Physiotherapists' moral distress: Mixed-method study reveals new insights.

BACKGROUND: Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of  professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists. RESEARCH QUESTION: What factors contribute to Moral distress among physiotherapists and how do they cope? OBJECTIVES: To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena. RESEARCH DESIGN: A 2017-2022 mixed-methods study: (1) Survey of 407 physiotherapists quantitatively testing a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis. PARTICIPANTS AND CONTEXT: Israeli physiotherapists from various occupational settings recruited via professional networks. ETHICAL CONSIDERATIONS: The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use. FINDINGS: Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress. DISCUSSION: Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors. CONCLUSIONS: Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies.

The effect of co-dependent (thinking in motion [TIM]) versus single-modality (CogniFit) interventions on cognition and gait among community-dwelling older adults with cognitive impairment: a randomized controlled study.

BACKGROUND: Cognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive impairment. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive impairment has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with "Thinking in Motion (TIM)," a co-dependent group intervention, among community-dwelling older adults with cognitive impairment. METHODS: Employing a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive impairment were randomly assigned to 8 weeks of thrice-weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome; and gait, under single- and dual-task conditions, as a secondary outcome. RESULTS: CogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p < .001, ηp2 = .283] but not for group [F (1, 44) = 0.001, p = .970]. No time X group interaction [F (1, 44) = 1.29, p = .261] was found. No changes in gait performance under single and dual-task performance were observed in both groups. CONCLUSIONS: The findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive impairment. Such investigations should be extended to include various populations and a broader set of outcome measurements. TRIAL REGISTRATION: ACTRN12616001543471. Date: 08/11/2016.

The Two-Track Model of Dementia Grief (TTM-DG): The theoretical and clinical significance of the continuing bond in sickness and in death.

Grief and mourning for family members caring for a dementia patient begin with the initial changes in the person's cognitive abilities, and intensify with the worsening of his or her condition. The aim of this article is to propose a Two-Track Model of Dementia Grief (TTM-DG). This model enlarges the theoretical, research and clinical lenses for dementia, and explores how the illness process as well as the bereavement responses after death stimulate the reworking of grief and mourning over the beloved family member. Based on the insights derived from the Two-Track Model of Loss and Bereavement and the Continuing Bonds paradigm, we propose that the clinical and research examination of dementia grief begin in life and continue after the death. The TTM - DG's Track I focuses on bio-psycho-social functioning and Track II focuses on the internalized psychological representation of the patient, the ongoing relational bond and the illness and death story. A case study illustrates how this combined perspective provides a comprehensive picture of the experience of grief for persons afflicted with dementia over the course of the disease trajectory. Future clinical and empirical research has an important role to play in the further development of this model.

Consumer Fraud: Older People's Perceptions and Experiences.

In view of the growing need to address the rights of older people as consumers, this study captures the perceptions and meanings that older people attribute to their experiences as older consumers, particularly regarding consumer fraud, using qualitative-phenomenological methodology based on semi-structured, open-ended interviews with 16 older consumers in Israel. The findings raise distinctive aspects of their experiences, including physical and cognitive characteristics of aging, social response to aging, and involvement of family members in decision making and support. The study concludes by offering several sociolegal policy recommendations for protecting older consumers, directed to them, their family members, professionals interacting with them, and the legal system.

Ethics Review Boards for Research With Human Participants: Past, Present, and Future.

The debate around ethics review boards (IRBs) has assumed an increasingly central place in academic practice and discourse. In this article, we summarize a unique workshop (study-group) that convened at the University of Haifa, attended by 27 academics from around the globe, representing nine countries in four continents. The participants presented data and points of view, which served as the basis for an open, interdisciplinary discussion. The group developed a set of recommendations, including working toward a transition from a review system to an advisory and validation system; focusing on respectful research approach to participants, rather than "ethical" research; building a procedure that focuses on feedback, rather than the process itself; recognizing that a unified examination need not necessarily be standardized; and constructing a feedback procedure in which researchers can respond to the review of their research.

Development and Validation of a Workplace Age-Friendliness Measure.

