Explaining the continuum of social participation among older adults in Singapore: from 'closed doors' to active ageing in multi-ethnic community settings.

OBJECTIVES: This study aims to identify and explain the continuum in which older people in Singapore participate in community and social life, highlighting the influence of culture and policy context on social participation. METHODS: Using an ethnographic approach in a neighbourhood (n=109), we conducted focus groups with older adults of different ethnicities, exploring experiences of social participation. Next, participants took 50 photographs relating to 'lives of elders', showcasing the socio-ecological context that influenced social participation. Lastly, go-along interviews were conducted in various precincts with community leaders. RESULTS: A continuum of social participation emerged among older adults, ranging from (1) marginalization and exclusion, to (2) 'comfort-zoning' alone (3) seeking consistent social interactions, (4) expansion of social network, and (5) giving back to society. Seeking consistent social interactions was shaped by a preference for cultural grouping and ethnic values, but also a desire for emotional safety. Attitudes about expanding one's social network depended on the psychosocial adjustment of the older person to the prospect of gossip and 'trouble' of managing social relations. Despite the societal desirability of an active ageing lifestyle, cultural scripts emphasizing family meant older adults organized participation in social and community life, around family responsibilities. Institutionalizing family reliance in Singapore's welfare approach penalized lower-income older adults with little family support from accessing subsidies, and left some living on the margins. DISCUSSION: To promote inclusiveness, ageing programs should address preferences for social participation, overcoming barriers at the individual, ethnic culture and policy level

An exercise in happiness: Physical activity choices and psychological wellbeing in post-partum mothers

Depression in the post-partum period affects a substantial number of mothers and can have serious consequences for quality of life and parenting. It is therefore imperative that the factors that can protect against and provide resilience to parental depression are identified. Exercise and physical activity has previously been found to be effective in decreasing symptoms of depression however the efficacy of exercise as an intervention is still unclear. Using a cross-sectional design and an opportunistic sample, this study sought to explore what exercise mothers choose to, or are able to, engage in and associations with depression and social support. Three-hundred and four mothers (mean age = 32.7 years) with young children (mean age = 14.2 months) completed an online questionnaire consisting of the Edinburgh Postnatal Depression Scale (EPNDS), Multidimensional Scale of Perceived Social Support (MSPSS) and questions on their physical activity choices (what type, how often, etc). Mothers were divided into groups based on their self-reported exercise habits: No exercise (N-E), own exercise (O-E) and mother-baby exercise classes (M-B). The results found that mothers who engaged in mother-baby exercise classes had significantly less depression symptomology. Frequency of attending classes was associated with social support, with higher scores on the measure of depression related to lower levels of social support (in total and separately from family, friends, and significant others). Not participating in any exercise was reported to be related to lack of childcare and time. These results suggest that, outside of targeted interventions, mother who seek out group exercise classes gain in social support, which may be protective against depression. Assisting mothers with opportunities to engage with such classes should be a priority

Global state of the art of teaching life cycle assessment in higher education

PurposeGlobally, there is an increased demand for education on life cycle assessment (LCA). In response, there has been an increase in course availability, but also a lack of clarity on the comprehensiveness of these offerings and the resulting student competencies.MethodsA global survey was conducted to obtain empirical evidence on teaching LCA. The survey explored the availability of LCA courses globally and the depth of the teaching, including expected core competencies and related teaching and learning workloads. A purposive sampling strategy was adopted wherein eligible participants were approached by the researchers.Results and discussionAccording to the survey, annually, over 10,000 students participate in more than 200 LCA courses. The results reflected the interdisciplinary nature of LCA with courses being taught across different disciplines, including engineering, chemical sciences, and economics. Estimated workload demands for achieving different competency levels were significantly lower than those estimated by an expert panel before. This may be attributed in part to respondents not accounting for the full workload beyond classroom interactions. Nonetheless, workload demands increased with competency levels.Conclusions and recommendationsThe results emphasize the need for a common understanding of LCA teaching with regard to content, literacy levels, and competencies to avoid false expectations of the labor and research markets in terms of available expertise. Therefore, LCA curriculum development and program planning remain significant challenges and essential tasks for the global LCA community

“I felt like I had been put on the shelf and forgotten about” – lasting lessons about the impact of COVID-19 on people affected by rarer dementias

