Delirium is more common and associated with worse outcomes in Parkinson's disease compared to older adult controls: results of two prospective longitudinal cohort studies.

BACKGROUND: Inpatient prevalence of Parkinson's disease (PD) delirium varies widely across the literature. Delirium in general older populations is associated with adverse outcomes, such as increased mortality, dementia, and institutionalisation. However, to date there are no comprehensive prospective studies in PD delirium. This study aimed to determine delirium prevalence in hospitalised PD participants and the association with adverse outcomes, compared to a control group of older adults without PD. METHODS: Participants were hospitalised inpatients from the 'Defining Delirium and its Impact in Parkinson's Disease' and the 'Delirium and Cognitive Impact in Dementia' studies comprising 121 PD participants and 199 older adult controls. Delirium was diagnosed prospectively using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria. Outcomes were determined by medical note reviews and/or home visits 12 months post hospital discharge. RESULTS: Delirium was identified in 66.9% of PD participants compared to 38.7% of controls (p < 0.001). In PD participants only, delirium was associated with a significantly higher risk of mortality (HR = 3.3 (95% confidence interval [CI] = 1.3-8.6), p = 0.014) and institutionalisation (OR = 10.7 (95% CI = 2.1-54.6), p = 0.004) 12 months post-discharge, compared to older adult controls. However, delirium was associated with an increased risk of developing dementia 12 months post-discharge in both PD participants (OR = 6.1 (95% CI = 1.3-29.5), p = 0.024) and in controls (OR = 13.4 (95% CI = 2.5-72.6), p = 0.003). CONCLUSION: Delirium is common in hospitalised PD patients, affecting two thirds of patients, and is associated with increased mortality, institutionalisation, and dementia. Further research is essential to understand how to accurately identify, prevent and manage delirium in people with PD who are in hospital.

Frailty in an Adult Acute Hospital Population: Predictors, Prevalence, and Outcomes.

Frailty is common among older hospital inpatients. While studies describe frailty prevalence in acute hospitals, it is usually based upon retrospective hospital-coded data or brief screening on admission rather than comprehensive geriatric assessment (CGA). Further, little is known about differences between pre-admission and current frailty status. Given this, we investigated the prevalence of pre-frailty and frailty among adult inpatients in a large university hospital after CGA. Of the 410 inpatients available, 398 were included in the study, with a median age of 70 years; 56% were male. The median length of stay (LOS) at review was 8 days. The point prevalence of frailty was 30% versus 14% for pre-frailty. The median Clinical Frailty Scale score pre-admission was 3/9, which was significantly lower than at review, which was 4/9 (p < 0.001). After adjusting for age and sex, frailty was associated with greater odds of prolonged LOS (odds ratio [OR] 1.7, p = 0.045), one-year mortality (OR 2.1, p = 0.006), and one-year institutionalisation (OR 9, p < 0.001) but not re-admission. Frailty was most prevalent on medical and orthopaedic wards. In conclusion, CGA is an important risk assessment for hospitalised patients. Frailty was highly prevalent and associated with poor healthcare outcomes. Frailty status appears to worsen significantly during admission, likely reflecting acute illness, and it may not reflect a patient's true frailty level. The development of frailty clinical care pathways is recommended in order to address the poor prognosis associated with a diagnosis of frailty in this setting.

Incidence and risk factors of institutionalisation in Parkinson's disease and atypical parkinsonism.

