Health Care for the Older Person

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    Cross-cultural comparison of attitudes and preferences for care of the elderly among Australian and Chinese nursing students
    (SAGE Publications, 2013-07-10) Xiao, Lily Dongxia; Shen, Jun; Paterson, Janice Betty
    Purpose: The aim of this study was to compare Australian and Chinese nursing students’ attitudes and intentions to care for the elderly and the factors affecting these intentions. Method: A cross-sectional design employed two questionnaires to survey 256 Australian nursing students and 204 Chinese nursing students within the first weeks of their nursing curriculum. Factor analysis and logistical regression analysis were performed to identify predictors of intent to care for the elderly. Results: The percentage of students more likely to care for the elderly was significantly higher among the Chinese group (72.1%) than the Australian group (45.3%). Work experience with older people and being under the age of 20 were found to be positive predictors, whereas factors such as prejudice toward the elderly and beliefs that elders should live in separate housing were negatively associated with an intention to care for the elderly. Conclusions: The collectivist culture has a more positive influence on nursing students’ attitudes toward the elderly compared with the individualist culture. Implications for Research and Practice: It is highly recommended that elderly care settings should be incorporated in clinical placements and further research is needed to explore how clinical experience affects students’ career choice.
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    Factors affecting nursing students' intention to work with older people in China
    (Elsevier, 2012-04) Shen, Jun; Xiao, Lily Dongxia
    Summary Background In Western countries, caring for older people was viewed as an unattractive area by nursing students. The literature reported a number of barriers, including ageism that contributed to this undesirable situation. Aim The purpose of this study was to explore factors affecting nursing students' intention to work with older people in a university in China. Method A cross-sectional survey was conducted with 622 nursing students enrolled in a 4-year Bachelor of Nursing programme at the university. Data analysis methods mainly included Chi-Square test, Mann–Whitney test, factor analysis and logistical regression. Results Working with older people was ranked as the second to least preferred area by nursing students. Ageist attitudes described as Prejudice was negatively associated with intention to work with older people; while students aged under-20 were more positively associated with an intention to work with older people. Conclusion Nursing curriculum should be designed to target ageist attitude, by promoting socialisation with older people and creating more supportive learning environments in the care setting of older people.
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    Factors contributing to caregiver burden in dementia in a country without formal caregiver support
    (Taylor & Francis, 2014-03-31) Wang (RN), Jing; Xiao, Lily Dongxia; He, Guo-Ping; Ullah, Shahid; De Bellis, Anita Marie
    Objectives: To investigate caregiver burden in dementia and explore factors associated with different types of burden in a country without formal caregiver support using a province in China as a case.Method: Cross-sectional questionnaire survey was used to collect data. One hundred and fifty-two family caregivers of people with dementia in community settings were recruited from 2012 to 2013 using convenience sampling. Objective burden was measured by caregiving hours and dementia-related financial burden. Subjective burden was measured and analysed using the Caregiver Burden Inventory and the Neuropsychiatric Inventory-Questionnaire. Multivariate regression models were employed to analyse factors associated with each type of subjective burden.Results: Five types of subjective burden were measured by the Caregiver Burden Inventory, namely, physical burden, emotional burden, time-dependence burden, developmental burden, and social burden. Caregiver distress, as a subjective burden, was measured by the Neuropsychiatric Inventory-Questionnaire and reported by relating to the severity of care recipients’ behavioural and psychological symptoms of dementia. This caregiver cohort showed a high level of physical, time-dependence, and developmental burdens, but a low level of emotional and social burdens. Factors contributing to each type of subjective burden measured by the Caregiver Burden Inventory differed from each other.Conclusion: The high level of objective and subjective burdens identified in this study suggests that government-funded formal caregiver support should be established and services should be designed to target different types of burdens and factors contributing to these burdens.
