Is age discrimination a risk factor for frailty progression and frailty development among older adults? A prospective cohort analysis of the English Longitudinal Study of Ageing.

BACKGROUND: With the increasing global burden of frailty on healthcare resources, it is important to understand the modifiable risk factors of frailty. This study examined perceived age discrimination as a potential risk factor for frailty progression and frailty development among older adults. METHODS: Prospective cohort study using data from Waves 5 to 9 of the English Longitudinal Study of Ageing (ELSA). Data on perceived age discrimination was collected only in Wave 5 of ELSA and analysed as baseline data in this study. Frailty was defined using the Frailty Index (FI) scores (0 to 1), calculated using the multidimensional deficits (scores ≥ 0.25 were considered frail). Binomial generalised estimating equation models (GEE) were fitted in R studio using perceived age discrimination as the main predictor with age, gender, long-standing illness, cognition, subjective social status status (SSS) and psychological wellbeing as covariates. Odd ratios were reported with 95 % confidence intervals (CI). RESULTS: A total sample of 2,385 ELSA participants were included in the analysis. 55.8 % (n = 1312) were female, mean age 71.9 (SD ± 5.27) years and baseline frailty prevalence was 12.1 % (n = 288). Perceived age discrimination was reported by 38.4 % (n = 916) of the participants. Both frailty progression (OR 1.50, CI [1.26- 1.70]) and frailty development (OR 1.39, CI [1.14-1.62]) were significantly associated with perceived age discrimination in the fully adjusted models. Age (80+ years) (OR 3.72, CI [2.84-4.86]) and long-standing illness (OR 5.45, CI [4.43-6.67]) had the strongest association with respondents' frailty progression. CONCLUSION: Perceived age discrimination significantly increased the risk of frailty progression and frailty development among ELSA participants.

The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statement.

INTRODUCTION: The menopause, or the cessation of menstruation, is a stage of the life cycle which will occur in all women. Managing perimenopausal and postmenopausal health is a key issue for all areas of healthcare, not just gynecology. AIM: To provide recommendations for the curriculum of education programs for healthcare professionals worldwide, so that all can receive high quality training on menopause. MATERIALS AND METHODS: Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS: Training programs for healthcare professionals worldwide should include menopause and postmenopausal health in their curriculum. It should include assessment, diagnosis and evidence-based management strategies.

A practical guide to the systematic application of nominal group technique.

BACKGROUND: Nominal group technique (NGT) is a highly structured, commonly used way of exploring areas of interest and developing consensus. However, it is sometimes conflated with focus group methods. AIM: To provide a rationale for selecting NGT as a research method and to examine its systematic application in a doctoral Q-methodology study exploring nursing students' perspectives of preserving dignity in care. DISCUSSION: An outline of NGT is provided, and it is distinguished from focus group methods. As well as providing a step-by-step guide to using NGT, each step is illustrated with its practical application in the study, and the lessons learned concerning the limitations and strengths of NGT in the context of one study are shared. CONCLUSION: When applied systematically, NGT enables nurse researchers to collaborate in a meaningful and engaging way with participants and generate tangible outcomes relatively quickly. IMPLICATIONS FOR PRACTICE: This paper offers practical insight into the use of NGT to explore perceptions and develop consensus.

Access to Learning Opportunities for Residents in Care Homes: Reviewing the challenges and possibilities.

International, national and regional policy documents and key reports espouse the benefits of lifelong learning and people's rights to it, yet little attention has been given to the learning needs of frail older people in nursing (care) homes. People living in care have frequently been cited as a forgotten sector of the community and this is apparent in the provision of learning opportunities. It appears that the learning needs of this population are largely ignored. This paper suggests that when the door of the care home is opened, the door to learning closes. The aim of this paper is to add to a small but growing body of literature on meeting the learning needs of people in long-term care. To investigate the topic, a scoping review of the literature (2002-2020) and a search of policy and key papers (1990-2020) were conducted. The results show a paucity of literature on the topic, which leads to the conclusion that many residents in nursing (care) homes are marginalised when it comes to furthering their learning requirements. This can be ascribed to limited resources in the care home sector but also suggests a form of ageism. The results show four themes that may contribute to designing a learning culture in care: Culture of learning vs culture of care; Learning vs recreational activity; Surviving vs thriving in care; and Outside vs care home communities. The paper concludes by recommending that links to community learning opportunities are vital for people in care to have their learning needs met.