INTRODUCTION: The basic epidemiology of institutionalisation (the need for long-term care in an institution) in parkinsonism is unclear. We aimed to identify the incidence of, and risk factors for, institutionalisation in Parkinson's disease (PD) and atypical parkinsonism (AP). METHODS: We analysed data from a prospective population-based incidence cohort of parkinsonism in North-East Scotland (the PINE study). 556 newly-diagnosed participants (PD, N = 200; AP, N = 98; controls, N = 258), recruited between 2002 and 2009, were prospectively followed life-long with data collection on place of residence. We determined the incidence and baseline predictors of institutionalisation using Cox regression. RESULTS: The median follow-up time was 9.3, 4.4, and 10.8 years in PD, AP, and controls respectively. 70 (35 %) PD, 53 (54 %) AP, and 43 (16 %) controls became institutionalised. The incidence rates of institutionalisation in PD, AP, and controls were 5.1, 20.8, and 1.8 per 100 person-years respectively. The median time to institutionalisation was 11.8 years in PD and 3.5 years in AP. Multivariable Cox regression showed that AP (HR versus PD = 3.05 [95 % CI 1.90,4.91]), increasing age (HR for 10-year increase = 1.82 [95 % CI 1.40,2.36]), poorer cognition (HR for MMSE<24 versus MMSE>27 = 2.62 [95 % CI 1.45, 4.73]), more-severe parkinsonian impairment (UPDRS part 3) (HR for 10-point increase = 1.25 [95 % CI 1.05, 1.48]) were independently associated with higher hazards of institutionalisation. Sex, co-morbidity, smoking history, and living alone were not associated with institutionalisation. CONCLUSION: Institutionalisation is much more frequent in parkinsonism, particularly in AP, than in controls. AP, older age, severe parkinsonian impairment, and poorer cognition were independent baseline predictors of institutionalisation.

Experiences of transition from hospital to community living via the Pathways to Community Living Initiative: A qualitative evaluation study of service users and family members.

OBJECTIVE: People with severe and persistent mental illness (SPMI) may be excluded from community-based care if their complex support needs cannot be met and are at risk of institutionalisation. The Pathways to Community Living Initiative (PCLI) aims to address barriers to community living. This study evaluated the PCLI from the perspective of service users and family members. METHODS: Evaluation questions were explored in semi-structured interviews. Transcripts were coded inductively and deductively. This article adheres to relevant EQUATOR standards for qualitative research and reporting. RESULTS: There were 37 interviews with 27 service users and 12 family members. Factors associated with positive experiences of transition from hospital included detailed planning, personalised care, and staged transitions which alleviated concerns around safety, support, and coping. Community living provided opportunities to exercise greater choice and control in everyday life and, for some, to reconnect with family. Poor physical health and social isolation were noted as potential risks. CONCLUSIONS: Participants regarded community living as preferable to hospital settings, and highly valued their freedom. They reported that clinical, aged care and disability supports helped them. Additional support may be required to improve physical health and social connectedness, and families appear to have unmet needs for psychosocial support.

Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence.

OBJECTIVES: To examine factors contributing to delaying care home admission; and compare the rates of care home admission and cost consequence between two government subsidised programmes, Veterans' Affairs Community Nursing (VCN) and Home Care Package (HCP). METHODS: Our national, population-based retrospective cohort study and cost analysis used existing, de-identified veterans' claims databases (2010-19) and the Registry of Senior Australians Historical Cohort (2010-17), plus aggregate programme expenditure data. This involved 21,636 VCN clients (20,980 aged 65-100 years), and an age- and sex-matched HCP cohort (N = 20,980). RESULTS: Service factors associated with lower risk of care home admission in the VCN cohort were periodic (versus continuous) service delivery (HR 0.27 [95%CI, 0.24-0.31] for ≤18 months; HR 0.89 [95%CI, 0.84-0.95] for >18 months), and majority care delivered by registered nurses (versus personal care workers) (HR 0.86 [95%CI, 0.75-0.99] for ≤18 months; HR 0.91 [95%CI, 0.85-0.98] for >18 months). In the matched cohorts, the time to care home admission for VCN clients (median 28 months, IQR 14-42) was higher than for HCP clients (14, IQR 6-27). Within 5 years of service access, 57.6% (95%CI, 56.9-58.4) of HCP clients and 26.6% (95%CI, 26.0-27.2) of VCN clients had care home admission. The estimated cost saving for VCN recipients compared to HCP recipients over 5 years for relevant government providers was over A$1 billion. CONCLUSIONS: Compared to an HCP model, individuals receiving VCN services remained at home longer, with potentially significant cost savings. This new understanding suggests timely opportunity for many countries' efforts to enhance community-based care services.

ASEAN as network governance: An alternative lens to evaluate policymaking and performance.