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    Family caregiver challenges in dementia care in a country with undeveloped dementia services
    (Wiley, 2014-06) Wang (RN), Jing; Xiao, Lily Dongxia; He, Guo-Ping; De Bellis, Anita Marie
    Aims To examine socially, culturally and politically constructed factors affecting family caregiver practice in dementia care, and to identify possible changes in a country with undeveloped dementia services. Background In China and many other low- and middle-income countries, social transformations are weakening the family care model, which has an impact on the population with dementia. Exploring the challenges that caregivers face may help the international healthcare community to improve dementia services. Design A double hermeneutic approach informed by Giddens' Structuration Theory was used. Methods In-depth semi-structured interviews with 23 family caregivers of people with dementia were conducted in 2012. The interviews were audiotaped, transcribed and analysed. Findings Analyses revealed three consequences of socially constructed factors in dementia care, which constrained caregiver practice. First, caregivers were unable to manage behavioural and psychological symptoms of dementia. Untreated aggressive behaviours caused harm to the person with dementia and endangered the caregiver and the public. Second, the burden on the primary caregiver was evident and caregivers received limited support. Third, there was little coordination between primary and specialist care services for people with dementia. On critical reflection of potential changes that could improve dementia services, caregivers suggested that community nurses have a leading role in coordinating dementia services and supporting caregivers. Conclusion Relying on family caregivers to care for people with dementia without the prevision of dementia services by the public healthcare system generates negative health outcomes for both care recipients and caregivers. The nursing workforce should be developed to support dementia services.
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    Family caregiver challenges in dementia care in Australia and China: a critical perspective
    (BioMed Central, 2014) Xiao, Lily Dongxia; Wang (RN), Jing; He, Guo-Ping; De Bellis, Anita Marie; Verbeeck, Jenny; Kyriaxopoulos, Helena
    Background: Both Australia and China have a large proportion of people with dementia and the prevalence will triple in Australia and increase five times in China by 2050. The majority of people with dementia are reliant on family caregivers to provide daily care and to maintain the dignity in both countries. As a consequence, caregiver burden has become a major concern because of the negative impact on the care recipients’ and the caregivers’ health. It is strongly recommended that cross-national collaboration should be conducted to share experiences in fighting dementia. The aim of this study was to compare socially and culturally constructed enablers and barriers pertinent to dementia caregivers in one capital city in Australia and one capital city in China through critical reflection on the caregivers’ subjective and objective experiences for the improvement of dementia care services in both countries. Methods: Giddens’ Structuration Theory was used as a framework to guide a concurrent mixed methods design with the qualitative strand as a priority. In the qualitative strand, data were collected by focus groups and in-depth interviews while in the quantitative strand, data were collected by questionnaire survey. Results: In total 148 caregivers participated in the project with 57 of them from Australia (26 and 31 in the qualitative and quantitative strands respectively) and 91 of them from China (23 and 68 in the qualitative and quantitative strands respectively). Findings from the qualitative and quantitative strands were presented as three categories: A higher objective burden in the Chinese cohort versus a higher subjective burden in the Australian cohort; Unmet need for caregiver support in Australia and China; and Expectations for improving dementia services in Australia and for developing dementia services in China. Conclusions: Dementia policy, services and resources need to be grounded on current research evidence in an ever-changing society like China. In Australia, dementia services need to have more components of preventing or reducing caregivers’ subjective burden. As subjective burden is mediated
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    General practitioners' knowledge of ageing and attitudes towards older people in China
    (John Wiley & Sons, 2013-10-09) Yang, Yanni; Xiao, Lily Dongxia; Ullah, Shahid; Deng, Lanlan
    Aim To explore general practitioners (GPs)' knowledge of ageing, attitudes towards older people and factors affecting their knowledge and attitudes in a Chinese context. Methods Four hundred GPs were surveyed using the Chinese version of the Aging Semantic Differential (CASD) and the Chinese version of the Facts on Aging Quiz (CFAQ1) scale. Results The CASD scores indicated that GPs had a neutral attitude towards older people. The CFAQ1 scores indicated a low level of knowledge about ageing. GPs' awareness of the mental and social facts of ageing was poorer compared to that of physical facts. Male GPs had a significantly higher negative bias score than female GPs. No other variables had a statistically significant influence on knowledge and attitudes. Conclusions The findings suggest the need for education interventions for GPs regarding knowledge of ageing and also provide evidence to guide future development of continuing medical programs for this group of medical doctors.
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    An Innovative Continuing Nursing Education Program Targeting Key Geriatric Conditions for Hospitalized Older People in China
    (Taylor & Francis, 2013-05-23) Xiao, Lily Dongxia; Shen, Jun; Wu, Haifeng; Ding, Fu; He, Xizhen; Zhu, Yueping
    A lack of knowledge in registered nurses about geriatric conditions is one of major factors that contribute to these conditions being overlooked in hospitalised older people. In China an innovative geriatric continuing nursing education program aimed at developing registered nurses’ understanding of the complex care needs of hospitalised older people with common geriatric conditions were conducted and evaluated. The program consisted of didactic sessions focused on evidence-based practice and unfolding case study designed to simulate the care trajectory of an older person with a hip fracture and key geriatric conditions. Findings from the program evaluations revealed a significant increase in attitudes towards older people and knowledge concerning common geriatric conditions. The satisfactory rate ranked by program participants was 90%. The study therefore drew the conclusion that effective geriatric continuing nursing education should target participants’ learning needs, support evidence-based practice and engage participants in active learning.
