Exploring the impact of social network change: Experiences of older adults ageing in place

Social networks are sources of support and contribute to the well‐being of older adults who are ageing in place. As social networks change, especially when accompanied by health decline, older adults’ sources of support change and their well‐being is challenged. Previous studies predominantly used quantitative measures to examine how older adults’ social networks change. Alternatively, this study explores the impact of changing social networks on older adults’ lives by examining their personal experiences. We held four focus groups, two with a total of 14 older adults who are ageing in place and receiving home care and two with a total of 20 home‐care nurses from different regions and organisations in the Netherlands. Subsequently, an expert team of home‐care professionals and managers discussed and verified the results. Procedures for grounded theory building were used for analysis. We revealed four themes of high‐impact experiences: (a) struggling with illness/death of the spouse; (b) working out a changing relationship with (grand)children; (c) regretting the loss of people they have known for so long and (d) feeling dependent and stressed when helpers enter the network. Also, network dynamics were found to follow three consecutive stages: (a) awareness of social network change; (b) surprise when social network change actually occurs and (c) acceptance and adjusting to new circumstances. Together, the four themes of experiences and three stages of network change form an integrative model of the role of social network dynamics for older adults’ lives when ageing in place.     

Impaired cognitive function and mental performance in mild dehydration

Dehydration is a reliable predictor of impaired cognitive status. Objective data, using tests of cortical function, support the deterioration of mental performance in mildly dehydrated younger adults. Dehydration frequently results in delirium as a manifestation of cognitive dysfunction. Although, the occurrence of delirium suggests transient acute global cerebral dysfunction, cognitive impairment may not be completely reversible. Animal studies have identified neuronal mitochondrial damage and glutamate hypertransmission in dehydrated rats. Additional studies have identified an increase in cerebral nicotinamide adenine dinucleotide phosphate-diaphorase activity (nitric oxide synthase, NOS) with dehydration. Available evidence also implicates NOS as a neurotransmitter in long-term potentiation, rendering this a critical enzyme in facilitating learning and memory. With ageing, a reduction of NOS activity has been identified in the cortex and striatum of rats. The reduction of NOs synthase activity that occurs with ageing may blunt the rise that occurs with dehydration, and possibly interfere with memory processing and cognitive function. Dehydration has been shown to be a reliable predictor of increasing frailty, deteriorating mental performance and poor quality of life. Intervention models directed toward improving outcomes in dehydration must incorporate strategies to enhance prompt recognition of cognitive dysfunction.     

NuBrain: UK consortium for optimal nutrition for healthy brain ageing

With an ageing global population, there is an urgent need to identify effective strategies to maintain brain health across the life course and therein minimise the risk of age‐related neurodegenerative disorders reaching a severe stage which may manifest as dementia. An increasing body of evidence indicates that nutrition is a modifiable lifestyle factor that can promote healthy brain ageing and reduce dementia risk. However, at present, little is known about which dietary patterns, foods and food bioactives influence brain function during ageing, and more research is required to identify at‐risk individuals and population subgroups who are most likely to benefit from future nutritional intervention intended to promote healthier brain ageing. This article introduces the newly established Medical Research Council‐funded NuBrain consortium, the vision of which is to provide a step change in research in the area by developing novel approaches and techniques to further understand the complex interactions between diet and brain health and how we can support appropriate behaviour changes in the population. NuBrain will form a new, sustainable and internationally field‐leading research consortium with multidisciplinary and complementary areas of expertise to address the fundamental research challenges in this area.     

Social networks and health in later life: a state of the literature

Late life is a period frequently marked by decline in personal health and heightened need for social support. Consequently, the social networks in which individuals are embedded assume an increasingly central role in the health and wellbeing of older adults. In the present article, I review the state of the literature on social networks and health in later life. By drawing on insights from the sociology of ageing and the life course, I address new developments and current challenges within the field. Chief among these developments and challenges is the recognition that the ageing process does not occur in a vacuum. Rather, individuals are consistently exposed to numerous changes to their social lives which have strong implications for current and future health outcomes. Upon highlighting the latest innovations within the field of networks and health, I conclude with useful directions for future research.     

Occupational health and safety in Australia

The focus of OHS in Australia is on workplace-based prevention rather than individual health care. Over the past decade, workers' compensation data have shown continuous improvement in work-related deaths, serious injuries and diseases. Injuries from work-related vehicle incidents are the leading cause of fatalities. There is a high incidence of on-road incidents in light vehicles; this problem is under-recognised, and better incidence data are required to support more effective interventions. Rates of many long-latency diseases such as cancers are underestimated, and again more reliable information is needed, particularly on work-related exposures to carcinogens. Disease-related deaths are largely confined to older workers. Musculoskeletal injuries and disorders are the most frequent and costly OHS problem, constituting a large majority of non-fatal injuries and diseases. There is growing recognition that their risk management should be more evidence based, integrating assessment and control of psychosocial and 'manual handling' hazards. A high rate of population ageing is increasing risk of chronic diseases, including musculoskeletal disorders, which is helping to raise awareness of the importance of protecting and promoting workforce health. Strategies to achieve this have been developed but implementation is at an early stage.     

