Enablement of older people with chronic disease attending an ambulatory care centre

Background: Population ageing, and the increasing incidence of chronic disease requires a responsive health service and new enabling models of care (Wren et al. 2017, Bridges et al. 2019, Kennedy 2019). Within the dynamics of healthcare engagement, there is recognition of the positive influence of the enabling skills of the health professional on patient enablement encompassing knowledge, confidence, coping and management of health and illness (Howie et al. 1997, 1998). The clinical consultation is a pivotal exchange between the health professional and patient, so it is vital to optimise its quality (Al Momen et al. 2015, Pawlikowska & Marinowicz, 2015). The Consumer Enablement Model (Batterham et al. 2017) acknowledges the diverse contexts in which people seek care and identifies dynamic determinants and key components (cognitive, affective/motivational, physical, and relational) that impact enablement. Little is known about the factors influencing enablement in an older adult population living with chronic health conditions attending an ambulatory care service. Aim: To examine enablement of older people with chronic disease post consultation with a health professional and identify influencing factors for low enablement. Method: A descriptive quantitative, cross-sectional survey was conducted. Data Collection: Data were collected using a 72-item questionnaire. In addition to demographic questions, it contained the validated instruments Patient Enablement Instrument (PEI) (Howie et al. 1997), Patient Activation Measure (Hibbard et al. 2005) and Clinical Frailty Scale (Rockwood et al. 2005) and modified Physician Enabling Skills Questionnaire (Hudon et al. 2015). Sample: In total, 300 older people with chronic disease were recruited from an ambulatory care centre (attending nurse, doctor, or therapist). Incomplete questionnaires were omitted, leaving a sample of 273 for analysis. Data Analysis: Descriptive and inferential statistical analysis was used. Logistic backward stepwise regression examined the association between the independent variables and the dependent variable low enablement (PEI score ≤ 4). Findings: The study population mean age was 79.7 years (SD 6.8) and 52% were female. Sixty-one per cent of participants had three or more chronic conditions, 35% described their health as fair or poor, and 26% indicated that they were frail (CFS ≥ 5). The population mean PEI score was 4.48 (SD 3.5). In the final multivariate analysis, four variables remained independent predictors of low enablement: female gender (OR 1.96 (CI 1.07- 3.60), clinical frailty (per 1 unit increase) OR 1.26 (95% CI 0.93-1.63), two variables were protective, patient activation OR 0.97 (95% CI 0.95-0.99) and health care professional enabling skills (OR 0.92 (95% CI 0.89-0.94). There were an additional eight variables that were significant in the univariate analysis: older age, living alone, three or more chronic diseases, poor self-reported health, psychological morbidity, receipt of home help, visit from a public health nurse and being seen by a single discipline during the clinic visit. Conclusion: This research affirms that older people have the capacity to become more enabled and are responsive to the enabling skills of the health professional and proactive coordinated multidisciplinary engagement. Enablement post-consultation is multi-faceted, with risk and protective factors that influence individual health gains. Quality measures & expectations of health gains should be viewed within this wider context. Implications for practice: Research findings support a person enablement model that provides for a heterogenous population in a state of transition (health, functional, psychological). Modifiable risk factors associated with low enablement, such as frailty and low patient activation require a comprehensive holistic assessment and bespoke interventions beyond a single consultation. The enabling skills of the health professional are important to optimise patient gains and enhance understanding, management and coping with chronic illness. Healthy ageing strategies reinforced by health professionals committed to making every contact count, supports the political and strategic paradigm shift towards sustaining older people in the community

Two-Legged Hopping in Autism Spectrum Disorders

Sensory processing deficits are common within autism spectrum disorders (ASD). Deficits have a heterogeneous dispersion across the spectrum and multimodal processing tasks are thought to magnify integration difficulties. Two-legged hopping in place in sync with an auditory cue (2.3, 3.0 Hz) was studied in a group of six individuals with expressive language impaired ASD (ELI-ASD) and an age-matched control group. Vertical ground reaction force data were collected and discrete Fourier transforms were utilized to determine dominant hopping cadence. Effective leg stiffness was computed through a mass-spring model representation. The ELI-ASD group were unsuccessful in matching their hopping cadence (2.21 ± 0.30 hops·s−1, 2.35 ± 0.41 hops·s−1) to either auditory cue with greater deviations at the 3.0 Hz cue. In contrast, the control group was able to match hopping cadence (2.35 ± 0.06 hops·s−1, 3.02 ± 0.10 hops·s−1) to either cue via an adjustment of effective leg stiffness. The ELI-ASD group demonstrated a varied response with an interquartile range (IQR) in excess of 0.5 hops·s−1 as compared to the control group with an IQR \u3c 0.03 hops·s−1. Several sensorimotor mechanisms could explain the inability of participants with ELI-ASD to modulate motor output to match an external auditory cue. These results suggest that a multimodal gross motor task can (1) discriminate performance among a group of individuals with severe autism, and (2) could be a useful quantitative tool for evaluating motor performance in individuals with ASD individuals

