload, work satisfaction, staff interactions and learning and reflection.

Abstract Aim To examine the association between organizational change, turnover intentions, overcommitment and perceptions of quality of care among nurses and nursing assistants employed in eldercare organizations. Design A longitudinal survey (baseline, 12‐month follow‐up) was used. Methods A panel sample of 226 eldercare employees in Spain and Sweden responded to survey questions concerning organizational change, turnover intentions, overcommitment and perceptions of quality of care. The data were analysed using structural equational modelling. Results We found a statistically significant positive relationship between organizational change, employees’ turnover intention and overcommitment. We also found a statistically significant negative relationship between organizational change and perceived quality of care.

Abstract Aim To explore the prevalence of workplace violence among nurses who care for older people and its association with working stress, job satisfaction and quality of care in Jordan. Design A cross‐sectional design was used. Methods A cluster random sampling was used to select three public hospitals, three private hospitals and 17 healthcare centres in Amman, Jordan. The researcher used a convenience sampling method to select 485 nurses. Data were collected between 2015–2016. Results Almost 60% of the participants have been victims of violence at the workplace during the past year. Nurses who consider violence a problem at work have high levels of working stress (p

Emigration is one of the sorest problems in Lithuania. Emigrants from Lithuania most often fill the sector of unskilled labour in the target countries, one of which is elder care. Financial factors are considered the main motivation for emigration; however, migration is a complex phenomenon and requires a more nuanced investigation. The aim of this article is to analyse subjectively identified reasons of emigration from Lithuania to work in the elder care sector and motivation in choosing a particular country. The thematic data analysis of 13 semi-structured interviews revealed that emigration is motivated by an entirety of reasons: beside financial factors other „push“ (family, health) and „pull“ (knowledge about the country, family formation) factors are important. The move also is facilitated by the chain migration factors. The importance of the economic reasons for migration is revealed in cases of financial insecurity (loss of employment, threat of company bankruptcy, financial difficulties in the parents’ family etc.). Economic considerations become significant again, when comparing the job options and working conditions available to migrants. Work in the care sector for older people is seen as relatively easy, accessible and well paid. Other “push” factors were related to an unsatisfactory life situation, including stressful employment, and unsatisfying family relationships. The desire to get to know a foreign country, the opportunity to start a family or establish oneself there can work as „pull“ factors. The decision to emigrate was supported by the chain migration factors – encouragement, help and support of previously established immigrants. In some cases, it emerged as an independent factor of migration people emigrated, invited by relatives or acquaintances from abroad even though they did not initially plan to migrate. With the rapidly growing share of older people in Lithuania and the underdeveloped care services, the opportunity to retain potential emigrants by creating attractive working conditions for them in Lithuania, remains untapped. Policies should aim to improve the working conditions and opportunities in the care sector in Lithuania in order to encourage Lithuanians to stay in the country. In addition, regulations to better absorb (returning) migrants should be in place, given the ongoing movement between countries.

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Désirée Seidel,1,2 Jochen René Thyrian2,31Department of Psychiatry and Psychotherapy, Helios Kliniken, Schwerin, Germany; 2German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany; 3Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine, Greifswald, GermanyPurpose: Caring for people with dementia is known to be accompanied by burden for the caregiver. This study aims at describing family caregivers’ and professional caregivers’ burden immediately after hospitalization of the person with dementia.Materials and methods: Twenty-five family caregivers and twenty-five professional caregivers of the locked gerontopsychiatric ward of a hospital in Northern Germany completed a questionnaire (BIZA-D-PV), which was evaluated in matched samples. The distribution of frequencies, differences in mean values and correlations were determined. Furthermore, family caregivers were categorized into risk groups.Results: Family caregivers perceived a higher burden due to cognitive impairment as well as aggressive and disoriented behavior of the person with dementia compared to professional caregivers. Differences with regard to care tasks were not detected. Female family caregivers rated a higher burden compared to male family caregivers, whereas in the sample of professional caregivers males perceived a higher burden. Correlations between several dimensions of burden and caregivers’ age, severity of dementia as well as physical symptoms were described. Categorizing family caregivers into risk groups showed high risks for depression of the caregiver, violence against the person with dementia and institutionalization of the person with dementia within the next months in 44–72% of cases.Conclusion: Our findings emphasize the importance of acquiring knowledge about caregivers’ burden in the course of time in order to develop targeting interventions to decrease caregivers’ burden and to prevent hospital admissions of people with dementia due to a crisis of home caring.Keywords: care of older people, informal care, formal care, nursing care, gerontopsychiatric hospital, cross-sectional study