Background: The public health measures imposed in many countries to contain the spread of COVID-19 resulted in significant suspensions in the provision of support and care for people with dementia. The negative effects of these measures have been extensively reported. However, little is known about the specific impact on people with young onset, non-memory-led and inherited dementias. This group may have experienced different challenges compared to those with late onset dementia given their non-memory phenotypes and younger age. We explored the impact of the first COVID-19 lockdown on people living with familial Alzheimer’s disease, behavioural variant frontotemporal dementia, familial frontotemporal dementia, dementia with Lewy bodies, posterior cortical atrophy and primary progressive aphasia and their carers in the UK and their self-reported strategies for coping.// Methods: This was a mixed methods study. An online survey was administered to people with dementia and family carers recruited via Rare Dementia Support. Free-text responses were analysed using framework analysis to identify key issues and themes.// Results: 184 carers and 24 people with dementia completed the survey. Overall, people with dementia experienced worsening of cognitive symptoms (70%), ability to do things (62%), well-being (57%) and changes to medication (26%) during lockdown. Carers reported a reduction in the support they received (55%) which impacted their own mental health negatively. Qualitative analysis of free-text responses shed light on how the disruption to routines, changes to roles and responsibilities, and widespread disconnection from friends, family and health and social care support varied according to phenotype. These impacts were exacerbated by a more general sense that precious time was being lost, given the progressive nature of dementia. Despite significant challenges, respondents demonstrated resilience and resourcefulness in reporting unexpected positives and strategies for adapting to confinement.// Conclusions: This study has highlighted the specific impacts of the COVID-19 restrictions on people with young onset, non-memory-led and inherited dementias, including behavioural variant frontotemporal dementia, primary progressive aphasia and posterior cortical atrophy, and their carers. The specific challenges faced according to diagnosis and the self-reported strategies speak to the importance of – and may inform the development of – tailored support for these underrepresented groups more generally

I felt like I had been put on the shelf and forgotten about” – lasting lessons about the impact of COVID-19 on people affected by rarer dementias

BackgroundThe public health measures imposed in many countries to contain the spread of COVID-19 resulted in significant suspensions in the provision of support and care for people with dementia. The negative effects of these measures have been extensively reported. However, little is known about the specific impact on people with young onset, non-memory-led and inherited dementias. This group may have experienced different challenges compared to those with late onset dementia given their non-memory phenotypes and younger age. We explored the impact of the first COVID-19 lockdown on people living with familial Alzheimer’s disease, behavioural variant frontotemporal dementia, familial frontotemporal dementia, dementia with Lewy bodies, posterior cortical atrophy and primary progressive aphasia and their carers in the UK and their self-reported strategies for coping.MethodsThis was a mixed methods study. An online survey was administered to people with dementia and family carers recruited via Rare Dementia Support. Free-text responses were analysed using framework analysis to identify key issues and themes.Results184 carers and 24 people with dementia completed the survey. Overall, people with dementia experienced worsening of cognitive symptoms (70%), ability to do things (62%), well-being (57%) and changes to medication (26%) during lockdown. Carers reported a reduction in the support they received (55%) which impacted their own mental health negatively. Qualitative analysis of free-text responses shed light on how the disruption to routines, changes to roles and responsibilities, and widespread disconnection from friends, family and health and social care support varied according to phenotype. These impacts were exacerbated by a more general sense that precious time was being lost, given the progressive nature of dementia. Despite significant challenges, respondents demonstrated resilience and resourcefulness in reporting unexpected positives and strategies for adapting to confinement.ConclusionsThis study has highlighted the specific impacts of the COVID-19 restrictions on people with young onset, non-memory-led and inherited dementias, including behavioural variant frontotemporal dementia, primary progressive aphasia and posterior cortical atrophy, and their carers. The specific challenges faced according to diagnosis and the self-reported strategies speak to the importance of – and may inform the development of – tailored support for these underrepresented groups more generally

Implementation of frailty screening for older people living with HIV in Brighton, UK

