Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.

Living alone, health and preventive care use among the elderly in Shanghai, China

Objective:The purpose of the study was to compare the preventive care use and health between the elderly living alone and living with other individuals and identify strategies to improve the preventive care use among the elderly living alone.Methods:A questionnaire including socioeconomic characteristics,preventive care use,health status and Social Support Rate Scale was administered to 240 elderly living alone and 244 elderly living with other individuals in Shanghai,China.Logistic regression analysis was used to examine the predictors of preventive care use.Results:The elderly living alone were more likely to be single(never married,divorced,separated and widowed),have lower social support and income,utilize less routine physical check-up and blood glucose screenings,have worse self-reported health and have limitations in IADL compared to the elderly living with other individuals.Women,old age,high education,income and social support and close to medical institutions were positively associated with routine physical check-up among the elderly.Conclusion:Living alone was associated with less preventive care use and worse health.It was important to provide more social support and economic support for the elderly living alone to increase their preventive health care service utilization and improve their health status.

Assessment of Comprehensive Health Care of the Elderly in Primary Health Care

Objective: To assess comprehensive care in the elderly population, as well as the quality of care in Primary Health Care. Methods: This is an exploratory descriptive study with a quantitative approach, conducted from July to December 2012, in the city of Santa Cruz, Rio Grande do Norte, Brazil. A sample of 130 subjects chosen by drawn was calculated, and data collection was performed at their homes. Results: There were interviewed 130 people, 92 (70.8%) women and 38 men (29.2%), with a minimum age of 60 and maximum of 96 years, with a mean of 72.8, median of 72.0 and a standard deviation of 8.3. Regarding the quality of care ratings of the PHC team, 48.5% (n = 63) of respondents stated this to be good, while 32.3% (n = 42) rated this as fair. Conclusions: In this perspective, one of the most appreciated meanings that were given to comprehensive care by health care professionals refers to holistic knowledge of each patient, resulting in the non-fragmentation of care. Thus, it is noticed that comprehensiveness has some weaknesses that need to be corrected, which shows the need for education and training of professionals assigned to primary health care services.

Health and Medical Care for the Elderly

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Problems of elderly health care and welfare arrangement --Case study of demand on elder care in northeastern of Thailand

This research attempted to explain the problems of elderly health care, the problems and suggestion in elder welfare arrangement and the demand on elder care. The survey underlying this study was conducted in Muang district, Khon Kaen province, Thailand. Eighteen subdistricts were interviewed in the study area. Data were collected in two areas of Khon Kaen province, that are, the city of Khon Kaen and the outside Thesaban Nakhon Khon Kaen. The random sample consisted of 386 elders： 112 elders lived in the city of Khon Kaen and 234 elders lived outside Thesaban Nakhon Khon Kaen, Muang district, Khon Kaen. The analysis of the demand on elderly welfare gave an interesting result that the elders demanded on monthly income to support living cost and medical services at high level; The demand on housing was at low level; The demand on education, religion and culture the demand on club, sport and entertainment, and the demand on job and art were at the moderate level; The main problem of elderly welfare arrangement was the scarcity of budget support, the weakness of elder health, and activities announcement. The analysis of pattern of elder welfare： The case study of elder care identified that 31.87 percent of the elders had demand on elder care. Price of the elder care at 100 Baht per day was mostly selected about one-fourth of all the case occurred. Female elder selected the elder care at 100 Baht per day, while male elder choose at a higher price level, which were 200 Baht per day and 150 Baht per day respectively. The female elder care was the most popular. The elder care age between 30-39 years was mostly selected. Finally, most of elders purposed the working day of the elder care depend on their appointment.

