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Results for 'prevention'

Results 11 - 20 of 180

Interventions to prevent or delay long-term nursing home placement for adults with impairments: a systematic review of reviews

DUAN-PORTER Wei, et al
2020

Background: With continued growth in the older adult population, US federal and state costs for long-term care services are projected to increase. Recent policy changes have shifted funding to home and community-based services (HCBS), but it remains unclear whether HCBS can prevent or delay long-term nursing home placement (NHP). Methods: This study searched MEDLINE (OVID), Sociological Abstracts, PsycINFO, CINAHL, and Embase (from inception through September 2018); and Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database, AHRQ Evidence-based Practice Center, and VA Evidence Synthesis Program reports (from inception through November 2018) for English-language systematic reviews. This study also sought expert referrals. Eligible reviews addressed HCBS for community-dwelling adults with, or at risk of developing, physical and/or cognitive impairments. Two individuals rated quality (using modified AMSTAR 2) and abstracted review characteristics, including definition of NHP and interventions. From a prioritized subset of the highest-quality and most recent reviews, this study abstracted intervention effects and strength of evidence (as reported by review authors). Results: Of 47 eligible reviews, most focused on caregiver support (n = 10), respite care and adult day programs (n = 9), case management (n = 8), and preventive home visits (n = 6). Among 20 prioritized reviews, 12 exclusively included randomized controlled trials, while the rest also included observational studies. Prioritized reviews found no overall benefit or inconsistent effects for caregiver support (n = 2), respite care and adult day programs (n = 3), case management (n = 4), and preventive home visits (n = 2). For caregiver support, case management, and preventive home visits, some reviews highlighted that a few studies of higher-intensity models reduced NHP. Reviews on other interventions (n = 9) generally found a lack of evidence examining NHP. Discussion: Evidence indicated no benefit or inconsistent effects of HCBS in preventing or delaying NHP. Demonstration of substantial impacts on NHP may require longer-term studies of higher-intensity interventions that can be adapted for a variety of settings.

Economic evaluation of a falls prevention exercise program among people With Parkinson's disease

FARAG Inez, et al
2016

Objective: The aim of this study was to determine the cost‐effectiveness of a 6‐month minimally supervised exercise program for people with PD. Methods: An economic analysis was conducted alongside a randomized, controlled trial in which 231 people age 40 years and over with PD were randomized into a usual care control group or an exercise group. Cost‐effectiveness was estimated using incremental cost per fall prevented (using falls calendars) as the primary analysis and cost per extra person avoiding mobility deterioration (defined as an improvement or no change in the 12‐point Short Physical Performance Battery Score between baseline and 6 month). A cost‐utility analysis using the Short Form‐6D was also performed. Uncertainty was represented using cost‐effectiveness scatter plots and acceptability curves. Planned subgroup analyses for the low‐disease‐severity group were also undertaken. Results: All results are reported in Australian dollars ($A). The average cost of the intervention was $A1,010 per participant. Incremental cost‐effectiveness of the program relative to usual care was $A574 per fall prevented, $A9,570 per extra person avoiding mobility deterioration, and $A338,800 per quality‐adjusted life year gained. The intervention had an 80% probability of being cost‐effective, relative to the control, at a threshold of $A2,000 per fall prevented. Subgroup analyses for the low‐disease‐severity group indicate the program to be dominant, that is, less costly and more effective than usual care for all health outcomes. Conclusion: The exercise intervention appeared cost‐effective with regard to fall prevention in the whole sample and cost saving in the low disease severity group, when compared with usual care.

