Using behavioral theory to adapt advance care planning for homeless‐experienced older adults in permanent supportive housing.
Background: Older adults experiencing chronic homelessness (i.e., prolonged homelessness and a disabling condition) have low rates of advance care planning (ACP) despite high rates of morbidity and mortality. Rehousing of homeless‐experienced individuals into permanent supportive housing (PSH) may p...
| Publicado en: | Journal of the American Geriatrics Society Vol. 71; no. 8; pp. 2615 - 2627 |
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| Autores principales: | , , , , , , , |
| Formato: | Artículo |
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Wiley-Blackwell
Aug2023
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=169783521&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 169783521 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: Aug2023 vid: 71 iid: 8 pid: 480 pub: Wiley-Blackwell artinfo: ui: 169783521 10.1111/jgs.18314 ppf: 2615 ppct: 12 formats: tig: atl: Using behavioral theory to adapt advance care planning for homeless‐experienced older adults in permanent supportive housing. aug: au: Pajka, Sarah E. Kushel, Margot Handley, Margaret A. Olsen, Pamela Li, Brookelle Enriquez, Celeste Kaplan, Lauren Sudore, Rebecca L. affil: Medical Student, The Ohio State University College of Medicine, Columbus Ohio,, USA Department of Medicine, The University of California San Francisco, San Francisco California,, USA Department of Epidemiology and Biostatistics, The University of California San Francisco, San Francisco California,, USA su: California Confidence Senior housing Cross-sectional method Motivation (Psychology) Pessimism Psychology Consumer attitudes Interviewing Advance directives (Medical care) Public housing Qualitative research Documentation Psychosocial factors Interpersonal relations Health attitudes Homeless persons Homelessness Middle age Old age Health facility employees Attitudes of medical personnel Research methodology Housing stability Theory Research funding Conceptual models Descriptive statistics Thematic analysis Video recording sug: subj: Confidence Senior housing Cross-sectional method Motivation (Psychology) Pessimism Psychology Consumer attitudes Interviewing Advance directives (Medical care) Public housing Qualitative research Documentation Psychosocial factors Interpersonal relations Health attitudes Homeless persons Homelessness Middle age Old age California Lessors of social housing projects Assisted Living Facilities for the Elderly Health facility employees Attitudes of medical personnel Research methodology Housing stability Theory Research funding Conceptual models Descriptive statistics Thematic analysis Video recording keyword: advance care planning homelessness implementation science older adults permanent supportive housing advance care planning homelessness implementation science older adults permanent supportive housing ab: Background: Older adults experiencing chronic homelessness (i.e., prolonged homelessness and a disabling condition) have low rates of advance care planning (ACP) despite high rates of morbidity and mortality. Rehousing of homeless‐experienced individuals into permanent supportive housing (PSH) may present an opportunity to introduce ACP; but this is unknown. Therefore, we explored staff and resident perceptions of conducting ACP in PSH. Methods: We conducted semi‐structured interviews with PSH staff (n = 13) and tenants (PSH residents) (n = 26) in San Francisco. We used the capability (C), opportunity (O), motivation (M), behavior (COM‐B) framework within the Behavior Change Wheel model and the Theoretical Domains Framework (TDF) to inform interviews, categorize themes, and guide qualitative thematic analysis. Results: The mean age of PSH residents was 67 (SD = 6.1) years and 52% were women. Of staff, 69% were women. Important COM‐B barriers included ACP complexity (C), complicated relationship dynamics (O), resource limitations (O), pessimism (M), variable staff confidence (M), and competing priorities (M). Facilitators included easy‐to‐use documents/videos, including the PREPARE for Your Care program (C), stability with housing (O), exposure to health crises (O), potential for strong relationships (O), and belief that ACP is impactful (M). Recommendations included adapting materials to the PSH setting, providing staff trainings/scripts, and using optional one‐on‐one or group sessions. Conclusions: We identified behavioral determinants related to ACP for formerly chronically homeless older adults in PSH. Future interventions should include using easy‐to‐use ACP materials and developing resources to educate PSH residents, train staff, and model ACP in groups or one‐on‐one sessions. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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