Gait Analysis of Teenagers and Young Adults Diagnosed with Autism & Severe Verbal Communication Disorders

Both movement differences and disorders are common within autism spectrum disorders (ASD). These differences have wide and heterogeneous variability among different ages and sub-groups all diagnosed with ASD. Gait was studied in a more homogeneously identified group of nine teenagers and young adults who scored as “severe” in both measures of verbal communication and overall rating of Autism on the Childhood Autism Rating Scales (CARS). The ASD individuals were compared to a group of typically developing university undergraduates of similar ages. All participants walked a distance of 6-meters across a GAITRite (GR) electronic walkway for six trials. The ASD and comparison groups differed widely on many spatiotemporal aspects of gait including: step and stride length, foot positioning, cadence, velocity, step time, gait cycle time, swing time, stance time, and single and double support time. Moreover, the two groups differed in the percentage of the total gait cycle in each of these phases. The qualitative rating of “Body Use” on the CARS also indicated severe levels of unusual body movement for all of the ASD participants. These findings demonstrate that older teens and young adults with “severe” forms of Verbal Communication Impairments and Autism differ widely in their gait from typically developing individuals. The differences found in the current investigation are far more pronounced compared to previous findings with younger and/or less severely involved individuals diagnosed with ASD as compared to typically developing controls. As such, these data may be a useful anchor-point in understanding the trajectory of development of gait specifically and motor functions generally.

Interfaith Dialogue: The Art of Listening

The political climate and discourse during the 2016 presidential campaign was divisive and unwelcoming of refugees, immigrants, Muslims, and other religious minorities. This toxic atmosphere was reflected on college and university campuses throughout the country. At Westfield State University, Jewish, Christian, and Muslim students were the targets of verbal attacks, prejudice, and disrespect. The Muslim students, in particular, were afraid to walk around campus and attend their classes. The Interfaith Chaplains Council, along with the Interfaith Advisory Council comprised of faculty, staff, and students, met to discuss the current concerns of the Jewish, Christian, and Muslim students, and collaborated to create a listening event based on the World Café model. This article addresses listening as a contemplative practice for building just communities and shares the process that went into the creation of the “Interfaith Dialogue: The Art of Listening” event, as well as participants’ responses to the event

Outcomes of 23- and 24-weeks gestation infants in Wellington, New Zealand: A single centre experience

Optimal perinatal care of infants born less than 24 weeks gestation remains contentious due to uncertainty about the long-term neurodevelopment of resuscitated infants. Our aim was to determine the short-term mortality and major morbidity outcomes from a cohort of inborn infants born at 23 and 24 weeks gestation and to assess if these parameters differed significantly between infants born at 23 vs. 24 weeks gestation. We report survival rates at 2-year follow-up of 22/38 (58%) at 23 weeks gestation and 36/60 (60%) at 24 weeks gestation. Neuroanatomical injury at the time of discharge (IVH ≥ Grade 3 and/or PVL) occurred in in 3/23 (13%) and 1/40 (3%) of surviving 23 and 24 weeks gestation infants respectively. Rates of disability at 2 years corrected postnatal age were not different between infants born at 23 and 24 weeks gestation. We show evidence that with maximal perinatal care in a tertiary setting it is possible to achieve comparable rates of survival free of significant neuroanatomical injury or severe disability at age 2 in infants born at 23-week and 24-weeks gestation

Palliative care for Parkinson's disease: Patient and carer's perspectives explored through qualitative interview

Background: Palliative care is recommended for non-malignant illnesses, including Parkinson’s disease. However, past research with healthcare workers highlights unmet palliative needs in this population and referral rates to Specialist Palliative Care are low. Some healthcare workers perceive a ‘fear’ in their patients about introducing palliative care. However, less is known about the views of people with Parkinson’s disease and their carers about palliative care. Aim: (1) To explore the palliative care and related issues most affecting people with Parkinson’s disease and their families and (2) to examine perceptions about/understanding of palliative care. Design: This was a qualitative study; semi-structured interviews were conducted, transcribed and analysed using thematic analysis. Setting/participants: A total of 31 people participated, both people with Parkinson’s disease (n = 19) and carers (n = 12), across three Movement Disorder Clinics in the Republic of Ireland. Results: People with Parkinson’s disease and their carers were unfamiliar with the term palliative care. When informed of the role of palliative care, most felt that they would benefit from this input. People with Parkinson’s disease and carers experienced a high illness burden and wanted extra support. Crises requiring Specialist Palliative Care involvement may occur at diagnosis and later, with advancing illness. Participants wanted more information about palliative care and especially further supports to address their psychosocial needs. Conclusion: A holistic palliative care approach could address the complex physical and psychosocial symptoms experienced by people with Parkinson’s disease and their carers, and people with Parkinson’s disease and their carers are open to palliative care. Further research needs to explore how palliative care can be introduced into the routine care for people with Parkinson’s disease

Colorado Native Plant Society Newsletter, Vol. 4 No. 4, July-August 1980

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