Predictors of attitudes towards aging in elderly living in community care.

BACKGROUND: Due to the aging of the population, the promotion of healthy aging is an important part of public health. Healthy aging of the population can be influenced by the attitudes of the elderly themselves towards old age and aging. The aim of this cross-sectional study was to find out the attitudes of older people living in a community environment toward old age and the predictors that influence these attitudes. METHODS: The evaluation of attitudes towards old age using the WHO AAQ (Attitudes to Aging Questionnaire) questionnaire involved 1,174 elderly people living in the community. Age, sex, marital status, education, subjective health assessment, social support, depression (GDS-15), anxiety (GAI), sense of coherence (SOC-13) and self-esteem (RSES) were used to evaluate related factors. RESULTS: As part of the exploratory factor analysis, a three-factor model (Psychosocial Loss, Physical Change, and Psychological Growth) was confirmed. The Cronbach alpha was found to be acceptable (α = 0.835). The predictors of better AAQ in the Psychological Loss domain were: subjective health, age, quality of life, self-esteem, sense of coherence, life satisfaction, anxiety, and social support; in the Physical Change domain: subjective health, quality of life, self-esteem, life satisfaction, cohabitation, and depression; and in the Psychological Growth domain: age, self-esteem, sense of coherence, life satisfaction, and social support. CONCLUSION: Preventive and policy measures should aim to increase the satisfaction and self-assessment of the elderly, which can help them evaluate the period of old age more positively. It is also important to create a positive perspective of ageing and elderly in society.

Palliative care to support the needs of adults with neurological disease.

Neurological diseases cause physical, psychosocial, and spiritual or existential suffering from the time of their diagnosis. Palliative care focuses on improving quality of life for people with serious illness and their families by addressing this multidimensional suffering. Evidence from clinical trials supports the ability of palliative care to improve patient and caregiver outcomes by the use of outpatient or home-based palliative care interventions for people with motor neuron disease, multiple sclerosis, or Parkinson's disease; inpatient palliative care consultations for people with advanced dementia; telephone-based case management for people with dementia in the community; and nurse-led discussions with decision aids for people with advanced dementia in long-term care. Unfortunately, most people with neurological diseases do not get the support that they need for their palliative care under current standards of healthcare. Improving this situation requires the deployment of routine screening to identify individual palliative care needs, the integration of palliative care approaches into routine neurological care, and collaboration between neurologists and palliative care specialists. Research, education, and advocacy are also needed to raise standards of care.

The Czech version of the life satisfaction index for the third age-short form (LSITA-SF12): Psychometric properties.

BACKGROUND: Evaluation of life satisfaction of older people using standardised tools can play a crucial role in evaluating the effectiveness of policy measures aimed at mitigating the effects of population aging. OBJECTIVES: The aim of the study was to verify the psychometric properties of the Czech version of a 12-item scale (the Life Satisfaction Index for the Third Age) for older people living in the community. METHODS: The research involved 1113 older people from the Moravian-Silesian Region over 60 years of age living in a home environment. For the newly created Czech version of LSITA-SF12, we tested validity (construct validity and convergent validity) and reliability (internal consistency). RESULTS: We confirmed a single-factor model for the LSITA-SF12 scale (χ2 = 71.33, p < .001, CFI = 0.995, TLI = 0.994, RMSEA = 0.065, SRMR = 0.056, GFI = 0.999) by confirmatory factor analysis and load factor analysis (values of explorations ≥0.45). The internal consistency of the scale was satisfactory (α = 0.878). Furthermore, there was a medium correlation rate (r = 0.592; p < .001) between the overall score of the LSITA-SF and quality-of-life score (OPQoL-Brief). CONCLUSIONS: We found the Czech version of the LSITA-SF12 questionnaire to have satisfactory psychometric properties. The questionnaire is suitable for use in research and clinical practice to evaluate the effectiveness of preventive measures. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov. PRS Protocol Registration and Results System; NCT05637177. IMPLICATION FOR PRACTICE: The LSITA_SF12 questionnaire can beadministered by a community gerontological nurse and can be used in clinicalpractice and research.

Predictors of life satisfaction in elders living at home in the Czech Republic.

