A call for solutions for healthy aging through a systems-based, equitable approach to obesity.
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ABSTRACT:
SUBMITTER: Callahan EA
PROVIDER: S-EPMC9314109 | biostudies-literature | 2022 May
REPOSITORIES: biostudies-literature
Publications
A call for solutions for healthy aging through a systems-based, equitable approach to obesity.
Callahan Emily A EA Vafiadis Dorothea K DK Cameron Kathleen A KA Stanford Fatima Cody FC
Journal of the American Geriatrics Society 20220309 5
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Project description:Methods to facilitate co-production in mental health are important for engaging end users. As part of the Technology for Healthy Aging and Wellbeing (THAW) initiative we organized two interactive co-production workshops, to bring together older adults, health and social care professionals, non-governmental organizations, and researchers. In the first workshop, we used two activities: Technology Interaction and Scavenger Hunt, to explore the potential for different stakeholders to discuss late life mental health and existing technology. In the second workshop, we used Vignettes, Scavenger Hunt, and Invention Test to examine how older adults and other stakeholders might co-produce solutions to support mental wellbeing in later life using new and emerging technologies. In this paper, we share the interactive materials and activities and consider their value for co-production. Overall, the interactive methods were successful in engaging stakeholders with a broad range of technologies to support mental health and wellbeing and in co-producing ideas for how they could be leveraged and incorporated into older people's lives and support services. We offer this example of using interactive methods to facilitate co-production to encourage greater involvement of older adults and other under-represented groups in co-producing mental health technologies and services.
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Project description:PurposeLesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals have health needs specific to their identities. However, they face discrimination and cis-heteronormativity in most patient-provider interactions, which often translate into poor healthcare. Evidence suggests doctors are inadequately trained to care for LGBTQ+ patients. Medical students are well-placed as the future workforce to establish affirming behaviours. This study garners LGBTQ+ patients' healthcare experiences, where limited qualitative evidence exists, and explores whether students have insight into these experiences.MethodThirty LGBTQ+ patients and twenty students, evenly divided between Singapore and the United Kingdom (UK), two legally and culturally different countries, consented to semi-structured interviews in 2022 to evaluate their LGBTQ+ healthcare perceptions. Thematic analysis was conducted using a collaborative, iterative process involving five investigators, with frequent auditing of data interpretation.ResultsMost patients described implicit biases with a lack of support and professionalism from doctors, hindering health outcomes. Patients experienced misgendering and a lack of recognition of sexual and gender diversity; students appreciated the need to acknowledge patient identity. Although perceptions surrounding certain themes were similar between patients and students in both countries, patients' voices on the complexity and dissatisfaction of gender-diverse care contrasted with students' lack of insight on these themes. Singapore patients were more concerned with sociolegal acceptance affecting health needs, whilst UK patients noted more nuanced barriers to healthcare. Although many students were unsure about specific health needs and perceived a lack of training, they expressed willingness to create an equitable healthcare environment.ConclusionsLGBTQ+ patients provided powerful narratives on discrimination surrounding their healthcare needs. To address these, medical students must be encouraged by healthcare educators to develop identity-affirming behaviours as future change-makers and challenge cis-heteronormative views. Alongside vital institutional changes tailored to each country, patients' and students' collective action would create meaningful educational opportunities to reach culture change.
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Project description:Background With the development trend of healthy aging and intelligent integration, escort products have become a new means of healthy aging. Healthy old-age care pays attention to the convenience and informatization of life. To meet the needs, designers often design multiple accompanying product solutions, and it is very important to use reasonable evaluation methods to decide on the optimal solution. Purposes A new comprehensive evaluation method is proposed to reduce the subjectivity and one-sidedness of the selection process of intelligent escort product design solutions, and to make the decision more objective and reasonable. Such decisions can enhance the experience and naturalness of the elderly using intelligent products. Methods First, a large number of user interviews were analyzed using the grounded theory, gradually refine through theoretical coding, and abstracted with the design scheme evaluation index. Second, the idea of game-theoretic weighting is used to optimize a linear combination of subjective and objective weights to determine the final weights of each evaluation indicator. Finally, the evaluation and selection are completed based on the solution ranking determined by the approximate ideal solution ranking method (TOPSIS). It is applied for the selection of the elderly escort robot design, and the usability test is conducted using the PSSUQ to verify the selection results. Results A new comprehensive evaluation method can better complete the preferential selection of product design solutions for healthy aging escorts, and reduce the subjectivity and one-sidedness of the evaluation. Conclusion This method compensates for the reliance on personal experience in the selection of options, and improve the subjectivity of the evaluation index determination process and the deviation of index weighting. Improving the objectivity and scientificity of decision-making reduces the blindness of design and production. It also provides a theoretical reference for the research scholars of healthy aging companion products.
