Measurement of stressful postures during daily activities: An observational study with older people.

This study measured the postures of older people during cooking and laundry. A sample of men and women aged 75+ years (n=27) was recruited and observed in a home-like environment. Postures were recorded with a measurement system in an objective and detailed manner. The participants were videotaped to be able to see where 'critical' postures occurred, as defined by a trunk inclination of ≥60°. Analysis of data was facilitated by specially developed software. Critical postures accounted for 3% of cooking and 10% of laundry, occurring primarily during retrieving from and putting in lower cabinets, the refrigerator, laundry basket or washing machine as well as disposing into the waste bin. These tasks involve a great variation in postural changes and pose a particular risk to older people. The results suggest that the use of stressful postures may decrease efficiency and increase fatigue, eventually leading to difficulties with daily activities. The specific tasks identified during which critical postures occurred should be targeted by designers in order to improve the activities. A few examples are given of how better design can reduce or eliminate some of the postural constraints.

Health of the older worker in Ireland - occupational physical and psychosocial factors in the autumn of work life

Introduction: Worldwide, governments are striving to keep people in work to an older age. However, little is known about the effects of work on an older workforce. This thesis aims to investigate the importance of job characteristics to the antecedents and evolution of cardiovascular disease and functional limitations for the older worker (50+ years). Methods: Three studies were used in this thesis. The 5C (Cork Coronary Care Case- Control) Study investigated the association between job strain and a coronary event in males (n=208) 35-74 years old. The Mitchelstown Study examined the association between job characteristics and positive lifestyle behaviours and further, job characteristics and blood pressure for males and females 50-69 years (n=2,047). Finally, the Cork & Kerry Study investigated the physical effects of manual work and reported functional limitations/disabilities in a sample of 60-80 year olds (n=362). Results: Results from the 5C Study show a clear difference between younger (<50 years) and older (≥50 years) workers, with older workers who had a coronary event more likely to have high job strain and low job control. Data from the Mitchelstown Study showed workers with intermediate possibility for development or high quantitative demands (versus low) at work significantly more likely to have co-occurrence of positive lifestyle behaviours. Further, those who had high possibility for development were more likely to have high systolic blood pressure with no indication of recovery from this activation at night. Physically demanding work as reported by the participants of the Cork & Kerry Study was associated with functional limitations and activities of daily living disability for both the paid and unpaid worker. Discussion: The findings from this piece of work highlight the necessity to examine job characteristics and health outcomes in isolation for the over fifties. The challenge is to get this information into the workplace.

A Home from Hospital service for older people.

Current policy and practice emphasises much more than ever before a need for purchasers and providers to reduce appropriately the length of hospital stay. Consequently, a number of early discharge “schemes” have been developed. This paper presents the findings from an evaluation of a “home from hospital” (HFH) scheme. The HFH service provides a maximum of six weeks intensive domiciliary care for older people on their discharge from hospital. The aim of the service is to facilitate early discharge from hospital and to assist patients to regain independence. The study reported here elicited the views and perceptions of clients and professionals involved in the HFH scheme about the quality, efficiency and effectiveness of the service. Seventy-five clients were discharged from hospital to the HFH scheme during a two month period and those who consented to participate in the study were interviewed after discharge from the HFH service (n = 40). Participants had attended hospital for various conditions but the largest group were fracture patients. Hospital staff and community based professionals completed a questionnaire about the service. Overall, clients and professionals perceived the HFH scheme as a beneficial service, though some minor problems existed at an individual level. Clients’ dependency levels generally decreased during their time on the scheme. Research using a controlled design is necessary in order to draw firm conclusions about the cost-effectiveness of a HFH service. Overall, home-from-hospital appears to be an effective model of an early discharge scheme worthy of further attention.

Older, Louder and Stronger: the Changing Ageing Partnership putting older people first

The Changing Ageing Partnership (Cap) in Northern Ireland was established to help place older people’s voices at the heart of policy development. Making research relevant to the needs of society and translating the findings of research into policy and practice are challenges shared by all working in the field of ageing. This paper describes Cap’s development and evolution over the past three years. It provides an insight into the strategies used by Cap to stimulate interest in ageing related research across Queen’s University Belfast and in enabling older people and others to be active participants in the research process. The paper concludes by highlighting the challenges that remain.

