Results for 'older people'
Results 151 - 160 of 160
Older people represent the main in-patient group, at any one time occupying more than two-thirds of acute hospital in-patient beds. Providers and commissioners need to put in place cost-effective, community based services, which can both prevent the need for hospital admission and safely reduce length of stay for older people. A hospital admission can occur when an older person has reached breaking point because of a combination of problems that have been building up before admission: social circumstances (such as living alone or having caring responsibilities) or general frailty. The aim of this publication is to disseminate examples of positive practice in avoiding hospital admission, supporting safe discharge and preventing readmission for older people. This publication highlights 5 examples of local Age UK services, charting the ‘pathway’ of prevention from identifying older people in the local community who may be at risk, to supporting people who are in A&E, and ensuring that discharge from in-patient care is safe and well co-ordinated.
MAYO-WILSON Evan, et al
Background: Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalisation and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services.
Methods and Findings: Data Sources: Ten databases including CENTRAL and Medline searched through December 2012. Study Selection: Randomised controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge. Two authors independently extracted data. Outcomes were pooled using random effects. Main Outcomes and Measures used were mortality, institutionalisation, hospitalisation, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.
Results: Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programmes may have small relative effects. There was moderate quality evidence of no overall effect on the number of people institutionalised. There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect, but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life and physical functioning respectively, but these may not be clinically important.
Conclusions: Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programmes that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, the authors cannot exclude the possibility that some programmes may be effective.
MILLER Robin, et al
Purpose: The purpose of this paper is to explore the delivery of preventative services for older people from third sector organisations (TSOs) and the extent to which current commissioning arrangements enables the aspirations of policy to be achieved.
Design/methodology/approach: Semi-structured interviews with key-contacts within a sample of TSOs which had been identified by directors of Adult Social Services as delivering one of the top three preventative interventions in their local authority area.
Findings: There was evidence of considerable trust between local authorities and TSOs and as a consequence TSOs were given autonomy to develop holistic and integrated models of delivery that supported rather than diverted the TSOs’ core missions. Both sectors found it difficult to set target outcomes and connected performance frameworks for preventative services. As a consequence a major element of the commissioning cycle is not being completed and TSOs cannot be confident that they are using their resources as effectively as possible.
Research limitations/implications: This study was based in one English region, and would benefit from being extended to other English regions and home nations.
Practical implications: Universities, policy makers, commissioners and the third sector need to work together to develop common outcome frameworks for preventative services and to gather consistent data sets that can be more easily synthesised to give a “realistic” understanding of the impact of different interventions and delivery models.
Originality value: The paper contributes to the limited evidence bases of commissioning of TSOs and preventative services.
AL-ORAIBI Saleh, FORDHAM Ric, LAMBERT Rod
This study looked at whether new assistive technology (AT) systems in care homes for elderly residents, reduced the number of falls and demands for formal health services. The project collected retrospective data about the incidence of falls before and after AT systems were installed in two care homes in Norfolk, UK. These homes were selected purposefully because a recent assessment identified the need for upgrading their call system. They had different resident profiles regarding the prevalence of dementia. Standard incident report forms were examined for a period starting ten months before the upgrades to ten months after in Care Home 1 and from six months before to six months afterwards in Care Home 2. Overall there were 314 falls reported during the course of the study; the number reduced from 202 to 112 after the introduction of AT. The mean health care costs associated with falls in Care Home 1 were significantly reduced (more than 50%). In Care Home 2 there was no significant difference in the mean cost. The results suggest that installing an AT system in residential care homes can reduce the number of falls and health care cost in homes with a lower proportion of residents with advanced dementia compared to those with more residents with advanced dementia.
DOUGHTY Kevin, ORTON Mike
Purpose: The purpose of this paper is to identify opportunities where technology interventions could help manage the risks associated with fire and explosions in homes of people who are older or who are vulnerable through other causes such as mental health problems or a history of substance abuse.
Design/methodology/approach: The approach focused on reviewing the latest available statistics in order to identify the major causes and rooms in which fire accidents occurred.
Findings: The authors found that the number of incidents and fatalities continues to decrease as a result of preventive measures such as a greater use of smoke detectors, but that there remained issues with cooking safety. New products for limiting damage and managing risks are available which could have a positive impact.
Research limitations/implications: The paper concludes that the challenges are making both professionals and the public aware of the available technologies and of introducing them following appropriate assessment of needs and risks.
Practical implications: Greater resources need to be offered for training of the public and of health and safety professionals. Further funding may be needed to implement the introduction of new technology.
Originality/value: This is the most up-to-date review of fire control measures employing assistive technology and telecare for domestic properties and will be of value to community health teams, adults care organisations, housing associations and other public bodies.
