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      Toward improved homecare of frail older adults: A focus group study synthesizing patient and caregiver perspectives

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          Abstract

          Background

          Adopting a better understanding of how both older adults and health care providers view the community management of frailty is necessary for improving home health, especially facing the coronavirus disease 2019 (COVID‐19) pandemic. We conducted a qualitative focus group study to assess how both older adults and health care providers view frailty and virtual health care in home health.

          Methods

          Two focus groups enrolled home‐living older adults and health care professionals, respectively (n = 15). Questions targeting the use of virtual / telehealth technologies in‐home care for frail older adults were administered at audio‐recorded group interviews. Transcribed discussions were coded and analyzed using NVivo software.

          Results

          The older adult group emphasized the autonomy related to increasing frailty and social isolation and the need for transparent dissemination of health care planning. They were optimistic about remote technology‐based supports and suggested that telehealth / health‐monitoring/tracking were in high demand. Health care professionals emphasized the importance of a holistic biopsychosocial approach to frailty management. They highlighted the need for standardized early assessment and management of frailty.

          Conclusions

          The integrated perspectives provided an updated understanding of what older adults and practitioners value in home‐living supports. This knowledge is helpful to advancing virtual home care, providing better care for frail individuals with complex health care needs.

          Abstract

          The study represents an updated understanding of supporting home care of older adults in the new era, by integrating perspectives of both care providers and receivers. It highlights improving virtual technology adaptation for care services and early management of frailty.

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          Most cited references49

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          Frailty in elderly people

          Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. In landmark studies, investigators have developed valid models of frailty and these models have allowed epidemiological investigations that show the association between frailty and adverse health outcomes. We need to develop more efficient methods to detect frailty and measure its severity in routine clinical practice, especially methods that are useful for primary care. Such progress would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            COVID-19 and the consequences of isolating the elderly

            As countries are affected by coronavirus disease 2019 (COVID-19), the elderly population will soon be told to self-isolate for “a very long time” in the UK, and elsewhere. 1 This attempt to shield the over-70s, and thereby protect over-burdened health systems, comes as worldwide countries enforce lockdowns, curfews, and social isolation to mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, it is well known that social isolation among older adults is a “serious public health concern” because of their heightened risk of cardiovascular, autoimmune, neurocognitive, and mental health problems. 2 Santini and colleagues 3 recently demonstrated that social disconnection puts older adults at greater risk of depression and anxiety. If health ministers instruct elderly people to remain home, have groceries and vital medications delivered, and avoid social contact with family and friends, urgent action is needed to mitigate the mental and physical health consequences. Self-isolation will disproportionately affect elderly individuals whose only social contact is out of the home, such as at daycare venues, community centres, and places of worship. Those who do not have close family or friends, and rely on the support of voluntary services or social care, could be placed at additional risk, along with those who are already lonely, isolated, or secluded. Online technologies could be harnessed to provide social support networks and a sense of belonging, 4 although there might be disparities in access to or literacy in digital resources. Interventions could simply involve more frequent telephone contact with significant others, close family and friends, voluntary organisations, or health-care professionals, or community outreach projects providing peer support throughout the enforced isolation. Beyond this, cognitive behavioural therapies could be delivered online to decrease loneliness and improve mental wellbeing. 5 Isolating the elderly might reduce transmission, which is most important to delay the peak in cases, and minimise the spread to high-risk groups. However, adherence to isolation strategies is likely to decrease over time. Such mitigation measures must be effectively timed to prevent transmission, but avoid increasing the morbidity of COVID-19 associated with affective disorders. This effect will be felt greatest in more disadvantaged and marginalised populations, which should be urgently targeted for the implementation of preventive strategies.
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              What Influences Saturation? Estimating Sample Sizes in Focus Group Research

              Saturation is commonly used to determine sample sizes in qualitative research, yet there is little guidance on what influences saturation. We aimed to assess saturation and identify parameters to estimate sample sizes for focus group studies in advance of data collection. We used two approaches to assess saturation in data from 10 focus group discussions. Four focus groups were sufficient to identify a range of new issues (code saturation), but more groups were needed to fully understand these issues (meaning saturation). Group stratification influenced meaning saturation, whereby one focus group per stratum was needed to identify issues; two groups per stratum provided a more comprehensive understanding of issues, but more groups per stratum provided little additional benefit. We identify six parameters influencing saturation in focus group data: study purpose, type of codes, group stratification, number of groups per stratum, and type and degree of saturation.
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                Author and article information

                Contributors
                xiaowei.song@fraserhealth.ca
                Journal
                Aging Med (Milton)
                Aging Med (Milton)
                10.1002/(ISSN)2475-0360
                AGM2
                Aging Medicine
                John Wiley and Sons Inc. (Hoboken )
                2475-0360
                21 January 2021
                March 2021
                : 4
                : 1 ( doiID: 10.1002/agm2.v4.1 )
                : 4-11
                Affiliations
                [ 1 ] Health Sciences and Innovation Surrey Memorial Hospital Fraser Health Surrey British Columbia Canada
                [ 2 ] Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
                [ 3 ] Health and Technology District Surrey British Columbia Canada
                [ 4 ] Faculty of Health Sciences Simon Fraser University Burnaby British Columbia Canada
                [ 5 ] Faculty of Applied Sciences Simon Fraser University Burnaby British Columbia Canada
                [ 6 ] Community Actions and Resources Empowering Seniors (CARES) Fraser Health Surrey British Columbia Canada
                [ 7 ] Home and Community Care Medicine Fraser Health Surrey British Columbia Canada
                [ 8 ] Faculty of Science Simon Fraser University Burnaby British Columbia Canada
                Author notes
                [*] [* ] Correspondence

                Xiaowei Song, Fraser Health Authority, Health Sciences and Innovation, Surrey Memorial Hospital, 13750 96th Avenue, Surrey, British Columbia V3V 1Z2, Canada.

                Email: xiaowei.song@ 123456fraserhealth.ca

                Author information
                https://orcid.org/0000-0001-9589-2520
                Article
                AGM212144
                10.1002/agm2.12144
                7954833
                90040e06-f23d-442b-b480-a43ab9048f9c
                © 2021 The Authors. Aging Medicine published by Beijing Hospital and John Wiley & Sons Australia, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 02 December 2020
                : 09 December 2020
                : 09 December 2020
                Page count
                Figures: 3, Tables: 3, Pages: 8, Words: 5984
                Funding
                Funded by: Michel Smith Foundation of Health Research
                Award ID: C2‐17509
                Funded by: Institute of Population and Public Health , open-funder-registry 10.13039/100009053;
                Award ID: PJT‐156210
                Funded by: Surrey Hospital Foundation
                Award ID: FHG2017‐001
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                March 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.9 mode:remove_FC converted:13.03.2021

                aging in place,focus group,frailty,homecare,technology,telehealth

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