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Helen P. Hamer, University of Auckland,
Debra Lampshire, University of Auckland,
Sue Thomson, Northern Regional Dementia Behavioural Support and Advisory Coordinator for all of Auckland and Northland – New Zealand
This chapter discusses the process of positive ageing, the life course and the changing cultural norms of older people within contemporary society. The chapter aims to assist practitioners to consider and understand how ageism and subsequent stigma and discrimination can affect the well-being of older people and their loved ones and carers. The multiple losses and associated mental health conditions are also discussed, and specific approaches to mental health care required to support human connectedness with older people are explored. Common mental health conditions, associated risk factors and considerations for treatment embedded within a recovery approach are explained. The chapter concludes with an exploration of future issues for this area of specialty practice.
Getting older and doing more (Office for Senior Citizens, 2012) is a description that epitomises older people as an increasingly diverse and active group that continues to maintain its autonomy and well-being, even into later life. As the life expectancy of people in both New Zealand and Australia increases (Australian Bureau of Statistics (ABS), 2012; Office for Senior Citizens, 2012), older citizens are living longer than the previous generation. The most significant ageing in the population is seen in the baby boomer generation, that group born in the period 1946 to 1964 (Ministry of Social Development (MSD), 2016). For example, demographic projections suggest that New Zealanders over the age of 65 years will exceed one million by 2030. Further, ageing citizens will live longer; in the year 2010, in New Zealand the male population in the 80 years and older age group increased by 5.1 per cent (2900) to reach 60 200, while the female population increased by 2.8 per cent (2500) to 93 200. Likewise, the Australian government has projected that the proportion of adults over 65 years will make up 25 per cent of the population by 2050. The majority of older Australians retain a reasonable standard of living; in 2009 only 7 per cent of older people were living below the low-income threshold, compared with 21 per cent of children (Pearson et al., 2012).
Importantly, by continuing to participate in society, older people maintain their status as full citizens (Brannelly, 2006; Hamer, 2012). Rather than being regarded as passive recipients of care, older people expect to continue to fulfil the same roles and responsibilities as others in society.
Psychosocial interventions that mitigate psychosocial distress in cancer patients are important. The primary aim of this study was to examine the feasibility and acceptability of an adaptation of the Mindful Self-Compassion (MSC) program among adult cancer patients. A secondary aim was to examine pre–post-program changes in psychosocial wellbeing.
The research design was a feasibility and acceptability study, with an examination of pre- to post-intervention changes in psychosocial measures. A study information pack was posted to 173 adult cancer patients 6 months–5 years post-diagnosis, with an invitation to attend an eight-week group-based adaptation of the MSC program.
Thirty-two (19%) consented to the program, with 30 commencing. Twenty-seven completed the program (mean age: 62.93 years, SD 14.04; 17 [63%] female), attending a mean 6.93 (SD 1.11) group sessions. There were no significant differences in medico-demographic factors between program-completers and those who did not consent. However, there was a trend toward shorter time since diagnosis in the program-completers group. Program-completers rated the program highly regarding content, relevance to the concerns of cancer patients, and the likelihood of recommending the program to other cancer patients. Sixty-three percent perceived that their mental wellbeing had improved from pre- to post-program; none perceived a deterioration in mental wellbeing. Small-to-medium effects were observed for depressive symptoms, fear of cancer recurrence, stress, loneliness, body image satisfaction, mindfulness, and self-compassion.
Significance of results
The MSC program appears feasible and acceptable to adults diagnosed with non-advanced cancer. The preliminary estimates of effect sizes in this sample suggest that participation in the program was associated with improvements in psychosocial wellbeing. Collectively, these findings suggest that there may be value in conducting an adequately powered randomized controlled trial to determine the efficacy of the MSC program in enhancing the psychosocial wellbeing of cancer patients.
To evaluate the impact of ‘holistic’ link-workers on service users’ well-being, activation and frailty, and their use of health and social care services and the associated costs.
UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the evidence to support this policy is generally weak and poorly conceptualised, particularly in relation to frail, older people and patient activation. Torbay and South Devon NHS Foundation Trust, an integrated care organisation, commissioned a Well-being Co-ordinator service to support older adults (≥50 years) with complex health needs (≥2 long-term conditions), as part of its service redesign.
A before-and-after study measuring health and social well-being, activation and frailty at 12 weeks and primary, community and secondary care service use and cost at 12 months prior and after intervention.
Most of the 86 participants achieved their goals (85%). On average health and well-being, patient activation and frailty showed a statistically significant improvement in mean score. Mean activity increased for all services (some changes were statistically significant). Forty-four per cent of participants saw a decrease in service use or no change. Thirteen high-cost users (>£5000 change in costs) accounted for 59% of the overall cost increase. This was largely due to significant, rapid escalation in morbidity and frailty. Co-ordinators played a valuable key-worker role, improving the continuity of care, reducing isolation and supporting carers. No entry-level participant characteristic was associated with change in well-being or service use. Larger, better conceptualised, controlled studies are needed to strengthen claims of causality and develop national policy in this area.