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    Nurse-led cognitive screening model for older adults in primary care
    (John Wiley & Sons, 2014-09-26) Yang, Yanni; Xiao, Lily Dongxia; Deng, Lanlan; Wang, Yan-Jiang; Li, Min; Ullah, Shahid
    Aim The present study aimed to establish a nurse-led cognitive screening model for community-dwelling older adults with subjective memory complaints from seven communities in Chongqing, China, and report the findings of this model. Methods Screenings took place from July 2012 to June 2013. Cognitive screening was incorporated into the annual health assessment for older adults with subjective memory complaints in a primary care setting. Two community nurses were trained to implement the screening using the Mini-Mental State Examination and Montreal Cognitive Assessment. Results Of 733 older adults, 495 (67.5%) reported having subjective memory complaints. Of the 249 individuals who participated in the cognitive screening, 102 (41%) had mild cognitive impairment, whereas 32 (12.9%) had cognitive impairment. A total of 80 participants (78.4%) with mild cognitive impairment agreed to participate in a memory support program. Participants with cognitive impairment were referred to specialists for further examination and diagnosis; only one reported that he had seen a specialist and had been diagnosed with dementia. Conclusions Incorporating cognitive screening into the annual health assessment for older adults with subjective memory complaints was feasible, though referral rates from primary care providers remained unchanged. The present study highlights the urgent need for simple screenings as well as community-based support services in primary care for older adults with cognitive or mild cognitive impairments.
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    Prevalence of faecal incontinence in community-dwelling older people in Bali, Indonesia
    (John Wiley & Sons, 2014-04-14) Suyasa, I Gede Putu Darma; Xiao, Lily Dongxia; Lynn, Penelope Ann; Skuza, Pawel Piotr; Paterson, Janice Betty
    Aim To explore the prevalence rate of faecal incontinence in community-dwelling older people, associated factors, impact on quality of life and practices in managing faecal incontinence. Method Using a cross-sectional design, 600 older people aged 60+ were randomly selected from a population of 2916 in Bali, Indonesia using a simple random sampling technique. Three hundred and three participants were interviewed (response rate 51%). Results The prevalence of faecal incontinence was 22.4% (95% confidence interval (CI) 18.0–26.8). Self-reported constipation (odds ratio (OR) 3.68, 95% CI 1.87–7.24) and loose stools (OR 2.66, 95% CI 1.47–4.78) were significantly associated with faecal incontinence. There was a strong positive correlation between total bowel control score and total quality-of-life score (P < 0.001, rs = 0.61) indicating significant alterations in quality of life. The current management practices varied from changing diet, visiting health-care professionals, and using modern and traditional medicines. Conclusion Faecal incontinence is common among community-dwelling older people in Bali.
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    以人为中心照护服务测评量表的研究进展
    (China Academic Journal Electronic Publishing House, 2013) Wang, Yan-Jiang; Xiao, Lily Dongxia; Wang (RN), Jing; De Bellis, Anita Marie; He, Guo-Ping
    【摘要】目前以人为中心的照护服务被广泛应用于医疗护理领域，国内外常用的以人为中心照护服务的测评量 表主要有两大类: 针对老年痴呆症患者的评定量表和用于老年护理的普适性量表。本文就以人为中心照护服务的测评 工具在老年护理和痴呆症照护中的应用及研究进展进行综述。应加强以人为中心照护服务测评量表的研究，发展并制 定出适合我国国情的量表，才能更好地评价照护服务的质量，同时为制定干预策略提供依据。 Abstract: Person - centered care is used widely in the field of medical care at present． There are mainly two categories of person - centered care assessment tools． One category is for the Alzheimer's disease，and the other is for the elderly care． In this paper we review the application of the person - centered care assessment tools in the elderly care and care for the patients with Alzheimer's disease，and the progress in research of the tools． It is necessary to enhance the research on person - centered care assessment tools so as to develop the tools that are suitable for our national conditions in order to assess the quality of care better and provide basis for the intervention.