Background: This article offers a new perspective of the Association of Southeast Asian Nations (ASEAN) as network governance (NG) using the policy network theory (PNT) for the analysis. Methods: Two case studies were selected from the ASEAN Community to examine the applicability and effectiveness of NG in promoting ASEAN cooperation. These case studies were chosen due to their prominence and the prevalence of critical comments about their effectiveness in promoting cooperation. The content analysis utilised primary data from ASEAN reports, documents, research articles and processes, and studies on NG and policy networks. A literature review was conducted using online academic databases and ASEAN-related websites. The search covered the period from June 2019 to March 2021, with further searches conducted between January and July 2023. These data collection efforts provided a robust analysis of the case studies within the NG and ASEAN integration contexts. Results: The findings show ASEAN as a hybrid structure which has supported its survival and relevance. This approach provides legitimacy for ASEAN globally by purposefully adopting structures similar to the EU without the supranational elements. It also showcases ASEAN's motivation for asserting its centrality. Adopting a hybrid structure has led to ASEAN's soft institutionalisation, driven by its norms and characterised by a less empowered secretariat, where the member states are the decision-makers and implementors of policies. It opens a pathway to recognising ASEAN states' autonomy, where the actors' will and interests affect decision-making and define performance. Conclusions: This article demonstrates NG's viability in promoting ASEAN's centrality in regional cooperation and institutional arrangements and allows for a nuanced assessment of its performance considering the context of the issue and ASEAN's history and emphasising the member states' primacy in policymaking. The NG framework contributes to ASEAN's legitimacy, regional cooperation and performance despite its inherent limitations.

Institutionalisation Is a Vital Element for Fairness of Priority Setting in the Package Design if the Target is Universal Health Coverage Comment on "Evidence-Informed Deliberative Processes for Health Benefits Package Design - Part II: A Practical Guide".

The evidence-informed deliberative processes (EDPs) guide provides a practical framework for fair priority setting of the health benefits package (HBP) that countries can reasonably use. The steps presented in the EDPs are applicable for prioritising health services in designing HBP and are consistent with practical experience in countries. However, institutionalisation must be considered an element of fairness in the priority-setting process if the aim is to reach broader goals of a health system, such as universal health coverage (UHC). Otherwise, the EDPs for priority setting might not be integrated into the formal health system or impactful, resulting in a waste of time and resources, which is unfair. Institutionalisation means formalising the desired change as an embedded and integrated system so that the change lasts over time. For the institutionalisation of EPDs, four stages are suggested, which are (1) establishing a supportive legal framework, (2) designating governance and institutional structure, (3) stipulating the EDPs processes and (4) individual and institutional capacity building.

The Institutionalisation of Brazilian Older Abused Adults: A Qualitative Study among Victims and Formal Carers.

Abuse against elders is acknowledged as a severe and pervasive problem in society. If support services are not tailored to the victims' knowledge or perceived needs, the intervention is likely to be unsuccessful. This study aimed to explore the experience of institutionalisation of abused older people from the perspective of the victims and their formal carers in a Brazilian social shelter. A qualitative descriptive study was performed with 18 participants, including formal carers and older abused persons admitted to a long-term care institution in the south of Brazil. Qualitative thematic analysis was used to analyse the transcripts of semi-structured qualitative interviews. Three themes were identified: (1) personal, relational, and social bonds: broken or weakened; (2) denial of the violence suffered; and (3) from imposed protection to compassionate care. Our findings provide insights for effective prevention and intervention measures in elder abuse. From a socio-ecological standpoint, vulnerability and abuse might be averted at the community and societal levels (e.g., education and awareness of elder abuse) by creating a minimum standard for the care of older individuals (e.g., law or economic incentives). Further study is needed to facilitate recognition and raise awareness among individuals in need and those offering assistance and support.

Daytime Sleepiness Predicts Mortality in Nursing Home Residents: Findings from the Frailty in Residential Aged Care Sector Over Time (FIRST) Study.