It is increasingly recognised that the preconception period is a window of opportunity to intervene to improve outcomes for women and the next generation. The importance of preconception mental health and comorbidity problems has not traditionally been taken into account by policy makers or mental health service providers. We argue that by addressing preconception physical and mental health in men and women, medical health professionals could improve health outcomes across the whole life course.
Excavations of pre-pottery levels at Gua Talimbue and Gua Sambagowala in Southeast Sulawesi, Indonesia, have yielded nearly 4kg of baked-clay fragments, half of which exhibit intentional patterning. The fragments appear to derive from clay hearths. Here, the authors link the patterning on Early Holocene (c. 9900–8800 cal BP) fragments with the intention to enhance the appearance of the hearths’ rims. During the Mid/Late Holocene (c. 4500–2000 cal BP), patterning shifts to the interior surfaces. The effort and specialised skills required to impress patterns on these hearths is, to date, unique in the archaeology of pre-Neolithic Island Southeast Asia.
Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.
This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.
Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.
At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.
To identify discrete approaches to specialist healthcare support for older care home residents in the UK and to estimate their prevalence.
Internationally, a range of new initiatives are emerging to meet the multiple and complex healthcare needs of care home residents. However, little is known about their relative effectiveness and, given their heterogeneity, a classification scheme is required to enable research staff to explore this.
A UK survey collected information on the funding, age, coverage, aims, staffing and activities of 64 specialist care home support services. Latent class analysis (LCA) was used to allocate the sample into subgroups with similar characteristics.
Three classes were identified. Class 1 (55% of sample) contained services with a high probability of providing scheduled input (regular preplanned visits) and support for all residents and a moderate probability of undertaking medication management, but a low probability of training care home staff (‘predominantly direct care’). Class 2 (23% of sample) had a moderate/high probability of providing scheduled input, support for all residents, medication management and training (‘direct and indirect care’). Class 3 (22% of sample) had a low probability of providing scheduled input, support for all residents and medication management, but a high probability of providing training for care home staff (‘predominantly indirect care’). Consultants were more likely to be members of services in Class 1 than Class 2, and Class 2 than Class 3.
LCA offers a promising approach to the creation of a taxonomy of specialist care home support services. The skills and knowledge required by healthcare staff vary between classes, raising important issues for service design. The proposed classification can be used to explore the extent to which different organisational forms are associated with better resident, process and service outcomes.
The focus of this paper is the Neolithic of northwest Europe, where a rapid growth in population between ~5950 and ~5550 cal yr BP is followed by a decline that lasted until ~4950 cal yr BP. The timing of the increase in population density correlates with the local appearance of farming and is attributed to the advantageous effects of agriculture. However, the subsequent population decline has yet to be satisfactorily explained. One possible explanation is the reduction in yields in Neolithic cereal-based agriculture due to worsening climatic conditions. The suggestion of a correlation between Neolithic climate deterioration, agricultural productivity, and a decrease in population requires testing for northwestern Europe. Data for our analyses were collected during the Cultural Evolution of Neolithic Europe project. We assess the correlation between agricultural productivity and population densities in the Neolithic of northwest Europe by examining the changing frequencies of crop and weed taxa before, during and after the population “boom and bust.” We show that the period of population decline is coincidental with a decrease in cereal production linked to a shift towards less fertile soils.
We aimed to provide comprehensive estimates of laboratory-confirmed respiratory syncytial virus (RSV)-associated hospitalisations. Between 2012 and 2015, active surveillance of acute respiratory infection (ARI) hospitalisations during winter seasons was used to estimate the seasonal incidence of laboratory-confirmed RSV hospitalisations in children aged <5 years in Auckland, New Zealand (NZ). Incidence rates were estimated by fine age group, ethnicity and socio-economic status (SES) strata. Additionally, RSV disease estimates determined through active surveillance were compared to rates estimated from hospital discharge codes. There were 5309 ARI hospitalisations among children during the study period, of which 3923 (73.9%) were tested for RSV and 1597 (40.7%) were RSV-positive. The seasonal incidence of RSV-associated ARI hospitalisations, once corrected for non-testing, was 6.1 (95% confidence intervals 5.8–6.4) per 1000 children <5 years old. The highest incidence was among children aged <3 months. Being of indigenous Māori or Pacific ethnicity or living in a neighbourhood with low SES independently increased the risk of an RSV-associated hospitalisation. RSV hospital discharge codes had a sensitivity of 71% for identifying laboratory-confirmed RSV cases. RSV infection is a leading cause of hospitalisation among children in NZ, with significant disparities by ethnicity and SES. Our findings highlight the need for effective RSV vaccines and therapies.
In arguing that autistic people are socially motivated, Jaswal & Akhtar miss the opportunity to puncture the notion that social motivation is a prerequisite for humanity. Instead, we contend that some autistic people may indeed find social interactions to be unmotivating and that this doesn't have to be seen as a problem.
