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Obstacles to improving visual health in older people
- Authors:
- ILIFFE Steve, KHARICHA Kalpa, MYERSON Sybil
- Publisher:
- Thomas Pocklington Trust
- Publication year:
- 2009
- Pagination:
- 7p.
- Place of publication:
- London
This publication summarises findings from research which aimed to explore the obstacles to improving visual health in an ageing population, and why screening does not lead to greater improvement. A mixed methodological approach was taken. Data from earlier health promotion studies was used and qualitative data were collected from older people. The conclusions include a proposal for an educational intervention. The research was funded by Thomas Pocklington Trust and carried out at the Research Department of Primary Care and Population Health, University College London.
Applying community-oriented primary care methods in British general practice: a case study
- Authors:
- ILIFFE Steve, et al
- Journal article citation:
- British Journal of General Practice, 52(481), August 2002, pp.646-651.
- Publisher:
- Royal College of General Practitioners
Health assessments for older people have become an increasing priority with the NSF for Older People. In response to low level of activity in primary care around health assessment for older people, Camden and Islington Health Authority initiated a project in 1996-97 to develop innovative primary care for older people. This article reports on the study which was conducted in four general practices. Results found all four practices identified problems needing attention in the older population, developed different projects focused on particular needs among older people, and tested them in practice. Patient and public involvement were central to the design and implementation process in only one practice. Innovations were sustained in only one practice, but some were adopted by primary care group and others extended to a wider group of practices by the health authority.
Depression in later life
- Authors:
- MANTHORPE Jill, ILIFFE Steve
- Publisher:
- Jessica Kingsley
- Publication year:
- 2005
- Pagination:
- 160p.,bibliog.
- Place of publication:
- London
The authors take a multidisciplinary approach and employ both medical and psycho-social models of depression. The medical model is used to identify symptoms, make diagnoses and work towards optimal treatment. Psycho-social perspectives provide insight into the scale and complexity of the condition and point to its social causes. The authors identify different levels of depression through in-depth analysis and consider the condition in relation to, but distinct from, dementia, psychosis and anxiety disorders, helping professionals to make the correct diagnosis. Supporting case studies show that depression, and the physical symptoms often linked to it, are amenable to treatment. The authors provide practical guidance for health and social care practitioners and suggest numerous coping strategies.
The development of a short instrument to identify common unmet needs in older people in general practice
- Authors:
- ILIFFE Steve, et al
- Journal article citation:
- British Journal of General Practice, 54(509), December 2004, pp.914-918.
- Publisher:
- Royal College of General Practitioners
No structured needs assessment tool appropriate for older people and also suitable for use in routine general practice consultations exists. This study aimed to engage older people in the development of a brief, valid, practical and acceptable instrument to help identify common unmet needs suitable for use in routine clinical practice in primary care by user involvement in a multi-stages approach to heuristic development in general practices, voluntary groups and community organisations in north and central London. Subjects included patients 65 and over in purposively selected practices, voluntary organisations for older people, community organisations involving older people, GPs and community nurses. Data were collected through mixed methodology interviews using a structured assessment tool, a postal questionnaire, and focus groups. Synthesis and interpretation was done through a consensus conference followed by a Delphi process involving primary care professionals. Five domains of unmet need were identified as priority areas by all 3 methods, the consensus conference, and the Delphi process: senses (vision and hearing), physical ability (mobility and falls), incontinence, cognition, and emotional distress (depression and anxiety). Concludes that public involvement in the design of clinical tools allowed the development of a brief assessment instrument that could potentially identify common, important and tractable unmet needs in older people.
Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people
- Authors:
- ILIFFE Steve, et al
- Journal article citation:
- British Journal of General Practice, 57(537), April 2007, pp.277-282.
- Publisher:
- Royal College of General Practitioners
This study aimed to explore the significance of social isolation in the older population for GPs and for service commissioners. Secondary analysis of baseline data from a randomised controlled trial of health risk appraisal. The study used secondary analysis of baseline data from a randomised controlled trial of health risk appraisal. Participants were a total of 2641 community-dwelling, non-disabled people aged 65 years and over in suburban London. Analysis included demographic details, social network and risk for social isolation based on the 6-item Lubben Social Network Scale, measures of depressed mood, memory problems, numbers of chronic conditions, medication use, functional ability, self-reported use of medical services. The results found more than 15% of the older age group were at risk of social isolation, and this risk increased with advancing age. In bivariate analyses risk of social isolation was associated with older age, education up to 16 years only, depressed mood and impaired memory, perceived fair or poor health, perceived difficulty with both basic and instrumental activities of daily living, diminishing functional ability, and fear of falling. Despite poorer health status, those at risk of social isolation did not appear to make greater use of medical services, nor were they at greater risk of hospital admission. Half of those who scored as at risk of social isolation lived with others. Multivariate analysis showed significant independent associations between risk of social isolation and depressed mood and living alone, and weak associations with male sex, impaired memory and perceived poor health. The risk of social isolation is elevated in older men, older persons who live alone, persons with mood or cognitive problems, but is not associated with greater use of services. These findings would not support population screening for individuals at risk of social isolation with a view to averting service use by timely intervention. Awareness of social isolation should trigger further assessment, and consideration of interventions to alleviate social isolation, treat depression or ameliorate cognitive impairment.
Health-related quality of life and attitudes to long-term care among carers of older people using social services
- Author:
- ILIFFE Steve
- Journal article citation:
- Research Policy and Planning, 23(3), 2005, pp.165-173.
- Publisher:
- Social Services Research Group
Using three standardised measures to screen for activity limitation (ADLs), depression (GHQ-28) and health related quality of life (HRQoL) (SF36), a study of carers and people aged 75 and over referred consecutively to social services departments in adjacent inner city areas showed a high prevalence of limitations in activities of daily living (ADLs), that a substantial proportion (42 per cent) had GHQ-28 scores high enough to suggest depression and their scores on the SF-36 showed that many carers were low in vitality and tired. Co-resident carers had poorer psychological health and more difficulties with social functioning than non-resident carers, and were older, but were not significantly different in self-reported physical health. Whether carers wanted the cared-for person to remain at home for as long as possible depended on their relationship (spouse or not) and whether the older person was depressed. The carers' own psychological health was not related to their attitude to institutional care. The study suggests that targeting social care resources on carers showing psychological distress may not reduce downstream expenditure on long-term care.