OBJECTIVES: The aim of this cross-sectional study was to determine the life satisfaction of older people living in a home environment and to find out what predictors influence it. METHODS: The research involved 1,121 older people 60 years and above from the Moravian-Silesian region who live in a home environment. The short form of the Life Satisfaction Index for the Thirds Age (LSITA-SF12) was used to assess life satisfaction. The Geriatric depression scale (GDS-15), the Geriatric Anxiety Inventory Scale (GAI), The Sense of Coherence Scale (SOC-13), and the Rosenberg Self-Esteem Scale (RSES) were used to evaluate related factors. In addition, age, gender, marital status, education, social support, and subjective health assessment were evaluated. RESULTS: The overall life satisfaction score was found to be 36.34 (s = 8.66). The satisfaction of older people was classified into four grades: high satisfaction (15.2%), moderate satisfaction (60.8%), moderate dissatisfaction (23.4%), and high dissatisfaction (0.6%). The predictors of the longevity of the lives of older people were confirmed, both health factors (subjective health assessment, anxiety, and depression [Model 1: R = 0.642; R2 = 0.412; p<0.000]) and psychosocial factors (quality of life, self-esteem, sense of coherence, age, and social support [Model 2: R = 0.716; R2 = 0.513; p<0.000]). CONCLUSION: In implementing policy measures, these areas should be emphasized. The availability of educational and psychosocial activities (e.g. reminiscence therapy, music therapy, group cognitive behavioural therapy, cognitive rehabilitation) within the community care of the older people and university of third age is appropriate to increase the life satisfaction of the older people. An initial depression screening is also required as part of preventive medical examinations to ensure early diagnosis and treatment of depression.

Pain, physical symptoms and functional assessment in progressive neurological disease in palliative care.

OBJECTIVES: The aim of the research was to identify the most frequent symptoms of patients with progressive neurological disease (PND) in relation to their functional state. Another objective was to determine the effects of consultations with a multidisciplinary palliative team on mitigating the symptoms burden, subjective evaluation of health, disease progression and improvement of the functional state. METHODS: The interventional control study included 151 patients with PND (98 patients in the intervention group, 53 patients in the control group). The intervention group was provided with consultations of a multidisciplinary palliative team. The symptoms scale of the progressive neurological diseases quality of life was used to collect data. The patients completed the questionnaire before the provided intervention and 3 months after that. RESULTS: Pain and fatigue were identified as the symptoms that trouble the patients the most. After the intervention, there was a determined statistically significant improvement in the evaluation of 9 out of 11 symptoms (except excretion and urination) among the patients from the intervention group compared with the control group. When assessed again, the patients from the intervention group showed an improvement with respect to six symptoms (pain, fatigue, tremor, stiffness, cramps, excretion), while the patients from the control group had six symptoms that deteriorated (drowsiness, dyspnoea, stiffness, swallowing, salivation, excretion). There was not any confirmed positive impact of the intervention on the cognitive functions of the patients. CONCLUSION: The provision of consultations with the multidisciplinary palliative team to patients with PND in an advanced stage of disease resulted in decreasing their symptoms burden and improving their functional state.

Psychometric properties of the Czech version of the brief Older People Quality of Life questionnaire (OPQoL-brief).

BACKGROUND: To evaluate the established interventions used for older adults, it is appropriate to use validated questionnaires for quality-of-life assessment. For older people, it is suitable to use specific questionnaires designed for old age and aging, with a lower number of questions. The aim of this research was to verify the psychometric properties of the Czech version of the OPQoL-brief questionnaire for seniors living in home environment in a community so that it can be used within the Czech Republic. METHODS: A cross-sectional study was performed on older adults in the Moravian-Silesian Region living at home. The study included 954 senior citizens (≥ 65 years, cognitively intact) (without diagnosed dementia, able to sign an informed consent). To test the psychometric properties of the created questionnaire, we tested the validity (construct validity, discriminant validity, convergent validity) and reliability (internal consistency, test-retest reliability). RESULTS: The single-factor model of the OPQoL-brief scale (CFI = 0.971, TLI = 0.959, RMSEA = 0.061, SRMR = 0.034, GFI = 0.960) was confirmed, for which excellent reliability was found (α = 0.921, ICC = 0.904). An inter-item correlation exceeding 0.5 was found for all items. Furthermore, a significant correlation was found between the overall score of OPQoL-brief and the scales measuring depression (r = - 0.520; p < 0.001), anxiety (r = - 0.355; p < 0.001), sense of coherence (r = 0.427; p < 0.001), and self-esteem (r = 0.428; p < 0.001). CONCLUSION: The results of our research revealed that the shorter Czech version of the OPQoL-brief questionnaire has appropriate reliability and validity and can be recommended for both health and social services to assess the quality of life of senior citizens in a community.