Health Literacy: Prevalence among Elderly Care Givers and Its Impact on the Frequency of Elderly Hospitalization and Elderly Health Related Quality of Life

Caring for the elderly is an extremely lonely and frustrating vigil. The care giver has the responsibility of caring for an elderly one to the myriad decisions on different topics such as diabetes care or cancer treatment. Care givers with low levels of health literacy have less health knowledge, worse management of chronic disease and lower use of preventive services. This study was conducted to determine the prevalence of health literacy among elderly care givers and its impact on the frequency of elderly hospitalization and elderly health related quality of life (QOL). The study was carried out on 200 elderly patients and their corresponding care givers. Rapid Estimate of Adult Literacy in Medicine (REALM) and Newest Vital Sign (NVS) were used to assess caregivers’ health literacy. Assessment of the elderly health related QOL was done by the use of short form-12 health survey (SF-12). The results were as followed, in elderly patients;92 were males and 108 were females. The mean elderly age was 69.4 ± 8.8. The mean age of caregivers was 42.1 ± 12.9 years. The prevalence of inadequate health literacy among elderly caregivers was 75.0%. There were significant associations between care givers, health literacy and the frequency of elderly hospitalization (p = 0.001), duration of hospital stay (p = 0.009), and the elderly health related QOL (p = 0.001). The study concluded that inadequate health literacy is a problem among elderly care givers in Egypt. Healthcare professionals must be made aware of this problem, which is to provide simplified educational materials to elderly care givers to maximize elderly care.

Elderly Health Care-Security and Privacy Issue

The current trend in offering universal health care based on open distributed health care network which will provide health care to elderly,socially and economically weak population,and physically challenged patients has lead to rapid digitization of health care data,and wireless medium for data communication.Although it has many advantages and has immense potential to improve health care availability,it has created many challenges in maintaining health care services,in particular in offering security and privacy of the most vulnerable members of society who are the elderly.In this paper we identify the current status of elderly care,their vulnerabilities,and challenges faced to offer them health care in total privacy and dignity.

Limited Focus on the Use of Health Care by Elderly Migrants——A Literature Review

Our premise for this literature review is the global demographic change caused by the world’s population living longer and becoming older, and extensive international migration leading to multicultural societies. Increasing age leads to health problems, often long-term or chronic, requiring investments in health care. Worse health and dissimilarities in pattern of morbidity/ mortality have been found in foreign-compared to Swedish-born persons, so it is reasonable to assume that this affects use of health care. The exploratory review focuses on elderly migrants’ (>65 years) use of healthcare. The databases Pub Med, EBSCO, CINAHL and ERIC were searched in 2000-2013. A limited number of studies were found;few had a comparative approach, most were from the USA, and focused on migrants from the former Soviet Union or countries in South-East Asia. A range of factors were identified that influence patterns of health care use: language fluency, ability to communicate, self-reported health status, prevalence of chronic disease, physical distance from care provision, availability of transport to reach care, cost of care, the health insurance system, cultural norms and values regarding different forms of care, level of education, and length of residence in the host country. Most studies treated health care from a general perspective and collected data from community and hospital settings, without analysing usage separately. Some studies indicated elderly migrants making use of health care less than other groups but the pattern is not unambiguous: other studies show that there is an overuse of health care. It is therefore difficult to show any particular pattern, or possible differences in use, regarding community versus in-patient care. Studies focusing on migrants’ actual use of health care are few and further research is needed, especially because elderly people form the largest group of users of health care and will be even larger in the future.

Significant Differences in Elderly Health between Urban and Rural Communities: A Literature Review

This study aimed to examine measures pertaining to elderly health in urban versus rural settings, and to identify differences in the health of elderly people living in urban and rural communities through a literature review. An electronic literature search was performed using PubMed for English articles published in peer-reviewed journals up to August 2018, with the following search terms: “urban”, “rural”, “comparison of community”, “elderly health”, and “comparison of community health”. A total of 35 articles were extracted for a critical full-text review, and six articles that met the inclusion criteria were subjected to analysis. Measures related to elderly health in urban and rural communities were classified into the following three categories: functional abilities, health, and health perception. Five of the six articles described functional abilities (e.g., social function) and health (e.g., mental health, depression) as categories with significant differences in elderly health between urban and rural communities. The results suggest that elderly health measures related to social function and mental health or depression are more important outcome measures of effective person-centered integrated community care systems from the perspective of community characteristics. As there were only a few articles reporting on elderly health according to differences in environment between urban and rural communities, further investigation is globally warranted.

