Analysis on the Development Dilemmas of Integrated Eldercare Services with Medical Care in China under the Healthy China Strategy / 中国医学伦理学

With the arrival of aging, various industries in society are facing great pressure, especially higher requirements for the medical and nursing industries. The integrated eldercare services with medical care breaks through the traditional endowment pattern and integrates medical treatment, elderly care, rehabilitation, and nursing. However, many factors hinder the development of this model at present, and it requires the cooperation of the country and various departments to improve. From the perspective of a Healthy China, based on the release and implementation of policies such as the "Healthy China 2030" Plan Outline and the "Healthy China Action (2019-2030)" , this paper briefly summarized the current status and existing problems of the development of integrated eldercare services with medical care in China, and put forward rectification suggestions, aiming to provide reference to build a new endowment pattern of integrated eldercare services with medical care with Chinese characteristics.

Barriers and enablers to deprescribing benzodiazepines in older adults: elaborating an instrument and validating its content / Facilitadores e dificultadores do processo de desprescrição de benzodiazepínicos em idosos: elaboração de um instrumento e validação de seu conteúdo

OBJECTIVE: To elaborate and validate an instrument on barriers and enablers to deprescribing benzodiazepines in the patient's perspective. METHODS: This study was conducted in 3 stages: (1) a methodological stage, (2) a semi-structured pilot interview with 25 older adults undergoing clonazepam deprescribing, and (3) content validation with the Delphi technique. Content validation was performed by 50 specialists with degrees and/or experience with primary health care and/or health care of older adults, such as physicians, pharmacists, and nurses. For evaluating the obtained results, we analyzed the concordance of evaluations with the coefficient of content validity (CCV). We considered values equal to or higher than 0.8 as acceptable levels of concordance. RESULTS: The instrument was considered validated in the first round of evaluation, where all items obtained a CCV of more than 0.8 in the specialists' assessment. Nevertheless, they proposed improvements that were incorporated to the final version of the questionnaire. CONCLUSION: The instrument represents an important tool to be used by health care professionals for optimizing benzodiazepine deprescribing, with suitable levels of clarity and validity.

OBJETIVO: Elaborar e validar um instrumento sobre facilitadores e dificultadores do processo de desprescrição de benzodiazepínicos na perspectiva do paciente. METODOLOGIA: Estudo desenvolvido em três etapas, quais sejam: (1) metodológica, (2) entrevista piloto semiestruturada com 25 idosos em desprescrição de clonazepam e (3) validação de conteúdo por meio da técnica de Delphi. A validação deu-se por 50 especialistas com formação e/ou experiência na área da Atenção Primária à Saúde e/ou Saúde do Idoso, entre eles médicos, farmacêuticos e enfermeiros. Como medidas para avaliar os resultados obtidos, foi analisada a concordância da avaliação por meio do coeficiente de validade de conteúdo (CVC). Considerou-se como nível aceitável de concordância o valor maior ou igual a 0,8. RESULTADOS: O instrumento foi considerado validado na primeira rodada de avaliação, em que todos os itens avaliados obtiveram CVC superior a 0,8 na avaliação dos especialistas. Entretanto, estes propuseram sugestões de melhorias que foram incorporadas na versão final do questionário. CONCLUSÃO: O instrumento apresenta-se como uma importante ferramenta a ser utilizada pelos profissionais de saúde para a otimização do processo de desprescrição de benzodiazepínicos, possuindo índice de clareza e de validade adequados.

Training eldercare workers in mental healthcare

<p><b>INTRODUCTION</b>A significant proportion of older persons who require support or care services have mental health concerns. There is a need to equip frontline eldercare workers with the necessary skills in caring for older persons with mental illnesses. The Community Psychogeriatric Programme aims to support community eldercare providers with training and consultation. We sought to measure eldercare workers' perceived levels of stress and knowledge about caring for older persons with mental illness before (pre-workshop), immediately after (post-workshop) and three months after (three-month follow-up) they underwent standardised training workshops on dementia and depression.</p><p><b>METHODS</b>Participants who attended two four-hour workshops on dementia and depression were recruited for the study. Their knowledge of topics was evaluated pre-workshop, post-workshop and at three-month follow-up. Perceptions of working with older persons with mental health problems were rated pre-workshop and at three-month follow-up.</p><p><b>RESULTS</b>A total of 71 staff members from various eldercare centres participated in the study, of which 51 (71.8%) were women. At three-month follow-up, there was a significant change in most measures on Ryden's Perception Scale (p < 0.05). There were significant improvements in knowledge scores for dementia and depression (p < 0.001). Knowledge gains after the workshop were maintained at three-month follow-up.</p><p><b>CONCLUSION</b>Training of eldercare workers in mental healthcare is helpful for knowledge improvement and altering perceptions of caring for older persons. With continued support from mental health professionals, such training could contribute to better care for this vulnerable population.</p>

Estado actual de capacidades en adultos mayores institucionalizados de Colima, México / Present status of functional, mental and social abilities of institutionalized elders in Colima, Mexico

Resumen

Introducción: en México, un adulto mayor es la persona de 60 años o más. A nivel nacional e internacional este sector crece demográficamente, por lo que debería ser una prioridad en salud garantizar su bienestar, independientemente de que pertenezcan a instituciones públicas o privadas.

