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Im Blickpunkt: ltere alleinstehende Migrantinnen In Focus: Elderly Single Migrants  [cached]
Elke Olbermann
querelles-net , 2005,
Abstract: In dem rezensierten Buch stellt die Autorin die Ergebnisse einer im Auftrag des Bundesministeriums für Familien, Senioren, Frauen und Jugend durchgeführten Untersuchung zur Lebenssituation lterer alleinstehender Migrantinnen vor. Die Untersuchung liefert umfassende und differenzierte Einblicke in zentrale Lebensbereiche lterer alleinstehender Migrantinnen und verweist auf diesbezügliche sozial- und gesellschaftspolitische Handlungsbedarfe. The author in the reviewed book presents the results of a study of the personal circumstances of elderly single migrants commissioned by the Ministry for Family, Seniors, Women, and Youth. The study presents comprehensive and differentiated insight into central spheres of life of older single migrants and, with this in mind, points to sociopolitical and societal need for action.
Access to healthcare and alternative health-seeking strategies among undocumented migrants in Denmark
Dan Biswas, Maria Kristiansen, Allan Krasnik, Marie Norredam
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-560
Abstract: Qualitative design using semi-structured interviews and observations. The participants included ten undocumented South Asian migrants and eight ER nurses.Undocumented migrants reported difficulties accessing healthcare. The barriers to healthcare were: limited medical rights, arbitrariness in healthcare professionals' attitudes, fear of being reported to the police, poor language skills, lack of network with Danish citizens, lack of knowledge about the healthcare system and lack of knowledge about informal networks of healthcare professionals. These barriers induced alternative health-seeking strategies, such as self-medication, contacting doctors in home countries and borrowing health insurance cards from Danish citizens. ER nurses expressed willingness to treat all patients regardless of their migratory status, but also reported challenges in the encounters with undocumented migrants. The challenges for ER nurses were: language barriers, issues of false identification, insecurities about the correct standard procedures and not always being able to provide appropriate care.Undocumented migrants face formal and informal barriers to the Danish healthcare system, which lead to alternative health-seeking strategies that may have adverse effects on their health. This study shows the need for policies and guidelines, which in accordance with international human rights law, ensure access to healthcare for undocumented migrants and give clarity to healthcare professionals.In recent years there has been increasing focus on the flow of irregular migration to Europe [1]. It is estimated that there are between 1.9-3.8 million undocumented migrants in the European Union (EU), corresponding to 7-13 percent of the foreign resident population in 2008 [2,3]. Undocumented migrants enter Europe through both legal and illegal channels and typically find employment within the informal economy, where they serve as a low-cost and flexible labour force [1,4,5]. Figure 1 gives definitions
Perspective of Elderly on Age-Friendliness of Services Provided in Primary Healthcare Centers of Dubai Health Authority: Focus Groups Discussions  [PDF]
Tamer Mohamed Farid, Amal Mohamad Saleh Abdulrahim Al Jaziri, Soha Abdelziz Abdelal, Anood Jamal Alshaali, Manal Mohammad Omran Taryam, Nahed Abdul Khaleq Monsef, Afaf Abdullatif Al Hashemi, Hamidah Saleh Al Shaibany
Advances in Aging Research (AAR) , 2018, DOI: 10.4236/aar.2018.76011
Abstract: Primary Health Care Services Sector (PHCSS) of Dubai Health Authority (DHA) provides many services dedicated to seniors. However, there have been no studies to date that consulted the seniors themselves regarding these services. Thus, this study was conducted to investigate the age-friendliness of outpatient clinic’s services provided in PHCSS from perspective of elderly service recipients. Methods: Three focus groups were designed. The focus groups included receivers of care (senior patients and caregivers for senior patients) and healthcare providers (physicians, nurses, administrators and medical record officers). The discussed topics in the focus groups were based on WHO’s recommended three domains of improvement for an age-friendly Primary Health Care (PHC): Information, education and training, community-based health care management systems, and the physical environment.
Bacterial Infections in the Elderly Patient: Focus on Sitafloxacin
Beniam Ghebremedhin
Clinical Medicine Insights: Therapeutics , 2012, DOI: 10.4137/CMT.S7435
Abstract: Sitafloxacin (DU-6859a) is a new-generation oral fluoroquinolone with in vitro activity against a broad range of Gram-positive and -negative bacteria, including anaerobic bacteria, as well as against atypical bacterial pathogens. Particularly in Japan this antibiotic was approved in 2008 for treatment of a number of bacterial infections caused by Gram-positive cocci and Gram-negative cocci and rods, including anaerobia atypical bacterial pathogens. As compared to oral levofloxacin sitafloxacin was non-inferior in the treatment of community-acquired pneumonia and non-inferior in the treatment of complicated urinary tract infections, according to the results of randomized, double-blind, multicentre, non-inferiority trials. Non-comparative studies demonstrated the efficacy of oral sitafloxacin in otorhinolaryngological infections, urethritis in men, cervicitis in women and odontogenic infections. Most common adverse reactions were gastrointestinal disorders and laboratory abnormalities in patients receiving oral sitafloxacin; diarrhea and liver enzyme elevations were among the common. In the Japanese population sitafloxacin covers broad spectrum of bacteria as compared to carbapenems, whereas in the Caucasians its use is currently limited due to the potential for ultraviolet A phototoxicity. Sitafloxacin is a promising therapeutic agent which merits further investigation in randomized clinical trials of elderly patients.