B-Vitamins and Bone Health–A Review of the Current Evidence

Because of ongoing global ageing, there is a rapid worldwide increase in incidence of osteoporotic fractures and the resultant morbidity and mortality associated with these fractures are expected to create a substantial economic burden. Dietary modification is one effective approach for prevention of osteoporosis in the general population. Recently, B vitamins have been investigated for their possible roles in bone health in human studies. In this review, we provide different lines of evidence and potential mechanisms of individual B vitamin in influencing bone structure, bone quality, bone mass and fracture risk from published peer-reviewed articles. These data support a possible protective role of B vitamins, particularly, B2, B6, folate and B12, in bone health. However, results from the clinical trials have not been promising in supporting the efficacy of B vitamin supplementation in fracture reduction. Future research should continue to investigate the underlying mechanistic pathways and consider interventional studies using dietary regimens with vitamin B enriched foods to avoid potential adverse effects of high-dose vitamin B supplementation. In addition, observational and interventional studies conducted in Asia are limited and thus require more attention due to a steep rise of osteoporosis and hip fracture incidence projected in this part of the world.     

Sector wide approaches for health in small island states: Lessons learned from the Solomon Islands

Abstract

Sector Wide Approaches (SWAps) have increasingly been implemented in countries around the world as a mechanism for effective delivery of health sector funding from various sources. Despite the global focus on aid effectiveness, SWAps have been under-examined. In 2007, the Solomon Islands and development partners began discussing a health SWAp making the Solomon Islands one of the first fragile states globally to adopt a SWAp. This paper explores the establishment and implementation of a health SWAp in the Solomon Islands as a specific case study with lessons learned for the region as well as for aid architecture in fragile states more generally. Tensions between donors and the government impeded agreement and early implementation and country ownership of the SWAp idea was muted. Since mid-2009, however, the Solomon Islands SWAp has made strong progress with greater government ownership and with more focus on partnership and harmonisation rather than on funding mechanisms. The SWAp mechanism has been a challenge for the capacity-constrained Solomon Islands health sector and for development partners familiar with other aid modalities, but current momentum suggests that the SWAp will have a positive impact on adherence to agreed aid effectiveness principles.     

开展老年健康影响因素的系统研究,推动老年健康促进行动的科学实践

当前我国人口老龄化形势日益严峻,多病共存、失能、失智和精神心理问题严重影响了老年人的生命质量。虽然我国在老年健康研究领域已经取得了很大的成果,但在研究假设、样本量、研究设计和随访质量上有一定的局限,还不足以形成高质量证据链,亦不能很好地指导制定中国老年人特别是高龄老人的健康指南或标准。本期重点号展示了老年健康生物标志物队列研究团队在老年健康流行规律、影响因素和生物标志物等方面产出的系列成果,以期为老年人健康服务提供更全面的科学证据,支撑老年健康促进行动的科学实施,推动实现健康老龄化。     

Reducing salt; preventing stroke

Life expectancy is increasing and populations are ageing around the world. This presents a number of challenges; namely an increase in the global burden of chronic diseases. Stroke is one of the most common non‐communicable diseases (NCDs) in an ageing population and is the leading cause of death worldwide; the most modifiable risk factor for which, is raised blood pressure (BP). Salt reduction as a means to reduce BP and therefore, stroke, is proven to be effective and has been recognised as such at a global level. Salt reduction reaches entire populations and can therefore benefit everyone, regardless of, gender, age, economic status or ethnicity. Excess salt consumption is a worldwide problem and so all countries need to work together to reduce population salt intake levels to reduce the global burden of stroke and other NCD's, including heart disease and heart failure. Our goal (Consensus Action on Salt and Health and World Action on Salt and Health), in line with the World Health Organization‐recommended target, is to reduce worldwide salt intake to less than 5 g per person per day by 2025. In light of this, National and World Salt Awareness Week 2012 (26 March to 1 April) will focus on ‘Reducing salt, preventing stroke’.     