The Attitudes of Progressive Neurological Disease Patients and Their Family Members to End of Life Care: A Cross-Sectional Study.

The objective was to identify the attitudes of progressive neurological disease (PND) patients and their family members regarding end-of-life care, and their worries about dying. The sample included 327 participants. The Attitudes of Patients with PND to End-of-Life Care questionnaire was used to collect the data. Statistically significant differences in the assessment of attitudes towards end-of-life care between patients and family members were identified (p < 0.001). Family members more frequently favored patients being kept alive at any cost; patients more commonly wished to have their end of life under control. Respondents most frequently deferred to doctors when it came to decisions on treatment to keep patients alive. However, both patients and family members wanted patients to be able to decide on their treatment by leaving a written record of their previously stated wishes. The demands of patients and their families regarding end-of-life care should be documented in individual care plans.

Satisfaction of Patients With Severe Multiple Sclerosis and Their Family Members With Palliative Care: Interventional Study.

BACKGROUND: Patients with MS should be provided palliative care, which could help them manage symptoms more efficiently and could solve some psychosocial problems. Evaluating the satisfaction with provided care may be one of the factors of the quality of care evaluation. AIM: The aim of this controlled intervention study was to determine the factors affecting one's satisfaction with care in patients in advanced stages of MS and their caregivers. Furthermore, the aim was to study the difference in the satisfaction of patients and family members with the provided specialized palliative care, as opposed to the standard care. METHODS: The sample consisted of 103 patients with MS who were randomized to either a palliative care intervention or the control group. Family members of each patient were invited in the study, and 97 caregivers agreed to participe. The patients in the intervention group were provided with neuropalliative care in the form of consultations with a multidisciplinary palliative team. A modified questionnaire, CANHELP Lite, was used to collect data. Patients and family members completed the questionnaire 3 months after the intervention. RESULTS: The patients and caregivers in the intervention group expressed significantly greater satisfaction in all analyzed areas (p = 0.000-0.002). The provided intervention predicted the satisfaction in the domains of a relationship with the doctor, disease management, and decision-making/communication. Another important predictor of the satisfaction in all domains was the functional state of the patient. CONCLUSION: Targeted consultations resulted in the greater satisfaction of patients with MS and their caregivers with the provided care.

The effect of neuropalliative care on quality of life and satisfaction with quality of care in patients with progressive neurological disease and their family caregivers: an interventional control study.

BACKGROUND: It is recommended that patients with progressive neurological disease (PND) receive general and specialized palliative care. The purpose of this study was to determine the effect of neuropalliative care on quality of life (QoL) and satisfaction with provided care in both patients with PND in advanced stages of disease and their family caregivers. METHODS: The sample consisted of 151 patients with PND and 140 family caregivers. The PNDQoL questionnaire was used for data collection. Patients and family caregivers completed the questionnaires both before and 3 months after the intervention. RESULTS: Before intervention, there were no statistically significant differences in the individual domains of QoL in patients and family caregivers in either the intervention or the control group. After intervention, differences were identified in the sample of patients in the domains of symptoms burden (p < 0.001), emotional (p < 0 .001), social functioning (p = 0.046), spiritual area (nonreligious) (p = 0.050), and in QoL. In the sample of family caregivers, there were differences in the domains of symptoms burden (p < 0.001), emotional functioning (p = 0.016), spiritual area (nonreligious) (p = 0.042), and in the assessment of health (p = 0.002), and QoL (p = 0.002). Patients and family caregivers from the intervention group evaluated their satisfaction with the quality of care provided significantly more positively in all five analyzed domains. CONCLUSION: The provision of neuropalliative care to patients with advanced stages of PND helped to maintain and slightly improve their QoL, and symptoms burden, and resulted in a more positive assessment of satisfaction with the quality of care provided.