Instruments for assessing nurses' palliative care knowledge and skills in specialised care setting: An integrative review.

AIMS AND OBJECTIVES: To examine the content and reported psychometric properties of instruments for assessing nurses' palliative care knowledge and skills in specialised healthcare units. BACKGROUND: Knowledge of palliative care, and competence in the delivery of care, is essential. Assessment of competence is an important means of evaluating the knowledge and skills of practitioners in order to improve the quality of care provided for patients and their families. DESIGN: An integrative review. METHODS: A systematic literature search was conducted in November 2018 in five databases: CINAHL, PubMed (Medline), Cochrane, Scopus and Web of Science. The quality assessment was conducted using the Joanna Briggs Institute's (JBI) Checklist for Analytical Cross-Sectional Studies. The data were analysed using content analysis. PRISMA guidelines were followed to ensure explicit reporting. RESULTS: Overall, 5,413 studies were identified and 23 met the inclusion criteria. Nurses' knowledge and skills, as assessed by the instruments, were as follows: (a) care for the patient, (b) care for the patient's family and (c) professional requirements. Ten instruments were identified assessing nurses' knowledge and skills through knowledge tests and skill evaluation self-tests. The psychometric properties of the instruments were reported to varying degrees, mainly focusing on internal consistency and content validation. CONCLUSIONS: Nurses' knowledge and skills were seen to contribute to the holistic care of the patient and his or her family, and the possession of adequate information and skills is essential when dealing with death and dying. The instruments are commonly available and potentially reliable, although reliability must be determined with caution, so validation studies in other cultures are recommended. RELEVANCE TO CLINICAL PRACTICE: These results could be utilised to improve the quality of palliative care by evaluating the knowledge and skills of nursing staff or when considering the needs of palliative care education.

Dignity in nursing care: What does it mean to nursing students?

BACKGROUND:: Despite growing interest in the potential of nursing education to enhance dignity in nursing care, relatively little is known about what dignity means to nursing students. RESEARCH QUESTION:: What meaning does dignity in nursing care have for nursing students? RESEARCH DESIGN:: Photo-elicitation was embedded within a Nominal Group Technique and responses were analysed by qualitative and quantitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT:: Participants were recruited from each year of a 3-year undergraduate preregistration adult nursing programme in Scotland. In total, 31 nursing students participated in the study. ETHICAL CONSIDERATIONS:: The study was approved by the Ethics Committee of the School of Health, Nursing and Midwifery, University of the West of Scotland. FINDINGS:: Participants articulated the meaning of dignity in nursing care in terms of the relationships and feelings involved. A total of 10 categories of meaning were identified. DISCUSSION:: The significance of the nature of the nurse-patient interaction to preserving dignity in nursing care is highlighted. CONCLUSION:: Understanding the meaning of dignity for nursing students may help prepare future nurses more able to preserve dignity in nursing care.

Migrants' Healthcare Experience: A Meta-Ethnography Review of the Literature.

PURPOSE: Worldwide, more than 214 million people have left their country of origin. This unprecedented mass migration impacts health care in host countries. This article explores and synthesizes literature on the healthcare experiences of migrants. DESIGN: A meta-ethnography study of qualitative studies was conducted. METHODS: Eight databases (Medline, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], PsycINFO, Embase, Web of Science, Migration Observatory, National Health Service Scotland Knowledge Network, and Adaptive Spectrum and Signal Alignment [ASSIA]) were searched for relevant full-text articles in English, published between January 2006 and June 2016. Articles were screened against inclusion criteria for eligibility. Included articles were assessed for quality and analyzed using Noblit and Hare's seven-step meta-ethnography process. FINDINGS: Twenty-seven studies were included in the review. Five key contextualization dimensions were identified: personal factors, the healthcare system, accessing healthcare, the encounter, and the healthcare experience. These five areas all underlined the uniqueness of each individual migrant, emphasizing the need to treat a person rather than a population. Within a true person-centered approach, the individual's cultural background is fundamental to effective care. CONCLUSIONS: From the findings, a model has been designed using the five dimensions and grounded in a person-centered care approach. This may help healthcare providers to identify weak points, as well as to improve the organization and healthcare professionals' ability to provide person-centered care to migrant patients. CLINICAL RELEVANCE: The proposed model facilitates identification of points of weakness in the care of migrant patients. Employing a person-centered care approach may contribute to improve health outcomes for migrant patients.