Objetivo: identificar el efecto del envejecimiento sobre el estado actual de las capacidades funcionales, mentales y sociales de adultos mayores residentes en cuatro instituciones del estado de Colima.

Metodología: estudio transversal descriptivo, realizado en 149 personas mayores residentes de cuatro asilos y casa hogar del estado de Colima. Mediante consentimiento informado, se recolecto la información de personas que reunieron los criterios de inclusión se utilizaron tres escalas validadas —Barthel, Folstein y Diaz-Veiga—. Se utilizó estadística descriptiva para el análisis de variables y X2 para la comparación con base en el género.

Resultados: del total de la población, más del 50% presentan algún grado de deterioro de las capacidades estudiadas. La escala de Barthel reporto, 16 adultos con independencia, el resto presenta algún grado de dependencia funcional. Folstein registró solo 47 de 143 como aptos mentales, y Diaz-Veiga registró 126 de 141 adultos con algún grado de compromiso social. Las diferencias basadas en el género no fueron significativas en ninguna escala.

Conclusiones: los adultos mayores no se incorporan voluntariamente a las actividades lúdicas y de cuidados que les brinda el profesional de enfermería, debido a que el envejecimiento ha afectado de manera importante sus capacidades funcionales, mentales y sociales.

Abstract

Introduction: In México, an older adult is a person who is sixty years of age or older. The number of individuals in this sector is increasing demographically in the national and international setting. Therefore their welfare should be a health priority regardless of whether they are in public or private eldercare facilities.

Objective: To identify the effect of aging on functional, mental, and social status of older adults residing in four facilities in the State of Colima.

Methodology: A descriptive cross-sectional study was carried out on 149 residents at four eldercare facilities in the State of Colima. After obtaining informed consent, information was collected on the individuals who fit inclusion criteria using three validated scales (Barthel, Folstein and Diaz-Veiga). Study variables were analyzed with descriptive statistics and sex-based comparison was done with chi square test.

Results: Of the total study population, more than 50% presented some degree of deterioration in the evaluated abilities. The Barthel scale reported 16 completely independent adults out of the total number, while the rest presented some degree of functional dependency. Folstein scale registered only 47 out of 143 adults as mentally fit, and the Diaz-Veiga scale results registered one 126 out of one 141 adults with some degree of social deterioration. Sex-based differences were not statistically significant for any of the scales.

Conclusions: Eider people do not incorporate voluntarily to recreational and care activities that nursing professional offers them since aging has affected in an important way functional, mental and social abilities.

The more you give, the more you get: reciprocal relationships between work engagement and task-related, interpersonal, and organizational resources / ¿Mientras más das, más recibes: relaciones recíprocas entre el engagement laboral y los recursos asociados a las labores, interpersonales y organizacionales

Drawing on broaden-and-build theory and conservation of resources theory, this study disentangles the reciprocal relationship between employee work engagement and job resources by separately examining task-related, interpersonal, and organizational job resources. More specifically, it hypothesizes that work engagement is not only a consequence of, but also antecedes, job control, esteem reward, and job security. Using data from a full two-wave panel study with a 15-month time lag among 591 eldercare workers, the authors examined normal, reversed, and reciprocal causation by means of structural equation modeling. They found that the reciprocal model best fits the data. As hypothesized, job security was mutually related to work engagement over time. By contrast, job control was shown to precede, and esteem reward was shown to follow from, work engagement. Theoretically speaking, these findings suggest that divergent mechanisms account for the relationships between job resources of various types and work engagement. Practically speaking, the development of a reciprocal cycle between work engagement and job security may represent an active coping process in an unstable economic situation, since data collection for this panel study commenced shortly after the onset of the global economic crisis.

Al utilizar la teoría abierta y construida junto con la teoría de la conservación de los recursos, este estudio desenmaraña la relación recíproca entre el engagement laboral de los trabajadores y los recursos laborales; esto, al examinar por separado los recursos laborales relacionados a las tareas interpersonales y organizacionales. Más específicamente, plantea que el engagement laboral no es sólo una consecuencia de, sino que antecede al control laboral, recompensa a la estima y a la seguridad laboral. Al utilizar los datos de un estudio completo de dos ondas con un desfase de 15 meses entre 591 personas que trabajan al cuidado de personas de la tercera edad, los autores examinan la causalidad normal, invertida y recíproca por medio del modelo de ecuaciones estructural. Los autores descubrieron que el modelo recíproco fue el que mejor se adaptaba a los datos. Tal y como se había planteado, la seguridad laboral se encontraba relacionada mutuamente con el engagement laboral a través del tiempo. En contraste, se encontró que el control laboral precedía al engament laboral, mientras que la recompensa a la estima era posterior. Hablando teóricamente, estos hallazgos sugieren que mecanismos divergentes explican las relaciones entre varios tipos de recursos laborales y engagement laboral. De manera práctica se podría decir que el desarrollo de un ciclo recíproco entre engagement y seguridad laboral podría representar un proceso de copia activo en un escenario económico inestable, debido a que la recolección de datos para este estudio de panel comenzó poco después del principio de la crisis económica mundial.