Dubai Primary Health Care Centers Conformation to WHO Age-Friendly Primary Healthcare Recommendations

The WHO project for conforming PHC to requirements of all age groups has resulted in publishing a toolkit for age-friendly PHC in 2008. The toolkit included checklists for physical environment and signage properties. This study matched the current physical environment properties of DHA’s PHC Health Centers against WHO’s recommendations. This is a cross sectional descriptive study that included visits to all 12 Primary Health Care Centers in Dubai city during August-September 2016 with the objective to assess the degree of fulfillment of current properties of Health Centers building to the recommendations of WHO as listed in “Age-friendly Primary Health Care Centres Toolkit” [1]. The study found that 81.86% of physical environment properties are matching the recommendation of WHO, while signage matching was 44.6%. The study concluded that most PHC properties have a physical design that met WHO’s recommendations. The two major deviations were accessibility by public transportations and presence of grab bars. Factors that had a significant impact on design were compliance with multiple international and local standards, the availability of private cars, and the availability of wheel chairs. Signage in DHA’s health centers followed a central plan that differed from WHO’s recommendations.

Aging in China: perspectives on public health

In line with the worldwide trend in population aging,China has stepped into an aging society since 2000.The outstanding features of aging,including a large proportion of the older population,rapid growth,dramatic expansion of the oldest-old,and uneven aging distribution,have put China in a unique position.Besides,older population is expanding in parallel with the escalating burden of disease,high prevalence of disability,and low social involvement.However,China is not prepared to solve these problems in terms of the economy,awareness,geriatric care system,geriatric team,social security,or age-friendly environment.From the perspective of public health,we summarized the major challenges and proposed the following policy recommendations:(1)strengthening the top-level design and building a"government-leading,multi-sectoral-cooperating,and society-participating"pattern;(2)enhancing health services by implementing the"comprehensive health"strategy;(3)developing home and community care,coordinately enhance institutional care,promote integration of medical and care systems,and establish a multidimensional tailored care system;(4)optimizing geriatric the supporting system,included the construction of geriatric team and the long-term care insurance system;and(5)establishing a physical and socially age-friendly environment.

Elderly healthcare service at the community health centers in the Pearl River Delta region,China

Objective:The recent population census showed China had officially become a graying society.In the meantime,China also faces a growing burden of non-communicable diseases.Since 2009,a series of policies have been implemented to enhance primary care at the community level.This study describes the elderly care services provided in the differently organized community health centers(CHCs).Methods:It covered 13 CHCs of six cities located within the Pearl River Delta(PRD)region.In-depth interviews were conducted with a total of 59 health administrators,CHC managers,and CHC doctors regarding elderly care.Results:The study found that accessibility of healthcare for elders has been improved due to the development of health insurance schemes as well as preferential policy to encourage the CHC utilization by the elderly.All the CHCs provide health examinations and chronic disease management to the permanent elderly within their catchment district.However,some preventative care such as fall prevention,immunization and mental health management are not provided.Conclusion:Key barriers include low capacity of health service providers in the CHCs,and a lack of government investment in CHCs.Our report provides an empirical evidence for the health care reform in China.

Meeting the Health-care Needs of the Rural Elderly:The Unique Role of Village Doctors

Despite their recent deterioration, village clinics have historically been an important source of health care for the poor and elderly in rural China. In this paper, we examine the current role of village clinics, the patients who use them and some of the services they provide. We focus specifically on the role of village clinics in meeting the health-care needs of the rural poor and elderly. We find that although clinics are continuing to decline financially, they remain a source of care for the rural elderly and poor. We estimate that the elderly are 10-15 percent more likely than young individuals to seek care at a clinic. We show that clinics provide many unique services to support the rural elderly （and the elderly poor）, such as in-home patient care, the option for patients to pay on credit, and free and discounted services.

