Geriatricians' views of advance decisions and their use in clinical care in England: qualitative study

Background: an anticipatory decision document records a person's wishes regarding medical treatment at a time when they have capacity to make choices, to be enacted when this capacity is lost. In England and Wales an advance decision to refuse treatment (ADRT, or advance decision), a legally binding document, is currently rarely used. A disparity is suggested to exist between physicians' support for anticipatory decisions in principle and their lack of impact on decision-making in practice. Objective: to elicit geriatricians' views on advance decisions and their use in decision-making in England. Design: a qualitative approach was taken. Semi-structured interviews were conducted with 10 geriatricians. An inductive approach was used for data analysis. Results: geriatricians held positive views on anticipatory decisions in principle. In practice, they reported being highly likely to follow a decision which was in line with their clinical view. They would also favour an ADRT which was prescriptive in terms of the situation and treatment to which it applied. However, geriatricians expressed concerns in relation to patient understanding of the role and limits of these documents. Participants expressed discomfort in following an ADRT which, in their professional opinion, did not represent the patient's best interests, despite it being a legally binding document. A conflict between doctors' beneficence and patients' autonomy was apparent, with geriatricians differing in their views on how ADRTs should fit into medical decision-making; particularly how far anticipatory decisions can represent ongoing patient autonomy. Conclusion: despite their status in law, an ADRT which conflicts with a geriatrician's clinical opinion may not be implemented, in breach of the Mental Capacity Act. To avoid this, they must be seated within wider advance care planning. © The Author 2011. Published by Oxford University Press on behalf of the British Geriatrics Society

Older care-home residents as collaborators or advisors in research: a systematic review

Background: patient and public involvement (PPI) in research can enhance its relevance. Older care-home residents are often not involved in research processes even when studies are care-home focused. Objective: to conduct a systematic review to find out to what extent and how older care-home residents have been involved in research as collaborators or advisors. Methods: a systematic literature search of 12 databases, covering the period from 1990-September 2014 was conducted. A lateral search was also carried out. Standardised inclusion criteria were used and checked independently by two researchers. Results: 19 reports and papers were identified relating to 11 different studies. Care-home residents had been involved in the research process in multiple ways. Two key themes were identified: (i) the differences in residents’ involvement in small-scale and large-scale studies, (ii) the barriers to and facilitators of involvement. Conclusions: small-scale studies involved residents as collaborators in participatory action research, whereas larger studies involved residents as consultants in advisory roles. There are multiple facilitators of and barriers to involving residents as PPI members. The reporting of PPI varies. While it is difficult to evaluate the impact of involving care-home residents on the research outcomes, impact has been demonstrated from more inclusive research processes with care-home residents. The review shows that older care-home residents can be successfully involved in the research process

A preliminary report on the Rural Neighbourhood Development Project in Tuen Mun and Yuen Long : implementation and achievement

With funding support from the Hong Kong Jockey Club Charities Trust, the Asia-Pacific Institute of Ageing Studies (APIAS) of Lingnan University collaborated with Tuen Tsz Wai San Hing Tsuen Tsing Chuen Wai Rural Community Service Centre of Yan Oi Tong and Ngau Tam Mei Community Development Project of the Salvation Army to launch the first batch of professional support team-led (PST) district-based programme: Jockey Club Age-friendly City Project – Rural Neighbourhood Development Project (the programme) in April 2018. The programme provided training to residents in Tuen Mun and Yuen Long rural areas to be Rural Befrienders, they were well-equipped with skills to regularly visit older persons residing in nearby areas, raise awareness among the older persons about home safety and fall prevention, and foster connection between the older persons and Rural Befrienders as well as their neighbourship by establishing a support network in rural areas. The programme also invited an occupational therapist to do home assessments and make changes to the older persons’ living environment in order to achieve the long-term goal of ageing in place. Ageing in place is considered to be a critical global approach to caring for older persons. The framework promotes an agenda that support older persons to live in a familiar environment and enjoy added autonomy, which is beneficial to their physical and mental health. Hong Kong Government has also embraced the concept of ageing in place in the elderly care policy. Accordingly, the government recently initiated different programmes for Community Care and Support Services to facilitate ageing in place by engaging older persons in their communities. However, the current social environment can barely keep pace with the needs of the rapidly ageing population. According to the results of the Jockey Club Age-friendly City Project baseline assessment conducted in Tuen Mun and Yuen Long Districts, older persons in rural Hong Kong tend to be overly disadvantaged as regards community support services when compared with those in urban areas, leaving many of them with no choice but to settle in elderly homes once having mobility decline. Given this context, the programme generated social capital by consolidating the mutual support network in rural neighbourhoods in Tuen Mun and Yuen Long Districts, in response to the needs of older persons. The programme lasted for over 10 months, and more than 50 trained Rural Befrienders participated in volunteer service with over 100 elderly beneficiaries. The programme enhanced public awareness of the living conditions of older persons in the rural communities through public education activities, such as street exhibitions and the production of Age-friendly City Teaching Kit. Study Funded ByThe Hong Kong Jockey Club Charities Trust(Part of the Jockey Club Age-friendly City Project) Contributors of ReportKa Ho MOKWai Tak SZECheuk Man LEUNGZhuoyi WENPadmore Adusei AMOAHChak Kwan CHANLai Wah L