Aim: To develop practice guidelines for nursing assistants who provide daily oral care to older adults. Background: The interRAI suite of instruments is internationally used in professional health care to assess the needs of care‐dependent older persons. An optimised oral health section was developed recently to identify care clients with poor oral health and hygiene. Internationally shared guidelines for daily oral care are needed to complement the optimised oral health section of the interRAI suite of instruments. Material and methods: The modified Delphi approach started with the preparation of an initial draft. Subsequently, an online survey and a face‐to‐face discussion were conducted with international experts. Their feedback was used to revise the draft. Two additional online surveys were conducted with the experts to reach consensus agreement for each item of the revised version. The same group of experts was invited to the different study phases. Results: The three surveys were completed by 26, 27 and 23 international experts, respectively. A group of 18 experts completed each survey, whereof a subgroup of 11 experts also took part in the face‐to‐face discussion. Experts were dental hygienists, dentists, nursing scientists, physicians and psychologists from 14 different countries. After the final survey, consensus agreement was reached for 54 of the 57 (94.7%) items, representing the final version of the guidelines. Conclusion: Available evidence was combined with practical feedback from international experts to develop clear and concise practice guidelines for daily oral care in older adults. Implications for practice: The guidelines will help to improve knowledge and reduce barriers of nursing assistants to provide daily oral care. [ABSTRACT FROM AUTHOR]

Background: Vision impairment can have an impact on cognition, health, and social function. Vision loss may be avoided if detected early and treated promptly. Eye health is a minor topic in general practice, but the ongoing relationship between doctor and patient has the potential to assist the patient in navigating the healthcare system and guaranteeing timely healthcare service delivery., Aim: To explore the attitudes of older members of the public (aged ≥60 years) towards navigating primary sector eye health care in Denmark, with a focus on optometrists, practising ophthalmologists (POs), and GPs., Design & Setting: Qualitative study in Copenhagen, Denmark., Method: Focus group interviews were performed in the spring of 2022 with 21 older members of the public., Results: Older members of the public perceived optometrists and POs to be the most relevant health professionals to consult about eye health. Opportunities were identified for enhancing the function of general practice including detecting early signs of visual impairment, being in charge of further referrals, and managing issues affecting quality of life such as dry eyes., Conclusion: Older members of the public sought help from health professionals who are directly qualified to treat symptoms of vision impairment that patients are experiencing or expect to face in the near future. Participants identified a potential for GPs to address vision impairment. This included focusing on the patient's general health and function, as well as potential comorbidities influencing treatment trajectories. The current denigration of general practice risks missing out on the potential benefits of robust engagement from general practice in eye health., (Copyright © 2024, The Authors.)

