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Background

Thai older adults are valuable resources in their society. The Thai health service system is challenged when it comes to ensuring that older Thai adults can continue to live healthy and independent lives in society. It is of great value to support independence and improve older people’s active ageing. Promoting lifestyle changes by applying the Plan-Do-Study-Act cycle (PDSA cycle), at group meetings in a municipality context, is a way of focusing on active ageing. This study aims to describe older adults´ experiences of lifestyle change six months after finishing group meetings applying the PDSA cycle.

Methods

A qualitative approach with individual interviews and a qualitative content analysis were used with 12 Thai older adults who participated in the meetings applying the PDSA cycle.

Results

Six months after finishing applying the PDSA cycle, some older adults kept their individual goals and were influenced by their family surroundings. They also formulated additional goals. Three categories and six sub-categories emerged: Keeping individual goals, influenced by the surroundings, and formulation of additional goals were the overall categories.

Conclusions

These Thai older adults showed that they had the ability to make lifestyle changes with the support of the PDSA cycle, but not all maintained their planned activities after six months. The question is how healthcare professionals and the surroundings, may further support and motivate these people to maintain these changes based on their own preferences in a sustainable way.

Aim: This study aims to describe experiences of the implementation of a new integrated healthcare model for older adults with complex care needs due to multimorbidity, living at home, from a health and welfare personnel perspective. The goal was to diminish hospitalization and still carry out high quality care at home for older adults living with multimorbidity. The model was implemented by two organizations working in cooperation, the municipality, and the region that handles interprofessional social care and healthcare in people's homes. Materials and Method: Open-ended group interviews with personnel were carried out, three of the group interviews preimplementations of the model, and three of the group interviews post -implementation. The interviews were audiotaped and analysed according to the procedure of thematic analysis. Results: The quality of the integrated care model was based on care -chain cooperation, shared professionalism, and creating relations with the patient including closeness to next of kin, which was underlined by the participants. Unencumbered time gave the professionals the possibility to develop quality in integrated healthcare as part of integrated and person -centred care. The coproduction of education, research interviews and the follow-up meeting identified successes in diminishing hospitalization rates according to the participants' experiences of the post -implementation interviews. An identified failure was, however, that shared professionalism was not developed over time, rather the different responsibilities were accentuated according to the information retrieved at the follow-up meeting. Conclusion: Quality aspects of the model were identified in the present study. However, when implementation of a new model is completed, the organizations always have their own interpretation of how to further understand the model in question. Plain language summary: The intention of the present study was to follow the process of working with a new model of providing care at home, thus preventing increased numbers of hospital readmissions, based on the professionals<acute accent> point of view of what quality care is for older adults with complex care needs due to multimorbidity, living in their own home. The professionals were interviewed in group settings on several occasions during the implementation. The result showed hopeful expectations expressed by the professionals before the new model was implemented, such as a hope for getting more time for high -quality care for the older adults with multimorbidity. During the teamwork, the conversation within the team members was praised as a key factor that included shared professionalism from professionals with different levels of education and focus on their work. According to the staff, unnecessary hospital stays were reduced, while the interprofessional care -chain cooperation was improved through the work of the integrated care team. For many team members, the positive difference in both work and care satisfaction was highlighted in comparison to regular home care as they were able to use their multi -disciplinary skills and support.

Background: Older people with multiple diagnoses often have problems coping with their daily lives at home because of lack of coordination between various parts of the healthcare chain during the transit from hospital care to the home. To provide good care to those persons who have the most complex needs, regions and municipalities must work together. It is of importance to develop further empirical knowledge in relation to older persons with multiple diagnoses to illuminate possible obstacles to person-centred care during the transition between healthcare institutions and the persons livelihood. The aim of the present study was to describe nurses' experienced critical incidents in different parts of the intended healthcare chain of older people with multiple diagnoses.

Methods: The sample consisted of 18 RNs in different parts of the healthcare system involved in the care of older people with multiple diagnoses. Data were collected by semi structured interviews and analysed according to Critical Incident Technique (CIT). A total of 169 critical incidents were identified describing experiences in recently experienced situations.