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Project description:BackgroundWhole-systems approaches (WSAs) are well placed to tackle the complex local environmental influences on overweight and obesity, yet there are few examples of WSAs in practice. Amsterdam Healthy Weight Approach (AHWA) is a long-term, municipality-led program to improve children's physical activity, diet, and sleep through action in the home, neighborhood, school, and city. Adopting a WSA, local political, physical, social, educational, and healthcare drivers of childhood obesity are viewed as a complex adaptive system. Since 2013, AHWA has reached >15,000 children. During this time, the estimated prevalence of 2-18-year-olds with overweight or obesity in Amsterdam has declined from 21% in 2012 to 18.7% in 2017. Declining trends are rarely observed in cities. There is a need to formally articulate AHWA program theory in order to: (i) inform future program evaluation which can interpret this decline within the context of AHWA and (ii) contribute a real-life example of a WSA to the literature.MethodsThis study aimed to formally document the program theory of AHWA to permit future evaluation. A logic framework was developed through extensive document review and discussion, during program implementation.ResultsThe working principles of the WSA underpinning AHWA were made explicit in an overarching theory of change, articulated in a logic framework. The framework was operationalized using an illustrative example of sugar intake.ConclusionsThe logic framework will inform AHWA development, monitoring, and evaluation and responds to a wider need to outline the working principles of WSAs in public health.
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Project description:BackgroundThe SARS CoV-2 (COVID-19) pandemic catalyzed a dramatic shift in healthcare delivery, with telemedicine emerging as a common mode of care provision. While pre-pandemic telemedicine services were more commonly used for preventive visits and had better adherence among younger and more affluent demographics, the landscape of telehealth in the post-pandemic period has shifted significantly to include surgical visits and publicly-insured patient populations. Without specific insights from patients and clinicians to guide this transition, telehealth delivery risks exacerbating disparities in access, experience and outcomes for medically underserved populations.MethodsWe utilized a human-centered design (HCD) approach to gain insights into patient and clinician perspectives on telehealth delivery at a surgical outpatient clinic in an urban safety-net hospital and level 1 trauma center. During the Inspiration phase of HCD, we conducted 19 in-depth interviews with patients and surgical clinicians, and applied a combined thematic analysis and design synthesis approach to identify key insight statements representing actionable tensions across cohorts. During the Ideation phase of HCD, we held a structured brainstorming session to identify solutions and facilitated a discussion with surgical faculty to co-design and refine a prototype.ResultsInterview analysis revealed 12 main themes, which were then reorganized into 5 core insights across both groups: "In-person appointments can be resource intensive for patients, making their attendance costly in more ways than one"; "When sacrificing connection for convenience, telehealth exacerbates discrimination felt by historically marginalized patients"; "Personal interactions are crucial for establishing new relationships and repairing mistrust between patients and clinicians"; "Visual cues and non-verbal communication are essential for personalized and effective surgical care"; "Patients and clinicians value the human infrastructure built into the in-person visit experience." Brainstorming participants generated ideas from the first insight statement. Subsequent prototyping and co-design sessions led to the development of a screening prototype allowing both clinic staff and patients to book telehealth appropriate appointments.ConclusionsThis study offers a HCD approach to developing insights and tailoring health service interventions to the local contexts for safety-net providers. By understanding the unique needs and preferences of underserved populations, we can develop telehealth interventions that increase adoption and ensure equitable access to care.