Study on the quality of life and the factors influencing it in elderly patients

A society of advanced age is arriving with the increasing number of elderly patients. Little attention has been paid to the quality of life of elderly patients, which is decreasing gradually. This article aims to study the quality of life among elderly patients and explore the factors influencing it, in addition to exploring effective ways to improve the quality of life of elderly patients.

Polypharmacy in Primary Care Practices among Chronic Elderly Patients in Gaza Strip

Introduction: The increasing number of elderly, and drug use among the elderly, emphasizes the need for continuous monitoring of drug utilization. Chronic diseases are frequent among the older population;the rate of drug related problems and drug-drug interactions (DDIs) with the medical and financial consequences are enormous. Polypharmacy (PP) is defined as the concomitant use of 5 or more medications. We studied PP among chronic elderly patients in Gaza Strip and its distri- bution among primary health care clinics in different areas. Materials and Methods: This study is a descriptive analytical study, analyzing prescription data from general practices during a 3-month time period, to measure the prevalence of PP and medication errors among chronic elderly pa- tients. Data were collected directly from the prescriptions and medical records, which contain per- sonal data for patients like patient age and gender, included the current illness, drug treatment for the current illness, chronic disease/s and drug treatment for chronic disease/s. SPSS software was used to analyze the obtained data. Results: Percent of major PP was the highest among patients aged 60 - 69 years when compared with other ages categories of study population but not reached to be statisticaly significant (0.012). Major PP was higher in female patients than that in male patients but difference wasn’t statistically significant (0.5). The average number of drug per prescription was 3.4 drug;and the minimum value per prescription was 1 meanwhile maximum value was 9 (SD + 1.7). Conclusion: PP (use of five drugs or more) is more prevalent among elderly patients with multiple diseases. Female patients consume more drugs than male do. There were some regional differences in drug utilization not explained by morbidity, suggesting some varia- tions in prescribing behaviors.

Elderly African Americans Insights on the COVID-19 Pandemic: An Exploratory Study of Risk Perception and Personal, Social, and Cultural Factors

This exploratory study examined elderly African Americans attitudes on the COVID-19 pandemic by identifying their perceptions of risk based personal, social, and cultural factors. It seeks to understand their insights toward public health pandemic response initiatives and other efforts to mitigate COVID-19 outbreak response measures impacting elderly African Americans, including policies, interventions, and public information/communication. The effectiveness of pandemic response measures and community caregiving support for the elderly African Americans was examined as well. Respondents in this study were a convenient sample of 60 residents predominantly in a Midwestern metropolitan area. Respondents were eligible for study participation if 1) there were 60 years and over and, 2) African American or people of African descent. A mixed research method design comprising focus groups and online survey was used to collect the data for the study. The respondents characterized the impact of the coronavirus as a personal, family, and community loss (e.g., less socially engaged and burdensome). An overwhelming majority (98.3%) expressed no worries about getting health care if they or their family members needed it. A sizable number of respondents expressed the need for all to be tested to help prevent the spread of the virus.

How many systolic and diastolic variables must be measured in elderly patients with symptoms of heart failure?

Objectives: To explore the concordance and the feasibility of obtaining systolic or diastolic variables of left ventricular function in elderly patients with heart failure symptoms. Methods: One hundred twenty four patients with symptoms of heart failure (mean age 77 years, 70% females) were included in a cross-sectional, explorative study. Nineteen echocardiographic variables (7 systolic and 12 diastolic) were measured. Results: Overall, feasibility ranged from 93% to 100% for 15 variables and was 48% for mitral regurgitation dp/dt(MRdp/dt), 66% for the difference between pulmonary AR-dur and mitral A-dur, 81% for the ratio between early and late mitral inflow velocity (E/A), and 76% for tissue Doppler imaging late dia-stolic velocity (TDI A’). Concordance was very good/ good in 83% and poor/missing in 17% of systolic variables, whereas it was very good/good for 67% of diastolic variables and poor/missing for 33%. Factor analysis reduced systolic variables to two factors that explained 69% of the total variance in systolic function. Conclusions: Low feasibility for some and questionable concordance of especially diastolic variables questions the rationale for routinely measuring a high number of echocardigraphic variables. The results of the factor analysis further strengthen the possibility of reducing the number of measured variables. The clinical value of such a reduction needs to be validated.

