Attitudes towards the use and acceptance of eHealth technologies : a case study of older adults living with chronic pain and implications for rural healthcare

Acknowledgements The research described here is supported by the award made by the RCUK Digital Economy programme to the dot.rural Digital Economy Hub; award reference: EP/G066051/1. MC’s time writing the paper is funded by the Scottish Government’s Rural and Environmental Science and Analytical Services Division (RESAS) under Theme 8 ‘Vibrant Rural Communities’ of the Food, Land and People Programme (2011–2016). MC is also an Honorary Research Fellow at the Division of Applied Health Sciences, University of Aberdeen. The input of other members of the TOPS research team, Alastair Mort, Fiona Williams, Sophie Corbett, Phil Wilson and Paul MacNamee who contributed to be wider study and discussed preliminary findings reported here with the authors of the paper is acknowledged. We acknowledge the feedback on earlier versions of this paper provided by members of the Trans-Atlantic Rural Research Network, especially Stefanie Doebler and Carmen Hubbard. We also thank Deb Roberts for her comments.Peer reviewedPublisher PD

Innovative Programs Serving Diverse Populations: The Community College Caregiver Training Initiative

Turnover among homecare workers is alarmingly high, due to difficult working conditions, low pay, few benefits and little opportunity for career advancement. The significance of our Community College Caregiver Training Initiative is reinforced by the recommendation by the Institute of Medicine in its 2008 report, Retooling for an Aging America, for improved education and training and support for professional caregivers

Citizens’ Juries: When Older Adults Deliberate on the Benefits and Risks of Smart Health and Smart Homes

open access articleBackground: Technology-enabled healthcare or smart health has provided a wealth of products and services to enable older people to monitor and manage their own health conditions at home, thereby maintaining independence, whilst also reducing healthcare costs. However, despite the growing ubiquity of smart health, innovations are often technically driven, and the older user does not often have input into design. The purpose of the current study was to facilitate a debate about the positive and negative perceptions and attitudes towards digital health technologies. Methods: We conducted citizens’ juries to enable a deliberative inquiry into the benefits and risks of smart health technologies and systems. Transcriptions of group discussions were interpreted from a perspective of life-worlds versus systems-worlds. Results: Twenty-three participants of diverse demographics contributed to the debate. Views of older people were felt to be frequently ignored by organisations implementing systems and technologies. Participants demonstrated diverse levels of digital literacy and a range of concerns about misuse of technology. Conclusion: Our interpretation contrasted the life-world of experiences, hopes, and fears with the systems-world of surveillance, e ciencies, and risks. This interpretation o ers new perspectives on involving older people in co-design and governance of smart health and smart homes

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time

Using a ‘wellbeing’ cost-effectiveness approach to improve resource allocation in social care

The promotion of wellbeing is the newly-stated guiding principle for the long-term care (social care) system in England. It signals a shift away from a focus on care need ‘deficits’ approach. Such a change in perspective has the potential to substantially alter how public care systems operate. The practical challenges are significant, both in the interpretation of wellbeing goals and in determining how the care system might be configured to achieve them. The main aim of this paper is to contrast a needs-led resource allocation system with one using a maximising wellbeing approach; that is, one based on: measuring the wellbeing consequences of using services and applying the principles of cost-effectiveness and opportunity cost. As a precursor, the paper also describes how a maximising wellbeing approach might be applied in the case of long-term care. We argue that in theory a maximising wellbeing approach with full information will produce greater total wellbeing improvement for the same budget than a needs-based system. In practice, the comparison will depend on: (a) whether we can actually measure wellbeing in a way that is consistent with the policy goals; (b) the availability of cost-effectiveness information; and (c) the decision rules used to implement a maximising wellbeing approach

Building Age-Friendly Community: Notes from the Field

Building age-friendly communities is a global as well as a national concern. The purpose of this paper is to explore fundamental tensions underlying the formulation of age-friendly goals and their implementation, based on a review of age-friendly projects and reflections on the journey towards age friendliness in one state (Rhode Island). The authors conducted a comprehensive investigation of the relevant literature on previous age-friendly initiatives, which included case studies of individual projects, meta-analyses of age-friendly work, and educational toolkits for promoting age-friendly community. They also collected original data from ten focus groups with older adults, interviews with key informant service providers, surveys of older adults and observational environmental audits. Through this multi-faceted approach, they identified recurrent questions often not overtly addressed in building livable communities, despite their being central to decisions made in age-friendly projects. This paper focuses on six questions: Age friendliness for whom? Older adults viewed as a burden or a benefit? Age friendliness by or for older adults? Is age friendliness affordable? Should the target be the aged overall or the needy aged in particular? Should interventions aim to change people or places? The Aging in Community Report, (prepared by the authors and submitted to Rhode Island’s General Assembly), reflected decisions made—albeit sometimes inadvertently—in response to these questions. It showed that priority was given to age friendliness over livability, assistance to vulnerable, older adults was given precedence over helping the entire older population, and top-down interventions were emphasized more than grass-roots endeavors. Its recommendations were geared to leveraging or modestly increasing existing resources to better serve older adults and enhancing opportunities for older adults to contribute to their community. Following the release of the report, the focus shifted from modifications of the environment to facilitating changes in individual behavior to optimize person-environment fit

Healthy People in a Healthy Economy: A Blueprint for Action in Massachusetts

Examines the recession's effects on health and the cost of chronic disease. Suggests proven strategies for schools, municipalities, state government, payers, employers, the food industry, physicians, philanthropies, and media to promote healthy behaviors