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Project description:BackgroundNearly one in every seven Americans is 65 years and older, facing day-to-day challenge of aging. Although interest in healthy aging is growing, most of the efforts are directed towards understanding the perceptions of older adults. Little is known about the perspectives of community-based practitioners who work with older adults and deliver programs to promote healthy aging. The purpose of this project was to expand knowledge on healthy aging by exploring the perspectives of community-based practitioners working directly with older adults.MethodsWe purposively sampled community-based practitioners (n = 12, including nurses, physician, social workers, and other community services professionals) working with older adults, who then participated in one of three in-depth focus group discussions conducted between March and June 2016. Each focus group discussion lasted for about 2 h. Verbatim transcript data were analyzed in Atlas.ti 7 using a conventional content analysis with an inductive approach, and consensual validation of coding was achieved.ResultsThree core categories of healthy aging were identified: (1) characteristics of healthy aging; (2) healthy aging attainment; and (3) programs and activities for healthy aging. Practitioners identified a number of characteristics of healthy aging under person-specific (physiological, basic, psych-emotional, and cognitive needs), social aspects (creating community and contributing to the community), and spiritual dimensions (cultural views and beliefs) of healthy aging. Healthy aging attainment was represented as facilitators and barriers both with respect to care recipients and care providers, and programs and activities through promoting fitness and wellness.ConclusionsThe rapidly changing demographics and aging population in the United States and their various needs suggest the implications for recognizing opportunities and developing and implementing programs to promote healthy aging. Although practitioners' perspectives had some overlap with traditional research and medical views on healthy aging, the unique and holistic conceptual framework derived in the study might provide a more refined foundation for delivering appropriate health care services to the American aging population.
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Project description:The eligibility criteria for social pension schemes in Africa hinder equitable and healthy aging. In 2019, women in 14 sub-Saharan African countries had an average life expectancy of 67 years but a healthy life expectancy of only 57 years, leaving them 5 years in poor health before receiving a pension at age 62. Men had a similar situation-a life expectancy of 62 years and a healthy life expectancy of 53 years, spending 10 years in poor health before becoming eligible for pensions at age 63. Many men do not receive pensions due to early death. Delays and low pension payouts contribute to a 2.5% increase in the death rate from Alzheimer's disease and dementia. HIGHLIGHTS: Eligibility criteria for social pension schemes in Africa hinder equitable and healthy aging. Delays and low pension payouts are associated with worsening death rates from dementia. Average health life expectancy for both genders should serve as a basis for initiating pension payouts.
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Project description:Childhood obesity in US Latinx and Latin American populations is a persistent, complex public health issue and, as such, requires solutions grounded on systems science theory and methods. In this paper, we introduce an action-oriented framework to design, implement, evaluate, and sustain whole-of-community systems changes for childhood obesity prevention in US Latinx and Latin American populations. Our framework covers six action steps: (1) foster multisectoral team; (2) map the system, its context, and drivers; (3) envision system-wide changes; (4) effect system-wide changes; (5) monitor, learn, and adapt; and (6) scale and sustain. We also propose 10 principles that put human and environmental rights and systems thinking at the center of these systems-based solutions. For each action step, we provide a list of concrete activities, methods, approaches, and examples that can be used to guide and inform the work needed to achieve the expected outputs. Finally, we discuss how a wider adoption of systems science for childhood obesity prevention among US Latinx and Latin American populations can be encouraged and sustained.
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Project description:Aging is increasingly thought to involve dysregulation of metabolism in multiple organ systems that culminate in decreased functional capacity and morbidity. Here, we seek to understand complex interactions among metabolism, aging, and systems-wide phenotypes across the lifespan. Among 2469 adults (mean age 74.7 years; 38% Black) in the Health, Aging and Body Composition study we identified metabolic cross-sectionally correlates across 20 multi-dimensional aging-related phenotypes spanning seven domains. We used LASSO-PCA and bioinformatic techniques to summarize metabolome-phenome relationships and derive metabolic scores, which were subsequently linked to healthy aging, mortality, and incident outcomes (cardiovascular disease, disability, dementia, and cancer) over 9 years. To clarify the relationship of metabolism in early adulthood to aging, we tested association of these metabolic scores with aging phenotypes/outcomes in 2320 participants (mean age 32.1, 44% Black) of the Coronary Artery Risk Development in Young Adults (CARDIA) study. We observed significant overlap in metabolic correlates across the seven aging domains, specifying pathways of mitochondrial/cellular energetics, host-commensal metabolism, inflammation, and oxidative stress. Across four metabolic scores (body composition, mental-physical performance, muscle strength, and physical activity), we found strong associations with healthy aging and incident outcomes, robust to adjustment for risk factors. Metabolic scores for participants four decades younger in CARDIA were related to incident cardiovascular, metabolic, and neurocognitive performance, as well as long-term cardiovascular disease and mortality over three decades. Conserved metabolic states are strongly related to domain-specific aging and outcomes over the life-course relevant to energetics, host-commensal interactions, and mechanisms of innate immunity.
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