Socially silenced topics such as racism can be of important social significance. Yet this significance can drive a topic underground, making it resilient and resistant to exposure and difficult for fieldworkers to observe as a phenomenon. While numerous ethnographic studies have demonstrated the importance of studying silenced phenomena, we still know little about how to conduct ethnographic research in silenced environments. Based on our experiences conducting ethnographic research (including participant observation, interviews and focus groups), along with the published reflections of others, in this chapter we discuss the broader significance and purpose of race-related silences and the various manifestations of racialized social silence, and then propose strategies for addressing them. We focus specifically on government and institutional silence, interpersonal silence, and interview or focus group silence. In doing so we hope to provide ethnographers with a toolkit for unearthing the deeper meanings associated with social silences. Although we focus on race in the Americas, our discussion and suggestions are intended to inform researchers encountering various forms of social silence across different contexts.
Reading the first part of this book presents a striking contrast between current preoccupations in healthcare systems and the science presented here. In other words, between extant public concerns about entitlement to, funding of, and delivering healthcare in the second decade of the twenty-first century and the contents of Chapters 2, 3 and 4.
Healthcare systems and the people who fund, run and deliver them are, arguably, necessarily acutely sensitive to the socio-economic environment in which countries sit. The potential capabilities of healthcare continue to develop at increasingly rapid rates. By contrast, we live in a world in which the resources available are affected by austerity and in which the spread of affluence between the most advantaged people and the least affluent continues to grow. This is contributing to an increasing gap between potential capability and actual capacity, which appears to be expanding rapidly.
While there is great optimism for healthcare to be gained from developments in neuroscience, genetics and epigenetics, the social contexts and social approaches revealed by research, including much that we cover in this book, are also very powerful contributors to our health and recovery from ill health. As Nestler et al. say, ‘Psychiatric disorders are complex multifactorial illnesses … While genetic factors are important in the etiology of most mental disorders, the relatively high rates of discordance among identical twins … clearly indicate the importance of additional mechanisms’ (Nestler et al., 2016, p. 447).
This book focuses on social and environmental mechanisms; this chapter draws together a selection of the topics raised in Sections 1 and 2. We link facets of the social science that have come up thus far with concepts that are implicit in public physical and mental healthcare, and we summarise the concept of mental health recovery.
This book has considered the nature of health and mental health using the definition of the World Health Organization (WHO) and other definitions in Chapter 6. We now move to considering what the term ‘parity of esteem’ means. This chapter brings together thoughts about parity of esteem for mental health and mental healthcare with physical health and physical healthcare, and the way in which that reflects the contents and values in this book. I have spoken at international events about this topic on many occasions.
The objective of the present study is to summarise trends in under- and over-nutrition in pregnant women on the Thailand–Myanmar border. Refugees contributed data from 1986 to 2016 and migrants from 1999 to 2016 for weight at first antenatal consultation. BMI and gestational weight gain (GWG) data were available during 2004–2016 when height was routinely measured. Risk factors for low and high BMI were analysed for <18·5 kg/m2 or ≥23 kg/m2, respectively. A total of 48 062 pregnancies over 30 years were available for weight analysis and 14 646 pregnancies over 13 years (2004–2016) had BMI measured in first trimester (<14 weeks’ gestational age). Mean weight at first antenatal consultation in any trimester increased over the 30-year period by 2·0 to 5·2 kg for all women. First trimester BMI has been increasing on average by 0·5 kg/m2 for refugees and 0·6 kg/m2 for migrants, every 5 years. The proportion of women with low BMI in the first trimester decreased from 16·7 to 12·7 % for refugees and 23·1 to 20·2 % for migrants, whereas high BMI increased markedly from 16·9 to 33·2 % for refugees and 12·3 to 28·4 % for migrants. Multivariate analysis demonstrated low BMI as positively associated with being Burman, Muslim, primigravid, having malaria during pregnancy and smoking, and negatively associated with refugee as opposed to migrant status. High BMI was positively associated with being Muslim and literate, and negatively associated with age, primigravida, malaria, anaemia and smoking. Mean GWG was 10·0 (sd 3·4), 9·5 (sd 3·6) and 8·3 (sd 4·3) kg, for low, normal and high WHO BMI categories for Asians, respectively.
To determine the extent of service disruption among home health agencies impacted by Hurricane Harvey.
Structured interviews with optional open-ended questions were conducted with home health agencies in and around Houston, Texas. A random sample of 277 agencies was selected and contacted via telephone during the study period, from February to May of 2018.
Only 45% of 122 participating agencies indicated that their offices were open during Hurricane Harvey, and three-fourths reported that home visits were disrupted. The length of disruption varied: 7% reported a disruption of 1 day or less and 46% indicated a disruption of 1 week or longer. Disruption occurred even though nearly all (99%) of the agencies had—and close to all (92%) of them activated—an emergency preparedness plan.
Although most of the participating home health agencies activated their emergency preparedness plan, significant disruption in home health services occurred. While agencies are required to have clear, detailed plans in place, gaps in effective implementation of emergency preparedness plans remain.