OBJECTIVES: To evaluate the implementation of frailty screening in people living with HIV (PLWH) in a large urban cohort of patients in Brighton, UK.METHODS: Focus group discussions with HIV professionals and PLWH interviews helped inform the design and implementation of the frailty screening pathway in the clinic. Data were collected from PLWH aged over 60 years attending their HIV annual health check from July 2021 to January 2023 (n = 590), who were screened for frailty by nurses using the FRAIL scale. We assessed the proportions of PLWH who screened as frail, prefrail or robust and compared patient characteristics across groups. All PLWH identified as frail were offered a comprehensive geriatric assessment delivered by a combined HIV geriatric clinic, and uptake was recorded.RESULTS: A total of 456/590 (77.3%) PLWH aged over 60 years were screened for frailty. Median age and time since HIV diagnosis (range) for those screened were 66 (60-99) years and 21 (0-32) years, respectively. In total, 56 (12.1%) of those screened were identified as frail, 118 (25.9%) as prefrail and 282 (61.8%) as robust. A total of 10/56 (18%) people identified as frail declined an appointment in the geriatric clinic. Compared with non-frail individuals, frail PLWH had been living with HIV for longer and had a greater number of comorbidities and comedications but were not chronologically older.CONCLUSIONS: Implementing frailty screening in PLWH over 60 years old is feasible in a large cohort of PLWH, as recommended by the European AIDS Clinical Society. More research is needed to determine if frailty screening can improve clinical outcomes of older PLWH and the use of the comprehensive geriatric assessment within HIV services.</p

Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis

Background:Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation.Objective:This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users.Methods:We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff.Results:Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users’ perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety.Conclusions:This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability

Identifying Parkinson's disease and parkinsonism cases using routinely collected healthcare data:A systematic review

BackgroundPopulation-based, prospective studies can provide important insights into Parkinson's disease (PD) and other parkinsonian disorders. Participant follow-up in such studies is often achieved through linkage to routinely collected healthcare datasets. We systematically reviewed the published literature on the accuracy of these datasets for this purpose.MethodsWe searched four electronic databases for published studies that compared PD and parkinsonism cases identified using routinely collected data to a reference standard. We extracted study characteristics and two accuracy measures: positive predictive value (PPV) and/or sensitivity.ResultsWe identified 18 articles, resulting in 27 measures of PPV and 14 of sensitivity. For PD, PPV ranged from 56-90% in hospital datasets, 53-87% in prescription datasets, 81-90% in primary care datasets and was 67% in mortality datasets. Combining diagnostic and medication codes increased PPV. For parkinsonism, PPV ranged from 36-88% in hospital datasets, 40-74% in prescription datasets, and was 94% in mortality datasets. Sensitivity ranged from 15-73% in single datasets for PD and 43-63% in single datasets for parkinsonism.ConclusionsIn many settings, routinely collected datasets generate good PPVs and reasonable sensitivities for identifying PD and parkinsonism cases. However, given the wide range of identified accuracy estimates, we recommend cohorts conduct their own context-specific validation studies if existing evidence is lacking. Further research is warranted to investigate primary care and medication datasets, and to develop algorithms that balance a high PPV with acceptable sensitivity

Global state of the art of teaching life cycle assessment in higher education

Purpose: Globally, there is an increased demand for education on life cycle assessment (LCA). In response, there has been an increase in course availability, but also a lack of clarity on the comprehensiveness of these offerings and the resulting student competencies. Methods: A global survey was conducted to obtain empirical evidence on teaching LCA. The survey explored the availability of LCA courses globally and the depth of the teaching, including expected core competencies and related teaching and learning workloads. A purposive sampling strategy was adopted wherein eligible participants were approached by the researchers. Results and discussion: According to the survey, annually, over 10,000 students participate in more than 200 LCA courses. The results reflected the interdisciplinary nature of LCA with courses being taught across different disciplines, including engineering, chemical sciences, and economics. Estimated workload demands for achieving different competency levels were significantly lower than those estimated by an expert panel before. This may be attributed in part to respondents not accounting for the full workload beyond classroom interactions. Nonetheless, workload demands increased with competency levels. Conclusions and recommendations: The results emphasize the need for a common understanding of LCA teaching with regard to content, literacy levels, and competencies to avoid false expectations of the labor and research markets in terms of available expertise. Therefore, LCA curriculum development and program planning remain significant challenges and essential tasks for the global LCA community