OBJECTIVES: Excessive daytime sleepiness is an increasingly frequent condition among older adults with comorbidities and living in nursing homes (NHs). This study investigated associations between participants' characteristics and excessive daytime sleepiness (EDS); the ability of the Epworth Sleepiness Scale (ESS) scores, EDS, and EDS severity levels to predict mortality at 12 months of follow-up; and the optimal cut-off for ESS to predict mortality among NH residents. DESIGN: Prospective and cross-sectional analysis in a prospective study. SETTING AND PARTICIPANTS: Older adults permanently residing in 12 NHs from South Australia. METHODS: Baseline characteristics including the ESS were collected and mortality at 12 months was assessed. Logistic regression analyzed associations between participants' characteristics and EDS (ESS >10). Kaplan-Meier cumulative survival estimates followed by log-rank and adjusted Cox proportional hazards models explored associations of ESS scores, EDS, and EDS severity levels with time-to-incident death. Receiver operator curve analysis assessed the best cut-off for ESS to predict mortality risk. RESULTS: A total of 550 participants [mean (SD) age, 87.7 (7.2) years; 968 (50.9%) female]. Malnutrition [adjusted odds ratio (aOR) 2.02, 95% confidence interval (CI) 1.13‒3.61], myocardial infarction (aOR 1.91, 95% CI 1.20‒3.03), heart failure (aOR 2.85, 95% CI 1.68‒4.83), Parkinson's disease (aOR 2.16, 95% CI 1.04‒4.47) and severe dementia (aOR 8.57, 95% CI 5.25‒14.0) were associated with EDS. Kaplan-Meier analyses showed reduced survival among participants with EDS (log-rank test: χ2 = 25.25, P < .001). EDS predicted increased mortality risk (HR 1.63, 95% CI 1.07-2.51, P = .023). ESS score of 10.5 (>10) was the best cut point predicting mortality risk (area under the curve = 0.62). CONCLUSIONS AND IMPLICATIONS: EDS predicts mortality risk and is associated with age-related comorbidities in NH residents. Screening for EDS is a simple strategy to identify NH residents at higher risk of adverse outcomes, triggering an assessment for reversibility or conversations about end-of-life care.

Freedom and loneliness: dementia caregiver experiences of the nursing home transition.

BACKGROUND: the transition to nursing home care has previously been linked to negative outcomes for spousal caregivers of persons with dementia (PwD). However, little is known about the experience or trajectory of loneliness in spousal caregivers during this time. OBJECTIVES: to explore experiences of loneliness in caregivers during the nursing home admission of their spouse or partner with dementia. METHODS: semi-structured interviews were conducted with 11 individuals living in Ireland between Oct 2020 and June 2021, who were married to/partnered with a PwD who had, in the past 7 years, moved to full-time nursing home care. Data were collected and analysed using a deductive qualitative analytic strategy in the grounded theory tradition. RESULTS: data were interpreted in the context of Weiss' typology of social and emotional loneliness and indicated that social loneliness increased for many at the point of diagnosis, decreasing somewhat after the transition, while emotional loneliness increased across the transition. Data were used to refine an existing synthesised model of loneliness, providing an updated model of the causes and contexts of loneliness. CONCLUSIONS: the transition to nursing home care differentially affects loneliness subtypes. Results have implications for other transitions, which should be assessed in terms of various subtypes of loneliness. Our refined theoretical synthesis model of loneliness also warrants further evaluation.

Does Aging Have an Impact on Vitamin C Status and Requirements? A Scoping Review of Comparative Studies of Aging and Institutionalisation.

The global healthcare burden of an aging population continues to increase, with nearly a quarter of the total global burden of disease attributable to people aged ≥60 years. Older people are at greater risk of micronutrient deficiencies, including immune-supportive vitamin C, which is both a contributor to and a consequence of acute and chronic illnesses. However, whether healthy aging, per se, is associated with depleted vitamin C status and increased requirements for the vitamin is less certain. A systematic scoping review was carried out to assess comparative studies that reported the vitamin C status and prevalence of deficiency in older versus younger people and in older people relative to residential status. Furthermore, vitamin C requirements were assessed through comparative studies reporting vitamin C status and pharmacokinetics in older people relative to younger people. Overall, there was limited evidence to suggest that healthy aging, per se, is related to lower vitamin C status or higher requirements for the vitamin. However, institutionalised elderly had lower vitamin C status and enhanced vitamin C requirements, primarily as a result of low intakes and/or chronic illnesses, which were not being met by hospital or residential diets. Because institutionalised elderly are vulnerable to malnutrition and micronutrient deficiencies, it is imperative that appropriate nutritional interventions are instigated to provide optimal micronutrient intake to support healthy aging.