What makes a nursing home homely? A Scottish based study, using Q methodology of the perceptions of staff, residents and significant others.

BACKGROUND: A 'homely' nursing or care home is of international interest and comes from a wide variety of academic disciplines and from policy makers and charities. However, 'homeliness' is a dynamic and complex concept and one worthy of further investigation. AIMS: (a) To explore what is meant by 'homely' in the care home environment, (b) to explore whether a 'homely' care home is a priority in the expressed views of residents, staff and visitors, and (c) to explore features contributing to the creation of homeliness in the care home environment. METHOD: A mixed methodology was used - a narrative literature review, an environmental assessment using the Sheffield care environment assessment matrix (SCEAM) tool and Q methodology. Participants (n = 16) included staff, residents and their relatives from care homes in the west of Scotland. RESULTS: The literature review generated eight themes: home as space; home as place, design features, homeliness, the outdoors, home and identity, dementia design and specific rooms. The SCEAM revealed that homely environments supported personalisation, safety and health, privacy, community, comfort and awareness, choice and staff accommodation. The Q method revealed three factors: standards driven, making the most of it and a sense of belonging. CONCLUSION: The results showed that staff and relatives placed priority on features included in national standards of care, while residents placed more importance on a feeling of belonging.

An inquiry into what organised difficult advance care planning conversations in a Scottish residential care home using institutional ethnography.

AIM: This paper provides an institutional ethnographic analysis of how advance care planning discussions, which included advance decisions about serious illness, hospital admission and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms, were systematically placed into the hands of senior social care workers (SSCWs) in a residential care home (RCH). RCHs are care settings where there are no on-site nurses, and access to hospital and/or community doctors and nurses is limited. METHODS: The paper traces the organising features of day-to-day work gathered from interviews with SSCWs (n = 4) and others (n = 6) whose (well-intentioned) work shaped what happened in the RCH. RESULTS: It shows how the experience of SSCWs was socially organised to happen as it did as they (and others) complied with powerful organising texts such as national and local policy documents, care plans and audit forms. The paper concludes that although SSCWs decision-making conversations were out of alignment with the national DNACPR policy, they cannot simply be described as poor practice. This is because they were socially organised by a complex web of institutional practices related to the occupancy rate in the RCH, the inspection process of the care home scrutiny body, the quality assurance process of the RCH company, the funding of palliative care education, and powerful political and fiscal drives to reduce spending on over-75s. These practices had little to do with the actual care needs of RCH residents or the actual support needs of RCH staff. CONCLUSIONS: The paper points towards necessary policy changes. It also highlights how 'competent' work driven by ideological institutional practices can result in ethically troubling situations in day-to-day working life. This emphasises the importance of carefully examining the social organisation of situations typically described as poor practice if we are to understand how they are (re)produced. It also offers a different account of care home deaths than is typically presented in the professional literature.

Living with an indwelling urethral catheter in a community setting: Exploring triggers for unscheduled community nurse "out-of-hours" visits.