Background: The international health workforce crisis had led to an increasing shortage of nurses, which has substantial implications for the quality of patient care. This shortage potentially results in nurse-perceived time pressure, which can be particularly challenging for nurses who provide care for older persons. Objective: This study aimed to show how geriatric nurses experience working under time pressure, perceive its impact on care and deal with time pressure in daily care. Research design: A qualitative descriptive interview design was used. Participants and research context: Purposive sampling led to the inclusion of 11 nurses from three geriatric nursing wards in two general hospitals in Flanders (Belgium). Data were collected using semi-structured in-depth interviews and analysed using the QUAGOL (Qualitative Analysis Guide of Leuven). Ethical considerations: The study protocol was approved by the Ethics Committee of the University Hospitals Leuven (Ethics committee of the University Hospitals Leuven). Findings: In all interviews, time pressure was described as ubiquitous in the daily care of older persons. A sense of failure in providing care was the common thread in many interviews. Nurses felt compelled to 'reduce' good-quality care to basic care by focusing on the physical and visible aspects of care. Nevertheless, personal experiences with time pressure and strategies to cope with it differed among the interviewees. These variations were related to the working environment and the nurses themselves. They underscored the importance of nurses' perspectives for a good understanding of the phenomenon of time pressure. Discussion and conclusion: Working under time pressure in the care of older persons leads to various important challenges for nursing ethics. The findings show that providing care that promotes the human dignity of older persons in busy working environments in which care is rationed is an important ethical challenge. As such, our study offers a baseline for further research and discussion on how to support nurses working under time pressure. [ABSTRACT FROM AUTHOR]

Background: Internationally, it is recognised that the transition to a care home environment can be an emotional and stressful occasion for older people and their families. There is a paucity of research that takes into consideration the initial phase of the relocation process, incorporating individuals' experiences of the move. Aim: To explore individuals' experiences of moving into a care home. This paper has a specific focus on the preplacement (7 days) and immediate postplacement (within 3 days) period of the move to the care home. Design: A grounded theory method was used to conduct semi‐structured interviews with 23 participants. Results: Data analysis revealed five distinct categories that captured the experience of the preplacement and immediate postplacement period. These were as follows: (a) inevitability of the move: "I had to come here," (b) making the move: "Abrupt Departures," (c) decision‐making and exercising choice: "What can I do, I have no choice," (d) maintaining identity: "Holding on to self" and (e) maintaining connections: "I like my family to be near." Together, these five categories formed the basis of the concept "You're at their Mercy" which encapsulates the perceived transition experience of the older people within the study. Participants felt that the move was out of their control and that they were "at the mercy" of others who made decisions about their long‐term care. Conclusions: Moving to a care home represents a uniquely significant relocation experience for the individual. Key factors influencing the move were the individuals' perceived lack of autonomy in the pre‐ and postrelocating period of moving to a care home. Nurses have a key role to play in working with older people to influence policy and practice around decision‐making, planning and moving to a care home with greater emphasis on autonomy and choice so that older people do not feel "at the mercy" of others as they navigate such a major transition. Implications for practice: There is a need to standardise approaches and develop person‐centred interventions to support older people considering relocation to a care home and nurses have a key role to play in making this happen. [ABSTRACT FROM AUTHOR]

Background: Research has indicated that clinical staff in long‐term care often lack self‐confidence in palliative care delivery, particularly at the end of life. Goals: (a) To examine the contribution of age, palliative care education, palliative care work‐related experience and psychological empowerment to palliative care delivery confidence and (b) to explore the social reality shaping those factors for long‐term care staff. Design: Explanatory sequential design. Setting: Twenty long‐term care facilities in two district health boards in New Zealand. Participants: Phase 1:139 clinical staff. Phase 2:46 clinical staff who provided care in the last month of a residents' life. Methods: Phase 1: Cross‐sectional survey. Phase 2: Individual semi‐structured interviews. Results: Phase 1: Previous experience (β =.319) and psychological empowerment (β =.311) contribute most to predicting an increase in palliative care delivery confidence. Phase 2: Four factors underlay palliative care delivery confidence, (a) mentorship by hospice nurses or colleagues (b) contextual factors (organisational culture, resources and experience), (c) maturity and (d) formal education. Conclusion: Organisational leadership should use multiple strategies (e.g. power‐sharing, increased opportunities for mentorship) to improve staff palliative care delivery confidence. Implications for Practice: This study adds to the literature in understanding the predictors of palliative care delivery confidence specific to long‐term care staff. The results indicate that educational interventions must be contextually appropriate to achieve sustainable improvements in palliative care confidence and ultimately in resident care at the end of life. [ABSTRACT FROM AUTHOR]

