Method to Evaluate the Location of Aged Care Facilitiesin Urban Areas Focusing on the Equity in Terms ofUsers’Accessibility

The present study developed and tested a method to evaluate the location of aged care facilities from the viewpoint of whether they are equitably located for users,using the improved Median Share Ratio(MSR).By evaluating the current location of aged care facilities,it is possible to extract the districts which are short of facilities.The evaluation method was applied to Chofu and Kiyose Cities in Tokyo Metropolis,Japan,and the evaluation result of weighting and that of not weighting by elderly population were compared and discussed.Consequently,adopting the evaluation method with weighting by elderly population,it is possible to adequately examine the districts where new aged care facilities should be constructed.From this evidence,it is significant to evaluate the location of aged care facilities,using the improved MSR with weighting by elderly population in the study.

Key Elements of “Family” Life Style of Old-age Residential Facilities

The problem of old-age care in China is more and more serious. Under the background of continuous promotion of community old-age, the importance of research on the"family" life style of oldage residential facilities has become increasingly prominent. Through field survey of different types of oldage residential facilities and questionnaire interviews, the shortcomings of the old-age residential facilities in Xi’an were compared and summarized, and the key elements of "family" life style of the old-age residential facilities were concluded, which mainly include urban community embeddedness, family structure elements, indoor furnishings and accompanying care system. The "family" life style of the old-age residential facilities can not only maintain the "kinship" living needs, but also conform to the new direction of promoting the "community" of the old-age residential facilities in China.

Measuring the spatial and social characteristics of the architectural plans of aged care facilities

This paper presents a method that combines visibility graph and isovist analyses to investigate the spatia[ and social properties of architectural plans for aged care facilities. The potential of the combined method is examined by measuring the properties of three sets of plans for residential aged care facilities. The first set is a pair of hypothetical, idealized plans, which allegedly reflect the ＂best practice＂ in the industry. The second set comprises a pair of plans for recent Australian designs, and the third set is a pair of plans for South Korean facilities. Results of the computational anatysis of these six plans suggest that social and cultural factors may shape the design of aged care settings and partially explain their international differences. The application of this methodological approach contributes to the understanding of the relation- ship between spaces and their cultural and social properties in the design of aged care facitities.

How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years:findings from 19 sub-Saharan African countries

Background Prompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries.However,more remains to be known about how a patient’s socioeconomic status(SES)would affect the access to diagnosis of malaria.Methods In this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey,we pooled the data of 38,567 febrile under-five children in 2016–2018 from 19 sub-Saharan countries.Multivariable logistic regression was used to assess the associations between SES and two binary outcomes:the visit to a health facility and a blood test for fever.Stratified analyses were further conducted by the type of health facilities(public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities)for the latter outcome.Results Fifty-eight percent of the febrile children were taken to health facilities,among whom only 55%took blood tests.Compared to children from households in the highest wealth quintile,children in the lowest quintile were less likely to be taken to medical facilities[adjusted odds ratio(aOR)=0.775,95%confidence interval(CI):0.675–0.889].Parents with more than secondary education were more likely to seek care(aOR=1.830,95%CI:1.561–2.145)and to have blood tests(aOR=1.729,95%CI:1.436–2.082)for their febrile children than parents without formal education.The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles,while these probabilities remained the lowest at private primary healthcare facilities,ranging from 0.100(95%CI:0.074–0.127)to 0.139(95%CI:0.083–0.194)across parental education levels and from 0.104(95%CI:0.078–0.130)to 0.125(95%CI:0.090–0.160)across wealth quintiles.Conclusions Significant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries.These disparities were particularly evident in the private sector.Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable.

Challenges in the provision of community aged care in China

Objective:Population ageing in China is a significant challenge for the Chinese government,the society and Chinese people.The dramatic process of population ageing together with social and economic diversity in China has created issues in the availability,equality and sustainability of social and financial support for older people.The aims of this review are to identify the social and economic challenges to the traditional caregiving system in China,and to examine possible solutions to improve the care of older people in China using the framework of ageing in place.Methods:Electronic literature searches were conducted in May and June 2013 using PubMed,CNKI,and MEDLINE.Statistical data and reports were retrieved from the United Nations,the World Health Organisation,the World Bank and National Bureau of Statistics of China.Government policy documents were found through government websites and formal publications.Results:Family-centred care for older people in China is recognised as a cultural tradition in the Chinese community.However,driven by large-scale social,political and economic changes,this model of caring for older people has dynamically changed over the last 50 years.Traditionally the family has been the most important source of social support for older people followed by neighbour support and support from friends.Today family obligations of caring are still centred in a cultural and practical context;however,support from family and children has weakened incrementally.Community-based aged services are absent in most areas,while older people and their families have to pay out-of-pocket expenses for non-residential services.There is a severe shortage of aged care or nursing home resources in China and those that exist are of low quality and expensive.The staff who work in these facilities rarely have any formal training in aged care.In addition,a market approach to the funding of residential aged care has the potential to create a moral hazard due to the poor regulatory control of aged care in China.While the building of residential aged care homes is seen as the solution to the care of older people in China,older people prefer to age in their own homes and expect the restoration of the family care tradition as well as more government support for them to“age in place”.This approach has the potential to be more cost effective than expensive aged care facilities.Conclusion:Given older people’s preferences,ageing in place,with the provision of community services and family support,potentially provides a fair and financially viable approach to promote healthy ageing and supportive care in China.Further studies are required to identify 1)how ageing in place can be supported by a national strategy,2)the financial arrangements required to fund such an approach,and 3)how to train high quality community-based professionals in both rural and urban areas to support the care of older people.