Vivencias de las personas mayores de una residencia durante el confinamiento por la COVID-19: un estudio cualitativo / Vivencias de las personas mayores de una residencia durante el confinamiento por la COVID-19: un estudio cualitativo

Objetivos: Conocer y explorar las preocupaciones y experiencias que genera el confinamiento por la COVID-19 en las personas mayores. Metodología: Estudio cualitativo de tipo fenomenológico basado en entrevistas semiestructuradas. La información se analizó mediante análisis de contenido y se verificó con la triangulación de los resultados. Resultados: Emergieron 8 categorías coincidentes: sentimientos durante el confinamiento, inquietudes por la salud, cambios en la propia salud, cambios en los hábitos de vida, apoyo profesionales de la salud, estrategias de afrontamiento, información sobre la COVID-19 y preocupaciones sobre el futuro. Conclusiones: Identificar las vivencias de los mayores durante el confinamiento por la COVID-19 ha mostrado, en esta población, las dificultades surgidas del día a día y las capacidades que han tenido que llevar a cabo para soportar y superar este difícil período de la pandemia (AU)

Objective: This paper aims to understand and explore the concerns and experiences generated by confinement by COVID-19 in the elderly. Methodology: Qualitative study of a phenomenological type based on semi-structured interviews. The information was analysed by content analysis and verified by the triangulation approach. Results: Eight coinciding categories emerged: feelings during confinement, health concerns, changes in one’s health, lifestyle changes, health professional support, coping strategies, information about COVID- 19, and concerns about the future. Conclusions: Identifying the experiences of the elderly during confinement by Covid-19 has shown in this population the difficulties that arise from day to day and the capacities that they have had to carry out to withstand and overcome this difficult period of the pandemic (AU)

Social inclusion revisited: sheltered living institutions for people with intellectual disabilities as communities of difference.

The dominant idea in debates on social inclusion of people with intellectual disabilities is that social inclusion requires recognition of their 'sameness'. As a result, most care providers try to enable people with intellectual disabilities to live and participate in 'normal' society, 'in the community'. In this paper, we draw on (Pols, Medicine Health Care and Philosophy 18:81-90, 2015) empirical ethics of care approach to give an in-depth picture of places that have a radically different take on what social inclusion for people with intellectual disabilities looks like: places known as 'sheltered living institutions'. We argue these places can be seen as 'communities of difference' catered to the specific needs and capacities of the residents. We then contend that these communities raise questions about what a good life for people with intellectual disabilities looks like and where and how it ought to be realised; questions not posed very often, as they get muzzled by the dominant rhetoric of normalisation and the emphasis on sameness.

Effectiveness of community hospital post-acute care on mortality, re-admission, institutionalization, and activation of a home care programme in Emilia-Romagna region, Italy.

BACKGROUND: In Italy, there is scant evidence on the impact of Community Hospitals (CHs) on clinical outcomes. AIMS: To assess the effectiveness of CHs versus long-term care hospital or inpatient rehabilitation facilities on mortality, re-admission, institutionalization, and activation of a home care programme in the Emilia-Romagna Region (ERR-Italy) after acute hospitalisation. METHODS: We implemented a cohort study drawing upon the ERR Administrative Healthcare Database System and including hospital episodes of ERR residents subject ≥ 65 years, discharged from a public or private hospital with a medical diagnosis to a CH or to usual care between 2017 and 2019. To control for confounding, we applied a propensity score matching. RESULTS: Patients transferred to CHs had a significantly lower risk of dying but an increased risk of being readmitted to community or acute hospital within 30/90 days from discharge. The hazard of institutionalisation within 30/90 days was significantly lower in the whole population of the CH exposed group but not among patients with cardiac or respiratory chronic diseases or diabetes. The activation of a home care program within 90 days was slightly higher for those who were transferred to a CH. DISCUSSION: The findings of our study show mixed effects on outcomes of patients transferred to CHs compared to those who followed the post-acute usual care and should be taken with cautious as could be affected by the so-called 'confounding by indication'. CONCLUSIONS: The study contributes to the intermediate care available evidence from a region with a well-established care provision through CHs.

