OAR@UM Collection:

A multiperspectival exploration of depression in old age : the lived experience of psychiatrists and community living older women

2021-01-20T10:11:37Z

Title: A multiperspectival exploration of depression in old age : the lived experience of psychiatrists and community living older women Abstract: Depression experienced by community-dwelling women in later life was found to have an intricate and complex relationship with culture and roles which impacted the way the condition was experienced. This research aimed to explore the lived experience of older women who lived with depression within their community and to look at the views of psychiatrists who worked with older women who suffered from depression. Interpretative phenomenological analysis (IPA) was used to analyse this phenomenon from multiple perspectives. Nine participants (group 1: five older females that lived with depression; group 2: four psychiatrists) were recruited through purposive and snowball sampling, and semi-structured interviews were carried out. The findings that emerged from the older women highlighted the diverse tools utilised to cope with their presenting symptoms. It was also elucidated how depression had a life-altering effect, in that the way they thought and perceived life was markedly different. The psychiatrists offered their insight and experience with depressed older women, such as how often depression stemmed from changes in family dynamics. Social norms, roles, duties, culture and one’s generation also played a major part in how older women experienced depression. After comparing and contrasting the interviews of group 1 and group 2, a holistic understanding of the lived experience of depressed older women was elicited. This resulted in an in-depth and comprehensive view of the biological, social, and psychological aspects of the phenomenon in question. In conclusion, this research highlighted various recommendations for clinical health practice, policymakers, education and future research in relation to the area of depression in older females. Description: M.GER.

The lived experiences of older persons who stop driving following a stroke

2021-01-20T09:57:36Z

Title: The lived experiences of older persons who stop driving following a stroke Abstract: Background: As the world population ages, the number of older drivers is noted to be increasing, since older persons are becoming increasingly active and more mobile in society. This was seen in various international studies. Literature revealed that older persons' most preferred choice of transportation is driving their own car, to be able to participate in their activities of daily life (ADLs). In fact, driving was considered as the second most important ADL amongst older persons. Nevertheless, after sustaining a stroke, despite undergoing through a rehabilitation process, not everyone has the skills to return to driving due to severe physical and/or cognitive consequences. Aims: After identifying a gap in the literature, this study aimed to explore the lived experiences of older persons who stopped driving following a stroke in Malta. This study aimed to discover the feelings, experiences, needs and challenges faced by older stroke survivors who could not drive anymore, due to severe stroke consequences. Another aim was to analyse how older persons adapted their lives from being a driver to a non-driver. Method: A qualitative approach was adopted to gain a deeper understanding of the older persons' perspectives and lived experience of becoming a non-driver. An interpretative phenomenological analysis (IPA) was deemed the best approach by the researcher to capture as closely as possible the lived experiences of older persons. Purposive sampling was utilised to obtain participants according to the inclusion and exclusion criteria. Eight (8) semistructured face-to-face-interviews with open-ended questions were carried out; consisting of 7 older males and 1 older female participant. A pilot study was carried out with 2 older males. Results: After data analysis, 5 superordinate themes emerged (a) the meaning of driving to older persons, (b) the experience of becoming a non-driver following a stroke, (c) coping after driving cessation, (d) becoming active after driving cessation and (e) barriers to becoming active following driving cessation. Respective subordinate themes emerged. Since all participants valued the ability to drive prior to the stroke, all older person participants found it very challenging to adapt to the new role of being a non-driver. Conclusion: This study proved to be significant as there is a dearth in international and local literature on driving cessation, particularly following a stroke. Although findings were similar to other studies on driving cessation in general, driving cessation following a stroke proved to be more traumatic as older persons had to deal with physical, psychological and cognitive losses following the stroke, as well as coping with driving cessation. Recommendations were provided to policymakers, governmental institutions and to allied healthcare professionals, with the aim of facilitating the transition of the older person from a driver to a non-driver and offering more support. Description: M.GER.

Achieving quality dementia care in nursing homes : understanding nurses’ perceptions of dignity and person-centred care