This article describes the process of an adapted e-Delphi technique and examines expert opinion on four aged care environment assessment tools in the context of minor refurbishments with resident based outcomes. A two round adapted e-Delphi survey was completed by professionals with expertise in aged care design and environments. Their evaluations on the content and applicability of the four tools were gathered. Ordinal responses were analysed using descriptive statistics and open ended responses analysed using content analysis. The four tools were subsequently ranked in order of recommendation to pilot using a weighting system. A 60% uptake rate resulted in a purposive sample (n=18 experts) from eight countries. The experts concurred in the priorities they identified when reviewing the tools, which included thoroughness, cultural specificity, accessibility, ease of use and time taken to complete. A range of advantages and challenges were presented for each tool in addition to application in a minor refurbishment context. Upon ranking, Residential Aged Care Audit Tool followed by Evaluation of Older People's Living Environments were prioritised as the top two tools to be piloted. It was concluded assessment of residential aged care environments using appropriate tools is necessary to ensure refurbishment works contribute to resident function and well-being. Expert perspectives through an adapted e-Delphi process facilitated local stakeholder decision making process to select a single tool to pilot for validity and reliability at a residential aged care facility preparing to undergo minor refurbishment. Using an adapted e-Delphi process in an international context may be useful for other aged care researchers seeking to gain expert input to a local problem. [ABSTRACT FROM AUTHOR]

Background: Heart failure with preserved ejection fraction (HFpEF) is less well understood than heart failure with reduced ejection fraction (HFrEF), with greater diagnostic difficulty and management uncertainty. Aim: The primary aim is to develop an optimised programme that is informed by the needs and experiences of people with HFpEF and healthcare providers. This article presents the rationale and protocol for the Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF) research programme. Design & setting: This is a multi-method programme of research conducted in the UK. Method: OPTIMISE-HFpEF is a multi-site programme of research with three distinct work packages (WPs). WP1 is a systematic review of heart failure disease management programmes (HF-DMPs) tested in patients with HFpEF. WP2 has three components (a, b, c) that enable the characteristics, needs, and experiences of people with HFpEF, their carers, and healthcare providers to be understood. Qualitative enquiry (WP2a) with patients and providers will be conducted in three UK sites exploring patient and provider perspectives, with an additional qualitative component (WP2c) in one site to focus on transitions in care and carer perspectives. A longitudinal cohort study (WP2b), recruiting from four UK sites, will allow patients to be characterised and their illness trajectory observed across 1 year of follow-up. Finally, WP3 will synthesise the findings and conduct work to gain consensus on how best to identify and manage this patient group. Results: Results from the four work packages will be synthesised to produce a summary of key learning points and possible solutions (optimised programme) which will be presented to a broad spectrum of stakeholders to gain consensus on a way forward. Conclusion: HFpEF is often described as the greatest unmet need in cardiology. The OPTIMISE-HFpEF programme aims to address this need in primary care, which is arguably the most appropriate setting for managing HFpEF. [ABSTRACT FROM AUTHOR]