China Elderly Care:A Confucian Legacy

This paper explores the Confucian roots of elderly care expectations and how these expectations may influence the current state of the elderly and elderly care in modem China.This paper posits that the outdated expectations combined with recent urbanization trends has put unrealistic pressures on society to adequately care for a rapidly aging population.Until expectations are adjusted to reflect modem day families and realities,the elderly will continue to struggle with a sense of inadequate care,which can lead to mental health issues and feelings of isolation.Once the shackles of Confucian expectations are removed,families,governments and private institutions will have the freedom to be more creative in the way they imagine solutions for elderly care.

中国老年人口健康状况及其家庭照料需求预测

中国人口老龄化快速发展,失能、半失能老年人口规模迅速扩大,老年照料需求快速增加。科学预测不同失能状况老年人口规模及其照料服务需求是推动老年照护服务体系建设的重要基础。文章基于中国老年健康影响因素跟踪调查(CLHLS)数据,使用Markov模型测算中国分性别、分年龄段老年人口健康状况转移矩阵,运用队列要素预测法、多元回归法等预测得到2020—2035年中国不同失能状况老年人口规模及其照料服务人员需求规模、家庭照料经济成本。预测结果显示:中国失能老年人口规模呈现增长态势,从2020年的1946万人增至2035年的3424万人,失能老年人口的比例从2020年的7.4%小幅增至2035年的7.9%,且中重度失能老年人口增幅更快,2035年时轻度失能老年人口规模相比2020年增加66%,中重度失能老年人口规模相比2020年增加92%。女性失能老年人口规模增速快于男性,80岁及以上老年人口失能比例增长更快,2035年男性70~79岁、80~89岁、90+岁三个年龄组失能老年人口规模分别为2020年的1.53倍、1.92倍、1.94倍;2035年女性三个年龄组失能老年人口规模分别为2020年的1.72倍、2.29倍、2.52倍。老年家庭照料需求将呈现快速增长态势,家庭照料服务人员需求量从2020年的2795万人增至2035年的4863万人,增长74%。2020—2035年健康老年人口的照料服务人员需求量占总需求量的比例在57%左右,中重度失能老年人口需求量占比在24%左右,轻度失能老年人口需求量占比在19%左右。60~69岁老年人口所需的照料服务人员占比最高,90岁及以上年龄组对照料服务人员的需求量增长更快。老年人口家庭照料经济成本从2020年的3027亿元增至2035年的11676亿元,将增长近3倍。中重度失能老年人口所需的家庭照料现金成本相比2020年增长3.1倍,轻度失能老年人口所需的家庭照料现金成本相比2020年增长2.6倍。男性老年人口所需家庭照料现金成本低于女性老年人口,且增速也低于女性老年人口。本研究基于定量预测结果提出积极推进健康老龄化,加大促进生育的政策支持力度,尽快推广长期照护保险制度,以赋能家庭为着力点加强失能老年人口的支持体系建设,大力发展老年护理服务业,大力发展养老护理职业教育等政策建议。

Senior Citizens’Cultural Activity and Participation in Community Life

Objective: This study has the objective to know the cultural activities of the senior citizen and their participation in community life as encouraged by Primary Health Care professionals. Methods: This is a quantitative study that was performed on 130 senior citizens in the city of Santa Cruz, in the Brazil state of Rio Grande do Norte. Results: The participation of senior citizens in groups is very beneficial because it increases their autonomy and self-esteem, socialization, well-being and consequently, which leads to a higher quality of life. However, there were some failures in the promotion of healthy aging and the adoption of strategic activities. Conclusions: Based on this observation, it is expected that this study can provide resources for the primary health care professionals to try to stimulate senior citizens by carrying out cultural activities that value and increase their potential, quality of life and self-esteem and, thus, promote active and healthy aging.