AIMS AND OBJECTIVE: To explore the experiences of community patients living with a urethral catheter and those caring for them. BACKGROUND: Living at home with an indwelling urethral catheter often results in consequences that create a double-edged burden: first, on patients and their relative carers and second, in terms of unscheduled community nurse service "out-of-hours" provision. DESIGN: One-to-one interviews were conducted with patients living at home, their relative carers, qualified community nurses, augmented home carers and healthcare assistant. Quantitative data in relation to frequency, duration and reason for visits were extracted from the community nurse "out-of-hours" service database. RESULTS: Quantitative data showed that 20% of all community nurses unscheduled "out-of-hours" visits were triggered by an indwelling urethral catheter consequence. Qualitative data revealed that health and social care staff felt knowledgeable and skilled in urethral catheter management. Conversely, patients and relative carers felt poorly equipped to manage the situation when something went wrong. The majority of patients described the catheter as being a debilitating source of anxiety and pain that reduced their quality of life. CONCLUSION: Urethral catheter complications are frequent and impact seriously on quality of life with informal carers also affected. Community nurses experienced frequent unscheduled visits. Patients often feel isolated as well as lacking in knowledge, skills and information on catheter management. Having better urethral catheter information resources could increase patient and relative carer confidence, encourage self-care and problem solving, as well as facilitate meaningful consistent dialogue between patients and those who provide them with help and support. RELEVANCE TO CLINICAL PRACTICE: Better patient information resources regarding urethral catheter management have potential to improve patient and relative carer quality of life and reduce service provision burden.

Care homes: The developing ideology of a homelike place to live.

This paper reports on part of a doctoral study which explored stakeholder perceptions of the importance of a homelike environment in a care home and which factors contributed to this. The changes in institutional care for older people have evolved from being a 'warehouse' type of environment for those too poor, too mad, too sick and too unloved, to a place where older people in need of care can spend their days in safety, in a 'homely' environment. Such an environment is one of the quality indicators of care home provision. Yet defining what 'homeliness' means is fraught with difficulties. This article presents a narrative literature review on the concept of 'home' and the common measures taken to address homeliness in a care home setting. The results show that although the word 'homely' is used with the presumption of a shared understanding, the concept is elusive and highly subjective. Given that long-term care now provides homes for an increasingly wide range of age groups and individuals with increasingly diverse backgrounds and personal histories, is a shared viewpoint on homeliness possible? Indeed, is it ever possible to make an institution homely?

Culture change in care homes: development and facilitation.

This article is the second of a two-part series that explores a programme of culture change in care homes. In this article, the authors describe their independent development and facilitation of a flexible learning programme for care homes, designed to meet a quality improvement request made by a care home company. The two selected care homes' staff conducted a review of their care culture, as a precursor to their creation of a new care philosophy. These activities provided a firm foundation from which the homes could, in theory, become a Remedial Enterprise Active Learning care home. Although the learning programme was not completed due to unavoidable circumstances, the staff's experiences highlight some of the challenges and successes that may be experienced when seeking to improve care homes' learning culture and practice.

Culture change in care homes: a literature review.

This article is the first of a two-part series that explores a programme of culture change in care homes. A UK care home company sought the authors' expertise to design and facilitate an independent programme of learning to encourage and support staff in two of its homes to become the architects of their own quality improvement. The article reviews the literature that was an essential information base for the authors in their dual roles as designers of the learning programme and facilitators of its delivery to participant staff. The literature is necessarily broad in reflecting the nature and context of care homes, residents' needs and wants from care, and the particular challenges that might be faced by care home staff and managers when making quality improvements. In the second article, the reality of running the programme in the two homes is described.

What doctors need to know: Prescribing or not for the oldest old.

Given the global increase in the number of people over the age of 85, there is a growing body of work concerning this group, termed the oldest old. Much of this work is confined to the literature specialising in geriatrics and the more generic health care papers refer to 'older people' with little definition of what is meant by 'older'. Iatrogenesis (ill health caused by doctors) is a major issue and general practitioners (GPs) need practical help in prescribing for the oldest old. This paper presents a narrative review of the literature on prescribing and the oldest old. The results showed that all papers sourced referred to prescribing for the 'old' as those aged over 65, with only scant mention of oldest old. Yet prescribing for the oldest old involves clinical judgement and knowledge of the patient. It includes weighing up what will do good, cause no harm and is acceptable to the individual. GPs have to make treatment choices mostly in isolation from colleagues, during time-limited consultations and with few relevant guidelines on managing multi-morbidities in the oldest old. A major issue in prescribing for people over the age of 85 is that guidelines for diseases are based on trials with younger adults, outline the best practice for one disease in isolation (i.e. not in the presence of other diseases) and take little account of the interactions between the drugs used in managing several diseases in frail older people. There is a growing body of work, however, calling for specialist services for the oldest old.