Management of chronic pain in the elderly: focus on transdermal buprenorphine  [cached]
Nalini Vadivelu,Roberta L Hines
Clinical Interventions in Aging , 2008,
Abstract: Nalini Vadivelu, Roberta L HinesDepartment of Anesthesiology, Yale University School of Medicine, New Haven, USAAbstract: Chronic pain in the elderly is a significant problem. Pharmacokinetic and metabolic changes associated with increased age makes the elderly vulnerable to side effects and overdosing associated with analgesic agents. Therefore the management of chronic cancer pain and chronic nonmalignant pain in this growing population is an ongoing challenge. New routes of administration have opened up new treatment options to meet this challenge. The transdermal buprenorphine matrix allows for slow release of buprenorphine and damage does not produce dose dumping. In addition the long-acting analgesic property and relative safety profile makes it a suitable choice for the treatment of chronic pain in the elderly. Its safe use in the presence of renal failure makes it an attractive choice for older individuals. Recent scientific studies have shown no evidence of a ceiling dose of analgesia in man but only a ceiling effect for respiratory depression, increasing its safety profile. It appears that transdermal buprenorphine can be used in clinical practice safely and efficaciously for treating chronic pain in the elderly.Keywords: transdermal buprenorphine, chronic pain, elderly
Determinants of health in recently arrived young migrants and refugees: a review of the literature  [cached]
Eva Pfarrwaller,Joan-Carles Suris
Italian Journal of Public Health , 2012, DOI: 10.2427/7529
Abstract: Background: adolescent migrants are in a state of double vulnerability because of their age and migration experience. The purpose of this review was to identify risk and protective factors serving as a base for health promotion of young recent migrants. Methods: we assessed 95 papers identified through a MEDLINE search. Thirty-five papers were retained for review and analysed within the following themes: general health, mental health, cigarette smoking and sexual health. Results: young migrants’ health was considered good at arrival, but deteriorated with length of stay due to factors linked to migration. Mental health was determined by pre-migration factors, such as violence, and was strongly related to post-migration factors, such as asylum procedures, discrimination and low socio-economic status. Social support and family cohesion were identified as protective factors. We found a lack in epidemiologic data about tobacco use and sexual health issues. Results from North America indicated less frequent smoking in certain groups of immigrants. Some data suggested more frequent teenage pregnancies and abortions in young refugee women as compared to the host population. We also found some evidence about increased risk of sexually transmitted infections and HIV/AIDS in certain immigrant populations. Conclusions: migrant adolescents are generally healthy at arrival. The migration process and social inequalities after arrival influence their long-term health. A comprehensive approach to health promotion is necessary, taking into account risk and protective factors. More research is needed, in order to obtain more specific epidemiologic data about adolescent migrants, as well as longitudinal and qualitative data.
The match between institutional elderly care management research and management challenges - a systematic literature review  [cached]
Kokkonen Kaija,Rissanen Sari,Hujala Anneli
Health Research Policy and Systems , 2012, DOI: 10.1186/1478-4505-10-35
Abstract: Background Elderly care practice and its management together with policy and research play a crucial role in responding to increasing challenges in institutional care for elderly people. Successful dialogue between these is necessary. The purpose of this systematic literature review is to compare how institutional elderly care management research meets the care challenges currently emphasized in international long-term care policy documents. Methods This paper was based on a systematic literature review. After screening 1971 abstracts using inclusion/exclusion criteria, 58 refereed articles published between 2000 and 2010 remained for analysis. The articles were analyzed using theory-based content analysis by comparing the results to the framework based on analysis of international long-term care management policy documents. Results The current challenges of long-term care management identified from policy documents were Integrated Care Management, Productivity Management, Quality Management, Workforce Management and ICT Management. The research on institutional elderly care management responded somewhat to the challenges mentioned in policy documents. However, some of the challenges were studied broadly and some were paid only minor attention. Further, only few studies focused on the core items of challenges addressed in policy documents. Conclusions Institutional care management research needs to focus more on challenges in integrated care, productivity, ICT and division of labor. Managers, researchers and policy-makers should assume more active collaborative roles in processes of research, policymaking and policy implementation. In addition managers’ and policymakers’ scientific literacy needs to be enhanced.
