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National audit of dementia memory: assessment services spotlight audit 2021
- Authors:
- CORRADO Oliver, et al
- Publisher:
- Healthcare Quality Improvement Partnership
- Publication year:
- 2022
- Pagination:
- 85
- Place of publication:
- London
Based on data from 5970 case notes of patients seen for initial assessment between January and August 2021, this report looks at community-based memory assessment services in England and Wales. The report found that the average waiting time from referral to diagnosis has increased to 17.7 weeks since 2019, up from 13 weeks. It also found that over 70% of services experienced periods of closure, and over 80% had staff redeployed during 2020. Other key findings include: 35% of patients had an appointment via phone or video call, while 45% took place at their usual place of residence; as part of their initial assessment, 61% of patients had a discussion recorded about their eyesight, 58% had a discussion recorded about hearing, and 76% had a falls history discussed and recorded; CT/MRI scans were requested for 47% of patients, with variation in requests of 0-97.4% of patients per service. This range implies that variation is at service/protocol level, rather than assessed as appropriate in each case. The report goes on to make a number of recommendations, including a call for services to use quality improvement methods to actively monitor waiting times from referral to diagnosis, and identify problem areas and barriers to access, including demographic and other factors (e.g. care home residents), as services continue to recover from the impact of the COVID-19 pandemic and associated service closures and staff redeployment. (Edited publisher abstract)
Factors influencing adult carer support planning for unpaid caregiving at the end of life in Scotland: qualitative insights from triangulated interviews and focus groups
- Authors:
- SWAN Susan, et al
- Journal article citation:
- Health and Social Care in the Community, 30(4), 2022, pp.1422-1432.
- Publisher:
- Wiley
Caring for a relative or friend at the end of life can be rewarding but all-encompassing. These caregivers are often not identified, meaning their diverse needs remain unmet, and the lack of assessment, support and planning increases the likelihood of crisis and burnout. The Carers (Scotland) Act 2016 places responsibility on local authorities to implement such a plan, which will be fast-tracked for carers supporting someone at the end of life. Our research described the factors which might influence this planning, triangulating primary focus groups with 15 carers and secondary qualitative data from transcripts with 30 carers, all of whom who had looked after someone with a terminal illness. Analysis was iterative, and constant comparative analysis of the secondary data informed the primary focus groups. Three main themes were identified; 1. The importance of early identification as a carer to enable timely assessment and support. 2. Carers experience isolation and loneliness which limits opportunities for support. 3. Responding in a timely fashion to carer assessment and support is vital to avoid crises. This research confirms that identifying carers early in the illness trajectory, ideally at diagnosis, is vital to avoid carer burnout. Health and social care providers have a key role in identification and should ensure, where possible, that carer needs are dynamically assessed, supported and documented. Finally, caring does not end after death, it extends into bereavement. Thus, we need to consider system and cultural change to ensure the experiences and needs of carers are addressed and valued. (Edited publisher abstract)
Cutting through the intersections to care for caregivers: secondary data analysis of a carers support service in Glasgow, Scotland
- Authors:
- DRUMMOND Maria, et al
- Journal article citation:
- Health and Social Care in the Community, 30(4), 2022, pp.1334-1343.
- Publisher:
- Wiley
As the number of people living longer with life-limiting conditions grows, so too does the number of caregivers and the complexity of the caring role. To understand more about the role and how caregivers can be supported, local and national registers have been created that collect data on caregivers. Our objective was to undertake comparative analysis of female and male adult caregiver assessments from a caregiver database created from a carers support service running in Glasgow, Scotland. Assessments were carried out over a 12-month period (01/04/17–29/03/18). We aimed to identify the prevalence of negative consequences of caring through descriptive statistical, comparative analysis. Seven hundred and eighty-three assessments were eligible for inclusion. In our dataset, 69% were female (n = 552), and 29% were male (n = 231). Female caregivers were more likely to be of working age but unemployed (p = 0.03) and experiencing mental ill-health (p = 0.011). Male caregivers were more likely to be retired (p < 0.001), caring for a parent (p = 0.017) and living with heart disease (p = 0.0004), addiction issues (p = 0.013) or diabetes (p = 0.042) than female caregivers. For caregivers using this support service, female and male caregivers experienced, recognised or reported negative impacts from caring on their personal identity, social life, ability to self-care and relationships similarly. Furthermore, a caregiver whose relationships had been negatively impacted was 13.8 times more likely (p > 0.00) to report a reduction in psychological well-being. Sex disaggregated data are an important consideration for caregiver research due to socio-political influences that impact caring roles and expectations. Disaggregating data by sex allow researchers to understand how the caring role differs between subsets and allow for the development of more targeted, sensitive support. (Edited publisher abstract)
How power dynamics and relationships interact with assessment of competence: exploring the experiences of student social workers who failed a practice placement
- Authors:
- ROULSTON Audrey, et al
- Journal article citation:
- British Journal of Social Work, 52(3), 2022, pp.1662-1682.