Efficacy and generalizability of falls prevention interventions in nursing homes: a systematic review and meta-analysis

GULKA Heidi J, et al
2020

Objectives: To determine the efficacy of fall intervention programs in nursing homes (NHs) and the generalizability of these interventions to people living with cognitive impairment and dementia. Design: Systematic review and meta-analysis. Setting and Participants: NH residents (n = 30,057) living in NHs defined as residential facilities that provide 24-hours-a-day surveillance, personal care, and some clinical care for persons who are typically aged ≥65 years with multiple complex chronic health conditions. Methods: Meta-analysis of falls prevention interventions on number of falls, fallers, and recurrent fallers. Results: Thirty-six studies met inclusion criteria for the systematic review. Overall, fall prevention interventions reduced the number of falls [risk ratio (RR) = 0.73, 95% confidence interval (CI) = 0.60-0.88], fallers (RR = 0.80, 95% CI = 0.72-0.89), and recurrent fallers (RR = 0.70, 95% CI = 0.60-0.81). Subanalyses revealed that single interventions have a significant effect on reducing fallers (RR = 0.78, 95% CI = 0.69-0.89) and recurrent fallers (RR = 0.60, 95% CI = 0.52-0.70), whereas multiple interventions reduce fallers (RR = 0.69, 95% CI = 0.39-0.97) and multifactorial interventions reduce number of falls (RR = 0.65, 95% CI = 0.45-0.94). Conclusions and Implications: Exercise as a single intervention reduced the number of fallers and recurrent fallers by 36% and 41%, respectively, in people living in NHs. Other effective interventions included staff education and multiple and multifactorial interventions. However, more research on exercise including people with cognitive impairment and dementia is needed to improve the generalizability of these interventions to the typical NH resident.

Perceptions of older people in Ireland and Australia about the use of technology to address falls prevention

MACKENZIE Lynette, CLIFFORD Amanda
2020

Falls are common events with serious consequences for older people. With an ageing population and increasing health-care costs, information and communication technologies (ICT) will have a potential role in future health-care delivery. However, research on technology acceptance in health care for older people is limited and its application to falls prevention is unknown. The aims of this study were to explore and describe the perceptions of community-dwelling Australian and Irish older people about their current use of technology, and the potential use of technology for falls prevention. Qualitative data were collected from three focus groups conducted in and around Limerick in Ireland, and three in the Sydney area, Australia. A total of 35 older people participated. Data were analysed using thematic analysis. Four themes emerged from the data: (a) perceptions of vulnerability to falls, (b) preferences for exercise interventions, (c) participation in and ownership of technology, and (d) perceptions about applications of technology for falls prevention. As the use of technology is an instrumental activity of daily living, health professionals need to assess the capacity of older people to adopt these technologies, and provide falls prevention interventions to accommodate the technology skills of older people. Some participants were reluctant to embrace technology and barriers to the effective use of technology to assist in preventing falls may conflict with future health service trends.

Connecting communities: a strategy for tackling loneliness and social isolation

WALES. Welsh Government
2020

The young person's and community version of the Welsh Government strategy to tackle loneliness and social isolation. It outlines the Government's plan to tackle loneliness and social isolation and build a more connected society. It covers four priority areas: providing more opportunities for people to connect; providing good quality transport, community spaces and internet that help people connect; cohesive and supportive communities; and raising awareness of loneliness and social isolation. The strategy will be supported by funding over three years to support community-based organisations to deliver and test innovative approaches to tackling loneliness and social isolation.

Quality and cost-effectiveness in long-term care and dependency prevention: the English policy landscape. CEQUA report

MARCZAK Joanna, FERNANDEZ Jose-Luis, WITTENBERG Raphael
2017

This report summarises policy developments in England in relation to quality and cost-effectiveness and dependency prevention in long-term care. These policy aims focus on maximising the cost-effectiveness of the social care system, so that service users’ and carers’ quality of life is maximised within available resources. The report provides an overview of the long-term care system in England. It then reviews key recent policy developments in four areas: reducing dependency cost-effectively; strategies for maximising care coordination; supporting unpaid carers; and use of innovative care models, with a focus on technological solutions and personalisation. An appendix lists key features of the Care Act 2014 and the Better Care Fund relevant to prevention.

Home modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: a cluster-randomised controlled trial

KEALL Michael D, et al
2015

Background: Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. This study tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. Methods: This study is a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. This study randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which was derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, this stanalysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. Findings: Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085–1263), the crude rate of fall injuries per person per year was 0·061 in the treatment group and 0·072 in the control group (relative rate 0·86, 95% CI 0·66–1·12). The crude rate of injuries specific to the intervention per person per year was 0·018 in the treatment group and 0·028 in the control group (0·66, 0·43–1·00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0·74, 95% CI 0·58–0·94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0·61, 0·41–0·91). Interpretation: The findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested.