Life by the river: neglected worm infection in Western Siberia and pitfalls of a one-size-fits-all control approach

The One Health movement aims to provide integrated responses to problems that emerge at the intersections of human, animal, and ecological health. However, it risks derailment due to over-reliance on top-down global responses and generalisations that often fail to fit real-world settings. In this article, we examine the case of parasitic Opisthorchis felineus infection in Western Siberia and argue that understanding the local social dynamics of disease exposure and transmission, and how people live their lives in interactions with other species is crucial for making One Health work in practice. This qualitative study was conducted in preparation for developing an opisthorchiasis control programme and involved 20 in-depth interviews, participant observation, and multiple unstructured interviews in the village of Melnikovo. We explored the social dynamics of O. felineus transmission and designed a participatory model of these dynamics. This model attests to the specificity of transmission dynamics in Western Siberia and demonstrates the importance of understanding this public health issue as embedded in social networks and animated by a variety of locally-specific linkages between ways of life, food and health cultures, health-care systems, economies, and landscapes. Our work highlights that such participatory approaches have to be an integral part of One Health interventions if these interventions are to be effective and legitimate.     

Young carers as social actors: Coping strategies of children caring for ailing or ageing guardians in Western Kenya

There is a vast body of research on the impact of HIV/AIDS on children, but little which acknowledges the role of children in providing care and support for ailing parents or ageing guardians. There has been a tendency to downplay the active role and agency of young carers, with young carers often represented as victims of damaging circumstances that compromise their psychosocial well-being. To counter-balance this tendency, and to develop the critical trend that views children as social actors, we explore how young carers cope with challenging circumstances, often with skill and ingenuity, drawing on data collected in Western Kenya in 2007. Forty-eight young carers (aged 11–17) used photography and drawing to provide accounts of their coping strategies. They described 240 of the resulting photographs and drawings in writing. In addition, 34 individual interviews and 2 group discussions were conducted with children to explore the findings further and 10 individual interviews with local adults were conducted to elucidate the dynamics between adults and children. Our data revealed that young carers cope by mobilising social support, engaging in income generating activities and constructing positive social identities around their caring roles. We conclude that children's ability to cope is determined by the extent to which they are able to participate in their community and negotiate support from it.     

Population ageing in Lebanon: current status, future prospects and implications for policy

During the past three decades, fast declines in fertility and mortality in Lebanon have created a compressed demographic transition, a growing trend towards survival into later life, and a larger proportion of elderly people in the population. Projections show that people aged 65 years and over are expected to constitute 10.2% of the population by 2025. Nevertheless, changes to the structure and composition of the population remain unmatched by any corresponding increase in support measures either through formal channels such as pension plans or through health or socioeconomic security measures such as the provision of subsidies for health care, home help or any form of nursing care. This means that an older person is forced to be dependent upon family support if it exists. We examine demographic trends of population ageing in Lebanon between 1970 and 1995 and provide projections until 2025. Variations in population ageing within the country are also considered. We also assess health care and social policy implications of demographic changes in the context of health and economic sector reforms initiated recently by the state, and explore their impact upon the expanding population of elderly people.     

The asbestos war

That asbestos is still being sold despite overwhelming evidence linking it to debilitating and fatal diseases is testament to the effectiveness of a campaign, spear-headed by Canadian interests, to promote a product already banned in many developed countries. Blessed by government and commercial support, asbestos apologists have implemented a long-term coordinated strategy targeting new consumers in Asia, the Far East and Latin America. At industry-backed "conferences" and on government-funded junkets, they spin a web of deceit, telling all who will listen that "chrysotile (white asbestos) can be used safely." The fact that Canada exports over 95% of all the chrysotile it mines suggests that while chrysotile is supposedly safe enough for foreigners, it is not safe enough for Canadians. Asbestos victims in many countries have struggled to gain public recognition of the human cost of asbestos use. In recent years, nongovernmental organizations working with these groups have created a global anti-asbestos virtual network; with the commitment and support of thousands of "virtual members," this network challenges industry's propaganda and exposes the forces that support its cynical attempt to offload this dangerous substance on developing countries.     

The Power of Mutual Aid in the Educational Process: A Seminar for New Field Instructors of Trainees

ABSTRACT

The promotion of mutual aid has special value to seminars for new supervisors of trainees. Sharing the benefits, potential strains, and demands in the assumption of this role facilitates a smooth progression toward increased professional competence. This socialization process is enhanced by the provision of adequate support through the processes of mutual aid. Challenges and obstacles to mutual aid in these seminars relate to the intrinsic difficulties regarding fears of discomfort and exposure, desire for an expert to emerge, and challenges in maintaining a balance between didactic teaching methods and mediation of group processes that promote mutuality, collaboration, and reciprocity. Illustrations provide guidance to seminar facilitators, create a foundation for understanding these processes, and promote recognition of opportunities for the enhancement and maximization of mutual aid.     