BACKGROUND AND OBJECTIVES: Measuring the extent to which the culture of organizations can be considered age-friendly is a significant anchor in the constructive inclusion process of older workers in workplaces, given the consistent aging of the workforce. Hence, the purpose of this research was to develop a novel, comprehensive, and theoretically driven measure of workplace age-friendliness. RESEARCH DESIGN AND METHODS: Three multiphased, multisourced studies were conducted: a qualitative assessment procedure and 2 separate quantitative field surveys of individual-level perceptions. RESULTS: A 24-item scale of workplace age-friendliness was developed, consisting of 4 dimensions that represent the different ways in which organizational culture aligns with an aging and older workforce: age-friendly core culture, development, wellness, and flexibility. Confirmatory factor analysis verified that a 4-factor structure is the most appropriate solution, with all dimensions having acceptable internal consistency. Preliminary evidence of construct validity is also presented. DISCUSSION AND IMPLICATIONS: The measure developed in this study may serve researchers as well as practitioners in the field of aging and work. Further implications and limitations of using this instrument in future empirical study on workplace age-friendliness are discussed.

Israel Ad Hoc COVID-19 Committee: Guidelines for Care of Older Persons During a Pandemic.

Early on, geriatricians in Israel viewed with increasing alarm the spread of coronavirus disease 2019 (COVID-19). It was clear that this viral disease exhibited a clear predilection for and danger to older persons. Informal contacts began with senior officials from the country's Ministry of Health, the Israel Medical Association, and the country's largest health fund; this was done to plan an approach to the possible coming storm. A group was formed, comprising three senior geriatricians, a former dean, a palliative care specialist, and a lawyer/ethicist. The members made every effort to ensure that their recommendations would be practical while at the same time taking into account the tenets of medical ethics. The committee's main task was to think through a workable approach because intensive care unit/ventilator resources may be far outstripped by those requiring such care. Recommendations included the approach to older persons both in the community and in long-term care institutions, a triage instrument, and palliative care. Patient autonomy was emphasized, with a strong recommendation for people of all ages to update their advance directives or, if they did not have any, to quickly draw them up. Considering the value of distributive justice, with respect to triage, a "soft utilitarian" approach was advocated with the main criteria being function and comorbidity. Although chronological age was rejected as a sole criterion, in the case of an overwhelming crisis, "biological age" would enter into the triage considerations, but only in the case of distinguishing between people with equal non-age-related deficits. The guideline emphasized that no matter what, in the spirit of beneficence, anyone who fell ill must receive active palliative care throughout the course of a COVD-19 infection but especially at the end of life. Furthermore, in the spirit of nonmaleficence, the frail, very old, and severely demented would be actively protected from dying on ventilation. J Am Geriatr Soc 68:1370-1375, 2020.

Ageism: can a museum exhibit make a difference?

Ageism is a key challenge to today's aging societies. "Dialogue with Time" is an original Israeli interactive museum exhibit that aims to change negative ageist attitudes by creating a meaningful and stereotype-breaking encounter between visitors and old age. The objective of this study was to examine whether the exhibition reduces ageist attitudes among its visitors. The study employed a comparative pre-post structure with a comparison group. A closed-answer questionnaire was supplied to 100 participants in the experimental group, visitors to the "Dialogue with Time" exhibit, and to 100 participants in the control group. Participants were asked to complete the questionnaire before entering the exhibits and again after experiencing them. Changes in the level of ageism were measured using the Farboni Scale of Ageism. A significant reduction in ageism attitudes was shown in the experimental group when comparing before and after the visit, t(91) = 11.75, p = 0.001, with a good effect size of Cohen's d = 0.50, whereas in the control group there was no significant change, t(76) = 0.05, p = 0.95, and a weak effect size of Cohen's d = 0.00. The findings indicate that combating ageism can also be sustained by means of museum exhibits. We recommend that museums and other similar public institutions (e.g. art galleries, exhibition halls) use public spaces to advance multigenerational exposure to positive images of aging.

Conceptualizing Age-Friendliness in Workplaces: Proposing a New Multidimensional Model.

Creating age-friendly workplace environments is considered a central organizational approach for addressing the challenges of supporting an aging and older workforce. However, there are no concrete definitions or theoretical frameworks that explain the full meaning, assumptions, and basic processes of this concept. This article critically reviews the conceptualizations of the age-friendly workplace in the fields of organizational psychology and gerontology, and proposes (a) a new working definition of the concept, and (b) a multidimensional model that consists of a typology of age-friendly dimensions, representing the implications of human resource policies and practices that demonstrate the ways in which organizational climate and organizational culture support aging workers. This framework enables a better understanding of the organizational-occupational realities within an aging and older labor market, and thus serves as an effective foundation upon which future organizational measurements can be constructed.