- Publisher:
- Oxford University Press
Students have identified practice placements (or practice learning) as the single most important factor of social work education, but it is usually where issues of professional suitability become apparent. Whilst most students successfully complete their placements, a number experience difficulty and a minority ultimately fail. Protecting the profession from students not deemed suitable for professional practice requires a rigorous gatekeeping function and fair standards. On receipt of written consent, we interviewed eleven social work students who failed placement, and accessed progress reports written by Practice Teachers/Practice Educators. Participants included nine females, mean age of 33 years, seven failed their final placement and eight had registered with university disability services. Professionally transcribed interviews were analysed using an adapted version of Braun and Clarke's method. Identified themes included the impact of personal issues; importance of working relationships; use and misuse of power; assessment and decision-making processes and developing insight and useful feedback. Students valued the opportunity to reflect on their experience and provided clear recommendations for improving how Practice Teachers, on-site supervisors, Tutors and peers can provide a supportive learning experience for students who require additional support during placement, and how to communicate concerns regarding competence more effectively. (Edited publisher abstract)
Assessment and management pathways of older adults with mild cognitive impairment: descriptive review and critical interpretive synthesis
- Authors:
- CHAMBERS Duncan, et al
- Journal article citation:
- Health and Social Care Delivery Research, 10(10), 2022, p.180. Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- London
Background: Mild cognitive impairment in older adults is a risk factor for dementia. Mild cognitive impairment is a result of a diverse range of underlying causes and may progress to dementia, remain stable or improve over time. Objectives: We aimed to assess the evidence base around the assessment and management pathway of older adults with mild cognitive impairment in community/primary care, hospital and residential settings. Data sources: In January 2021, we searched MEDLINE, EMBASE, PsycInfo, Scopus, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (i.e. Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), Science Citation Index and Social Science Citation Index. The search was limited to studies published in English between 2010 and 2020. Grey literature and citation searches were also performed. Methods: We performed two separate evidence reviews: (1) a descriptive review with narrative synthesis focusing on diagnosis, service provision and patient experience; and (2) a critical interpretive synthesis of evidence on the advantages and disadvantages of 'mild cognitive impairment' as a diagnostic label. Results: A total of 122 studies were included in the descriptive review, of which 29 were also included in the critical interpretive synthesis. Study participants were most commonly recruited from populations of community-living older adults or those who had sought medical help from their general practitioner for memory problems. Follow-up searching identified a further 11 studies for the critical interpretive synthesis. The descriptive review identified multiple barriers to efficient diagnosis, starting with patient reluctance to seek help. General practitioners have a variety of cognitive tests available, but substantial numbers of patients meeting criteria for dementia do not have a diagnosis recorded. Patients may be referred to a memory clinic, but these clinics are mainly intended to identify and support people with dementia, and people with mild cognitive impairment may be discharged back to their general practitioner until symptoms worsen. Availability of scanning and biomarker tests is patchy. Qualitative studies show that patients with mild cognitive impairment and their carers find the process of investigation and diagnosis difficult and frustrating to negotiate. The key finding from the critical interpretive synthesis was that the need for a 'timely' diagnosis outweighs the ongoing debate about the value, or otherwise, of early investigation and labelling of memory problems. Determining what is a timely diagnosis involves balancing the perspectives of the patient, the health system and the clinician. Conclusions: The two reviews reported here have applied different 'lenses' to the same body of evidence. Taken together, the reviews highlight the importance of a timely diagnosis for memory problems and identify barriers to obtaining such a diagnosis, from reluctance to seek help through to patchy availability of advanced diagnostic tests. Limitations: The review was primarily descriptive, reflecting the prespecified review questions. Study selection was complicated by lack of a consistent definition of mild cognitive impairment and its overlap with other memory disorders. It was not possible to employ double study selection, data extraction or quality assessment, although processes of checking and verification were used throughout the review. Future work: Priorities include evaluating remote methods of memory assessment and preparing for the likely future availability of disease-modifying treatments for early dementia. Research is needed on the investigation of memory problems in hospital and social care settings. (Edited publisher abstract)