'The spirit is willing, but the flesh is weak?': systemic unknown-knowns for ergonomics in India.

While the worldwide ergonomics community increases its sophistication in solving global problems, specific systemic challenges still plague Indians in urban mega-cities such as Mumbai. This paper aims to highlight the gaps using the knowns-unknowns framework, which exists in the Indian ergonomics community's capability to address such systemic challenges. Within this framework, the epistemological category of 'unknown-knowns' is explicated further using a case study of urban accidental deaths and injuries in Mumbai, India. These systemic casualties are essential to note because they are not only hidden from public awareness but can be avoided by proper ergonomics interventions. The article concludes with four main directions for the Indian ergonomics community in solving systemic problems in terms of, (a) capacity-building, (b) advocacy; (c) developing all realms of ergonomics with particular emphasis on complex systems; (d) developing India-centric pathways for ergonomics as a discipline. Practitioner's summary: This paper aims to highlight gaps in the academic Indian ergonomics community's capacity to solve public systemic problems. An India-centric way forward for awareness, engagement, and academic capacity building is suggested to develop a comprehensive national ergonomics mission.

The institutionalisation of biology in the British Association for the Advancement of Science, 1866-1894 / A institucionalização da biologia na British Association for the Advancement of Science, 1866-1894

Abstract Biology, like most scientific disciplines, emerged in the nineteenth century. However, disciplinary institutionalisation processes are not linear; a concept can be proposed, but not develop. Biology originated in the presence of established traditions such as anatomy, physiology, botany, and zoology, which represent the thematic and practical diversity under which it was understood. Based on the records of the annual meetings of the British Association for the Advancement of Science, the process by which biology emerged will be described. We will also recount how the discipline underwent changes throughout the century, where contrasting methodologies and theories were emphasized at different times.

Resumo A biologia, assim como a maioria das disciplinas, surgiu no século XIX. No entanto, os processos de institucionalização das disciplinas não são lineares; um conceito pode ser proposto, mas não ser desenvolvido. A biologia originou-se em meio a tradições estabelecidas, como a anatomia, fisiologia, botânica e zoologia, que representam a diversidade temática e prática sob a qual era compreendida. O processo do qual a biologia emergiu será descrito com base nos registros dos encontros anuais da British Association for the Advancement of Science. Relatamos também como a disciplina passou por modificações ao longo do século, em que metodologias e teorias contrastantes ganharam evidência em diferentes momentos.

What obstacles to nursing home for Dependent older adults' entry? Analysis of 186 situations resulting from an Inter-Establishment Resident Orientation Commission / Quels freins à l'entrée en Établissement d'hébergement pour personnes âgées dépendantes ? Analyse de 186 situations issues d'une Commission d'orientation des résidents inter-établissement

The decision to admit an older adult with loss of autonomy to an institution is complex. There are many obstacles to the decision to be referred to an institution and it partly explain long hospital stays and inadequate health care spending. Several of these obstacles have been identified in the literature (medical complexity, psycho-behavioural disorders, social vulnerability, etc.). This work is based on an experiment that aimed at coordinating the players during an "inter-hospital consultation meeting" dedicated to the decision to admit older patients who cannot find a solution immediately. This work aim to identify the obstacles to the referral of patients to HITH services. This is a single-centre descriptive study. It analyses prospective data collected between January 2017 and the end of June 2019. The average length of hospitalisation before leaving the institution is relatively homogeneous according to the different complexity criteria defined, except for heavy dependence and obesity, where in these situations there are longer average lengths of hospitalisation. The absence of complexity criteria is not necessarily associated with a shorter hospital stay. The commission makes it possible to create synergies between players in the same gerontological basin and facilitates the admission of complex cases to hospital.