Management of peripheral arterial disease in the elderly: focus on cilostazol  [cached]
Travis M Falconer,John W Eikelboom,Graeme J Hankey,Paul E Norman
Clinical Interventions in Aging , 2008,
Abstract: Travis M Falconer1, John W Eikelboom2, Graeme J Hankey3, Paul E Norman11School of Surgery, University of Western Australia, Fremantle Hospital, Western Australia; 2Department of Medicine, McMaster University, Hamilton, Canada; 3Department of Neurology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western AustraliaAbstract: Symptomatic and asymptomatic peripheral arterial disease (PAD) is a common problem in the elderly. The management of PAD includes the prevention of cardiovascular events and relief of symptoms – most commonly intermittent claudication (IC). Both require treatment of the causes and consequences of atherothrombosis, but some strategies are more effective for prevention of cardiovascular events and others are more effective for the relief of symptoms. Priorities for the prevention of cardiovascular events include smoking cessation, exercise, antiplatelet therapy, and the treatment of dyslipidemia, hypertension, and diabetes. Walking time and ability are improved by exercise. The benefit of numerous drugs in the treatment of IC has been assessed. The results have generally been disappointing, but there is some evidence that statins and cilostazol (an inhibitor of phosphodiesterase 3) are of benefit. Meta-analyses suggest that cilostazol increases maximum walking distance by 40%–50% and improves other objective measures of walking. The safety profile of cilostazol in patients with PAD appears to be acceptable although the mechanism for its effect on IC is unclear. In addition to risk factor management, treatment with cilostazol should be considered in patients with disabling IC.Keywords: peripheral arterial disease, intermittent claudication, risk factors, cilostazol
The design of the Dutch EASYcare study: a randomised controlled trial on the effectiveness of a problem-based community intervention model for frail elderly people [NCT00105378]
René JF Melis, Monique IJ van Eijken, George F Borm, Michel Wensing, Eddy Adang, Eloy H van de Lisdonk, Theo van Achterberg, Marcel GM Olde Rikkert
BMC Health Services Research , 2005, DOI: 10.1186/1472-6963-5-65
Abstract: DGIP is a community intervention model for frail elderly persons where the GP refers elderly patients with a problem in cognition, mood, behaviour, mobility, and nutrition. A geriatric specialist nurse applies a guideline-based intervention with a limited number of follow up visits. The intervention starts with the application of the EASYcare instrument for geriatric screening. The EASYcare instrument assesses (instrumental) activities of daily life, cognition, mood, and includes a goal setting item. During the intervention the nurse regularly consults the referring GP and a geriatrician. Effects on functional performance (Groningen Activity Restriction Scale), health related quality of life (MOS-20), and carer burden (Zarit Burden Interview) are studied in an observer blinded randomised controlled trial. 151 participants were randomised over two treatment arms – DGIP and regular care – using pseudo cluster randomisation. We are currently performing the follow up visits. These visits are planned three and six months after inclusion. Process measures and cost measures will be recorded. Intention to treat analyses will focus on post intervention differences between treatment groups.The design of a trial evaluating the effects of a community intervention model for frail elderly people was presented. The problem-based participant selection procedure satisfied; few patients that the GP referred did not meet our eligibility criteria. The use of standard terminology makes detailed insight into the contents of our intervention possible using terminology others can understand well.In frail elderly persons chronic conditions and loss of function challenge their autonomy. This harms their well-being, and often leads to institutionalisation and high health care costs.There is much heterogeneity in the degree to which frailty affects older people. While some have many problems, others age successfully [1]. The introduction of the concept of successful aging voiced a change in ou
Characteristics of multiple-diseased elderly in Swedish hospital care and clinical guidelines: Do they make evidence-based priority setting a “mission impossible”?
Ekerstad, Niklas,Edberg, Annika,Carlsson, Per
International Journal of Ageing and Later Life , 2009,
Abstract: In Sweden, an expected growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines and priority setting into focus. There are problems, however, in areas where the evidence base is weak and underlying ethical values are controversial. Based on a specified definition of multiple-diseased elderly patients, the aims of this study are: (i) to describe and quantify inpatient care utilisation and patient characteristics, particularly regarding cardiovascular disease and co-morbidity; and (ii) to question the applicability of evidence-based guidelines for these patients with regard to the reported characteristics (i.e. age and co-morbidity), and to suggest some possible strategies in order to tackle the described problem and the probable presence of ageism. We used data from three sources: (a) a literature review, (b) a register study, based on a unique population-based register of inpatient care in Sweden, and (c) a national cost per patient database. The results show that elderly patients with multiple co-morbidities constitute a large and growing population in Swedish inpatient hospital care. They have multiple and complex needs and a large majority have a cardiovascular disease. There is a relationship between reported characteristics, i.e. age and co-morbidity, and limited applicability of evidence-based guidelines, and this can cause an under-use as well as an over-use of medical interventions. As future clinical studies will be rare due to methodological and financial factors, we consider it necessary to condense existing practical-clinical experiences of individual experts into consensus-based guidelines concerning elderly with multi-morbidity. In such priority setting, it will be important to consider co-morbidity and different degrees of frailty.
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