Hospital at Home admission avoidance with comprehensive geriatric assessment to maintain living at home for people aged 65 years and over: a RCT
- Authors:
- SHEPPERD Sasha, et al
- Journal article citation:
- Health and Social Care Delivery Research, 10(2), 2022, Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- London
Background: Evidence is required to guide the redesign of health care for older people who require hospital admission. Objectives: this study assessed the clinical effectiveness and cost-effectiveness of geriatrician-led admission avoidance hospital at home with comprehensive geriatric assessment, the experiences of older people and their caregivers, and how the services differed. Design: A multisite, randomised, open trial of comprehensive geriatric assessment hospital at home, compared with admission to hospital, using a 2 : 1 (hospital at home to hospital) ratio, and a parallel economic and process evaluation. Participants were randomised using a secure online system. Setting: Participants were recruited from primary care or acute hospital assessment units from nine sites across the UK. Participants: Older people who required hospital admission because of an acute change in health. Intervention: Geriatrician-led admission avoidance hospital at home with comprehensive geriatric assessment. Main outcome measures: The main outcome, ‘living at home’ (the inverse of death or living in a residential care setting), was measured at 6-month follow-up. Secondary outcomes at 6 months were the incidence of delirium, mortality, new long-term residential care, cognitive impairment, ability to perform activities of daily living, quality-adjusted survival, length of stay and transfer to hospital. Secondary outcomes at 12 months were living at home, new long-term residential care and mortality. Results: Participants were allocated to hospital at home (n = 700) or to hospital (n = 355). All reported relative risks (RRs) were adjusted and are reported for hospital at home compared with hospital. There were no significant differences between the groups in the proportions of patients ‘living at home’ at 6 months [528/672 (78.6%) vs. 247/328 (75.3%), RR 1.05, 95% confidence interval (CI) 0.95 to 1.15; p = 0.36] or at 12 months [443/670 (66.1%) vs. 219/325 (67.4%), RR 0.99, 95% CI 0.89 to 1.10; p = 0.80]; mortality at 6 months [114/673 (16.9%) vs. 58/328 (17.7%), RR 0.98, 95% CI 0.65 to 1.47; p = 0.92] or at 12 months [188/670 (28.1%) vs. 82/325 (25.2%), RR 1.14, 95% CI 0.80 to 1.62]; the proportion of patients with cognitive impairment [273/407 (67.1%) vs. 115/183 (62.8%), RR 1.06, 95% CI 0.93 to 1.21; p = 0.36]; or in ability to perform the activities of daily living as measured by the Barthel Index (mean difference 0.24, 95% CI –0.33 to 0.80; p = 0.411; hospital at home, n = 521 patients contributed data; hospital, n = 256 patients contributed data) or Comorbidity Index (adjusted mean difference 0.0002, 95% CI –0.15 to 0.15; p = 0.10; hospital at home, n = 474 patients contributed data; hospital, n = 227 patients contributed data) at 6 months. The varying denominator reflects the number of participants who contributed data to the different outcomes. There was a significant reduction in the RR of living in residential care at 6 months [37/646 (5.7%) vs. 27/311 (8.7%), RR 0.58, 95% CI 0.45 to 0.76; p < 0.001] and 12 months [39/646 (6.0%) vs. 27/311 (8.7%), RR 0.61, 95% CI 0.46 to 0.82; p < 0.001], a significant reduction in risk of delirium at 1 month [10/602 (1.7%) vs. 13/295 (4.4%), RR 0.38, 95% CI 0.19 to 0.76; p = 0.006] and an increased risk of transfer to hospital at 1 month [173/672 (25.7%) vs. 64/330 (19.4%), RR 1.32, 95% CI 1.06 to 1.64; p = 0.012], but not at 6 months [343/631 (54.40%) vs. 171/302 (56.6%), RR 0.95, 95% CI 0.86 to 1.06; p = 0.40]. Patient satisfaction was in favour of hospital at home. An unexpected adverse event that might have been related to the research was reported to the Research Ethics Committee. At 6 months, there was a mean difference in NHS, personal social care and informal care costs (mean difference –£3017, 95% CI –£5765 to –£269), and no difference in quality-adjusted survival. Older people and caregivers played a crucial role in supporting the delivery of health care. In hospital at home this included monitoring a patient’s health and managing transitional care arrangements. Limitations: The findings are most applicable to patients referred from an acute hospital assessment unit. Conclusions: Comprehensive geriatric assessment hospital at home can provide a cost-effective alternative to hospitalisation for selected older people. Further research that includes a stronger element of carer support might generate evidence to improve health outcomes. (Edited publisher abstract)
An attachment-based parental capacity assessment to orient decision-making in child protection cases: a randomized control trial
- Authors:
- CYR Chantal, et al
- Journal article citation:
- Child Maltreatment, 27(1), 2022, pp.66-77.
