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Improving older adults' functional ability through service use in a home care program in Hong Kong
- Authors:
- CHEUNG Chau-kui, NGAN Raymond Man-Hung
- Journal article citation:
- Research on Social Work Practice, 15(3), May 2005, pp.154-164.
- Publisher:
- Sage
Despite past findings about the contribution of home care services to older users’ functional ability, the effective processes and components of the services are not transparent. Such processes appear to rely on the actual use of component services of the home care programme. The study gathered 116 observations during 2 years concerning 49 home care service users in Hong Kong. The study shows that an older user maintained better functional ability with a longer time of using a home care program in Hong Kong using the service. The time effect, in turn, was primarily due to the increased use of seven services provided by the programme. Among the service components, the home-nursing services generated a unique contribution to the user's functional ability, with its prior score controlled. Multidisciplinary services under case management underpin an effective home care programme.
Core components and impact of nurse-led integrated care models for home-dwelling older people: a systematic review and meta-analysis
- Authors:
- DESCHODT Mieke, et al
- Journal article citation:
- International Journal of Nursing Studies, 105, 2020, p.103552.
- Publisher:
- Elsevier
Background: Integrated care models are highly recommended to overcome care fragmentation in the multimorbid older population. Nurses are potentially ideally situated to fulfil the role as care coordinator to guide integrated care. No systematic review has been conducted specifically focusing on the impact of nurse-led integrated care models for older people in community settings. Objectives: To identify core components of nurse-led integrated care models for the home-dwelling older population; to describe patient, service and process outcomes; and to evaluate the impact of these care models on quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions and mortality. Design: Systematic review and meta-analysis. Data sources: English, Dutch, French, German and Spanish articles selected from PubMed and CINAHL, hand-search of reference lists of the included articles and grey literature. Review methods: A systematic search was conducted to identify prospective experimental or quasi-experimental studies detailing nurse-led integrated care models in the older home-dwelling population. Study characteristics and reported outcomes were tabulated. The core components of the models were mapped using the Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE (SELFIE) framework. A random effects meta-analysis was conducted to study the overall effectiveness of the included care models on health-related quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions or mortality. Risk of bias was appraised using the revised Cochrane risk-of-bias tool for randomized trials and ROBINS-I tool for non-randomized studies. Results: Nineteen studies were included studying a total of 22,168 patients. Core components of integrated care for multimorbid patients such as the involvement of a multidisciplinary team, high risk screening, tailored holistic assessment and an individualized care plan, were performed in a vast majority of the studies; however variability was observed in their operationalisation. Twenty-seven different patient, provider and service outcomes were reported, ranging from 1 to 13 per study. The meta-analyses could not demonstrate a beneficial impact on any of the predefined outcomes. Most included studies were of high risk for several biases. Conclusion: The summarized evidence on nurse-led integrated care models in home-dwelling older people is inconclusive and of low quality. Future studies should include key components of implementation research, such as context analyses, process evaluations and proximal outcomes, to strengthen the evidence-base of nurse-led integrated care. (Edited publisher abstract)
Satisfaction with personal assistance services of people with disabilities in Korea
- Author:
- KIM Kyung Mee
- Journal article citation:
- Asia Pacific Journal of Social Work and Development, 20(2), December 2010, pp.49-62.
- Publisher:
- Taylor and Francis
Looking at community settings for physically, developmental, visual and brain or head injury associated disabled people in South Korea, this article details utilisation rates for personal assistance services helping with the activities of daily living including bathing, toilet attendance, housework and mobility. Service users’ levels of satisfaction according to data collected from 299 participants in 2007 are detailed. The parameters of service control, attendants’ quality and competence and the quality of the overall service were used as measures. Service control consisted of 5 items relating to possibility of having to change attendants; the direction of services to the attendants; the choice of services that users want; reception of services that users want to customise and the reception of service when the users want it. Attendants’ quality and competence included 8 items such as understanding of impairment; user’s intentions and directions; kind and respectful treatment; punctuality; good communication; relevance of training and wishing to recommend to others. The quality of service was gauged via its appropriateness, readiness, safety and likelihood of referral to others. Findings included high satisfaction when users were able to use all the hours assigned, hours assigned were sufficient to meet their needs, and users’ views were used in formulating care plans. Comparisons are made with literature from USA, Japan, and Germany.