Building Bridges between Gerontology and Elder Law.

BACKGROUND: Academics have long called for greater interaction between gerontologists and legal scholars. However, prior studies have suggested that disciplinary borders remain a barrier to such interaction, hampering gerontology's ability to function as a truly multi- or interdisciplinary field. OBJECTIVE: This study was designed to understand the nature of current interactions between legal scholars and gerontologists, and to identify opportunities to advance scientific dialogue and cooperation between the two. METHODS: Semi-structured, open-ended interviews with 27 participants (12 elder law scholars, 15 gerontologists) were conducted by phone, recorded, and analyzed by an interdisciplinary team. RESULTS: Both elder law scholars and gerontologists indicate that their field would benefit from research collaboration and cross-disciplinary teaching with the other field, but the fields remain distinct with little cross-disciplinary learning. Participants identified a series of opportunities, however, for increasing such learning and collaboration. CONCLUSIONS: The authors identify ways gerontologists can be encouraged to integrate elder law into their teaching and research, and suggest how this integration could enhance understanding of the aging experience.

Comparing Older Persons' Human Rights: Exploratory Study of the International Older Persons' Human Rights Index (IOPHRI).

BACKGROUND AND OBJECTIVES: Over the last 2 decades, several international indices have been developed to describe the status of older persons. None, however, have examined their human rights. The International Older Persons' Human Rights Index (IOPHRI) fills in this gap by analyzing the formal legislative foundation of human rights for older people. The objective of this exploratory study is to examine the IOPHRI while comparing the legislation in 6 countries. RESEARCH DESIGN AND METHODS: A comparative international exploratory study comparing the human rights legislation of 6 countries: United States, Chile, Ireland, South Africa, India, and Australia in 5 different human rights domains: constitutional, protection, familial and informal support, planning, and empowerment. RESULTS: The findings suggest that the actual relationship between formal human rights of older persons and the real world is complex: for example, while the IOPHRI index places South Africa in first place, it is far behind compared with all other participants in the Global AgeWatch Index (which measures objective elements such as life expectancy at 60, or poverty rates in old age). DISCUSSION AND IMPLICATIONS: Measuring and indexing human rights of older persons reveal significant methodological issues. Beyond these methodological challenges, comparing the ranking of the IOPHRI to nonlegalistic indices raises significant questions about the relationship between formal human rights and the actual living experiences of older persons.

The meanings of the unlicensed assistive personnel role in nursing homes: A triadic job analysis perspective.

AIM: This study described and analyzed how older residents, professional nurses and unlicensed assistive personnel (UAP) perceive the meaning and content of the job carried out by UAP in nursing homes (NHs), as a basis for job analysis. BACKGROUND: Increasing numbers of NH beds and financial restraints have led UAP to become a significant part of the long-term care service system, yet in numerous contexts, the UAP job remains misunderstood and underexplored. METHOD: The research employed a qualitative phenomenological methodology. Data were collected from 50 semi-structured in-depth interviews with 18 UAP, 15 certified nurses and 17 older NH residents. RESULTS: We identified six content dimensions in the participants' descriptions regarding the meanings of the roles and duties of the UAP: (a) care for the physical environment, (b) bodily-physical care, (c) psycho-social interpersonal care, (d) professional hierarchy and boundaries, (e) UAP personal traits and (f) UAP skills, or the need for training and professional education. CONCLUSIONS: Future job definition and formal regulation of UAP should place more focus on the personal characteristics of UAP, as a prerequisite to enter the job. IMPLICATIONS FOR NURSING MANAGEMENT: The study takes a step forward toward better defining the professional boundaries delineating the meaning of the UAP position.

Gender, aging, and the economics of "active aging": Setting a new research agenda.

The world is aging, and the percentages of older people are on a dramatic ascent. This dramatic demographic aging of human society is not gender neutral; it is mostly about older women. One of the key policy approaches to address the aging revolution is known as "active aging," crystalized by the WHO in 2002 by three pillars: participation, health, and security. The active aging policy has financial and economic aspects and affects both men and women. However, as argued in this article, a gender-based approach has not been adopted within the existing active aging framework. Therefore, a new gender-specific research agenda is needed, one that focuses on an interrelation between gender and different economic aspects of "active aging" from international, comparative, cultural, and longitudinal perspectives.

Ageism among physicians, nurses, and social workers: findings from a qualitative study.