Background: Heart failure with preserved ejection fraction (HFpEF) is less well understood than heart failure with reduced ejection fraction (HFrEF), with greater diagnostic difficulty and management uncertainty. Aim: The primary aim is to develop an optimised programme that is informed by the needs and experiences of people with HFpEF and healthcare providers. This article presents the rationale and protocol for the Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF) research programme. Design & setting: This is a multi-method programme of research conducted in the UK. Method: OPTIMISE-HFpEF is a multi-site programme of research with three distinct work packages (WPs). WP1 is a systematic review of heart failure disease management programmes (HF-DMPs) tested in patients with HFpEF. WP2 has three components (a, b, c) that enable the characteristics, needs, and experiences of people with HFpEF, their carers, and healthcare providers to be understood. Qualitative enquiry (WP2a) with patients and providers will be conducted in three UK sites exploring patient and provider perspectives, with an additional qualitative component (WP2c) in one site to focus on transitions in care and carer perspectives. A longitudinal cohort study (WP2b), recruiting from four UK sites, will allow patients to be characterised and their illness trajectory observed across 1 year of follow-up. Finally, WP3 will synthesise the findings and conduct work to gain consensus on how best to identify and manage this patient group. Results: Results from the four work packages will be synthesised to produce a summary of key learning points and possible solutions (optimised programme) which will be presented to a broad spectrum of stakeholders to gain consensus on a way forward. Conclusion: HFpEF is often described as the greatest unmet need in cardiology. The OPTIMISE-HFpEF programme aims to address this need in primary care, which is arguably the most appropriate setting for managing HFpEF.

Healthcare is increasingly complex and requires the ability to adapt to changing demands. Teamwork is essential to delivering high quality care and is central to nursing. The aims of this study were to identify the processes that underpin nursing teamwork and how these affect the care of older people, identify the relationship between perceived teamwork and perceived quality of care, and explore in depth the experience of working in nursing teams. The study was carried out in three older people's wards in a London teaching hospital. Nurses and healthcare assistants completed questionnaires (n = 65) on known dynamics of teamwork (using the Nursing Teamwork Survey) together with ratings of organisational quality (using an adapted AHRQ HSPS scale). A sample (n = 22; 34%) was then interviewed about their perceptions of care, teamwork and how good outcomes are delivered in everyday work. Results showed that many care difficulties were routinely encountered, and confirmed the importance of teamwork (e.g. shared mental models of tasks and team roles and responsibilities, supported by leadership) in adapting to challenges. Perceived quality of teamwork was positively related to perceived quality of care. Work system variability and the external environment influenced teamwork, and confirmed the importance of team adaptive capacity. The CARE model shows the centrality of teamwork in adapting to variable demand and capacity to deliver care processes, and the influence of broader system factors on teamworking. [ABSTRACT FROM AUTHOR]

Background: Medication reviews may improve the safety of prescribing and the National Institute for Health and Care Excellence (NICE) highlights the importance of involving patients in this process.Aim: To explore GP and pharmacist perspectives on how medication reviews were conducted in general practice in the UK.Design and Setting: Analysis of semi-structured interviews with GPs and pharmacists working in the South West of England, Northern England, and Scotland, sampled for heterogeneity. Interviews took place between January and October 2017.Method: Interviews focused on experience of medication review. Data saturation was achieved when no new insights arose from later interviews. Interviews were analysed thematically.Results: In total, 13 GPs and 10 pharmacists were interviewed. GPs and pharmacists perceived medication review as an opportunity to improve prescribing safety. Although interviewees thought patients should be involved in decisions about their medicines, high workload pressures meant that most medication reviews were conducted with limited or no patient input. For some GPs, a medication review was done 'in the quickest way possible to say that it was done'. Pharmacists were perceived by both professions as being more thorough but less time efficient than GPs, and few pharmacists were routinely involved in medication reviews even in practices employing a pharmacist. Interviewees argued that it was easier to continue medicines than it was to stop them, particularly because stopping medicines required involving the patient and this generated extra work.Conclusion: Practices tended to prioritise being efficient (getting the work done) rather than being thorough (doing it well), so that most medication reviews were carried out with little or no patient involvement, and medicines were rarely stopped or reduced. Time and resource constraints are an important barrier to implementing NICE guidance. [ABSTRACT FROM AUTHOR]