Engagement in activities: experiences of persons with dementia and their caregiving spouses
- Authors:
- VIKSTROM Sofia, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 7(2), May 2008, pp.251-270.
- Publisher:
- Sage
This study identifies how persons with dementia and their caregiving spouses individually perceive their own, their spouse's and their mutual engagements in everyday activities. Fifty-two cohabiting spouses, half of whom were diagnosed with dementia, were interviewed. A qualitative constant comparative analysis was performed, identifying four major themes: perceived changes in activity engagements; consequences of experienced changes; dilemmas experienced by the caregivers; and management approaches to handle a changed everyday life. Each individual described their activities to include loss of social engagements and changes in the relationship. Dilemmas experienced by the caregivers included `interfering with the spouse's engagement or not' and `placing the spouse's or one's own needs first'. The caregiver management approaches identified included `taking over' or `encouraging initiative'; `lowering demands or avoiding problematic engagements'; and `managing through collaboration'. Findings provide insight into everyday engagements for persons with dementia and their caregivers, important to healthcare support providers.
Paid personal assistance services: an exploratory study of working-age consumers’ perspectives
- Authors:
- GROSSMAN Brian R., et al
- Journal article citation:
- Journal of Aging and Social Policy, 19(3), 2007, pp.27-45.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
Structured interview data were collected from a convenience sample of 24 individuals using paid personal assistance services to help with activities of daily living. They were recruited from Centers for Independent Living in nine US states and came from diverse backgrounds. Although respondents were generally satisfied with the services they currently received, many reported previous experience of poor care associated with the low wages, lack of training and inadequate supply of care providers. They also had continued unmet needs in areas such as child care, social activities and transport because of the limited hours of service provided, and strongly supported the notion of consumer-directed care. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Domiciliary support for people with sight loss
- Author:
- THOMAS POCKLINGTON TRUST
- Publisher:
- Thomas Pocklington Trust
- Publication year:
- 2003
- Pagination:
- 20p.
- Place of publication:
- London
The services which people with sight loss receive are not currently meeting their needs very effectively. Homecare services primarily helped with housework and shopping and were the main source of personal care where this was needed. Friends, family or volunteers fulfilled virtually all other aspects of daily living, which needed support. This meant that those who did not have any close informal support were often very lonely and isolated. The most important unmet need of people with sight loss was simply a wish to go out. Communication difficulties meant that they were cut off socially and in several cases they were virtually housebound. Other unmet needs included help with small tasks such as changing light bulbs and small sewing jobs. Help with, and privacy for, correspondence and financial matters were also a concern.
Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study
- Authors:
- CHEN Shanquan, et al
- Journal article citation:
- BMC Geriatrics, 22(181), 2022, Online only
- Publisher:
- BioMed Central Ltd
Background: Older adults who live alone and have difficulties in activities of daily living (ADLs) may have been more vulnerable during the COVID-19 pandemic. However, little is known about pandemic-related changes in ADL assistance (such as home care, domiciliary care) and its international variation. We examined international patterns and changes in provision of ADL assistance, and related these to country-level measures including national income and health service expenditure. Methods: We analysed data covering 29 countries from three longitudinal cohort studies (Health and Retirement Study, English Longitudinal Study of Aging, and Survey of Health, Ageing and Retirement in Europe). Eligible people were aged ≥50 years and living alone. Outcomes included ADL difficulty status (assessed via six basic ADLs and five instrumental ADLs) and receipt of ADL assistance. Wealth-related inequality and need-related inequity in ADL assistance were measured using Erreygers’ corrected concentration index (ECI). Correlations were estimated between prevalence/inequality/inequity in ADL assistance and national health-related indicators. We hypothesized these measures would be associated with health system factors such as affordability and availability of ADL assistance, as well as active ageing awareness. Results: During COVID-19, 18.4% of older adults living alone reported ADL difficulties (ranging from 8.8% in Switzerland to 29.2% in the USA) and 56.8% of those reporting difficulties received ADL assistance (ranging from 38.7% in the UK to 79.8% in Lithuania). Females were more likely to receive ADL assistance than males in 16/29 countries; the sex gap increased further during the pandemic. Wealth-related ECIs indicated socioeconomic equality in ADL assistance within 24/39 countries before the pandemic, and significant favouring of the less wealthy in 18/29 countries during the pandemic. Needs-related ECIs indicated less equity in assistance with ADLs during the pandemic than before. Our hypotheses on the association between ADL provision measures and health system factors were confirmed before COVID-19, but unexpectedly disconfirmed during COVID-19. Conclusion: This study revealed an unequal (and in some countries, partly needs-mismatched) response from countries to older adults living alone during the COVID-19 pandemic. The findings might inform future research about, and policies for, older adults living alone, particularly regarding social protection responses during crises. (Edited publisher abstract)
Experiences of older people with dementia: homecare enablement to support transitions in daily life at home
- Author:
- CHUNG Pat
- Journal article citation:
- British Journal of Occupational Therapy, 82(12), 2019, p.716–725.