This study investigated ageism among healthcare professionals in various therapeutic settings in Israel. Using a qualitative approach, the current study aimed to examine similarities and differences across healthcare disciplines. Three focus groups were conducted with physicians, nurses, and social workers. Data from each focus group were analyzed separately, and then commonalities and differences across the groups were evaluated. Three main themes relating to older adults emerged from the data. The first theme pertains to perceived difficulties that healthcare professionals experience in working with older adults and their family members; the second focuses on invisibility and discriminatory communication patterns; and the third theme relates to provision of inappropriate care to older adults. Similarities and differences across the three disciplines were found. The differences related mainly to the examples provided for manifestations of ageism in the healthcare system. Provision of inadequate treatment to older adults due to their age appeared to be the most complex theme, and is discussed at length in the Discussion. Briefly, the complexity stems from the fact that although some behaviors can be clearly described as inappropriate and undesirable, other behaviors such as avoidance of invasive medical procedures for older patients raise ethical dilemmas. Potentially, avoidance of invasive medical treatment can be perceived as compassionate care rather than as undertreatment due to ageist perceptions. A related dilemma, i.e., longevity versus quality-of-life, is also discussed in light of the finding that the balance of these two aspects changes as patients grow old.

The legal appearances of dementia in court rulings: mapping the terrain.

BACKGROUND: Individuals with dementia may appear before the court in different roles: as victims, as witnesses, and as those standing up for their rights. While there is growing interest in the rights of older persons with dementia, relatively little empirical data exists regarding their actual interactions in courts. Therefore, the goal of this study was to empirically map this legal terrain. METHODS: This study used a descriptive quantitative method. A computerized search of a national legal database limited to the period 2004-2014 and a screening process for the results were used to establish a sample of 280 court rulings that directly addressed dementia. All cases were analyzed and categorized into the following four criteria groups: characteristics of the person with dementia; characteristics of the legal procedure; the legal substance of the case; and the legal outcome. RESULTS: The majority of cases involved a single, very-elderly (i.e. over 80 years) woman, living in the community, with unspecified dementia. The majority of cases were heard and decided in lower level courts, addressing a broad range of primarily non-criminal legal issues. Finally, in the majority of non-criminal cases, the person with dementia was found to be legally capable, whereas in the majority of criminal cases, the person with dementia was found incapable. CONCLUSIONS: The legal needs and rights of persons with dementia are much broader than issues of legal capacity or social protection. Deeper knowledge and more research is needed in order to fully understand the contexts in which dementia is constructed under the law.

Age limitation for organ transplantation: the Israeli example.

In 2013 the Israeli Ministry of Health appointed a public committee to examine the policy of placing an age limitation on candidates listed for organ transplantation. The committee rejected the use of an age limit criterion for listing candidates for transplantation and recommended to abolish it. However, opinions differed regarding the use of recipients' age in shaping a fair organ allocation policy. The committee's recommendations were adopted and put into force as of April 2014. This article unfolds the committee deliberations on accommodating values of formal equality for optimising the use of organ transplantation.

Law and Intergenerational Relationships.

BACKGROUND: In any aging society, the sociolegal construction of intergenerational relationships is of great importance. This study conducts an international comparison of a specific judicial issue: whether active labor unions have the legal right to strike for the purpose of improving the benefits given to nonactive workers (specifically, pensioners). METHOD: A comparative case law methodology was used. The texts of three different Supreme Court cases-in the United States, Canada, and Israel-were analyzed and compared. FINDINGS: Despite the different legal outcomes, all three court rulings reflect a disregard of known and relevant social gerontology theories of intergenerational relationships. CONCLUSION: Social gerontological theories can play an important role in both understanding and shaping judicial policies and assisting the courts in choosing their sociojudicial narratives.

The Human Right to Leisure in Old Age: Reinforcement of the Rights of an Aging Population.

The right to leisure is recognized as a human right under the 1948 United Nations Universal Declaration of Human Rights. The actual meaning and material content of this human right is subject to debate. The aim of this study is to examine the extent and the context to which this human right is specifically recognized with regard to older persons. Methodologically, this study textually analyzed 17 different international older persons' human rights documents. The findings reveal that in the majority of these documents there is no reference to the right to leisure. In the remaining documents, the right to leisure is mostly referred to indirectly or in a narrow legal construction. These findings support the notion that despite the growing body of knowledge regarding the importance of meaningful leisure in old age-and its empowering and anti-ageist nature-this knowledge has not transformed into a legal human rights discourse.