Identifying the communication activities of older people with aphasia: Evidence from naturalistic observation

Background: Increasingly there is a call from clinicians and researchers for measures that document the impact of aphasia on a person's everyday communication. Do existing assessments of communication disability adequately sample communication activities relevant to our clients? Communication skills and networks change with age. A need exists to determine the everyday communication activities of older people and in particular those with aphasia. Aims: The primary aim of this study was to describe and compare the everyday communication activities of older people with aphasia and healthy older people who are living in the community. A secondary aim was to investigate the content validity of the American Speech-Language Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS, 1997) for older Australians. Methods & Procedures: Naturalistic observation was the method of choice for detailing the everyday communication of 15 older people with chronic aphasia following stroke and a matched group of 15 healthy older people who were living in the community. Researchers, in the role of participant observer, took field notes for 8 hours, over three occasions within a week. A total of 240 hours of observation have been coded in terms of communication activity, topic, communication partners, and place of communication. A brief 5-day diary served to check the representativeness of the observational data. After each hour of observation, the researcher checked which ASHA FACS items had been observed. Outcomes & Results: Naturalistic observation provided a rich, rigorous, and systematic methodology for detailing the dynamics and complexities of authentic communication. The most common communication activities for both groups were conversations at home and in social groups. Real-life communication was revealed to serve the dual purposes of transaction and interaction. Results indicate that older people with aphasia engage in similar communication activities to healthy older people although differences were evident in the frequency of communication and in specific activities such as story telling, writing, commenting, and acknowledging. ASHA FACS items were generally relevant to older Australians living in the community. Conclusions: This study demonstrated that communication activity is multifaceted in terms of the type of communication and contextual factors. The observational data describe the effects of aphasia on a person's everyday communication activity and reveal the impact of aphasia on the social functions of communication including sharing information, maintaining and establishing relationships, and telling one's story. Functional communication assessment requires a greater focus on the interactional and uniquely interpersonal aspects of social communication.

Screening for depressive symptoms in older adults in the Family Health Strategy, Porto Alegre, Brazil

OBJECTIVE To analyze the prevalence of depression in older adults and associated factors. METHODS Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity. RESULTS The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression. CONCLUSIONS A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.

Access to childbirth care by adolescents and young people in the Northeastern region of Brazil

ABSTRACT OBJECTIVE To identify the factors that interfere with the access of adolescents and young people to childbirth care for in the Northeast region of Brazil. METHODS Cross-sectional study with 3,014 adolescents and young people admitted to the selected maternity wards to give birth in the Northeast region of Brazil. The sample design was probabilistic, in two stages: the first corresponded to the health establishments and the second to women who had recently given birth and their babies. The data was collected by means of interviews and consulting the hospital records, from pre-tested electronic form. Descriptive statistics were used for the univariate analysis, Pearson’s Chi-square test for the bivariate analysis and multiple logistic regressions for the multivariate analysis. Sociodemographic variables, obstetrical history, and birth care were analyzed. RESULTS Half of the adolescents and young people interviewed had not been given guidance on the location that they should go to when in labor, and among those who had, 23.5% did not give birth in the indicated health service. Furthermore, one third (33.3%) had to travel in search of assisted birth, and the majority (66.7%) of the postpartum women came to maternity by their own means. In the bivariate analysis, the variables marital status, paid work, health insurance, number of previous pregnancies, parity, city location, and type of health establishment showed a significant association (p < 0.20) with inadequate access to childbirth care. The multivariate analysis showed that married adolescents and young people (p < 0.015), with no health insurance (p < 0.002) and from the countryside (p < 0.001) were more likely to have inadequate access to childbirth care. CONCLUSIONS Adolescents and young women, married, without health insurance, and from the countryside are more likely to have inadequate access to birth care. The articulation between outpatient care and birth care can improve this access and, consequently, minimize the maternal and fetal risks that arise from a lack of systematic hospitalization planning.

Facing the challenge: The impact of the recession and unemployment on men's health in Ireland

The economic recession with its accompanying rise in unemployment rates is linked to extremely adverse effects for men’s mental health. This research report Facing the Challenge – The Impact of the Recession and Unemployment on Men’s Health in Ireland identifies a strong expectation of increased mental health problems for men given the very strong correlation between unemployment and male mental ill health. The report is the result of a research and consultation process carried out, in Northern Ireland and the Republic of Ireland, by Nexus Research Co-operative on behalf of IPH. 93% of frontline organisations, North and South, in contact with unemployed men linked health challenges to unemployment and recession and all organisations surveyed noted adverse health challenges for men they work with. In addition to health challenges being higher for unemployed men, they were also very high for men who saw themselves as being threatened with unemployment. The organisations surveyed and the men who were interviewed identified the challenges to health as:•    High levels of stress or anxiety•    Dependency on or over-use of alcohol/other drugs•    Deterioration in physical health•    Development of conflict in family or close personal relationships•    Isolation (including sharing or communicating problems)•    A reluctance to approach services or seek help

Investing for Health - Consultation Paper

Investing for Health aims to improve the health of our people and reduce inequalities in health. It sets out a broad range of areas where new and concerted action could make a significant difference to health and wellbeing. Three priority groups are identified; the very young, children and young people, and older people. In line with best practice elsewhere a settings approach is proposed, and homes, schools, workplaces and communities are identified as priority settings. As part of an integrated lifestyle and lifeskills programme the priority topics identified include; smoking, physical activity, eating for health, harm related to alcohol and drug misuse, mental health, sexual health and accidents. åÊ

