Late Additions
Asynchronous Session
Advance Care Planning for Older People in End-of-life Healthcare: Focusing on the 2016 Legislation in Victoria and 2018 Guidelines in Japan View Digital Media
Paper Presentation in a Themed Session Yukio Sakurai
Japan constitutes the most aged society in the world. The ratio of older people aged 65 and over in the national population was 29.1% in September 2021, which is projected to reach 38.4% in 2055. The arrangements to prepare end-of life is however not so advanced that most older people rely on relatives or nursing-home managers with their health/aged care. It is a serious concern on how older people will have a quality of life with satisfaction until the final moment. In theory, the values of autonomy and self-determination of older people must be respected in end-of-life care. Advance Care Planning (ACP) is a common method enables these people to realize their wishes in the process of end-of-life. In practice, the story is not so simple because statistics indicate that ACP is underutilized among people, namely, 37% in the US, 8-10% in the UK, the Netherland, Germany, 3% in Taiwan, and nearly zero in Japan. Even if ACP were created, no guarantee was available that ACP would be respected by medical professionals subject to their judgement. Opinions of relatives are sometimes more respected than ACP. Why does it so happen? Healthcare treatments are conducted between medical professionals and patients based on the foundation of the national healthcare policy and medical law. ACP exists within such framework and needs some adjustment. To clarify what adjustments are essential, two different ACP systems in theory and practice are comparatively examined between the 2018 guidelines in Japan and 2016 legislation in State of Victoria (Australia).
Evidence-informed Approach to De-prescribing of Atypical Antipsychotics in the Management of Behavioral Expressions in Advanced Neurocognitive Disorders: Results of a Retrospective Study View Digital Media
Paper Presentation in a Themed Session Atul Sunny Luthra
LuBAIR™ Paradigm, a novel approach to ascribing meaning for behavioral expression in advanced neurocognitive disorder, was used to identify behavioral categories that are likely to respond to the use of atypical antipsychotics in their management. LuBAIR™ Inventory filled on two occasions. The data collected on the second occasion, in the successful and failed de-prescribed groups, were compared in this retrospective study. Chi-Square paired t-test and Cohen d Statistical tests were used to detect the difference in the behavioral categories between the two cohorts. Patients who did not have Mis-Identification and Goal-Directed Expressions were more likely to successfully de-prescribe : X2 (1, N = 40) = 29.119 p<.0001 and X2 (1, N = 40) = 32.374, p<.0001, respectively. Alternatively, the same behavioral categories were more likely to be present in patients who failed de-prescribing: paired t-test and Cohen-d (P<0.0001). Atypical antipsychotics, in their role as an antipsychotic and mood stabilizer, may be used to manage Mis-Identification and Goal-Directed Expressions, respectively.
The Paradox of (In)dependence: Conflicting Logics in Reablement for Older People
Paper Presentation in a Themed Session Chunhua Chen
Reablement is time-limited home-based intermediate care for older adults to regain independence. The UK has been a pioneer in developing, piloting, and rolling out reablement; however, widespread misunderstandings of reablement by health professionals, service users, and families indicate that the ethos of reablement – independence, has not been embraced by the wider public. This contrast challenges the fit between the core notion of reablement and UK practices; and its sustainability. This paper is part of an investigation into user engagement in reablement. Five research sites across England and Wales were selected, representing different models of service organisation and delivery and broader contexts. Data were collected through focus group discussions with reablement staff (n=78) and interviews with service users (n=12) and families (n=5) during June and August 2022. Thematic analysis was applied. The analysis identified three paradoxes in service organisation and delivery that threatened the core of reablement. Overall, the increasing number of low-potential referrals undermined its ability to achieve independence. As a key player, families were more of a barrier to engaging seniors with reablement activities, leading to constant negotiations among multi-stakeholders that inevitably compromised the pursuit for independence. The functionality-focused model has caused an unintended consequence of user dependency on staff companionship, exacerbated by disjointed services. The paradoxes suggest that current practices undermine the sustainability of reablement. The quest for active ageing and independence requires forward-thinking and sound management, as some influencing factors are unamenable to limited resources. Therefore, policy rethinking and resource mobilization and reallocation are imperative.
The Association between Fertility and Female Employment within OECD Countries: The First 20 Years of the 21st Century View Digital Media
Paper Presentation in a Themed Session Milos Milovanovic
The cross-sectional association between female employment and fertility in developed countries shifted from negative to positive during the 1980s. Ever since researchers have applied different statistical approaches, to understand the nature of this relationship, often with opposite conclusions. Therefore, the present study estimates the relation by the fresh statistical approach and the latest data for 32 countries belonging to the Organization for Economic Co-operation and Development (OECD). Specifically, the paper implemented the multilevel mixed-effect method, thereby expanding the analysis beyond the limitations of models implemented in the previous studies. Eventually, the results of the selected statistical approach verified the persistence of negative signs in a time-series association between fertility and female employment for the most recent period (2010-2020), while the positive sign of cross-country association still persists. Given the bi-directional relationship between fertility rate and female labour participation, it is problematic to draw firm causal inferences. Nevertheless, it is evident that the change in the participation rate and a change in the fertility rate are interrelated.
Yes, the Years Pass Faster: Functional Limitations in Three Generations in Portugal and Estonia in a 6-year Follow-up Study View Digital Media
Paper Presentation in a Themed Session Daniela Craveiro
Functional decline is a major contributor to disability and dependence in older adults, which has significant social and economic implications for a country. Understanding functional decline trends and determinants can provide important insights for social policy. In this scope, longitudinal population surveys are a crucial source of information and have provided important clues on the effects of early and life course factors. Due to data availability, southern and eastern Europe countries are underrepresented in international comparative longitudinal studies. This study contributes to this empirical gap. Using data from three waves of the Survey of Health, Ageing and Retirement in Europe, we draw on nationally representative samples of men and women aged 50 and older in Portugal and Estonia. An ageing vector model was used to estimate the trajectories of functional limitations in each sample, namely the estimations of age-specific prevalence risk and age-specific prevalence risk change in 6 years period. With these longitudinal growth models, the study of the role of early and adult life socioeconomic determinants was assessed, and the trends of younger and older cohorts were compared. Significant international variation was found in the region in the effect of some socioeconomic determinants. In the two countries, younger cohorts were found to be less healthy at comparable ages than the older cohorts contradicting some more optimistic expectations of longevity gains. Implications of these trends to the national trajectories for sustainable development are discussed.
The Beloved Community: A Social and Cultural Perspective on the Benefit of Inter-generational Dialogue in Faith Communities View Digital Media
Innovation Showcase Jesse Eugene Herriott
In the United States, over 47.8 Million adults were over the age of 65 in 2016. Advances in the fields of science, technology, medicine, psychology, and other areas have contributed to advanced states of well-being and quality of life that have provided opportunities for Americans to live longer. The role of the Church as a community, provides a healthy container in which intergenerational presence, support, interbeing, and dialogue assists younger generations in navigating rites of passage that can provide positive benefits within the larger society. The Church possesses a knowledge economy and its primary currency is the subjective experience of faith. By providing positive and psychologically affirming theology, faith communities can make an effort to build a subjective, life-affirming, epistemological framework that supports inter-generational dialogue, which would contribute to a more positive and just society. The religious experience can be deeply cultural, familial, and personal. Those deep ties offer opportunities of mentorship, the chance to heal familial bonds, and provide internal strength and willpower to live.