- Publisher:
- Sage
Introduction: The majority of people with dementia live at home. Homecare enablement services are considered an important short-term intervention, using a person-centred approach. Little is known about people with dementia’s perspectives of the services. This study aimed to explore the users’ experiences. Method: Following ethical approval, participants who had recently used homecare enablement services were invited to participate in two semi-structured interviews through homecare enablement services’ teams within a local authority. Interviews focused on people with dementia’s narratives of the impact of homecare enablement services on their daily functioning. Overall findings were taken back to the participants at the follow-up interviews for member checking. Interviews were digitally recorded, transcribed and analysed using grounded theory. Findings: Sixteen participants with dementia and eight carers took part. Three key themes were revealed: the meaning of enablement in later life; homecare enablement services as instrumental to support transitions in daily life; and enablement through activity engagement in everyday life. Conclusion: The scope of homecare enablement services is evolving to meet the requirements of the Care Act of 2014 and National Institute for Health and Care Excellence guidelines. Services’ improvements and redesign must consider the viewpoints of people with dementia. (Publisher abstract)
Social and functional health of home care clients with different levels of cognitive impairments
- Authors:
- GARMS-HOMOLOVA Vjenka, et al
- Journal article citation:
- Aging and Mental Health, 21(1), 2017, pp.18-23.
- Publisher:
- Taylor and Francis
Objectives: The ability to manage one's life with some degree of independence, to fulfill basic obligations, and to participate in social activities are social functions that delineate the core of ‘social health’. This study examines to what extent clients of community care in Europe (n = 2884) complete such activities despite their cognitive problems. It focuses on mildly and moderately impaired people, aged 65+ years. Methods: Data were collected using the interRAI HC-Assessment in IBenC-project. The association between participants' capacity and performance was tested in three LADLs (instrumental activities of daily living) and their cognitive performance and specific memory problems. Results: About 30 % of home care clients in Europe suffer from mild-to-moderate cognitive impairment. Their relatively independent coping with requirements of routine activities is strongly determined by overall cognitive performance. Specific memory functions seem unimportant, except for procedural memory. It is striking that all clients, and particularly those with mild-to-moderate cognitive impairment, interact mostly with close relatives and friends. Mild-to-moderate cognitive limitations do not hinder clients from coping semi-independently with routine requirements. Discussion: When considering the influence of cognitive function on clients' capacity and performance in everyday activities and social relations, a comprehensive construct of cognitive function has to be applied. (Edited publisher abstract)
The costs of smoking to the social care system in England, January 2017
- Author:
- ASH
- Publisher:
- ASH
- Publication year:
- 2017
- Pagination:
- 11
- Place of publication:
- London
Summarises the findings of research, commissioned by ASH and carried out by Landman Economics, to compare the care needs of current and former smokers with those of never smokers. The study estimated the increased risk ratios for adults aged over 50 in receipt of domiciliary care and residential care separately. The analysis was used to estimate the extent to which local authority-funded social care services were used, as well as the costs to those funding their own care and the number of people requiring support from family and friends. The research used data from the English Longitudinal Study of Ageing (ELSA) and figures on social care spending taken from the National Audit Social Care Intelligence Service (NASCIC). It estimates that the social care costs of smoking to local authorities are approximately £760 million a year. However, no statistically significant difference was found between the proportions of smokers, ex-smokers and never smokers receiving residential care. Two short case studies are included. (Edited publisher abstract)