TRAPPES-LOMAX Tessa, HAWTON Annie
Effective reablement is dependent on service users' co-operation and motivation. It therefore needs to be highly responsive to their needs and views. This study offers specific user views about their experiences in different settings and at different stages of reablement, together with their ideas for how it might work better. The study describes the experiences of 42 older people in rehabilitation services in community hospitals and local authority short-term residential units followed by “usual care” services at home. It is based on semi-structured face-to-face interviews in 2002/3, from East and Mid Devon, England. Findings revealed four main themes: the complexity of rehabilitative need; the influence of the setting; the role of the staff; and the availability of reablement support back at home. The authors concluded that the findings demonstrate changing rehabilitative needs along the care pathway, with implications for commissioners and providers of reablement services.
HIRANI Shashivadan Parbati, et al
Background: Home-based telecare (TC) is utilised to manage risks of independent living and provide prompt emergency responses. This study examined the effect of TC on health-related quality of life (HRQoL), anxiety and depressive symptoms over 12 months in patients receiving social care.
Design: A study of participant-reported outcomes [the Whole Systems Demonstrator (WSD) Telecare Questionnaire Study; baseline n = 1,189] was nested in a pragmatic cluster-randomised trial of TC (the WSD Telecare trial), held across three English Local Authorities. General practice (GP) was the unit of randomisation and TC was compared with usual care (UC).
Methods: Participant-reported outcome measures were collected at baseline, short-term (4 months) and long-term (12 months) follow-up, assessing generic HRQoL, anxiety and depressive symptoms. Primary intention-to-treat analyses tested treatment effectiveness and were conducted using multilevel models to control for GP clustering and covariates for participants who completed questionnaire measures at baseline assessment plus at least one other assessment (n = 873).
Results: Analyses found significant differences between TC and UC on Short Form-12 mental component scores (P < 0.05), with parameter estimates indicating being a member of the TC trial-arm increases mental component scores (UC-adjusted mean = 40.52; TC-adjusted mean = 43.69). Additional significant analyses revealed, time effects on EQ5D (decreasing over time) and depressive symptoms (increasing over time).
Conclusions: TC potentially contributes to the amelioration in the decline in users’ mental HRQoL over a 12-month period. TC may not transform the lives of its users, but it may afford small relative benefits on some psychological and HRQOL outcomes relative to users who only receive UC.
HEMINGWAY Ann, JACK Eleanor
A UK charity established a network of 70 friendship clubs in the south of England, facilitated by volunteers, with the aim of promoting well-being for older people. The charity provides venues and transport for participants to meet and enjoy activities locally every week for 2 hours. This article reports on a 3 year research project exploring the impacts of the intervention, using qualitative research methods and including participant observation and individual and focus group interviews. The study was based on 10 of the friendship clubs and collected information from 82 members and 18 volunteers. The article describes the intervention and the study methodology. It presents the results, with illustrative quotations from participants, covering views on the risk of becoming isolated, feeling isolated, and friendship and support. It identifies additional factors that can predispose an individual to become socially isolated, including environment and safety fears, fear of falling, and loss of confidence, and notes that even when living with their families older people can still feel socially isolated. It reports that club members and volunteers viewed themselves as assets for each other, offering support, advice and friendship, and that, overall, the perceived benefits for attendees of attending the friendship clubs fell into 3 key areas: improved well-being, social relations, and mental and physical health.
SEABROOKE Viniti, MILNE Alisoun
Purpose: This study aims to systematically evaluate the impact and effectiveness of two early intervention services in NW Kent.
Design/methodology/approach: Data were gathered via evaluation questionnaires for both projects; these included quantitative post-intervention data and qualitative comments. Data on referrals to secondary care and a specialist third sector organisation were also collected for the primary care project.
Findings: Findings from the primary care project indicate that targeting a specific age cohort of patients can be effective in terms of: early identification of dementia-related concerns, the provision of support, appropriate referrals to secondary care, and increased referrals to a third sector dementia service. At the end of the project most practitioners felt they were better informed about dementia, more committed to facilitating early diagnosis, and had gained confidence in using a screening tool (the General Practitioner Assessment of Cognition Test). Evidence from evaluating the Carers Group suggests that attendance helped members manage emotional difficulties, increased understanding of dementia, and enhanced coping skills. They also felt less isolated and knew how to access support services.
Practical implications: The projects offer two models of intervention: how a proactive third sector agency can work with primary care professionals to enhance commitment to dementia case finding and the provision of group support to relatives of those in receipt of a recent dementia diagnosis.
Originality/value: The study provides insights into early intervention in dementia care how to evaluate impact of effectiveness.
NATIONAL INSTITUTE FOR HEALTH RESEARCH. School for Social Care Research
Third sector organisations (TSOs) have historically played a significant role in the delivery of adult social care. Often seen to be associated with qualities such as strong community links, access to disadvantaged groups and innovative practice, TSOs remain a popular choice with local authority commissioners as providers of preventative services. This study explored the views of nine locally commissioned TSOs and two national organisations which provide preventative services for older people. Senior managers were interviewed about their views of the purpose of such services, how the TSO understood their impacts, and their experience of being commissioned by the public sector. The results were added to previous research with local authorities to build a picture of the local authority and third sector relationship. The research identifies positive aspects within the current arrangements, but also gaps in respect of setting and understanding of outcomes and a reliance on personal relationships within the commissioning process.
Results 151 - 160 of 160