2021-01-18T14:27:44Z

Title: Achieving quality dementia care in nursing homes : understanding nurses’ perceptions of dignity and person-centred care Abstract: Aims: This study sought to narrow the gap in the knowledge surrounding Person-Centred Care (PCC) and dignity in Maltese state-administered nursing homes by seeking to establish the following: (a) The extent to which nurses rated their work environment to be ‘personcentred’ and how this potentially informs us of their perceptions of dignity, specifically, the provision of dignified care within these environments, and (b) The challenges and obstacles to PCC within these environments, and how they also potentially inform us of nurses’ perceptions surrounding the delivery of dignified care. Background: The National Strategy for Dementia in the Maltese Islands (2015-2023) has called for a ‘needs analysis’ to identify gaps in knowledge and experience of healthcare workers working with older persons living with dementia (Parliamentary Secretariat for the Rights of Persons with Disability and Active Ageing: PSRPDAA, 2014). Furthermore, publication of the National Minimum Standards for Nursing Homes for Older Persons mandated that all local nursing homes adopt a person-centred approach. (Social Care Standards Authority: SCSA, 2015). PCC has become synonymous with both high quality dementia and geriatric care (Brooker & Latham, 2015), whilst dignified care is recognised as an outcome of effective PCC (McCormack & McCance, 2016). Despite this, several recent published and unpublished studies have indicated that PCC is not being practiced effectively in local nursing homes (Borg, 2019; Scolaro, 2016; Teebi, 2017; Zammit & Florini, 2015). Design and Methodology: This study utilised a qualitative research design from a post-positive world view perspective. The identified research sites were five state-administered nursing homes. These included: (a) Dar il-Madonna tal-Melleiha Home, (b) Floriana Home, (c) Mosta Home, (d) Msida Home, and (e) Mtarfa Home. From within these homes, 78 nurses were eligible to participate in this study. This also included nurses from the relieving pool whom were invited to participate in this study. To gather data, this study utilised a combination of both the Person-Centred Care Assessment tool (P-CAT) developed by Edvardsson, Fetherstonhaugh, Nay and Gibson (2010) and a demographic questionnaire. Statistical analysis was used to determine the association or otherwise between the mean results of the P-CAT and factors within the demographic questionnaire. This data, in combination with calculated percentages of responses to the P-CAT and relevant surrounding literature was used to address and discuss the aims of this study. Results: The results showed that the majority of nurses agreed that their workplace was personcentred, which suggests there is scope for dignity-preserving dementia care to take place within these environments. Barriers and obstacles to PCC were identified as a ‘chaotic environment’ and nurses having to get the work done before they can worry about a homelike environment. Furthermore, statistical analysis demonstrated that there were significant statistical differences between nurses’ place of work and their mean P-CAT scores related to organisational support, and nurses’ country of origin and mean P-CAT scores relating to environmental accessibility. However, these results ran contrary to the vast majority of local and international research, whilst also containing contradicting majority responses to questions within the P-CAT. This resulted in the study being unable to effectively discuss nurses’ perceptions of dignity in relation to the identified challenges and obstacles to PCC. Conclusion: The results from this study demonstrated that further research in this area is needed with potentially differing research designs in order to effectively validate the reality of nurses’ perceptions of PCC and dignity in residential care settings. Description: M.A.AGEING&DEMENTIA

Introducing a translated cognitive assessment tool to general practitioners in Malta : a feasibility study

2021-01-18T14:26:33Z

Title: Introducing a translated cognitive assessment tool to general practitioners in Malta : a feasibility study Abstract: The aim of the study was to translate and adapt the General Practitioner Assessment of Cognition (GPCOG) into the Maltese language and to validate the translated tool in older individuals within the local population. A framework for translation and cultural adaptation process was followed to create the Maltese GPCOG. A symmetrical translation was used for the Maltese GPCOG and the same format and construct was kept across items. A pilot study followed to ascertain that the tool was free from any language or cultural bias and was relevant to the Maltese culture and its intended use. The targeted populations were recruited from within the community through a purposive sampling procedure. The tool was implemented with 207 individuals aged ≥55 years, including 54 individuals previously diagnosed with dementia at the local geriatric rehabilitation outpatient facility, (Karen Grech Rehabilitation Hospital) and Dementia Day Centre (St. Vincent de Paul Long Term Care Facility), as well as 153 healthy individuals who visited the 3 main health centres in the northern, central and southern regions. The majority consisted of females 66.8% (n=139) and 32.7% (n=68) were males, mean age was 68.2 years (r_55 – 95). Mean years of education of the sample was 9.1 ± 3.0 (r_0 – 19). Data collection took place over fourteen weeks and all assessments were administered by the researcher. The study was approved by the University Research and Ethics Committee (UREC) and the members of the Ethics Board Committee at KGRH. Results from the translation analysis, test-retest and inter-rater analysis showed very good reliability statistics. Compared with the Maltese MMSE, the Maltese GPCOG Step 1 demonstrated excellent content validity. Correlation between the two tests was very strong (r = 0.932, p = < 0.001), which is stronger than that reported in the original GPCOG Step 1 study (r = 0.683, p = 0.001). Besides, the Maltese GPCOG takes about half the time to administer than the Maltese MMSE, making it more time-efficient and thus more practical in a busy general practice setting. The sensitivity and specificity of the Maltese GPCOG Step 1 (patient section), with a cut- off score of 7 points, was 92% and 97% respectively in this sample, the tool showed a very high predictive validity in identifying persons with cognitive impairment (area under the ROC curve = 95%). The Maltese GPCOG Step 2 (informant interview), collects collateral information about the patient from a reliable informant to establish any observed cognitive or functional changes over the previous 5-to-10 years. Step 2 was administered with 25 individuals who scored 5, 6, 7 or 8 on Step 1, as per instructions of the tool. The Logistic regression model on Step 1 indicated that a score 0-to-6 points predicted cognitive impairment and a score of 7-to-9 points predicted normal cognition. The diagnostic accuracy of the Maltese GPCOG Step 1, was confirmed by the likelihood ratio test, which indicated that for every 1 unit increase on Step 1, the probability of cognitive impairment decreases by 88.5%. In conclusion, the Maltese GPCOG is very brief and simple. The results of the present study confirm that the Maltese version is both reliable and valid in the assessment of cognitive impairment in the local population. In addition, the brief duration (3.5 minutes ± 1.49) make it an efficient instrument suitable for cognitive screening at primary care level in Malta. Description: M.A.AGEING&DEMENTIA