Aims: To investigate how undergraduate nursing students' career expectations relate to their career choices, particularly employment in care of older people, in the first 10 years of nurses' careers. Background: Due to an increasing demand for nurses, it is important to understand nurses' career choices over the course of their careers. Design: A quantitative longitudinal study of 445 undergraduate nursing students based on a questionnaire survey and register data. Methods: Data were analysed by multinomial logistic regression analyses. The questionnaire was distributed to all undergraduate nursing students in 2001–2003 in their final study semester at four universities in Norway (N = 445) to collect the students' career expectations. Register data on clinical fields for the first 10 years after graduation were merged into the survey in 2014 (Statistics Norway). Results: With exception of the very first years after graduation, care of older people is the most common field for undergraduate nurses to enter for a career. This choice can be understood in light of nurses' career expectations. Among newly educated nurses, the choice to work in care of older people (rather than general hospital care) correlates with expectations of achieving a management position. Ten years after graduation, the likelihood of working in care of older people rather correlates with nurses' expectations of part‐time work. Conclusion: The likelihood of moving into care of older people increases with time in nursing careers and relates to nurses' career expectations such as achieving a leadership position and working part‐time. [ABSTRACT FROM AUTHOR]

Background: Despite the frequency of hospital readmissions, there is still a relatively incomplete understanding of the broader array of factors pertaining to readmission in older persons. Few studies have explored how older persons experience readmission and their perceptions of circumstances affecting the course of care. Research indicates that males experience poorer health outcomes and are at higher risk of readmission compared to women. Aim: To explore life conditions and critical incidents pertained to hospital readmission from the perspective of older males. Methods: The study used a qualitative explorative design using the Critical Incident Technique. A purposive sample of four males aged 65–75 were recruited from two internal medical wards. Data were collected through narrative double interviews. The study was registered by the North Denmark Region's joint notification of health research (ID 2008‐58‐0028). Findings: The analysis revealed four themes of life conditions: 'Ambiguity of ageing', 'Living with the burden of illness', 'Realisation of dependency' and 'Growing sense of vulnerability and mortality'. Critical incidents comprised four areas: 'Balancing demands and resources in everyday life', 'Back home again – a period of recovery', 'Care interaction' and 'Navigating within and between healthcare system(s)'. Conclusion: This study illustrated the interconnectedness, dynamics and complexity of life conditions and critical incidents that over time and across diverse healthcare sectors affected the course of care in older persons. Hospital readmissions seem related to a complex web of interacting life conditions and critical incidents rather than growing age or specific illnesses. [ABSTRACT FROM AUTHOR]