Professional perspectives on decision making about the long-term care of older people

With the increasing pressure on social and health care resources, professionals have to be more explicit in their decision making regarding the long-term care of older people. This grounded theory study used 19 focus groups and nine semi-structured interviews (99 staff in total) to explore professional perspectives on this decision making. Focus group participants and interviewees comprised care managers, social workers, consultant geriatricians, general medical practitioners, community nurses, home care managers, occupational therapists and hospital discharge support staff. The emerging themes spanned context, clients, families and services. Decisions were often prompted by a crisis, hindering professionals seeking to make a measured assessment. Fear of burglary and assault, and the willingness and availability of family to help were major factors in decisions about living at home. Service availability in terms of public funding for community care, the availability of home care workers and workload pressures on primary care services influenced decision 'thresholds' regarding admission to institutional care. Assessment tools designed to assist decision making about the long-term care of older people need to take into account the critical aspects of individual fears and motivation, family support and the availability of publicly funded services as well as functional and medical needs.

Talking about colds and flu: The lay diagnosis of two common illnesses among older British people

This paper reports on a study of the ways in which 54 older people in South Wales (UK) talk about the symptoms and causes of cold and influenza (flu). The study was designed to understand why older people might reject or accept the offer of seasonal flu vaccine, and in the course of the interviews respondents were also asked to express their views about the nature and causes of the two key illnesses. The latter are among the most common infections in human beings. In terms of the biomedical paradigm the common cold is caused by numerous respiratory viruses, whilst flu is caused by the influenza virus. Medical diagnosis is usually made on clinical grounds without laboratory confirmation. Symptoms of flu include sudden onset of fever and cough, and colds are characterized by sneezing, sore throat, and runny nose, but in practice the symptoms often overlap. In this study we examine the degree by which the views of lay people with respect to both diagnosis and epidemiology diverge with that which is evident in biomedical discourse. Our results indicate that whilst most of the identified symptoms are common to lay and professional people, the former integrate symptoms into a markedly different observational frame from the latter. And as far as causation is concerned it is clear that lay people emphasize the role of 'resistance' and 'immunity' at least as much as 'infection' in accounting for the onset of colds and flu. The data are analyzed using novel methods that focus on the co-occurrence of concepts and are displayed as semantic networks. As well as reporting on its findings the authors draw out some implications of the study for social scientific and policy discussions concerning lay diagnosis, lay expertise and the concept of an expert patient.

Providing Legal Information and Advice to Older People: as much a question of accessibility as affordability

No continent has as high a proportion of older people as Europe. In this paper, we report the findings of an empirical project examining the legal advice needs of older people. An important element of the project also sought information about the capacity of the internet for meeting the legal advice needs of older people. Overall our findings broadly indicate considerable failings in legal information provision for older people from more traditional advice sources. Whilst we have uncovered some examples of individualised good practice, our research in the main revealed an alarming sense of fear, mistrust, uncertainty and ambivalence among older people towards accessing legal advice. The research was funded by the Changing Ageing Partnership (CAP). We believe our findings have broad implications and applicability across Europe.

The Advent of Modern Irish Drama and the Abjection of Peasant Popular Culture: Folklore, Fairs and Faction Fighting

This paper is part of a larger project in which the author is interested in recovering popular performative traditions and practices that have been occluded by the modernist project of the Irish Revival. This erasure has been compounded by subsequent historiographical paradigms that have reinforced the revivalist narrative of theatre history and excluded indigenous forms, traditions and practices (mumming, rhymers, strawboys) along with the wider performative culture of patterns, wakes, fairs, faction fights etc. This essay subjects to scrutiny what the author sees as a disjuncture between the riotous reality of peasant popular culture and its representation in Revivalist dramas to argue that Irish Theatre Studies needs to develop alternative historiographies of performance and to methodologically engage with theoretical models extant in Performance Studies.