Health personnel's experience with resident-centered care in nursing homes in Korea: A qualitative study

Objectives: Changing the culture in nursing homes in South Korea comes with challenges,and the key issues of resident-centered care have been described.This study aims to describe health personnel's experience in providing resident-centered care in nursing homes.Methods: Qualitative data were collected through individual and focus group interviews consisting of registered nurses (n =4),certified nurse assistants (n =2),and long-term caregivers (n =12) working at nursing homes in South Korea.The participants (n-18) completed the interviews from May to June 2018,and all interviews were recorded,transcribed,and analyzed by employing the content analysis method.Results: Five main categories are conceptualized: (1) residents' participation in decision making,(2) the sharing of the history and story of residents,(3) the recognition of facility-or task-based attitudes,(4) the guarantee of private time and space for residents,and (5) the need for standardized guidelines.Conclusions: Results corroborate that health personnel regard resident-centered care as a desirable nursing paradigm.However,facility-or task-centered care is the most effective in hectic situations.A standardized protocol on the application of resident-centered care based on the facility-tailored specification is unavailable.Therefore,health personnel's perception and practice of resident-centered care can differ.Efficient nursing intervention programs should be developed after clarifying facility culture.

Roles of mutual help of local community networks in community health activities: Improvement for the quality of life of older people in Thailand

Objectives: This study aimed to describe work and activities of community networks focusing on the improvement of the quality of life (QOL) of older people in Thailand.The understanding of the work can help enhancing the community development and strengthening of local communities and their networks.Methods: Qualitative methods including in-depth interview,observation,and focus group discussion were employed to the study.64 participants participated to the study and were recruited from 4 key actors within the community.Content analysis was used to analyze the obtained data.This study was conducted in 6 local administrative organizations (LAOs) which selected from the outstanding areas of the project.Each LAO represents one sub-district of the regions of Thailand namely;(1) the upper north,(2) the lower north,(3)the upper eastern,(4) the lower eastern,(5) the central and (6) the south.Results: The findings of this study were categorized into three main themes: (1) Social capital including people in the community,social groups,and organizations,(2) Mutual help/collaboration activities composed of six sets of activities related to social capitals working on the improvement of QOL of older people,and (3) Impacts of the mutual help/collaboration activities on older people and local communities who help to improve of QOL of older people.Conclusion: The findings are important features for the community development.These themes should be recommended for community nurses,health related groups and organizations for the improvement of QOL of older people in the community.

Examining older patient preferences for quality of care in postacute transition care and day rehabilitation programs

Background: Quality in health care has traditionally been determined based on clinical or health outcomes. However, these factors may not be the only aspects of health care that are important to patients. Within rehabilitation factors related to the process of care, the way in which rehabilitation services are delivered, may also be important to patients when defining quality of care. Objective: The purpose of this study was to examine and compare the preferences of older people receiving post-acute outpatient rehabilitation or residential intermediate (transition) care for alternative configurations of rehabilitation programs. Methods: A discrete choice experiment (DCE) was designed to elicit the preferences of older people for the design and delivery of post-acute rehabilitation programs. The participants were older adults (≥65 years) receiving post-acute outpatient rehabilitation or residential intermediate (transition) care in South Australia. Each participant was presented with a series of choice questions involving two hypothetical programs, the characteristics of which varied in every choice. Participants were then asked to select their preferred program. Results: Despite marked differences in case-mix and dependency levels, the preferences of the two groups were very similar, focusing on relationships and communication with health care professionals. Both groups demonstrated very strong preferences for the use of an electronic medical record and for receiving information about their treatment and progress via a meeting with a specialist physician and nurse. The outpatient rehabilitation group also exhibited a strong preference for a shared decision making model in relation to their future care needs. Conclusions: The findings highlight the commonality of preferences of older patients receiving post-acute services for the optimal configuration of rehabilitation services. Issues prioritised were service integration and access to senior medical and nursing staff. The study demonstrates the practicality and validity of DCEs to determine older people’s preferences in defining quality of care.

Cognitive decline is related to high blood glucose levels in older Chinese adults with the ApoE ε3/ε3 genotype

Background:Few studies have investigated the effects of blood glucose(BG)on cognitive function in communitydwelling elderly individuals carrying the apolipoprotein E(APOE)ε3 allele.Objective:To explore the effect of high BG levels on cognitive function in APOEε3-carrying,non-demented,community-dwelling older adults,as compared to their counterparts carrying the APOEε4 or APOEε2 alleles.Methods:Within the China Longitudinal Ageing Study,we recruited 282 elderly adults without dementia.Data collected included demographic information;psychological measures;laboratory test results,including BG and plasma lipid levels;and APOE genotypes.We divided the participants into APOEε2(ε2/ε2,ε2/ε3),ε3(ε3/ε3),andε4(ε3/ε4,ε4/ε4)groups.Partial correlation analyses and multivariate linear regression analyses were utilized to compare the cognitive function and laboratory data between the APOE groups.White matter hyperintensity(WMH)was measured on magnetic resonance images in 77 participants.Results:With adjustment for age,sex,education,and diabetes,higher BG in non-demented community-dwelling older adults was associated with cognitive decline in immediate memory and executive function.In the APOEε3 group,elevated BG was associated with cognitive decline in immediate memory,executive function,and perceptual reasoning.In the APOEε4 group,higher BG was also correlated with a decline in abstract reasoning.There was a trend for association between higher BG and more severe WMHs.Conclusion:Worse cognitive function was correlated withApoEε3/ε3 genotype carriers with higher BG in community-dwelling older adults.