Health & Social Care in the Community最新文献

There is an increasing recognition of the impact of built environment in the neighbourhood on healthy ageing, especially in the context of ageing in place. This study examines perceptions of third place and its potential value for mitigating loneliness in older adults. Thirty participants aged 65–89, living in ordinary housing across three neighbourhoods in the city of Stockholm, Sweden, conducted the interview-based sorting procedures, namely, Multiple Sorting Tasks (MST). In each individual MST procedure, the participant was asked to sort twenty pictures into groups using his or her own categories. The data were analysed using Multidimensional Scalogram Analysis, integrating qualitative data input and quantitative statistical analysis of the categorisations. Accessible local third places, which facilitate physical activities (especially walking) and community building (meaningful social connections) and provide options for food (a medium for social interactions), were seen as vital resources to combat loneliness. Thus, these places are supportive built environment elements of healthy ageing and ageing in place. The management aspect in third places operated by municipalities, including designing diverse public programs and services, and the service mentality of the staff members play an important role in making these places feel safe, at home, and potentially lessen the experience of loneliness to some extent. This study adds an urban design and planning perspective that can be integrated into environmental approaches to combat loneliness among older adults living in the community.

The perception of aging is widely acknowledged as a key determinant of personal satisfaction with the aging process, and it marks an individual’s adaptability to life changes. As older adults encounter psychophysical changes and disabilities, thoughts surrounding mortality often become more pronounced, leading to a surge in death anxiety, which is recognized as prevalent psychological distress among this population. This study aimed to investigate the relationship between aging perception and death anxiety among older adults in Eastern Iran during coronavirus disease 2019 (COVID-19). This descriptive-analytical study included 300 older adults (118 men and 182 women) using a stratified random sampling method. Data were collected using a demographic survey, Barker’s Ageing Perceptions Questionnaire (APQ), and Templer’s Death Anxiety Scale (DAS). Data were analyzed in SPSS software (V.22) using Pearson’s correlation coefficient, independent t-tests, analysis of variance (ANOVA), and linear regression. The mean aging perception score was 102.50 ± 15.55. After normalizing the scores, while the highest mean was related to the chronic and acute dimensions (65.32 ± 16.31), the lowest was related to the positive results dimension (65.29 ± 18.71). Also, the death anxiety score was 6.35 ± 1.99. The results from the linear regression analysis indicated an increase in negative emotions, correlating with an uptick in the death anxiety score (P = 0.001). Furthermore, retired individuals had a higher death anxiety score than those still working (P = 0.02). According to the results of this study, older adults with more negative emotions toward aging had higher death anxiety levels. Hence, interventions to foster positive emotions and attitudes towards aging are crucial to healthy aging. Moreover, considering the high level of death anxiety among retired people, further studies are required to investigate the mental health of this population.

We describe the coproduction, pilot implementation, and user evaluation of an evidence-based training intervention addressing prevention of Sudden Unexpected Deaths in Infancy (SUDI) for the multiagency workforce supporting vulnerable families with babies in a northern English county. We aimed in this pilot study to improve knowledge, skills, and engagement of professionals and support staff providing services for vulnerable families with increased risk of SUDI. The training intervention was co-produced by the academic team and the project Steering Committee which comprised senior leaders from the local authority, health and care sectors, and third-sector organisations, and rolled out to multiagency teams between November 2022 and March 2023. Evaluation data were collected using a post-training questionnaire, followed up by the Normalisation Process Theory (NPT) NoMAD survey issued at two time-points post-training, and interviews with stakeholders. The evaluation, conducted from January to May 2023, aimed to assess how well the multiagency workforce accepted SUDI prevention as part of their remit and incorporated SUDI prevention activities into their everyday work. Most multiagency professionals and support staff were enthusiastic about the training and their role in SUDI prevention. Fewer health professionals completed the training than expected. Forty percent (397/993) of invited staff completed the training. Our results revealed initial lack of knowledge and confidence around SUDI prevention and targeted provision for vulnerable families which improved following the Eyes on the Baby training. The proportion of nonhealth professionals rating their knowledge of SUDI prevention as good or excellent increased significantly from 28% before training to 57% afterwards. Self-rated confidence in discussing SUDI prevention with families increased significantly from 71% to 97%. Health professionals’ ratings increased significantly for knowledge from 62% to 96%, and confidence from 85% to 100%. Use of NPT allowed us to identify that by the time of evaluation, the earliest adopters were cognitively involved with the programme and engaged in collective action, while later adopters had not yet reached this stage. We conclude that effective implementation of multiagency working for SUDI prevention can be accomplished by providing clear training and guidance for all staff who have regular or opportunistic contact with vulnerable families. Our next step is to evaluate the sustainability of MAW SUDI prevention over the medium to long term and assess the responses of recipient families to this approach.

