Social engagement and health and social care use and medication use among older people.
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ABSTRACT:
SUBMITTER: Bath PA
PROVIDER: S-EPMC5547669 | biostudies-other | 2005 Mar
REPOSITORIES: biostudies-other
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Project description:BACKGROUND:There may be less primary health care engagement among people who use drugs (PWUD) than among the general population, even though the former have greater comorbidity and more frequent use of emergency department care. We investigated factors associated with primary care engagement among PWUD. METHODS:The Participatory Research in Ottawa: Understanding Drugs (PROUD) cohort study meaningfully engaged and trained people with lived experience to recruit and survey marginalized PWUD between March-December 2013. We linked this survey data to provincial-level administrative databases held at ICES. We categorized engagement in primary care over the 2?years prior to survey completion as: not engaged (<?3 outpatient visits to the same family physician) versus engaged in care (3+ visits to the same family physician). We used multivariable logistic regression to determine factors associated with engagement in primary care. RESULTS:Characteristics of 663 participants included a median age of 43?years, 76% men, and 67% living in the two lowest income quintile neighborhoods. Despite high comorbidity and a median of 4 (interquartile range 0-10) primary care visits in the year prior to survey completion, only 372 (56.1%) were engaged in primary care. Engagement was most strongly associated with the following factors: receiving provincial benefits, including disability payments (adjusted odds ratio [AOR] 4.14 (95% confidence interval [CI] 2.30 to 7.43)) or income assistance (AOR 3.69 (95% CI 2.00 to 6.81)), having ever taken methadone (AOR 3.82 (95% CI 2.28 to 6.41)), mental health comorbidity (AOR 3.43 (95% CI 2.19 to 5.38)), and having stable housing (AOR 2.09 (95% CI 1.29 to 3.38)). CONCLUSIONS:Despite high comorbidity, engagement in primary care among PWUD was low. Our findings suggest that social care (housing, disability, and income support) and mental health care are associated with improved primary care continuity; integration of these care systems with primary care and opioid substitution therapy may lessen the significant morbidity and acute care use among PWUD.
| S-EPMC7487534 | biostudies-literature
Project description:BACKGROUND: Older people in long-term residential care are at increased risk of medication prescribing and administration errors. The main aim of this study was to measure the incidence of medication administration errors in nursing and residential homes using a barcode medication administration (BCMA) system. METHODS: A prospective study was conducted in 13 care homes (9 residential and 4 nursing). Data on all medication administrations for a cohort of 345 older residents were recorded in real-time using a disguised observation technique. Every attempt by social care and nursing staff to administer medication over a 3-month observation period was analysed using BCMA records to determine the incidence and types of potential medication administration errors (MAEs) and whether errors were averted. Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Further analysis compared data for residential and nursing homes. In addition, staff were surveyed prior to BCMA system implementation to assess their awareness of administration errors. RESULTS: A total of 188,249 medication administration attempts were analysed using BCMA data. Typically each resident was receiving nine different drugs and was exposed to 206 medication administration episodes every month. During the observation period, 2,289 potential MAEs were recorded for the 345 residents; 90% of residents were exposed to at least one error. The most common (n = 1,021, 45% of errors) was attempting to give medication at the wrong time. Over the 3-month observation period, half (52%) of residents were exposed to a serious error such as attempting to give medication to the wrong resident. Error incidence rates were 1.43 as high (95% CI 1.32-1.56 p < 0.001) in nursing homes as in residential homes. The level of non-compliance with system alerts was very low in both settings (0.075% of administrations). The pre-study survey revealed that only 12/41 staff administering drugs reported they were aware of potential administration errors in their care home. CONCLUSIONS: The incidence of medication administration errors is high in long-term residential care. A barcode medication administration system can capture medication administration errors and prevent these from occurring.
| S-EPMC3254134 | biostudies-literature
Project description:BackgroundHealth literacy skills tend to decline during ageing, which is often attributed to age-related cognitive decline. Whether health literacy skills may be influenced by technological and social factors during ageing is unknown.MethodsWe investigated whether internet use and social engagement protect against health literacy decline during ageing, independent of cognitive decline. We used prospective data from 4368 men and women aged ?52?years in the English Longitudinal Study of Ageing from 2004 to 2011. Health literacy was measured at baseline (2004-2005) and at follow-up (2010-2011) using a reading comprehension test of a fictitious medicine label. The influences of consistent internet use and engagement in each of the civic, leisure and cultural activities on health literacy decline over the follow-up were estimated.ResultsAfter adjusting for cognitive decline and other covariates, consistent internet use (1379/4368; 32%) was protectively associated with health literacy decline (OR=0.77; 95% CI 0.60 to 0.99), as was consistent engagement in cultural activities (1715/4368; 39%; OR=0.73; 95% CI 0.56 to 0.93). As the number of activities engaged in increased, the likelihood of health literacy decline steadily decreased (ptrend<0.0001), with OR=0.51 (95% CI 0.33 to 0.79) for engaging in all four of the internet use and civic, leisure and cultural activities versus none.ConclusionsInternet use and social engagement, particularly in cultural activities (eg, attending the cinema, art galleries, museums and the theatre), may help older adults to maintain health literacy during ageing. Support for older adults to maintain socially engaged lives and to access the internet should help promote the maintenance of functional literacy skills during ageing.
