Health & Social Care in the Community最新文献

Background and Objectives. Older adults who lack a secure sense of social belonging may report loneliness, isolation, and ostracization in their communities. Little attention has been paid to the perceptions of social belonging among immigrant Muslim older (IMO) women. This study aimed to address this gap by exploring IMO women’s experiences of social belonging. Research Design and Methods. This qualitative descriptive study used photo elicitation and narrative interviewing to draw on the experiences of 14 IMO women living in Edmonton, Canada. An integrative framework of social belonging was used to guide theoretical conceptualizations of what comprises belonging, and a thematic analysis approach was used to highlight factors and influences that shape how participants have constructed their experiences of belonging. Results. The findings suggest that a sense of belonging is influenced by feelings of loneliness and loss, opportunities for community engagement, and social competencies related to maintaining family relationships. Additionally, the findings indicate the importance of IMO women’s perceptions and reflections on aging as these shape their sense of belonging. These findings not only provide insight into the intricate and shifting nature of belonging but also emphasize the need for structural support to benefit both IMO women and the communities they reside in. Discussion and Implications. Cultivating belonging is a collective responsibility involving older women, their social networks, and society at large, including government and public services. A sense of belonging is crucial to counter ageism and promote positive self-perceptions of aging, particularly within ethnocultural communities.

Introduction. Young people with intellectual/developmental disabilities (IDDs) are often placed in residential educational placements. There is little research examining the use of such placements and outcomes following these, despite emerging recognition that they may be linked to out-of-area placements in adulthood (which are themselves often linked to poor outcomes for individuals). This study aimed to examine the characteristics of young people with IDD transitioning from a residential educational setting in England, describe post-transition placement characteristics, and identify factors that predict post-transition placement location. Methods. All residential educational placements in England were invited to complete a survey about the setting (e.g., size, pupil characteristics, specialism, and fees) and anonymous questionnaires for each young person with IDD who had recently transitioned from the setting (focusing on young person characteristics, educational placement, and post-transition placement characteristics). Results. Responses were received for 47 residential educational settings and 320 young people. Young person characteristics differed between those who had attended a school or a college. 35.9% of post-transition placements were out-of-area, with 31.2% of home-area placements being in the family home. Out-of-area placement was found to be significantly predicted by young person characteristics, prior placement in a residential school, post-transition placement in residential care, or in a setting that was linked to the educational placement. Discussion. Extrapolation from the current study suggests that several hundred young people transition from residential educational settings each year, more than a third of whom are likely to be transitioning to an out-of-area placement. This underscores the importance of improved support for this population around their transition. Implications for policy and practice are highlighted.

Objective. This study used a random-intercept cross-lagged panel model (RI-CLPM) to explore the longitudinal relationship between cognitive function (CF) and subjective well-being (SWB) for older adults and investigate if older adults with cognitive decline can be happy. Older adults were divided into two groups according to gender, and the effect of gender with different groups on CF and SWB was discussed. The effects of age, marital status, self-rated health, exercise, and education level on the CF and SWB were investigated. Methods. This study adopted a longitudinal design and selected 4,672 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which spanned 3 time points from 2008 to 2014 (N = 4,672). The mean age was 78.18 years (SD = 9.75, range = 61–111) and 2,238 (47.9%) were males. The CF was measured using the cognitive function scale, and the SWB was measured using 6 questions related to positive and negative emotions from CLHLS. Results. (1) The chi-square difference test between the two models further showed that the RI-CLPM fitted data significantly better than traditional CLPM (∆χ² (3) = 203.656, p < 0.001). The RI-CLPM was more suitable for this study than the CLPM. (2) This study examined whether the relationship between CF and SWB for older adults was bidirectional or unidirectional. The article only partially supported them, which indicates that including the gender role was successful. (3) Self-rated health, exercise, and education level had a significant positive impact on both CF and SWB. The only distinguishable factor that affects CF between males and females is the marital status. The effect for female CF is not significant (β = −0.001, p = 0.961), but the effect for male CF is significant (β = −0.146, p < 0.001). Conclusion. Gender discrimination is necessary to better understand the impact of cognitive decline on SWB. Female older adults with cognitive decline could be happy, but male older adults could not. Male CF is more affected by marital status than females. It is more important to care about the cognitive decline of unmarried male older adults. Older age and unmarried males are risk factors for older adults, but better self-rated health, more regular exercise, and continuous learning are the protective factors for older adults. These risk factors need to be prevented and these protective factors should be strengthened.