Aim and objective: To describe the meaning of the phenomenon home care from the perspective of older persons who live alone with multimorbidity. Background: In line with worldwide changing demographics, conditions for older people in need of home care are changing. In Sweden there is a stay‐in‐place policy and older people are expected to live and be cared for in their own home as long as possible. Home care, instituted by different laws, is a challenge affecting the older person when the private home becomes a workplace. Design: This study uses a qualitative design with a lifeworld approach. Methods: The study having been conducted in Sweden in 2016, the researchers interviewed 12 older persons that live alone and receive home care. Data were analysed using qualitative content analysis. Results: The findings illustrate four sub‐themes: adapting to a caring culture, feeling exposed, unable to influence care and forced relations. The overall theme reveals that older people experience a life‐changing situation when receiving home care and they become a guest in their own home. Conclusions: Becoming older with increased needs means to disrupt one's life when one's private home becomes a public arena. The gap between an older person's rights by law and the older person's experiences of receiving home care needs to be highlighted to meet the oncoming challenges in providing a home care that includes participation of the older themselves. Only then can care be offered that enables older people to have a sense of control and experience their home as their own. Implications for practice: The findings emphasise the need to view older people as being self‐determinant and independent. Older people receiving home care need to be seen as individuals, and their entire life situation should be considered by also acknowledging the important role played by relatives and caregivers. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to clarify the concept of self‐care among older people living with chronic health conditions. This concept clarification will assist nurses in addressing self‐care among older people through research, policy and practice in offering an expanded conceptual model. Background: Several policy influences over the past decade directly relate to the increased importance and economic necessity to require self‐directed care for older people living with chronic health conditions to maintain their care at home in the community. Method: A selective review of literature on the concept of self‐care included 31 sources. The Norris Concept Clarification method (1982) was used for clarification. The phenomenon is described historically according to its antecedents, attributes and consequences. Results: A proposed definition is provided based on the clarification of this concept. A conceptual model is presented through an ecological framework. Self‐care among older people living with chronic conditions is multidimensional and has multilevel influences (individual, community, system levels) and is mediated by the contexts and processes of ageing. Self‐care originates along one's life course and is learned. Self‐care responses are based on care needs when living with chronic health conditions. Conclusion: Self‐care is an individual capacity, disposition and activity older people manifest in living with multiple chronic conditions. These features (capacity, disposition, action) influence one another and are hierarchical and continuous. Research, practice and policies that promote self‐care among older people can focus on these features to improve health outcomes and promote new models of care consistent with personal development and chronic care needs in older age. Implications for practice: This concept clarification can offer a model to support self‐care among older people living with chronic conditions. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To adapt the Family Involvement and Alienation Questionnaire (FIAQ) for use in the care of older people, psychiatric care, palliative care and diabetes care and to evaluate its validity and reliability. Background: Involvement in the professional care has proven to be important for family members. However, they have described feelings of alienation in relation to how they experienced the professionals’ approach. To explore this issue, a broad instrument that can be used in different care contexts is needed. Design: A psychometric evaluation study, with a cross‐sectional design. Method: The content validity of the FIAQ was evaluated during 2014 by cognitive interviews with 15 family members to adults in different care contexts. Psychometric evaluation was then conducted (2015–2016). A sample of 325 family members participated, 103 of whom in a test–retest evaluation. Both parametric and non‐parametric methods were used. Results: The content validity revealed that the questionnaire was generally understood and considered to be relevant and retrievable by family members in the contexts of the care of older people, psychiatric care, palliative care and diabetes care. Furthermore, the FIAQ (Revised), demonstrated satisfactory psychometric properties in terms of data quality, homogeneity, unidimensionality (factor structure), internal consistency and test–retest reliability. Conclusion: The study provides evidence that the FIAQ (Revised) is reliable and valid for use in further research and in quality assessment in the contexts of the care of older people, psychiatric care, palliative care and diabetes care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore nursing home nurses' experiences and views of work identity. Background: Nursing home nurses are in a unique position as they work at the interface of health and social care. Little is known about nursing home nurses' perceptions and experiences of working within this context. Evidence suggests that using the concept of work identity can support understanding of how workers make sense of their work. Design: Hermeneutic phenomenological study. Methods: The study was carried out in seven nursing homes in North East England. Findings are based upon literary analysis of multiple episodic interviews with 13 nursing home nurses. Results: Participants' responses suggested that nursing “residents” is different to nursing “patients,” and nursing home nurses are required to modify their care activities to account for these differences. Participants also proposed that they are isolated and excluded from the rest of the healthcare workforce group. These issues led participants to feel uncertain about work identity. Many participants attempted to strengthen their work identity by aligning their role with what they perceived the “nurse identity” to be. Conclusion: Nurses' work activities and professional group identity influence their work identity. When work activities and professional group identity do not align with role expectations, as can be the case for nursing home nurses, work identity may be compromised. These nurses may attempt to change work practices to strengthen their work identity. Relevance to clinical practice: Health‐ and social care providers need to account for work identity factors in the organisation of care, and planning and implementation of integrated health‐ and social care initiatives. [ABSTRACT FROM AUTHOR]