Interventions for preventing falls in older people living in the community (review)

GILLESPIE Lesley D., et al
2012

Background: Approximately 30 per cent of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009.Objective: To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community. Search methods: this review searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2012), CENTRAL (The Cochrane Library2012, Issue 3), MEDLINE (1946 to March 2012), EMBASE (1947 to March 2012), CINAHL (1982 to February 2012), and online trial registers. Selection criteria: Randomised trials of interventions to reduce falls in community-dwelling older people. Main results: this review included 159 trials with 79,193 participants. Most trials compared a fall prevention intervention with no intervention or an intervention not expected to reduce falls. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Findings: Group and home‐based exercise programmes, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi. Overall, exercise programmes aimed at reducing falls appear to reduce fractures. Multifactorial interventions assess an individual's risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow‐up. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined. Interventions to improve home safety appear to be effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti‐slip shoe device worn in icy conditions can also reduce falls. Taking vitamin D supplements does not appear to reduce falls in most community‐dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment. Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls. Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls. Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure. In people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling. The evidence relating to the provision of educational materials alone for preventing falls is inconclusive.

Connected communities: a strategy for tackling loneliness and social isolation and building stronger social connections

WALES. Welsh Government
2020

The Welsh Governnment's first strategy for tackling loneliness and social isolation. It defines what is meant by loneliness and social isolation, describes the key priorities in tackling these issues and sets out the Government's approach for implementing the strategy. The strategy focuses on approaches that reduce the risk of, or prevent, loneliness and social isolation or that intervene early, before these become more entrenched. The strategy looks at the role Government can play and also how it can support local authorities, wider public services, the third sector and also the private sector. It also describes the important role that individuals can play in supporting each other in communities. The strategy has four priority areas: increasing opportunities for people to connect; improving the community infrastructure to support people to come together, including the areas of planning, housing and transport; cohesive and supportive communities; and build awareness and promote positive attitudes, which sets out how the Welsh Government will raise the profile of loneliness and social isolation and reduce stigma. Key commitments are listed under each priority area. The strategy will be supported by funding over three years to support community-based organisations to deliver and test innovative approaches to tackling loneliness and social isolation.

Evaluating social care prevention in England: challenges and opportunities

MARCZAK Joanna, WISTOW Gerald, FERNANDEZ Jose-Luis
2019

Context: The Care Act 2014 placed a statutory duty on adult social care (ASC) to prevent and delay the development of needs for care and support. There is little clarity about how to translate this national obligation into effective local practice. Objectives: This exploratory study sought to lay the foundations for understanding approaches to this new duty by identifying: emerging local understandings of prevention; associated implementation strate­gies; and the potential for designing evaluation frameworks. Methods: Local perspectives were secured through: in-depth interviews in six English local authorities; reviews of local strategy, implementation documents and reviews of data sources; and methods for evaluating local initiatives in sampled authorities. Findings: The findings indicate important differences between and within local authorities in conceptuali­sations of prevention. Although willingness to commission services was strongly linked to the availability of evidence on what works in prevention, council conducted limited local evaluations. This study also found limited collaboration between ASC and Health in developing joint prevention approaches, in part due to differ­ences in conceptualisation and also constraints arising from different priorities and information systems. Limitations: The exploratory nature of the study and the small sample size limits the generalisability of its findings. Overall, the number of local authorities and respondents allowed us to explore a range of local views, opinions and practices related to the prevention agenda in a variety of contexts, however the findings are not generalisable to all English local authorities. Implications: This study suggests that the limited local evidence about prevention, combined with finan­cial austerity, may lead to disproportionate investment in a small number of interventions where existing evidence suggests cost-savings potential, which, in turn, may impact authorities’ ability to fulfil their statutory duties related to preventing and delaying the needs for care and support. In this connection, this study highlights the potential for developing local evaluation strategies utilising existing but largely unexploited local administrative data collections.

Results 11 - 20 of 180

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