A strategy for cancer control in Ireland / National Cancer Forum

To address the rapidly rising burden of cancer, this second National Cancer Strategy A Strategy for Cancer Control in Ireland 2006 advocates a comprehensive cancer control policy programme. Cancer control is a whole population, integrated and cohesive approach to cancer that involves prevention, screening, diagnosis, treatment, and supportive and palliative care. It places a major emphasis on measurement of need and on addressing inequalities and implies that we must focus on ensuring that all elements of cancer policy and service are delivered to the maximum possible extent. This Strategy also focuses substantially on reform and reorganisation of the way we deliver cancer services, in order to ensure that future services are consistent and are associated with a high-quality experience for patients and their carers. There is evidence of considerable variation in cancer survival between regions and also significant fragmentation of services for cancer patients. These interrelated factors are of major concern to the National Cancer Forum.

Perspectives On The Provision Of Counselling For Women In Ireland

The last decade has seen a growing interest in attention to womenâ?Ts health, including womenâ?Ts mental health. Women are the most frequent users of the health services and are more likely to present with mental health issues, most notably depression and anxiety (Breslau et al., 1995). During the consultative process for the Plan for Womenâ?Ts Health (1997-1999) the health services were criticised for not responding appropriately to womenâ?Ts mental health needs. Women perceived the services as being primarily concerned with treating mental illness, rather than protecting and promoting mental health. Women specifically requested greateraccess to counselling1 services, located in appropriate physical environments that were not medically  orientated. Such counselling should be proactive, attracting clients for whom mental health issues had not developed into more serious problems. These services would help them to develop coping skills and assertiveness.   Download document here

Health and Social Care Implications of Population Ageing In Ireland 1991-2011

This report has two main objectives. The first is to set out national and health board area population projections for Ireland in the period 1991-2011, with special reference to the elderly population. The second is to consider the implications of the predicted trends in the elderly population for health and social care services over the same period, taking account of official policy objectives and service norms for the health services. Download the Report here

Proceedings of a conference on the Years Ahead Report

The National Council on Ageing and Older People is an advisory body to the Minister for Health on all aspects of ageing and the welfare of older people. In fulfilment of its terms of reference, the Council has recently published a Review of the implementation of the recommendations of the 1988 report The Years Ahead â?" A Policy for the Elderly The Review was a major undertaking and required contact with Government Departments, the eight health boards, a large sample of local authorities and many other organisations. All of the recommendations contained in The Years Ahead report were analysed, and a comprehensive picture of health and social services for older people was presented. The Council is indebted to the authors of the review, Dr Helen Ruddle, Dr Freda Donoghue and Mr Ray Mulvihill for their efforts in preparing such a comprehensive and high quality reportDownload the Report here

An Action Plan for Dementia

The Action Plan takes as its guiding principle the recognition of the individuality of the person with dementia and of his or her individual needs. This principle has informed and influenced the development of the plan. The needs and uniqueness of the person with dementia must be paramount when we talk of care and service provision. Action on the treatment of dementia can be delayed no longer. Given the increasing proportion of older people in the population and the higher prevalence of dementia in older age groups, action is needed now. This plan should serve as a model of best practice for the provision and planning of services to meet the individual needs of people with dementia and their carers Download the Report here

Planning for Dementia Care in Ireland: Conference Proceedings

The Conference, which took place on 4th June 1999 in the Royal Marine Hotel, Dun Laoghaire, marked the publication of the Councilâ?Ts latest report â?" An Action Plan for Dementia.  The Action Plan takes as its guiding principle the recognition of the individuality of the person with dementia and of his or her needs. It outlines an approach to developing available, accessible and high quality services in the context of existing resources and public expenditure constraints. Its aim is to describe a best practice model of dementia care in Ireland â?" a model which may inform and guide policy makers and others involved in planning service provision, and which may give support and assistance to those who endeavour to provide flexible services at the local level. Download the Report here

Health in Ireland, Key Trends 2007

This booklet provides an overview of selected key trends in health in Ireland in recent years. Tables and graphs are presented which summarise information on demographics, on health status and on health care in order to give a quick reference guide in major areas of health and health services. The past decade has been a time of rapid change in many aspects of life in Ireland. The evidence presented in this booklet reflects this period of change with respect to health. Download document here

Quality Assurance Standards for Symptomatic Breast Disease Services

Quality Assurance Standards for Symptomatic Breast Disease Services People in Ireland have a right to expect that medical care be of good quality. They expect that standards of care are consistently high. They expect that access to care is easy, speedy, effective and efficient. Society expects quality of care to measure up to international norms of good practice. Such assurance can be given by auditing the quality of activity. Click here to download PDF 606kb

Older People's Experiences of Housing Exclusion

Older People’s Experiences of Housing Exclusion Click here to download PDF 625kb

Health In Ireland: Key Trends 2010

This edition of Health in Ireland: Key Trends provides an overview of significant trends in health and the health services during the past decade. The aim is to reflect the main areas of health and health care and to highlight selected topics of growing concern and/or where new data has become available. Click here to download 2.03MB PDF