Studies have revealed an association between the built environment and the health of older adults. However, few studies distinguish between the objective and perceived built environments and explore their associations with older adults’ health, especially when considering housing differentiation. Drawing on a survey of 426 older adults in ten residential neighbourhoods in Dongfeng Township, Beijing, this study employed structural equation modelling and the Kruskal–Wallis test to analyse the relationship between the built environment of different housing types and older adults’ health. The findings revealed that the objective and perceived environments were significantly associated with older adults’ health, with physical activity and social interactions as mediating factors. The perceived built environment mediates the relationship between the objective built environment and older adults’ health. Moreover, it was observed that the relationship between the built environment and older adults’ health varied depending on housing type, which is a crucial reflection of spatial non-stationary in the relationship between health and environment. Therefore, the varying impacts of different housing types on older adults’ health should not be overlooked when developing planning and other policies for aging-friendly cities.

There has been an increasing acknowledgement in the UK of the importance of recognising frailty as a condition that leaves older people vulnerable to dramatic, sudden changes in health triggered by seemingly small events. In policy, the approach to managing frailty is often an emphasis on staying well with limited consideration to frailty as an end-of-life phase. Meanwhile, discharge from hospital continues to be complex. Overstretched acute hospitals are juxtaposed with community and social services that struggle to keep up with the demand of those being discharged and the labelling of older people as “bed blockers” at the centre of delayed discharges. This paper reports a study underpinned by constructivist grounded theory methodology, with the aim of exploring the experiences and perceptions of stakeholders. Semistructured interviews were conducted with 57 participants including patients, their informal carer(s), community hospital staff, community health professionals, and care home managers. The core category of “the drive to discharge conveyor belt” was derived from data analysis. A significant finding of this study was that of the carer, their burden, and their intrinsic role in facilitating discharge, filling in gaps in services, coordinating services, and enabling the patient to stay at home, with little consideration of their choices or autonomy. The “drive to discharge” impacts older people, their informal carers, and health professional. This study suggests how they may be supported, through an ethical lens.

Maternal mental health plays a vital role in the overall wellbeing of mothers, children, families, whānau (core support network) and communities. However, many mothers face mental health challenges during the transition to parenthood. In this study, we used an online story-sharing platform to collect the experiences of mothers who have faced unmet needs while using the Well Child Tamariki Ora (WCTO) service in Aotearoa New Zealand. From the 420 submitted stories, 125 stories related to mental health need while using the WCTO service. Using thematic analysis, we identified three main themes that highlighted the experiences of mothers with the service. This includes (1) making it seem that I’m coping: Mothers’ fear of being judged; (2) i wish I had connected with my WCTO nurse: Fostering meaningful relationships to facilitate personal information sharing; and (3) beyond the baby: Mothers desire for recognition and support during WCTO visits. These findings point to several missed opportunities for WCTO providers to inquire about mental health and offer support needed by mothers. To address this, a relational approach to care would prioritise families and whānau as the focus of care rather than just monitoring the development of babies.