Jockey Club Age-Friendly City Project : Action plan : Islands

In response to the global ageing population, the World Health Organization (the “WHO”) devised the concept of “Global Age-friendly Cities” in 2005 to encourage cities all around the world to develop a healthy and comfortable living environment with age-friendly facilities and provide sufficient community support and health care services which benefit the older people, family and society. In order to proactively tackle the challenges of an ageing population and promote the concept of an age-friendly city, the Hong Kong Jockey Club Charities Trust launched the Jockey Club Age-friendly City Project (“Project”) in 2015 in partnership with four gerontology research institutes of local universities, including CUHK Jockey Club Institute of Ageing, Sau Po Centre on Ageing of the University of Hong Kong, Asia-Pacific Institute of Ageing Studies of Lingnan University (“LU APIAS”), and Institute of Active Ageing of the Hong Kong Polytechnic University. The four institutes have formed professional teams under this project to support eighteen districts in Hong Kong to adopt a bottom-up and district-based approach to develop age-friendly communities. Under the Project, LU APIAS conducted a baseline assessment, which comprised questionnaire surveys, focus group interviews and field observation from July 2015 to February 2016 in order to provide relevant information to the Islands District Council and other district stakeholders on the existing age-friendliness of the Islands District, Hong Kong (“District”). Senior residents in the District have also been recruited as ambassadors to spread the messages of age-friendly city. Training workshops and seminars have been arranged to equip them with necessary skills and knowledge to perform qualitative research by making assessment in the District with reference to the eight domains of the “Age-friendly City”. Meanwhile, the residents are encouraged to express their views regarding age-friendly facilities and measures in the community. LU APIAS has compiled the results of baseline assessment, including questionnaire surveys, focus groups and observations by the ambassadors, into a baseline assessment report. The report, together with this action plan for improving the age-friendliness of the District, will be submitted to WHO for joining its Global Network of Age-friendly Cities and Communities

Seductive Solutions, Inspiration, Easy-to-Remember Phrases, and Ambiguity: Why Is the Idea of Active Ageing so Successful?

The idea of active ageing has become one of the most influential perspectives in modern gerontology, social work, and social policy. This paper discusses factors that helped to establish active ageing as a successful theoretical concept that has significantly influenced contemporary social representations of ageing and has a practical impact on social work and policy. The perspective of the philosophy of social science is employed to explain what makes the idea of active ageing so attractive despite the remaining confusions concerning what “activity‘ and “ageing actively‘ means. The paper aims to answer the following question: What makes the concept of active ageing so successful? It draws upon the work of Murray Davis and her insight into the key aspects that make sociological theory “seductive.‘ The paper analyzes in what ways the concept of active ageing fulfills the specific features that, according to Davis, determine the success of social theories. Simultaneously, the paper critically evaluates the ways the idea of active ageing is translated into ageing policy. The case of Czech Republic is used to illustrate the problematic aspect of active ageing policies as well as the specific rhetoric that makes the idea of active ageing so attractive for a broad spectrum of disciplines as well as for social policy

Ageing in Action: Hollywood’s Ageing Ensemble Action Hero Series

This paper explores the treatment of ageing in the ensemble action hero series RED (2010 and 2013) starring Bruce Willis and Helen Mirren and The Expendables (2010, 2012, and 2014) starring Sylvester Stallone and other 1980s action stars. These two series combine action with comedy to thematize two sets of issues in relation ageing—first, about competence and usefulness and, second, about meaningful relationships. In the RED series, these two overarching concerns are linked explicitly to ageing whereas, in the Expendables films, these concerns replace those about ageing. In other words, the Expendables series mainly ignores ageing and presents its heroes as operating in a continuum of middle-age action, while the RED series explores many of the key issues of ageing in twenty-first century America. The RED and Expendables series rewrite the established narrative of ageing and it is this departure from stereotyped representations of ageing which generates the comedic moments in the films but also what makes them interesting to ageing audiences. The stars and heroes of RED and Expendables are popular precisely because they are not acting their age

HAGR: the Human Ageing Genomic Resources

The Human Ageing Genomic Resources (HAGR) is a collection of online resources for studying the biology of human ageing. HAGR features two main databases: GenAge and AnAge. GenAge is a curated database of genes related to human ageing. Entries were primarily selected based on genetic perturbations in animal models and human diseases as well as an extensive literature review. Each entry includes a variety of automated and manually curated information, including, where available, protein–protein interactions, the relevant literature, and a description of the gene and how it relates to human ageing. The goal of GenAge is to provide the most complete and comprehensive database of genes related to human ageing on the Internet as well as render an overview of the genetics of human ageing. AnAge is an integrative database describing the ageing process in several organisms and featuring, if available, maximum life span, taxonomy, developmental schedules and metabolic rate, making AnAge a unique resource for the comparative biology of ageing. Associated with the databases are data-mining tools and software designed to investigate the role of genes and proteins in the human ageing process as well as analyse ageing across different taxa. HAGR is freely available to the academic community at http://genomics.senescence.info