Background. Professionalism in collaboration means working based on competencies and ethics, showing accountability and respect in communication and care by each professional group. It is required to ensure seamless, integrated, and quality of care for patients. Previous research has focused on professionalism among single professional groups; little is known about how ethics of professionalism appear in collaboration between different professional groups. Our aim was to fill the gap in this knowledge. The objectives of the study were how health and social care workers evaluated professionalism in collaboration, how professionalism was associated with the various professional groups, and how it was related to the personal characteristics of the workers. Methods. A cross-sectional study with an online survey was conducted in collaboration with 15 professional trade unions in Finland. The 26-item Interprofessional Professionalism Assessment questionnaire was used. The R program, version 4.0.2, was used for advanced descriptive and statistical methods. Results. Together, 1,769 trade union members participated in the study, representing eight professional groups and students from care, rehabilitation, and social services. The mean professionalism score was 4.20 ± 0.70 out of 5, suggesting excellent professionalism in collaboration. Care assistants, childcare and youth workers, and nurses scored professionalism statistically significantly higher than social workers (p < 0.001). Participants who experienced mutual ethical reflections at work (p < 0.001), received organizational support for ethical practice (p < 0.01), and experienced satisfaction at work (p < 0.001) scored professionalism statistically significantly higher. Conclusions. Professionalism in collaboration between health and social workers was very consistent and strong, despite the fact that different professional groups participated in the survey. Organizations should further work satisfaction and opportunities to participate in shared ethical reflection. Future studies should investigate organizational structures and leadership that support this kind of well-executed professionalism in collaboration between professional groups and if workers recognize these.

Background. Local government is important for health equity because local policies often affect place-based health, health equity, and their wider social determinants of health. In England, local governments must produce Joint Health and Wellbeing (JH&W) Strategies, outlining local strategies for health improvement. These strategies have been produced concurrently with budget cuts to local governments that are associated with adverse health and mortality outcomes. Using a novel approach, we assessed whether English local governments’ strategies for place-based health and equity help explain why some disadvantaged areas have better mortality trends than others. Methods. We sampled “Joint Health and Wellbeing” (JH&W) Strategies for 20 disadvantaged localities covering the years 2013–2017. We sampled areas to include some with larger and some with smaller budget cuts. We developed a qualitative appraisal process for scoring the extent to which JH&W strategies focused on (i) place-based social determinants of health and (ii) health equity. Using qualitative comparative analysis, we assessed whether mortality trends might be explained by JH&W scores or wider contextual factors such as budget cuts, population age, and disadvantage. Results. JH&W strategies on place-based social determinants of health and equity were often underdeveloped. Only a minority of strategies were highly rated (i.e., scoring >2 out of 3) for addressing social inequalities of health (n = 6), and even fewer scored highly for place-based social determinants of health (n = 3). Our qualitative comparative analysis found that external and contextual factors (e.g., budget cuts and disadvantages) offer more plausible explanations than JH&W strategies for place variations in life expectancy trends. Conclusion. Budget cuts and other contextual factors better explain mortality trends than JH&W strategies. This raises concerns about what such strategies can realistically achieve in the face of structural disadvantage and national policies that restrict local spending.

Background. Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. This systematic review examines the effectiveness of community-based multidisciplinary integrated care strategies with general practitioner (GP) participation for community-dwelling older adults and describes the level of care integration in each study. Methods. PubMed, Embase, CINAHL, Central Register of Controlled Trials in the Cochrane Library, and MEDLINE were systematically searched in February 2024. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community-dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence, and used the rainbow model of integrated care taxonomy to describe the elements of integrated care. Outcomes included functional status, healthcare utilisation, participant satisfaction with care, health-related quality of life, mortality, nursing home admission, and adverse outcomes. Meta-analyses were performed using Review Manager 5.4. Results. Twelve trials recruiting 8069 participants across 8 countries were included. Community-based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD): 0.21; 95% confidence interval (CI): 0.05–0.37; low certainty evidence), hospitalisation (risk ratio (RR): 0.77; 95% CI: 0.63–0.95; very low certainty evidence), and participant satisfaction with care (SMD: 0.46; 95% CI: 0.15–0.76; low certainty evidence) from 12 to 36 months. No statistically significant effects favouring community-based MDT interventions for functional status at 6-month follow-up, emergency department presentation, mortality, health-related quality of life, or nursing home admission were established. Conclusion. Community-based MDT integrated care with GP participation improves functional status, reduces hospitalisations, and increases patient satisfaction among community-dwelling older adults in the long term. Future research should focus on models of integrated care that respond to the needs and preferences of older adults. This trial is registered with CRD42022309744.