Results: The result showed that organizational restrictions in providing care and limitations in collaboration were the main areas of experienced critical incidents. Actions took place due to the lack of preventive actions for care, difficulties in upholding patients' legal rights to participation in care, deficiencies in cooperation between organizations as well as ambiguous responsibilities and roles. The RNs experienced critical incidents that required moral actions to ensure continued person-centred nursing and provide evidence-based care. Both types of critical incidents required sole responsibility from the nurse. The RNs acted due to ethics, 'walking the extra mile', searching for person-centred information, and finding out own knowledge barriers.

Conclusions: In conclusion and based on this critical incident study, home-based healthcare of older people with multiple diagnoses requires a nurse that is prepared to take personal and moral responsibility to ensure person-centred home-based healthcare. Furthermore, the development of in-between adjustments of organizations to secure cooperation, and transference of person-centred knowledge is needed.

BACKGROUND: The proportion of the older Thai population is increasing rapidly. Lifestyle may impact active ageing in later life. Interventions that empower older Thai adults to initiate and carry out lifestyle changes are needed. This study applied the Plan-Do-Study-Act (PDSA) cycle, a tool for improving lifestyle changes, with the aim of exploring interactions among older Thai adults when participating in group activities. METHOD: Focused ethnography was used based on participant observations, field notes and video recordings of 15 older Thai adults aged 62-78 years. RESULTS: Older Thai adults faced difficulties at the beginning since they were unfamiliar with initiating and carrying out lifestyle changes according to the PDSA concept. This provided a learning opportunity enabling older Thai adults to reach their individual goals of lifestyle change. CONCLUSIONS: The PDSA cycle has the potential to empower older adults in group contexts to promote lifestyle changes related to active ageing. 

Background: Health, participation, and security are the basic pillars of active ageing suggested by the WHO. The concept is used by professionals but requires exploration from the perspectives of older people themselves. This study aims to explore how older adults experience and describe health, participation, and security. Methods: A qualitative research approach was used based on open-ended interviews with 20 older Thai adults aged 60–92 years. The interviews were analysed using qualitative content analysis. Results: The results showed perspectives related to experiences of daily life and local culture. Health while ageing, was described as the absence of barriers to continued daily living, combined with a peaceful and adaptive mindset. Participation was described as maintaining social networks and being a formal volunteer, with an emphasis on the “making of merits”, of meaningful activities and being respected. Security was described as manageable living conditions and managing to finalize life well by balancing dependency and independency in relation to children to sustain the traditional value of gratitude between generations. Conclusions: These understandings will support healthy policy planning by providing resources and activities that relate to older Thai adults’ perspectives of health, participation and security and ultimately contribute to a better quality of life.

Purpose: The aim is to explore how family relations are affected by societal

changes in relation to informal and formal caregiving and self-determination

of older adults.

Design/methodology/approach: Care managers (CMs)/social workers (SWs)

(N = 124) participated in a comparative vignette study including Japan, South

Korea, and Sweden. Systems theory was used.

Findings: Japanese CMs/SWs clearly describe their efforts to create networks

in a relational way between formal and informal actors in the community. South

Korean CMs/SWs balance between suggesting interventions to support daily

life at home or a move to a nursing home, often acknowledging the family as the

main caregiver. In Sweden, CMs/SWs highlight the juridical element in meeting

the older adult and the interventions offered, and families primarily give social

support. Regarding self-determination, the Japanese priority is for CMs/SWs

to harmonize within the family and the community. South Korean CMs/SWs

express ambivalent attitudes to older adults’ capability for self-determination in

the intersection between formal and family care. Swedish CMs/SWs adhere to

the older adult’s self-determination, while acknowledging the role of the family

in persuading the older adult to accept interventions. The results suggest emerging

defamilialization in South Korea, while tendencies to refamilialization are

noticed in Japan and Sweden, albeit in different ways.

Research limitations/implications: In translation, nuances may be lost. A

focus on changing families shows that country-specific details in care services

have been reduced. For future research, perspectives of “care” need to be studied

on different levels.

Originality/value: Using one vignette in three countries with different welfare

regimes, discussing changing views on families’, communities’ and societal caregiving

is unique. This captures changes in policy, influencing re- and defamilialization.

This paper reports a study conducted to illuminate older adults’ perceptions of multiproffesional team's caring skills as success factors for health support in short-term goal-directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short-term goal-directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults’ reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short-term goal-directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health-support in short-term goal-directed reablement: a motivating caregiver, a positive atmosphere-creating caregiver, a human fellowship-oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver–patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area of elderly home care.