Background. One in 5 people in the United States live with disability; however, the public health needs of this community have been largely overlooked. Although U.S. law mandates the availability of accessible medical exam equipment, people with mobility disabilities (PWMD) frequently encounter barriers that require self-advocacy to receive basic primary care. Objective. The purpose of this study was to qualitatively explore the impact of healthcare access barriers—specifically, the experiences of the need to self-advocate and factors that inform decisions to make accommodation requests—for PWMD. Methods. Qualitative semistructured interviews were performed across two phases of data collection with each of the 6 participants. Interpretative phenomenological analysis was used to highlight the essence of participants’ experiences in making decisions to request healthcare accommodation. Results. Participants included a purposive sample of self-advocates with physical disabilities (3 men and 3 women). While individual approaches to self-advocacy varied, participants identified a process of “recognizing the normalization of disability discrimination and disability stigma” which necessitates the development of “agency in self-advocacy.” This process has a lasting impact on people that includes a shared embodied experience of disability, as well as a sense of empowerment based on their collective and individual identities. Conclusions. Findings have implications for supporting individual disability consumer advocacy efforts as well as the need to address the normalization of disability discrimination within healthcare systems levels.

Objectives. Throughout the world, medical trainees have experienced psychological distress during the COVID-19 pandemic due to substantial changes in their educational programs and COVID-19 patient care. When medical trainees live with a disability, their psychological distress may be exacerbated. This study aimed to explore how having a disability may be associated with an additional emotional toll for medical trainees during the COVID-19 pandemic. Methods. Participants in the study were 201 medical trainees (62 interns and 138 residents) and 147 medical attending physicians in various fields of medicine. Participants completed an online survey including the Fear of COVID-19 scale, the Depression Anxiety and Stress Scale, and the Mental Health Continuum Scale measuring aspects of wellbeing, including emotional wellbeing, belonging, and sense of psychological meaning. Results. Disabled participants experienced higher levels of fear of COVID-19, depression, anxiety, stress, and lower levels of emotional wellbeing, sense of belonging, and psychological meaning compared to participants with no disabilities. Residents generally experienced higher stress levels and lower wellbeing levels than attendings. Residents living with disabilities were more prone to experience stress and fear of COVID-19, and residents and interns living with disabilities experienced higher levels of depression, anxiety, and stress compared to their peers who live without disabilities and compared to attendings living with disabilities. Conclusions. Medical trainees living with disabilities were more prone to experience high levels of psychological distress and lower levels of wellbeing during the COVID-19 pandemic compared to their peers without disabilities. Therefore, there is a need to address this emotional toll and provide support in medical education programs promoting trainees’ wellbeing, sense of belonging, and psychological meaning.

Alongside formal agencies and specialist services, informal and social networks play a pivotal role in responding to domestic abuse in the community. Friends, relatives, and neighbours are uniquely placed to recognise domestic abuse, respond to victim-survivors, and refer to wider services. Yet, informal networks may not know how to respond and feel overwhelmed or ill-equipped to offer support. This mixed method systematic review examined the role of training for equipping and enabling informal supporters to respond to disclosures of abuse. To do so, four bibliographic databases, alongside specialist repositories and websites, were searched for empirical studies of educational programmes tailored towards informal networks. Nine included studies were subject to data extraction and quality appraisal by two members of the review team. A thematic synthesis of qualitative data was undertaken to identify the characteristics of training deemed important by informal supporters. The findings focused on engaging informal supporters in the issue of domestic abuse, training content, materials, and delivery. The themes were translated into ten recommendations and juxtaposed with studies reporting quantitative evidence of effectiveness. The resulting matrix was used to identify five characteristics of successful training for informal supporters. These included training content that covered (a) warning signs and nature of domestic abuse, (b) impacts of abuse, and (c) how to respond/local resources. Tailoring training to the context/audience and the use of nontext formats were also evidenced by included studies. The review highlights the potential of educational programmes for enabling community responses to victim-survivors. Such interventions offer opportunities for formal agencies to collaborate with informal networks and strengthen the societal-wide response to domestic abuse.