The decision to move from independent to supported housing is a key life decision. Research focusing on the potential barriers to transition to supported housing for people with hoarding behaviours and the impact of social networks on the decision-making process is scarce. 16 participants, including 4 participants with hoarding behaviours, took part in in-depth semistructured interviews providing information about their social networks, support received, their perceptions of supported housing, and their decisions made. Relatives and friends were the most widely reported networks of support for discussing supported housing options for participants both with and without hoarding behaviours. Three key themes were extracted from the dataset: Before the Move: Crisis and Stigma; During the Move: Possessions and Support; and After the Move: Supported Housing = a Bright Tomorrow. The data revealed stigmatised and negative perceptions of supported housing prior to moving, with a crisis event initiating the move in most cases. For people with hoarding behaviours, existing life traumas proved an additional barrier. All participants reported “moving day” as an acutely stressful event, and participants with hoarding behaviours reported greater stress and anxiety over possessions. All moved participants reported living in supported housing as a positive outcome. Three key considerations are apparent: awareness raising to combat stigmatised perceptions of supported housing; targeted support during the moving process to manage and pre-empt problems; promoting supported housing as a positive environment and making participants, and their networks aware, potentially reducing the perceived impact of the move. Further research with a larger, and more socially and geographically diverse sample of individuals with and without hoarding behaviours, is recommended to further explore these considerations.

Family doctors serve as the initial contact for individuals seeking regular medical service like routine physical exam, diagnosis, and treatment of illness. Nonetheless, immigrant population who do not speak the official language usually prefers receiving healthcare in their own mother tongues. Past studies have focused on exploring accessibility to family doctors speaking Mandarin Chinese, which is not mutually intelligible with another major Chinese language called Cantonese. Despite the significant number of Cantonese-speaking population in the Greater Toronto Area (GTA) and a recent wave of immigration from Hong Kong, China (hereafter “Hong Kong”) to Canada, little knowledge has been obtained regarding the geographic accessibility to Cantonese-speaking family doctors. This study seeks to fill the knowledge gap of spatial accessibility to Cantonese-speaking family doctors in the GTA by using the two-step floating catchment area (2SFCA) method. By considering the vulnerability in terms of spatial accessibility and attractiveness to the new immigrants from Hong Kong, we have unveiled that more than 90% of neighbourhoods, with below-median accessibility scores across all five thresholds yet high likelihood of attracting new Hong Kong immigrants, are clustered within four lower-tier municipalities of Markham, Toronto, Richmond Hill, and Vaughan. This study not only sheds lights on the knowledge gap but also provides timely guidance in formulating public health policies in light of the incoming Cantonese-speaking immigrants from Hong Kong.

Postwar migrants from the Caribbean and Indian subcontinent (Bangladesh, India, and Pakistan) to the UK are now experiencing the onset of age-related diseases such as dementia. Our evidence base, both quantitative and qualitative, documenting the experiences of family caregivers of people with dementia is largely drawn from studies undertaken with white European, North American, and Australasian populations. Consequently, there is a need for research in the field of dementia caregiving to reflect the increasing diversity in ethnic identities of the older adult population of the UK. Using semistructured interviews, we investigated the experiences of 18 caregivers of people with dementia in Black Caribbean, Black African, and South Asian (Indian, Pakistani, and Bangladeshi) communities in England. Participants were recruited from the Join Dementia Research platform and were predominantly female intergenerational carers. We identified the following three themes: motivation to care (spending time with the care recipient and reciprocity), positive and negative consequences of caregiving (rewards and consequences), and the cultural context of caregiving (cultural norms and values supporting caregiving and negative attitudes towards dementia). Our findings develop existing literature by identifying (a) the importance of spending time with the person they care for, (b) the absence of faith as a caregiving driver, and (c) the challenge of watching the declining health of a parent. We highlight how the different motivations to care are intertwined and dynamic. This is illustrated by the linking of obligation and reciprocity in our dataset and positive and negative experiences of caregiving.

Despite increased incidence of stroke in young adulthood across the world, young adults report significant difficulties finding services with the expertise and experience to meet their needs. This service mapping study sought to identify and characterise the availability, accessibility, and accommodation of services to meet the needs of young adults (aged 18–44 years) with stroke in two Australian states. Methods. Relevant clinical, rehabilitation, and allied health services were systematically identified from previous publications; the National Health Service Directory; professional association “find a provider” listings; and Stroke Foundation service lists. Desktop audit (n = 465 services) and key informant interviews (n = 321 services) were used to collect service design and delivery characteristics; level of experience, confidence, and willingness to work with young adults with stroke; and accommodation of communication impairments. Results. Most services (85%) were in major cities or inner regional areas. No services worked solely with young adults with stroke; however, several reported having relevant expertise, training, experience, and programmes to provide neurological rehabilitation to meet the needs of young adults with stroke. Reported willingness (91.0%) to work with young adults with stroke was high, but only 57.0% were very confident to do so. Most services with neurorehabilitation expertise addressed psychosocial recovery needs (e.g., emotional adjustment and relationships) as well as functional recovery, but few supported return-to-driving, peer support, and sensory processing disturbances. Further gaps were the use of accessible communication materials in only 50.2% of services, and staff had completed communication training at only 60.4% of services. Conclusion. Findings highlight that while expert neurorehabilitation services exist, they are not sufficiently available, accessible, or accommodating of the needs of young adults with stroke. There remains a need to improve access to services where clinicians have the skills to meet the rehabilitation needs of young adults with stroke in Australia.