Jockey Club Age-Friendly City Project : Action plan : Tuen Mun

In response to the global ageing population, the World Health Organization (the “WHO”) devised the concept of “Global Age-friendly Cities” in 2005 to encourage cities all around the world to develop a healthy and comfortable living environment with age-friendly facilities and provide sufficient community support and health care services which benefit the older people, family and society. In order to proactively tackle the challenges of an ageing population and promote the concept of an age-friendly city, the Hong Kong Jockey Club Charities Trust launched the Jockey Club Age-friendly City Project (“Project”) in 2015 in partnership with four gerontology research institutes of local universities, including CUHK Jockey Club Institute of Ageing, Sau Po Centre on Ageing of the University of Hong Kong, Asia-Pacific Institute of Ageing Studies of Lingnan University (“LU APIAS”), and Institute of Active Ageing of the Hong Kong Polytechnic University. The four institutes have formed professional teams under this project to support eighteen districts in Hong Kong to adopt a bottom-up and district-based approach to develop age-friendly communities. Under the Project, LU APIAS conducted a baseline assessment, which comprised questionnaire surveys, focus group interviews and field observation from May to September 2017 in order to provide relevant information to the Tuen Mun District Council and other district stakeholders on the existing age-friendliness of Tuen Mun District, Hong Kong (“District”). Senior residents in the District have also been recruited as ambassadors to spread the messages of age-friendly city. Training workshops and seminars have been arranged to equip them with necessary skills and knowledge to perform qualitative research by making assessment in the District with reference to the eight domains of the “Age-friendly City”. Meanwhile, residents have been encouraged to express their views regarding age-friendly facilities and measures in the community. LU APIAS has compiled the results of baseline assessment, including questionnaire surveys, focus groups and observations by the ambassadors, into a baseline assessment report. The report, together with this action plan for enhancing the age-friendliness of the District, will be submitted to WHO for joining its Global Network of Age-friendly Cities and Communities

The use of urinary proteomics in the assessment of suitability of mouse models for ageing

Ageing is a complex process characterised by a systemic and progressive deterioration of biological functions. As ageing is associated with an increased prevalence of age-related chronic disorders, understanding its underlying molecular mechanisms can pave the way for therapeutic interventions and managing complications. Animal models such as mice are commonly used in ageing research as they have a shorter lifespan in comparison to humans and are also genetically close to humans. To assess the translatability of mouse ageing to human ageing, the urinary proteome in 89 wild-type (C57BL/6) mice aged between 8–96 weeks was investigated using capillary electrophoresis coupled to mass spectrometry (CE-MS). Using age as a continuous variable, 295 peptides significantly correlated with age in mice were identified. To investigate the relevance of using mouse models in human ageing studies, a comparison was performed with a previous correlation analysis using 1227 healthy subjects. In mice and humans, a decrease in urinary excretion of fibrillar collagens and an increase of uromodulin fragments was observed with advanced age. Of the 295 peptides correlating with age, 49 had a strong homology to the respective human age-related peptides. These ortholog peptides including several collagen (N = 44) and uromodulin (N = 5) fragments were used to generate an ageing classifier that was able to discriminate the age among both wild-type mice and healthy subjects. Additionally, the ageing classifier depicted that telomerase knock-out mice were older than their chronological age. Hence, with a focus on ortholog urinary peptides mouse ageing can be translated to human ageing

Healthy ageing and home: The perspectives of very old people in five European countries

This paper reports on in-depth research, using a grounded theory approach, to examine the ways in which very old people perceive healthy ageing in the context of living alone at home within urban settings in five European countries. This qualitative study was part of a cross-national project entitled ENABLE-AGE which examined the relationship between home and healthy ageing. Interviews explored the notion of healthy ageing, the meaning and importance of home, conceptualisations of independence and autonomy and links between healthy ageing and home. Data analysis identified five ways in which older people constructed healthy ageing: home and keeping active; managing lifestyles, health and illness; balancing social life; and balancing material and financial circumstances. Older people reflected on their everyday lives at home in terms of being engaged in purposeful, meaningful action and evaluated healthy ageing in relation to the symbolic and practical affordances of the home, contextualised within constructions of their national context. The research suggests that older people perceive healthy ageing as an active achievement, created through individual, personal effort and supported through social ties despite the health, financial and social decline associated with growing older. The physicality and spatiality of home provided the context for establishing and evaluating the notion of healthy ageing, whilst the experienced relationship between home, life history and identity created a meaningful space within which healthy ageing was negotiated