| S-EPMC4345520 | biostudies-literature
Project description:Young people are increasingly turning to social media for health-related information in areas such as physical activity, diet/nutrition and body image. Yet, there are few robust empirical accounts of the content and form of the health-related material young people access and attend to, or the health-related content they create and share. Furthermore, there is little guidance from research or policy on young people's engagement with health-related social media. This leaves many relevant adults ill-equipped to protect young people from the negative influences of social media and to optimize the potential of social media as a medium for health promotion. This article presents new evidence on young people's engagement with social media and the influences they report on their health-related behaviors. The research was undertaken with 1296 young people (age 13-18) using a participatory mixed methods design. Initially, a public pedagogy [Giroux, 2004. Public pedagogy and the politics of neo-liberalism: Making the political more pedagogical. Policy Futures in Education, 2, 494-503] theoretical framework was used to guide data analysis but this was found to be limiting. An adapted framework was developed, therefore, drawing on Miller et al. [2016. How the world changed social media. London: UCL Press] and Lomborg [2011. Social media as communicative genres. Journal of Media and Communication Research, 51, 55-71] to account for the unique ways in which pedagogy operates in a social media context. Young people accessed and used a range of health-related information on body transformations, diet/nutritional supplements or recipes and workouts/exercises, albeit in different ways. Moreover, young people identified five forms of content that influenced their understandings and behaviours: (i) automatically sourced content; (ii) suggested or recommended content; (iii) peer content; (iv) likes; (v) reputable content. The findings also suggest that relevant adults can reduce risk and realize more of the positive impacts of social media for young people by focusing on content, and the ways in which content is shaped in the interplay between interactive functionalities of social media (e.g. likes and followers) and young people's social uses of social media (e.g. friends, information).
| S-EPMC6859869 | biostudies-literature
Project description:OBJECTIVE:Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay. METHODS:Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients aged 65 years or older who received HHC in 2006-2007 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (versus discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy. RESULTS:About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10- to 20-percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change. CONCLUSIONS:Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions.
| S-EPMC4291306 | biostudies-literature
Project description:The sense that one is living a worthwhile and meaningful life is fundamental to human flourishing and subjective well-being. Here, we investigate the wider implications of feeling that the things one does in life are worthwhile with a sample of 7,304 men and women aged 50 and older (mean 67.2 y). We show that independently of age, sex, educational attainment, and socioeconomic status, higher worthwhile ratings are associated with stronger personal relationships (marriage/partnership, contact with friends), broader social engagement (involvement in civic society, cultural activity, volunteering), less loneliness, greater prosperity (wealth, income), better mental and physical health (self-rated health, depressive symptoms, chronic disease), less chronic pain, less disability, greater upper body strength, faster walking, less obesity and central adiposity, more favorable biomarker profiles (C-reactive protein, plasma fibrinogen, white blood cell count, vitamin D, high-density lipoprotein cholesterol), healthier lifestyles (physical activity, fruit and vegetable consumption, sleep quality, not smoking), more time spent in social activities and exercising, and less time spent alone or watching television. Longitudinally over a 4-y period, worthwhile ratings predict positive changes in social, economic, health, and behavioral outcomes independently of baseline levels. Sensitivity analyses indicate that these associations are not driven by factors such as prosperity or depressive symptoms, or by outcome levels before the measurement of worthwhile ratings. The feeling that life is filled with worthwhile activities may promote healthy aging and help sustain meaningful social relationships and optimal use of time at older ages.