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    发展性案例讨论法在中国老年护理继续教育中的应用
    (Zhongguo Laonian Xuehui, 2012) Xiao, Lily Dongxia; Shen, Jun; Liu, H
    【摘要】 <正>20世纪90年代,老年护理学才陆续被我国多所护理高等院校列为必修课程。这就造成大多数护士缺乏系统的老年护理知识〔1〕,因此,举办各种类型的老年护理继续教育,提高护士老年护理知识和技能尤为重要。国家卫生部于1997年颁发了《继续护理教育暂行规定》和《继续护理学教育学历授予试行办法》,对继续护理学教育的对象、时间、内容和形式都作了详 English Abstract : in the 1990s, before being gerontological nursing is a compulsory course of more than nursing colleges. This has resulted in the majority of aged care nurses lack of systematic knowledge [1], therefore, held various aged care continuing education, to improve the knowledge and skills of nurses aged care is especially important. Ministry of Health issued the "Interim Provisions continuing nursing education" and "continuing nursing education qualifications awarded pilot scheme", for the object of continuing nursing education, time, content and form have been detailed in 1997
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    影响一年级本科护生从事老年护理工作的因素
    (Zhongguo Laonian Xuehui, 2013) Shen, Jun; Xiao, Lily Dongxia; Wu
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    教育干预对护士预防老年住院患者跌倒知识和态度及行为的影响研究
    (China Academic Journal Electronic Publishing House, 2013) He, HY; Liu, H; Shen, Jun; Xiao, Lily Dongxia
    目的 对临床护士实施预防老年住院患者跌倒教育干预,评价干预措施对护士预防老年住院患者跌倒知识、态度、行为的影响.方法 采用方便抽样法,选取参加我市2012年老年护理继续教育培训大会的74名护士为研究对象,通过一系列教育干预,对比干预前后护士在预防老年住院患者跌倒知识、态度、行为等方面的改变,评估干预措施的效果.结果 74名护士均对培训满意;培训前护士预防老年人跌倒知识的中位得分18分,培训后中位得分26分,培训前后得分间差异有统计学意义(Z=-7.270,P=0.000).干预前后护士对老年人的总体态度和消极态度得分间差异均有统计学意义(P＜0.05),但积极态度间差异无统计学意义(P＞0.05).179份(95%)问卷明确表示护士在工作中运用了培训所学的知识.结论 对临床护士进行有组织、有计划的教育干预能改善护士对待老年人的态度,提高护士预防与处理老年住院患者跌倒的知识水平,并能对护士预防和处理老年住院患者跌倒的行为产生积极影响. English Abstract: The purpose of the clinical nurses fall prevention educational intervention in elderly hospitalized patients, evaluation of interventions for prevention nurse falls in elderly inpatients impact of knowledge, attitude and behavior. Methods convenience sampling method, choose to participate in the city in 2012 aged care continuing education and training of the General Assembly 74 nurses for the study, through a series of educational intervention, nurses change in the prevention of falls in elderly hospitalized patients with the knowledge, attitude, behavior, and to assess the effect of interventions before and after the intervention results 74 nurses were satisfied with the training; former training Prevention of falls among the elderly nurse median knowledge score 18 points, the median score after 26 minutes of training, before and after the training had a significant difference between scores (Z = -7.270, P = 0.000). The overall attitude of nurses before and after the intervention of the elderly and negative attitude scores were statistically significant differences between (P <0.05), but the difference between a positive attitude no significant (P> 0.05) .179 parts (95%) used the questionnaire made it clear that nurses have learned on the job training knowledge. Conclusion clinical nurses organized and planned educational intervention can improve the nurse's attitude towards the elderly, to improve the prevention and treatment of nurses falls in elderly inpatients level of knowledge, and is able to nurse the prevention and treatment of falls in elderly inpatients behaviors have a positive impact.
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    老年痴呆患者家庭照护者负担及其应对策略
    (Zhongguo Laonian Xuehui, 2014) Wang (RN), Jing; Xiao, Lily Dongxia; He, Guo-Ping
    【摘要】：正老年痴呆主要包括阿尔茨海默病和血管性痴呆,患者表现为认知功能损害和精神行为症状,最终生活无法自理,不仅严重影响患者的生活质量,也给家庭和社会带来沉重的负担〔1〕。由于照护的性质,如照护者需要24 h不间断地看护痴呆症老人以及在应对痴呆症老人精神和行为症状过程中的困难,照护居家痴呆症老人被公认为是一项极具挑战性的工作〔2,3〕。各种并发症如尿失禁、压力性溃疡、跌倒及营养不良所致的髋关节骨折等进一步加重了痴呆老人的照护需求。据文献报道,高达.