The influence of sociodemographic factors and close relatives at hospital discharge and post hospital care of older people with complex care needs: nurses' perceptions on health inequity in three Nordic cities.

Hospital discharge of older people in need of both medical and social care following their hospital stay requires extensive coordination. This study aims to examine and compare the views of nurses in three Nordic cities on the influence of sociodemographic factors and having close relatives, for the hospital discharge and post hospital care of older people with complex health and social care needs. Thirty-five semi-structured interviews (Copenhagen n = 11, Tampere n = 8, Stockholm n = 16) with nurses were conducted. The nurses were identified through the researchers' networks, invitation and snowball sampling, and recruited from hospitals, primary care practices, home care units, home nursing units, and geriatric departments. The interviews were transcribed and analysed using thematic analysis. Interpretations were discussed and agreed within the team. Four main themes and 13 sub-themes were identified. Across the cities, informants reported that the patient's health status, rather than their gender or ethnicity, steered the discharge date and further care. Care costs, commonly reported in Tampere but also in Copenhagen and Stockholm including costs for medications and home help, were considered barriers for disadvantaged older people. Home situation, local arrangements and differences in collaboration between healthcare professionals at different sites also influenced the hospital discharge. Generally, the patient's health status steered the hospital discharge and post-hospital care. Close relatives were regarded important and a potential advantage. Some informants tried to compensate for the absence of close relatives, highlighting the importance of care systems that can compensate for this to minimise avoidable inequity. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00701-6.

The impact of organisational characteristics of staff and facility on infectious disease outbreaks in care homes: a systematic review.

BACKGROUND: Infectious disease outbreaks are common in care homes, often with substantial impact on the rates of infection and mortality of the residents, who primarily are older people vulnerable to infections. There is growing evidence that organisational characteristics of staff and facility might play a role in infectious disease outbreaks however such evidence have not previously been systematically reviewed. Therefore, this systematic review aims to examine the impact of facility and staff characteristics on the risk of infectious disease outbreaks in care homes. METHODS: Five databases (MEDLINE, EMBASE, ProQuest, Web of Science, CINAHL) were searched. Studies considered for inclusion were of any design reporting on an outbreak of any infectious disease in one or more care homes providing care for primarily older people with original data on: facility size, facility location (urban/rural), facility design, use of temporary hired staff, staff compartmentalizing, residence of staff, and/or nursing aides hours per resident. Retrieved studies were screened, assessed for quality using CASP, and analysed employing a narrative synthesis. RESULTS: Sixteen studies (8 cohort studies, 6 cross-sectional studies, 2 case-control) were included from the search which generated 10,424 unique records. COVID-19 was the most commonly reported cause of outbreak (n = 11). The other studies focused on influenza, respiratory and gastrointestinal outbreaks. Most studies reported on the impact of facility size (n = 11) followed by facility design (n = 4), use of temporary hired staff (n = 3), facility location (n = 2), staff compartmentalizing (n = 2), nurse aides hours (n = 2) and residence of staff (n = 1). Findings suggest that urban location and larger facility size may be associated with greater risks of an infectious disease outbreak. Additionally, the risk of a larger outbreak seems lower in larger facilities. Whilst staff compartmentalizing may be associated with lower risk of an outbreak, staff residing in highly infected areas may be associated with greater risk of outbreak. The influence of facility design, use of temporary staff, and nurse aides hours remains unclear. CONCLUSIONS: This systematic review suggests that larger facilities have greater risks of infectious disease outbreaks, yet the risk of a larger outbreak seems lower in larger facilities. Due to lack of robust findings the impact of facility and staff characteristics on infectious disease outbreaks remain largely unknown. PROSPERO: CRD42020213585 .

The relationship between self-reported sensory impairments and psychosocial health in older adults: a 4-year follow-up study using the English Longitudinal Study of Ageing.

OBJECTIVES: To explore cross-sectional and longitudinal relationships between self-reported hearing and vision impairments and self-rated health, quality of life (QoL) and depressive symptoms at 4-year follow-up. STUDY DESIGN: The study involved cross-sectional and longitudinal analyses with 4-year follow-up using data from the English Longitudinal Study of Ageing. METHODS: Community-dwelling adults (n = 3931) aged ≥50 years from the English Longitudinal Study of Ageing participated in this study. Self-reported hearing and vision were defined as good or poor. Self-rated health was treated as a dichotomous variable (good and poor health). QoL was based on the 19-item Critical Appraisal Skills Programme and treated as a continuous variable (score 0-57). Depressive symptoms were assessed using the eight-item Center for Epidemiologic Studies Depression Scale (CES-D8) and defined as CES-D≥3. Relationships between sensory impairments and self-rated health and depressive symptoms were analysed using logistic regression. Linear regression was used to assess the relationships between sensory impairments and QoL. RESULTS: In cross-sectional analyses, both self-reported hearing and vision impairment were positively associated with all outcomes assessed. In longitudinal analyses, self-reported poor hearing and vision were associated with increased risks of poor self-rated health (hearing: odds ratio [OR] 1.65, 95% confidence interval [CI] 1.32, 2.05; vision: OR 1.57, 95% CI 1.16, 2.12) and depressive symptoms (hearing: OR 1.35, 95% CI 1.07, 1.71; vision: OR 1.44, 95% CI 1.09, 1.90) after adjustment for sociodemographic and lifestyle factors, chronic illness, mobility limitations and cognition. Poor hearing and poor vision were not associated with reduced QoL after adjustment for covariates. CONCLUSIONS: The findings stress the importance of identifying and addressing sensory impairments in older adults to improve their health and well-being.

Socio-demographic characteristics, lifestyle factors and burden of morbidity associated with self-reported hearing and vision impairments in older British community-dwelling men: a cross-sectional study.

BACKGROUND: Hearing and vision problems are common in older adults. We investigated the association of self-reported sensory impairment with lifestyle factors, chronic conditions, physical functioning, quality of life and social interaction. METHODS: A population-based cross-sectional study of participants of the British Regional Heart Study aged 63-85 years. RESULTS: A total of 3981 men (82% response rate) provided data. Twenty-seven per cent (n = 1074) reported hearing impairment including being able to hear with aid (n = 482), being unable to hear (no aid) (n = 424) and being unable to hear despite aid (n = 168). Three per cent (n = 124) reported vision impairment. Not being able to hear, irrespective of use of hearing aid, was associated with poor quality of life, poor social interaction and poor physical functioning. Men who could not hear despite hearing aid were more likely to report coronary heart disease (CHD) [age-adjusted odds ratios (ORs) 1.89 (95% confidence interval 1.36-2.63)]. Vision impairment was associated with symptoms of CHD including breathlessness [OR 2.06 (1.38-3.06)] and chest pain [OR 1.58 (1.07-2.35)]. Vision impairment was also associated with poor quality of life, poor social interaction and poor physical functioning. CONCLUSIONS: Sensory impairment is associated with poor physical functioning, poor health and poor social interaction in older men. Further research is warranted on pathways underlying these associations.