| S-EPMC6347683 | biostudies-literature
Project description:BackgroundHealth care systems are increasingly moving towards more integrated approaches. Shared decision making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; particularly for older people with complex needs. The aim of this review was to provide a context relevant understanding of how interventions to facilitate SDM might work for older people with multiple health and care needs, and how they might be applied in integrated care models.MethodsIterative, stakeholder driven, realist synthesis following RAMESES publication standards. It involved: 1) scoping literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, 2) systematic searches for evidence to test and develop the theories, and 3) validation of programme theory/ies with stakeholders (n = 11). We searched PubMed, The Cochrane Library, Scopus, Google, Google Scholar, and undertook lateral searches. All types of evidence were included.ResultsWe included 88 papers; 29 focused on older people or people with complex needs. We identified four context-mechanism-outcome configurations that together provide an account of what needs to be in place for SDM to work for older people with complex needs. This includes: understanding and assessing patient and carer values and capacity to access and use care, organising systems to support and prioritise SDM, supporting and preparing patients and family carers to engage in SDM and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that allow older people to feel that they are respected and understood, and that engender confidence to engage in SDM.ConclusionsTo embed SDM in practice requires a radical shift from a biomedical focus to a more person-centred ethos. Service providers will need support to change their professional behaviour and to better organise and deliver services. Face to face interactions, permission and space to discuss options, and continuity of patient-professional relationships are key in supporting older people with complex needs to engage in SDM. Future research needs to focus on inter-professional approaches to SDM and how families and carers are involved.
| S-EPMC6052575 | biostudies-literature
Project description:BackgroundSocial isolation is a serious public health issue affecting a significant number of older adults worldwide. However, associations between different dimensions of social isolation and functional health are unclear. We assessed the varied effects of social isolation on health among a nationwide sample of older adults from China.MethodsWe assessed social isolation among 5,419 people aged 65 and older who took part in both the 2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Social isolation includes objective social isolation (kinlessness and lack of social contacts) and subjective social isolation. Four functional health outcomes were examined: self-rated health (SRH), activities of daily living (ADLs), instrumental activities of daily living (IADLs), and cognitive function measured by the Mini-Mental State Examination (MMSE). We used multivariable regression analyses to examine the associations between social isolation and health outcomes.ResultsOlder people who never married or who had recently lost a spouse were more likely to report poor SRH (OR=2.44) and difficulty with IADLs (ORs=1.46) than those who were married and lived with a spouse. Older people who never gave birth were less likely to report cognitive impairment (OR=0.53) than those who had living children, while older people who had recently lost a child were more likely to report poor SRH than those who had living children (OR=1.32). Older people who had no children visiting were more likely to report difficulty with IADLs than those who had children visiting (OR=1.25). In terms of subjective social isolation, older people who felt lonely were more likely to report poor SRH, cognitive impairment, and difficulty with ADLs and IADLs (ORs=1.19, 1.27, 1.28 and 1.21, respectively), and older people who had no one to talk to were more likely to report poor SRH, cognitive decline, and difficulty with ADLs and IADLs (ORs=2.08, 5.32, 2.06 and 1.98, respectively).ConclusionsKinlessness, lack of social contacts and subjective social isolation may impact various dimensions of health in older people. Due to the varied health consequences of social isolation, targeted health interventions should be developed to address relevant situations of social isolation.
| S-EPMC8683828 | biostudies-literature
Project description:BACKGROUND:About ten years ago, an age-related digital divide was identified, where 'the elderly' denoted a group of people at risk of losing the benefits of a digital society. The aims of this work are to find a relationship between self-assessed health and internet use by older people in European countries and to ascertain whether this relationship differs in countries with a more developed eHealth policy. MATERIALS AND METHODS:An ordered logistic regression is estimated for all countries in the sample and for two countries subsets which differ in their eHealth performance. Individual data is collected by SHARE. The classifying criterion of eHealth performance is based on the 'eHealth' policy dimension of the indicator used to construct the Digital Economy and Society Index. The average marginal effects are computed for the variable of internet use. RESULTS:Results show that older people who use the internet tend to report better health status. This relationship however may not hold for low levels of health and it is stronger in countries with low eHealth performance. CONCLUSION:Policy measures on eHealth not only contribute to people's health but also help to alleviate critical situations such as the one created by the Covid-19 pandemic.
| S-EPMC7392126 | biostudies-literature
Project description:People living with HIV (PLWH) experience chronic pain that may impact function. Gaps in knowledge exist for factors that impact pain and pain medication use in older (age 50+) PLWH. Data for this study were obtained from the Aging with Dignity, Health, Optimism and Community (ADHOC) cohort, an observational study of older PLWH from 10 clinics across the United States. Participants self-reported socioeconomic, psychosocial, and health factors via an online questionnaire. Of 1,051 participants, 66% reported pain. In a multivariable regression model, multimorbidity and tobacco use were associated with a greater likelihood of experiencing pain, whereas being male, black, and having higher cognitive function were associated with a lower likelihood of experiencing pain. Of the 696 participants who reported pain, 46% reported using pain medication. In a multivariable regression model, pain medication use was associated with multimorbidity and with lower income. Recognition of the factors associated with pain and pain medication use in this vulnerable population may lead to strategies that mitigate negative health outcomes.
| S-EPMC7414800 | biostudies-literature