La décision d'entrée en établissement d'un sujet âgé en perte d'autonomie est complexe. Les freins à la décision d'orientation en établissement expliquent en partie des durées d'hospitalisation longues et à l'origine de dépense de santé inadéquates. Plusieurs de ces freins ont été identifiés dans la littérature (complexité médicale, troubles psycho-comportementaux, vulnérabilité sociale…). À partir d'une expérimentation qui vise la coordination des acteurs lors d'une « réunion de concertation inter-établissement ¼ dédiée à la décision d'entrée de patients âgés ne trouvant pas de solution dans l'immédiat, l'objectif de ce travail est d'identifier les freins à l'orientation des patients en Ehpad. Il s'agit d'une étude descriptive mono-centrique analysant des données prospectives recueillies entre janvier 2017 et fin juin 2019. Les durées moyennes d'hospitalisation avant le départ en institution sont relativement homogènes en fonction des différents critères de complexité définis sauf pour la dépendance lourde et l'obésité où dans ces situations il existe des durées moyennes d'hospitalisation plus longues. L'absence de critère de complexité n'est pas obligatoirement associée à un raccourcissement du séjour hospitalier. La CORIE permet de créer des synergies entre les acteurs d'un même bassin gérontologique et facilite l'entrée en établissement des cas complexes.

The Ethics and Politics of Academic Knowledge Production: Thoughts on the Future of Business Ethics.

To commemorate 40 years since the founding of the Journal of Business Ethics, the editors in chief of the journal have invited the editors to provide commentaries on the future of business ethics. This essay comprises a selection of commentaries aimed at creating dialogue around the theme The Ethics and Politics of Academic Knowledge Production. Questions of who produces knowledge about what, and how that knowledge is produced, are inherent to editing and publishing academic journals. At the Journal of Business Ethics, we understand the ethical responsibility of academic knowledge production as going far beyond conventions around the integrity of the research content and research processes. We are deeply aware that access to resources, knowledge of the rules of the game, and being able to set those rules, are systematically and unequally distributed. One could ask the question "for whom is knowledge now ethical'"? (See the Burrell commentary.) We have a responsibility to address these inequalities and open up our journal to lesser heard voices, ideas, and ways of being. Our six commentators pursue this through various aspects of the ethics and politics of academic knowledge production. Working with MacIntyre's scheme of practices and institutions, Andrew West provides commentary on the internal good of business ethics learning and education. Inviting us to step out of the cave, Christopher Michaelson urges a clear-eyed, unblinking focus on the purposes and audiences of business ethics scholarship. As developmental editor, Scott Taylor uncovers some of the politics of peer review with the aim of nurturing of unconventional research. Mike Hyman presents his idiosyncratic view of marketing ethics. In the penultimate commentary, Julie Nelson attributes difficulties in the academic positioning of the Business Ethics field to the hegemony of a masculine-centric model of the firm. And finally, Gibson Burrell provides a powerful provocation to go undercover as researcher-investigators in a parallel ethics of the research process.

Decoding the Psychiatric Space: Cross Country Comparison of Facilities for Mental Health Service Users.

Normalisation theory made perfect sense at the onset of de-institutionalisation. To map its influence on mental health facilities, research was conducted and began with ten facilities within England (UK) and France, followed by a further two in England and four in New Zealand. A checklist tailored to mental health facilities was used to measure the extent to which the facility looked domestic or institutional. Hence, the mental health checklist architecturally measured domesticity versus institutionalisation in psychiatric architecture. It consisted of 212 features, grouped into three main categories-context and site; building; and space and room-and was based on a pre-existing checklist designed for hostels for those with learning disabilities. The mental health checklist was developed and piloted in Europe and reflected European de-institutionalisation principles. Cross-country comparison revealed that patient acuity was potentially not a determinant of institutional buildings for mental health. Institutional facilities in France were detected, and some of the most domestic facilities were within England, with the most recent sample having a greater tendency towards the more institutional end. Those in New Zealand tended towards the most institutional. Across all 16 facilities, there were very few universal institutional and domestic features, raising the ambiguity of a clearly defined stereotype of facilities for mental health service users. Consequently, the current fluidity of design across and within countries provides a significant opportunity for designers and mental health providers to consider non-institutional design, particularly at the planning stage. The use of the mental health checklist facilitates this debate. Future research in other geographical areas and through further consideration of cultural differences provides further opportunities to extend research in this area, with the potential to enhance and improve the lived experience of users of mental health services.