Current evidence linking nutrition with brain health in ageing

Cognitive dysfunction and depression are significant problems of ageing with major health and socio‐economic impacts; therefore, preventing or delaying the onset of these disorders should be a public health priority. In particular, there is a need to identify modifiable factors that could be targeted to promote better brain health in ageing. Epidemiological studies indicate a protective role for certain dietary patterns, in particular the Mediterranean diet, and for specific nutrients, including n‐3 polyunsaturated fatty acids, polyphenols and B vitamins. Although, the evidence to date from randomised controlled trials is generally inconsistent, there is clearer evidence to support a role for folate and related B vitamins in slowing the progression of cognitive decline and possibly reducing the risk of depression in ageing. Future studies incorporating new technologies offer much promise for the development of effective nutrition strategies that could reduce the risk of cognitive and mental disorders and improve quality of life in our ageing population.     

The role of schools of public health in capacity building

Public health has been an enormously effective instrument for improving life expectancy and quality of life. Historically a sphere of governmental activity led by physicians and staffed by sanitarians and nurses, public health has evolved to become a multi-facetted field of societal activity. It engages many agencies and community action in reducing infectious and non-communicable diseases as well as many aspects of lifestyle and health equity. Education for an adequate professional workforce is one of its key functions. Schools of public health have fulfilled this role only partly even in developed countries, but in countries in transition and in low-income countries the problem is much more acute. We discuss the role of mentoring of new schools calling for strong public and private donor support for this as a key issue in global health.     

A far greater sense of community: The impact of volunteer behaviour on the wellness of rural older Australians

This paper builds on place-based research investigating the transformative potential of volunteering for service-deprived, ageing rural communities. Here, we critically explore the relationship between communities of place, voluntarism and wellness for rural older Australians. We draw on data from a large qualitative multi-site study, and utilise Ryan et al.’s (2005) systemic model of community attachment. Findings support the dual perspective of strong community sentiments through social embeddedness in rural communities; and personal interests, associated with rational choice theory, through healthy ageing practices. Both aspects have demonstrated positive impact on wellness, but also risks to wellness associated with over-expectations of volunteers.     

Globalization and emerging governance modalities

This paper explores the possibilities for global governance effectively dealing with the international transmission of disease. First, zoonotic regulation and control pose a special case for public health agencies, and this paper proposes a propositional model for an effective public health stance. Second, globalization dynamics are briefly reviewed in terms of an emerging consensus on the need for global governance in public health. Third, a brief examination of global governance modalities suggests that a strong global governance case has distinct limitations (despite its possible justification); an exploration of contemporary directions in global governance follows. Finally, the paper examines the phenomenon of contemporary zoonotic control within the conditions of an effective regulatory regime.     

The direct, indirect and intangible costs of visual impairment caused by neovascular age-related macular degeneration

Neovascular age-related macular degeneration (nvAMD) is a chronic, progressive disease of the central retina, and its prevalence is expected to rise with the ageing population. Using a bottom-up approach based on retrospective data, this cross-sectional study estimated average annual direct costs of nvAMD to be £4,047, and average annual indirect costs to be £449. An attempt to measure intangible costs through willingness-to-pay yielded a lower response rate and estimated intangible costs to be 11.5% of monthly income. Direct costs were significantly higher for male participants, for those who have mild or moderate visual impairment in both eyes, and for those who have been diagnosed for a shorter time. The findings of this study suggest that the availability of early diagnosis, effective treatment, support services, and sustained research into the management of nvAMD may reduce the burden of visual impairment caused by nvAMD to affected individuals and the state.     

Population ageing in developed and developing regions: implications for health policy

Population ageing is now recognised as a global issue of increasing importance, and has many implications for health care and other areas of social policy. However, these issues remain relatively under-researched, particularly in poorer countries, and there is a dearth of specific policy initiatives at the international level. For example, the 1994 International Conference on Population and Development agreed to 15 key principles for future policy, but none of these even make indirect mention of the aged (International Conference on Population and Development, 1995, Documents. Programme of action of the 1994 International Conference on Population and Development. Population and Development Review, 21(2), 437-461). This paper seeks to highlight some of the key issues arising from population ageing. It begins with a brief overview of international trends in demographic ageing, and considers the health needs of different groups of older people. It sketches out some implications for policy, paying particular attention to the financing and organisation of health services. The final part of the paper contains a discussion about how older people have been affected by, and have adapted to, processes of social, economic and political change. Given the wide scope of these concerns, it is not possible to discuss any issue in detail, and the paper does not claim to give the subject matter a comprehensive or global treatment. It must be stressed that patterns of ageing and their implications for policy are highly complex and variable, and, as such, great care should be taken in generalising between the experiences of different groups of older people, and between different settings.