- Publisher:
- Sage
Two parenting capacity assessment (PCA) protocols, with a short parent-child intervention embedded in each protocol, evaluated the potential for enhanced parenting to orient child placement decision. Parents (n = 69), with substantiated reports of maltreatment by child protective services, and their children (0-6) were randomly assigned to one of two PCAs with either the Attachment Video-feedback (PCA-AVI) or a psychoeducational intervention (PCA-PI) as the embedded intervention component. The PCA-AVI group showed the highest increases in parent-child interaction quality at post-test. Also, at PCA completion, evaluators’ conclusions about the parents’ capacity to care for both PCA groups were associated with parent-child interactive improvements at post-test, the court’s placement decision at post-test, and child placement one year later. However, only conclusions drawn by PCA-AVI evaluators were predictive of child re-reports of maltreatment in the year following PCA. PCAs, relying on short attachment interventions to assess the potential for enhanced parenting, are promising tools to orient child placement decisions. (Edited publisher abstract)
The availability of section 12 doctors for Mental Health Act assessments: interview perceptions and analysis of the national MHA Approvals Register Database
- Authors:
- STEVENS Martin, et al
- Publisher:
- King's College London
- Publication year:
- 2022
- Pagination:
- 93
- Place of publication:
- London
This report presents the findings of a study which explored the reasons for and nature of reported difficulties in accessing section 12 (s12) doctors for Mental Health Act (MHA) assessments. For a person to be legally detained in hospital, the law requires that MHA assessments must involve such doctors and also other professionals (mainly social workers) acting as Approved Mental Health Professionals (AMHPs). The study was commissioned by the Department of Health and Social Care (DHSC). We combined interviews (n=52) with an analysis of the national MHA Approvals Register Database (Approvals Register), maintained on behalf of the Secretary of State for Health and Social Care by four regional Approvals Panels. This is the first time that external analysts have been given this access and we are grateful for this permission. We also consulted with people with direct experience of being assessed by s12 doctors for their views on our initial findings. There are two main findings from the research. First is that the main problem is availability of s12 doctors, rather than overall numbers. This suggests a need to focus on encouraging psychiatrists and other s12 doctors to make themselves more available for doing MHA assessments. Increasing fees and simplifying payment processes may encourage more s12 doctors to do this. Mounting promotion campaigns and cascading encouragement by supervisors and other managers may also increase availability. Including undertaking MHA assessments as a requirement in NHS contracts may also be of value, coupled with the use of rotas, although careful consideration of the impact on workload would be needed. Second, there is currently no real way to tell how many s12 doctors are needed without better information about the numbers of MHA assessments attended by different doctors, in what circumstances. This is a problem of workforce planning. (Edited publisher abstract)
The GCP2 assessment tool for neglect: understanding how the Graded Care Profile 2 supports families and practitioners to achieve change
- Authors:
- MARGOLIS Rachel, et al
- Publisher:
- NSPCC
- Publication year:
- 2022
- Place of publication:
- London
The Graded Care Profile 2 (GCP2) is an assessment tool that helps practitioners take a strengths-based approach to measuring the quality of care a child is receiving and supports them to identify neglect. This study sought to find out if using the GCP2 could benefit, and/or contribute to positive changes for, families who undergo the assessment. For example, if there were any changes to parents’ mental health or wellbeing after an assessment using the GCP2. Using a case study approach, interviews were held with the practitioner who carried out the assessment, the parent/carer assessed, and an additional professional (for example, a family support worker or schoolteacher) working closely with the family. Four local authorities, where the GCP2 was well established, participated in the research. This study shows how assessments using the GCP2 can help bring about positive changes for families. Parents can develop new skills, their mental health can improve, as can their help seeking behaviours and relationships with others. There is also potential for children to experience changes following an assessment. These changes include improvements to behaviour, development and health, and safer living spaces. They may be seen as an indirect outcome of the assessment, associated with positive changes experienced by their parents. In addition, using the GCP2 can support practitioners in making informed decisions about cases. (Edited publisher abstract)
An evaluation of the Stratford multiagency, multidisciplinary, assessment clinic
- Authors:
- COOPER Catherine, et al
- Journal article citation:
- Mental Health Review Journal, 26(4), 2021, pp.392-402.
- Publisher:
- Emerald
Purpose: This study aims to assess a novel clinic whereby new patients were discussed in a multi-agency, multi-disciplinary panel and given feedback on the same day. The objectives were to determine the impacts on time to commencing treatment, need for further assessment, discharges and staff and patient experiences. Design/methodology/approach: Outcomes from the new assessment clinic were compared to previous individual assessments. Feedback questionnaires were given to patients, while a focus group was conducted with staff. Findings: There was a significant reduction in the time to agreeing a treatment plan (34 days to <1 day), the need for further assessment (61%-023.2%) and a significant increase in the proportion discharged from secondary care (26.9%-49.8%). Clinician and patient feedback on the clinic was positive. Practical implications: The model of a multi-agency, multi-disciplinary clinic could be used for assessing new referrals to community mental health teams. Originality/value: The use of a multi-agency, multi-disciplinary clinic is a novel approach within community mental health teams which led to improvements in efficiency, while demonstrating positive patient and clinician feedback. (Edited publisher abstract)