Aims and objectives In this article, we introduce care itself as a narrative practice. We emphasise that all interactions between care providers and older adults in long-term care settings are narrative in nature and foreground experience. Background Every person consists of innumerable stories based on experiences over time. Some experiences can be recalled and told as narratives, while others are inscribed into our bodies; they are embodied. These narratives shape who we are and are becoming, and influence how care providers experience and provide nursing care in long-term care settings. Main contributions of the theoretical considerations We highlight the importance of stories to narrative identities and focus on the embodied act of coconstructing new stories in interaction. We emphasise the idea that care in gerontological nursing would benefit from acknowledging and fostering embodied narratives in a systematic way with older adults. Conclusions To foster, elicit, and coconstruct evolving and forward-looking narratives based on older adults' verbal and embodied narratives is essential for the quality of care in long-term settings. Care providers must be aware that they are co-authors of older adults' continuous storying and restorying of their lives. Implications for practice To recognise that both residents and care providers are narrative beings shift the current culture of care away from rationalised and emotionally devoid consequences of care. Understanding the theoretical underpinnings of care itself as narrative practice is a first step in developing care practices that place relationships between residents and care providers at the centre of practice. There is a need for the implementation of strategies to think and work narratively in long-term care settings. [ABSTRACT FROM AUTHOR]

Geriatrics before 1980s was a non-existent academic discipline across the globe. The (1st) World Assembly on Ageing in Vienna in 1982 may be considered as the starting point when social scientists, biologists and ultimately the health care professionals took note of the burgeoning ageing population and developed interest in this field of science. In the health sector, rapid development and growth of organ specific sub-specialties in subsequent years led to a paradigm shift in the way medicine was practiced at institutional as well as individual level. An older patient, who was visualized as a constellation of multiple organ specific disease states; failed to receive the quality health care as there was no evidence based protocol to address complex multi-morbidity and functional decline. While professionals were struggling to understand what is old age care beyond the sum total of care for each organ several issues became clear slowly but definitely. Assessment that is comprehensive yet meaningful, a very ill patient with no apparent illness, muscles that just disappear, failing mind, quick surgery for broken bones, lack of control over bladder and bowel are some of the challenges that made health systems and physicians to believe Geriatrics can be an umbrella under which an older patient with complex health and social issues can be provided quality health care at an affordable cost with a different way of looking at symptoms and signs, beyond organs and systems. Frailty, sarcopenia, cognitive decline, geriatric syndromes are yet to be included in the ICD system of disease nomenclature and coding. On the other hand, mundane issues of long term care and end of life care have emerged as big challenges for the family, community and the health system. Training medical and paramedical health professionals in care of older patients over and above their basic professional training and organization of health systems in old age care at different levels are challenges that have been faced and addressed in these years. Some of the critical questions remain; namely; how much of expertise the geriatricians should have in managing communicable diseases; how to organize intensive care for critically ill patients, the decision making in intensity of resuscitation and mechanical ventilation, and how to communicate with the older patients and their family members etc. The COVID 19 pandemic and the public health measures to limit its spread caused enormous misery to the ageing population; but paced substantial focus on care and well being of this vulnerable population. From infirmary care to health care of the older population has been a long journey; but healthy ageing is the ultimate goal of life and an end point of the discipline of Geriatrics. In December 2020, the United Nations and World Health Organization declared the 2021 -2030 as the Decade of Healthy Ageing. It is imperative on practicing and future geriatricians to achieve this goal. [ABSTRACT FROM AUTHOR]

The learning landscape of the higher education environment is changing, with an increased focus over the past decade on how educators might begin to cultivate reflective skills in health professions students. In addition, changing professional requirements demand that health professionals are adequately prepared to practise in today’s complex healthcare systems, including responding to changing demographics of population ageing. In this educational case study, we will share how we (a group of education, medical and nursing academics) developed ‘Depth of Field: Exploring Ageing’ a digital, consumer-driven, interprofessional reflective learning resource that uses photographs, narrative and small-group work to strengthen reflective capacity in current and/or future health professionals. [ABSTRACT FROM PUBLISHER]