Community Learning Centres (CLCs) for Adult Learning and Education (ALE): development in and by communities.

Institutionalised forms of adult learning and education (ALE) such as community learning centres (CLCs) and related models are found in most parts of the world. These are spaces offering opportunities for literacy and skills training, health and citizenship, general, liberal and vocational education, in line with fuller recognition of the meaning of lifelong learning, and in the context of local communities. Often these institutions form the basis for even more informal and participatory learning, like study circles and community groups. They may share facilities like libraries and museums, clubs and sports centres, which are not within the remit of the Ministry of Education. This article reviews relevant literature and identifies recent studies and experiences with a particular focus on the Asia-Pacific and Africa regions, but also considers insights related to interventions at the global level. Findings point to low levels of participation of adults in general, and more specifically so for vulnerable and excluded groups which can hardly cross respective barriers. The authors' discussion is guided by the question What conditions are conducive to having more and better ALE for lifelong learning - and which roles can CLCs and other community-based ALE institutions play? This discussion is timely - the authors argue that CLCs need to be given more attention in international commitments such as those made in the context of the International Conferences of Adult Education (CONFINTEA) and the United Nations 17 Sustainable Development Goals (SDGs). CLCs, they urge, should be part of transformative discourse and recommendations at CONFINTEA VII in 2022.

Les centres d'apprentissage communautaires (CLC) pour l'apprentissage et l'éducation des adultes (AEA) : leur développement dans et par les communautés ­ Des formes institutionnalisées d'apprentissage et d'éducation des adultes (AEA) telles que les centres d'apprentissage communautaires (CLC) et les modèles qui y sont liés se retrouvent dans presque toutes les régions du monde. Ce sont des espaces d'alphabétisation et d'acquisition de compétences, d'instruction en matière de santé et de citoyenneté, et d'éducation générale, libérale et professionnelle, et ce pleinement en accord avec ce que l'on entend par apprentissage tout au long de la vie et avec le contexte des communautés locales. Souvent, ces établissements constituent la base d'un apprentissage encore plus informel et participatif comme dans les cercles d'études et les groupes communautaires. Ils peuvent se partager des locaux avec des bibliothèques et des musées, des clubs et des centres sportifs qui n'entrent pas dans les attributions du ministère de l'Éducation. Cet article passe en revue la littérature pertinente sur ce thème et recense à ce sujet des études et expériences récentes en s'intéressant particulièrement à l'Asie-Pacifique et à l'Afrique, tout en tenant compte également de connaissances liées à des interventions au niveau mondial. Les résultats révèlent de faibles niveaux de participation des adultes en général, et plus particulièrement des groupes vulnérables et exclus, qui peinent à franchir les obstacles auxquels ils se heurtent respectivement. La question dominante dans le débat des auteurs est la suivante : quelles sont les conditions propices à l'intensification et à l'amélioration de l'apprentissage et de l'éducation des adultes dans l'apprentissage tout au long de la vie ­ et quels rôles les centres d'apprentissage communautaires et autres établissements communautaires d'apprentissage et d'éducation des adultes peuvent-ils jouer ? Ce débat tombe à point nommé : les auteurs affirment que les centres d'apprentissage communautaires doivent occuper une place plus importante dans les engagements internationaux comme ceux pris dans le cadre des Conférences internationales sur l'éducation des adultes (CONFINTEA) et dans les 17 Objectifs de développement durable des Nations Unies (ODD). Ils préconisent d'intégrer les centres d'apprentissage communautaires dans le discours transformateur et les recommandations de la CONFINTEA VII en 2022.