‘Making Older People Equal: Reforming the Law on Access to Education and Other Services’

Age-based discrimination in the supply of goods and services (including educational services) has only very recently been outlawed in the United Kingdom by the Equality Act 2010, the relevant sections of which have not yet been brought into force. This paper critically considers the Act and its implications, as well as the current proposal for an EU Directive on Goods and Services.The greatest immediate potential of the Equality Act lies in the general prohibition against age discrimination and the scope of the exceptions to it. The paper argues that exceptions permitting service providers to discriminate against older people (i.e. negative exceptions) should be very specifically set out in the reforming legislation.There should be no general defence to a claim of age discrimination based around the concept of ‘reasonableness’, which would not be consistently interpreted by courts and tribunals in a way that steers clear of traditional ageist assumptions and stereotyping.The paper argues that service providers should be permitted to discriminate in favour of older people (i.e. make positive exceptions) if the reason for doing do so satisfi es legislative criteria which are designed, amongst other things, to meet the particular needs of older persons or to promote social inclusion. Under this proposal, preferential treatment such as age-related concessionary fees for adult education courses and programmes would be lawful.

Recruitment and capacity-building challenges in participatory research involving young people in Northern Ireland

Consulting young people in social research is increasingly popular and is not confined to their recruitment as participants but extends to the design, delivery and dissemination of research. In this chapter we explore the recruitment and capacity building challenges involved in working with young people as researchers. We will introduce some of the theoretical issues around young people’s participation. Drawing on experiences from four separate participatory research projects with young people in Northern Ireland, we will highlight some of the difficulties encountered and give some practical approaches to managing the research process. Strategies for recruiting and training young researchers will be considered and we also reflect on what the benefits of young people’s involvement can be; not only enhancing the research process but also empowering young people and creating the potential for social agency.

Popular Culture, 1600-1914

A review of changes in language, custom, amusements during Ulster's transition from a rural to an urban industrial society

Potentially inappropriate prescribing in older residents in Irish nursing homes

STOPP/START was formulated to identify potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) in older people. The purpose of this study was to determine the prevalence of PIP and PPO in older Irish patients in residential care using STOPP/START.

Interventions to improve the appropriate use of polypharmacy for older people

Background
Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, hence interest in appropriate polypharmacy, where many medicines may be used to achieve better clinical outcomes for patients, is growing.

Objectives
This review sought to determine which interventions, alone or in combination, are effective in improving the appropriate use of polypharmacy and reducing medication-related problems in older people.

Search methods
In November 2013, for this first update, a range of literature databases including MEDLINE and EMBASE were searched, and handsearching of reference lists was performed. Search terms included 'polypharmacy', 'medication appropriateness' and 'inappropriate prescribing'.

Selection criteria
A range of study designs were eligible. Eligible studies described interventions affecting prescribing aimed at improving appropriate polypharmacy in people 65 years of age and older in which a validated measure of appropriateness was used (e.g. Beers criteria, Medication Appropriateness Index (MAI)).

Data collection and analysis
Two review authors independently reviewed abstracts of eligible studies, extracted data and assessed risk of bias of included studies. Study-specific estimates were pooled, and a random-effects model was used to yield summary estimates of effect and 95% confidence intervals (CIs). The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to assess the overall quality of evidence for each pooled outcome.

Main results
Two studies were added to this review to bring the total number of included studies to 12. One intervention consisted of computerised decision support; 11 complex, multi-faceted pharmaceutical approaches to interventions were provided in a variety of settings. Interventions were delivered by healthcare professionals, such as prescribers and pharmacists. Appropriateness of prescribing was measured using validated tools, including the MAI score post intervention (eight studies), Beers criteria (four studies), STOPP criteria (two studies) and START criteria (one study). Interventions included in this review resulted in a reduction in inappropriate medication usage. Based on the GRADE approach, the overall quality of evidence for all pooled outcomes ranged from very low to low. A greater reduction in MAI scores between baseline and follow-up was seen in the intervention group when compared with the control group (four studies; mean difference -6.78, 95% CI -12.34 to -1.22). Postintervention pooled data showed a lower summated MAI score (five studies; mean difference -3.88, 95% CI -5.40 to -2.35) and fewer Beers drugs per participant (two studies; mean difference -0.1, 95% CI -0.28 to 0.09) in the intervention group compared with the control group. Evidence of the effects of interventions on hospital admissions (five studies) and of medication-related problems (six studies) was conflicting.

Authors' conclusions
It is unclear whether interventions to improve appropriate polypharmacy, such as pharmaceutical care, resulted in clinically significant improvement; however, they appear beneficial in terms of reducing inappropriate prescribing.