Factors Influencing Health-Related Quality of Life of Patients with Multiple Sclerosis and Their Caregivers.

BACKGROUND: Only a few studies have been done focusing on the quality of life (QoL) of patients with multiple sclerosis (MS) as well as their family members. The aim of our research was to determine the factors that influence the QoL of MS patients in advanced stage of disease and their caregivers. METHODS: The sample of the cross-sectional study included 153 patients with MS and 74 caregivers. QoL was measured using the PNDQoL questionnaire (Progressive Neurological Diseases Quality of Life), and the severity of illness was assessed through the following scales: EDSS (Expanded Disability Status scale), PPS (Palliative Performance Scale), and ADL (Activity Daily Living). RESULTS: The following predictors of the global QoL of the MS patients were identified - age, EDSS, symptom burden, daily care, emotional functioning, and spiritual_nonreligion functioning (R2 = 0.569; F = 32.900; p < 0.001). The following predictors of the global QoL of caregivers were identified - age, emotional functioning, spiritual_nonreligion functioning, patient's QoL, and feeling of care (R2 = 0.431; F = 18.690; p < 0.001). CONCLUSION: Appropriate intervention should be directed particularly at older patients and caregivers who have faced the disease for longer time and at patients without any partner. Supporting the emotional and social well-being and mitigating the burden caused by symptoms of the patients as well as caregivers can improve the QoL of both groups.

Development and psychometric evaluation of a new tool for measuring the attitudes of patients with progressive neurological diseases to ethical aspects of end-of-life care.

BACKGROUND: Knowing the opinions of patients with Progressive Neurological Diseases (PNDs) and their family members on end-of-life care can help initiate communication and the drawing up of a care plan. The aim of this paper is to describe the creation and psychometric properties of the newly developed APND-EoLC questionnaire (the Attitudes of Patients with Progressive Neurological Disease to End of Life Care questionnaire). METHODS: Following focus group discussion, four main areas of interest were identified: patients' and family members' attitudes towards end-of-life care, factors influencing decisions about treatment to prolong patients' life, concerns and fears regarding dying, and opinions on the system of care. The created questions were divided into domains based on factor analysis and psychometric properties were evaluated by sample of 209 patients with PND and 118 their family members. RESULTS: The final version of the scale contains a total of 28 questions divided into six domains (end-of-life control, keeping patients alive, trust in doctors/treatment, trust in social support, sense of suffering, and dependence/loss of control) and five individual questions determining views of the care system with specified response options. Construct validity was verified by confirmatory factor analysis for each evaluated area individually. Appropriate psychometric properties were identified in the questionnaire. CONCLUSIONS: The APND-EoLC questionnaire can be recommended for use in both research and clinical practice.

Informing patients with progressive neurological disease of their health status, and their adaptation to the disease.

BACKGROUND: Progressive neurological diseases, such as multiple sclerosis, Parkinson's disease, Huntington's disease, significantly interfere with patients' lives, and those of their families. The aim of the research was to establish whether the extent of the information on patients' health conditions, and the way patients learn this information from doctors affect their adaptation to chronic and progressive diseases. METHODS: Qualitative methodology was used for a total of 52 participants (patients with progressive neurological diseases, their family members, and health and social workers). Data were collected using individual, in-depth interviews and focus groups. Analysis of data for interpretation, conceptualization, and re-integration was performed by open, axial, and selective coding. RESULTS: It was determined that adequate information about patients' health status, and the use of coping strategies are related to their adaptation to their disease, and consequently, to their quality of life. The participants often considered the extent of the information provided, and the way they were informed to be inadequate. Receiving the diagnosis, the progression of the disease, and the end of life were found to be the most burdensome. CONCLUSION: Our results show that Czech neurologist should develop better communication skills, particularly for informing patients with progressive neurological diseases. Open communication, emotional support, and support in selecting effective coping strategies can help patients adapt more readily to their disease, and improve their quality of life.

Perinatal palliative care education: An integrative review.

OBJECTIVES: The aim of this review was to analyze the effectiveness of teaching healthcare professionals in perinatal palliative care, methods of evaluating the teaching, and the teaching strategies used. DESIGN: An integrative review. METHODS: A systematic search was conducted for English language peer reviewed publications of any research design via SCOPUS, Medline/PubMed, EBSCOhost, Science Direct, ERIC, Web of Science, Wiley, Nursing Ovid, and ProQuest databases. Fourteen research papers published between 2002 and 2017 that met the selection criteria were included in the review. FINDINGS: All 14 studies considered perinatal bereavement education to be effective. Eight studies reported statistical improvements in knowledge, security/comfort in providing end-of-life care, or increased perceptions of the emotional care needs of bereaved families, after attending an educational program. Questionnaires or interviews were used to evaluate the educational programs. Innovative teaching strategies, in particular, were evaluated positively (e.g., simulation, discussion, and arts-based methods). CONCLUSION: Perinatal palliative care education is essential in pregradual education for midwives and neonatal nurses. Other research is vital for finding out the effectiveness of this education for pregraduate nursing students. Perinatal palliative care education programs need to be available in postgraduate education for professionals who encounter perinatal death and bereaved families in hospital and community care.

The unmet needs of family members of patients with progressive neurological disease in the Czech Republic.

BACKGROUND: Caring for patients with a progressive neurological disease (PND) causes stress that may impact on the state of health as well as the quality of life of the caring family. OBJECTIVE: The aim of the study was to explore the unmet needs of the family members of patients with PND in advanced stages. METHODS: Grounded theory (constructivist approach) was used to conceptualize the patterns of unmet care needs. Data collection methodology involved focus groups (n = 4) and interviews, in which a total of 52 people participated (patients, family members, and professionals). RESULTS: Based on the data analysis, three domains (family situation, role of the caregiver, and professional help) were identified, which illustrate the unmet needs. In particular, lack of information about the disease and available support available resulted in a deterioration mutual understanding between the patient, family, and the medical staff; also increased stress for the caregiver, and lowered quality of life for the caring family. CONCLUSION: Family members expect health workers to provide them with support, which includes informing them about the possible help available from the health and social welfare systems.

Czech Adaption of the Collett-Lester Fear of Death Scale in a Sample of Nursing Students.

The use of multidimensional scales for assessing fear of death among nursing students can assist in teaching and evaluating the effectiveness of targeted training in thanatology. Research has demonstrated good psychometric characteristics of the Czech version of the Collett-Lester Fear of Death Scale (CL-FODS). It was applied to nursing students (N = 256), who reported as their biggest fear the process of their own dying. Greater fear of death and dying was found in students who had no experience of the dying and death of a loved one. Good internal consistency was achieved for the four subscales of the Czech CL-FODS.

The Unmet Needs of Patients With Progressive Neurological Diseases in the Czech Republic: A Qualitative Study.

AIM:: The aim of our research was to explore the unfulfilled needs of patients with a progressive neurological disease in advanced stage of the illness within the current system of health and social care in the Czech Republic. DESIGN AND SETTING:: Qualitative research (grounded theory) was used to conceptualize the patterns of unmet palliative care needs in Czech Republic. METHODS:: The data collection method comprised individual, in-depth interviews (n = 19) and focus groups (n = 4) where a total of 52 respondents participated (patients with progressive neurological diseases [PNDs], family members, and professionals). RESULTS:: Two main categories of unfulfilled needs were determined (life with the disease, professional help), and they were described in the context of the 3 crucial themes identified in the study-the symptoms of the advanced stage of the disease resulted in substantial reduction of physical self-sufficiency, loss of autonomy, and social isolation; the level of dependence on the support and help of others increased; the patients also highlighted several problems related to health-care services. CONCLUSION:: The unmet needs should be taken into consideration when creating the concept of the neuropalliative and rehabilitation care, including the mental health support plan, because of the emotional, behavioral, and cognitive disorders that frequently occur in the lives of a substantial amount of patients with PND.

[The review of questionnaires and scales evaluating patients with amyotrophic lateral sclerosis]. / Prehled dotazníku a skál hodnotících pacienty s amyotrofickou laterární sklerózou.

In patients with amyotrophic lateral sclerosis (ALS), it is advisable to provide multidisciplinary care, due to rapid progression and specific disease symptoms, in order to maintain the best quality of life for the patient and their family. Abroad, questionnaires and scales are used to assess the patient´s health condition, to determine disease progression, followed by the provision of personalized care. The aim of this review article is to describe and analyze the scales used in evaluating ALS patients in both functional and psychosocial areas. Having searched in electronic databases, 14 scales for patients with ALS or motor neuron disease were found, and 4 scales for patients with chronic diseases, which are appropriate and used also in patients with ALS. The ALSFRS scale (The Amyotrophic Lateral Sclerosis Functional Rating Scale) is most often used for assessment of functional status. All areas of care are best covered in the ALSSQOL-R (Amyotrophic Lateral Sclerosis Specific Quality of life) questionnaire, designed for assessment of quality of life. The use of both scales is recommended in clinical practice and research.

The effect of reminiscence therapy on quality of life, attitudes to ageing, and depressive symptoms in institutionalized elderly adults with cognitive impairment: A quasi-experimental study.

The aim of this study was to analyse the effect of group narrative reminiscence therapy on cognition, quality of life, attitudes towards ageing, and depressive symptoms in a group of older adults with cognitive impairment in institutional care. A quasi-experimental pretest/post-test control group design was employed. Interventions involving reminiscence therapy with a narrative approach were included in the care plan and implemented in groups of between five and ten respondents once a week for 8 weeks (total 59 participants). The members of the control group (n = 57) received standard care. A study questionnaire was designed to measure demographic characteristics, quality of life (WOHQOL-BREF, WHOQOL-OLD), depressive symptoms (GDS), cognition (MMSE), and attitudes towards ageing (AAQ). Reminiscence therapy positively affected older adults' quality of life (mostly the areas of mental health and social participation), and also their attitudes to ageing and old age. It reduced symptoms of depression, but had no discernible effect on cognitive function. Reminiscence therapy can positively affect selected aspects of quality of life, attitudes towards old age, and symptoms of depression in the elderly in long-term healthcare facilities. Group reminiscence therapy can be used as a nursing intervention.

Validity and Reliability of the Czech Version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).

PURPOSE: The purpose of this study was to validate the Czech version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in adult patients undergoing elective surgery. DESIGN: A cross-sectional study. METHODS: Data were collected from July 2012 to January 2013. For reliability and validity testing, two instruments measuring preoperative anxiety were administered to the participants on the same occasion, (APAIS and the Spielberg State Anxiety Inventory (STAI-S)). The sample consisted of 344 patients undergoing elective surgery. FINDINGS: Reliability of APAIS anxiety subscale measured by Cronbach's alpha was 0.91. Reliability of APAIS information subscale measured by Cronbach's alpha was 0.78. The APAIS anxiety subscale correlated significantly with the STAI-S (0.69). Women scored significantly higher on anxiety scales than men. CONCLUSIONS: APAIS may be a useful tool to measure preoperative anxiety in Czech patients undergoing elective surgery.

Predictors of Change in Quality of Life in Patients With End-Stage Disease During Hospitalization.

BACKGROUND: Currently, there are no studies aimed at evaluating the quality of life (QoL) of patients with end-stage disease during hospitalization and the factors that influence it. AIM: The aim of the research was to identify predictors of change in the QoL of patients hospitalized due to advanced stage of disease. METHODS: The sample consisted of 140 patients with end-stage disease who were hospitalized on this account. For evaluation of QoL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used. The Hospital Anxiety and Depression Scale and Karnofsky Performance Status questionnaires were used for the assessment of mental and functional status. For the evaluation of predictors of negative change in QoL, a logistic regression analysis was used. RESULTS: During hospitalization, there was a significant deterioration in the scores given for all domains of the functional QLQ-C30 scale, but not the symptomatic scale. Predictors of change in overall QoL detected were marital status, improved functional status, and depression detected on admission to hospital. Gender and age were found to be protective factors against deterioration in overall QoL. CONCLUSION: Sociodemographic characteristics and mental and functional status may be associated with change in QoL of patients with end-stage disease during hospitalization.