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COVID-19 outbreak: organisation of a geriatric assessment and coordination unit. A French example
- Authors:
- KOEBERLE Severine, et al
- Journal article citation:
- Age and Ageing, 49(4), 2020, pp.516-522.
- Publisher:
- Oxford University Press
Older people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient’s level of care and the organisation of specific networks is essential. To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: 1) To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level; 2) To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist. 3) To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service. This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory. (Edited publisher abstract)
Real-life implementation of guidelines on the hospital-to-home transition for older patients: a cohort study in general practice
- Authors:
- HURTAUD Aline, et al
- Journal article citation:
- Age and Ageing, 49(1), 2020, p.46–51.
- Publisher:
- Oxford University Press
Background: hospital discharge is a critical event for older patients. The French guidelines recommended the swift transmission of a discharge summary to the general practitioner (GP) and a primary care consultation within 7 days. The relevance and feasibility of these guidelines have not previously been assessed. Objective: to perform a real-life assessment of compliance with French guidelines on the transmission of discharge summaries and post-discharge medical reviews and to examine these factors’ association with 30-day readmissions. Design: a prospective multicentre cohort study. Setting: primary care (general practice) in France. Subjects: a sample of GPs and the same number of patients aged 75 or over having consulted within 30 days of hospital discharge. Methods: the main endpoints were the proportion of discharge summaries available and the proportion of patients consulting their GP within 7 days. The 30-day readmission rate was also measured. Factors associated with these endpoints were assessed in univariate and multivariate analyses. Results: seventy-one GPs (mean ± standard deviation age: 49 ± 11; males: 62%) and 71 patients (mean age: 84 ± 5; males: 52%; living at home: 94%; cognitive disorders: 22%) were included. Forty-six patients (65%, [95% confidence interval [CI]]: 53–76) consulted their GP within 7 days of hospital discharge. At the time of the consultation, 27 GPs (38% [95% CI]: 27–50) had not received the corresponding hospital discharge summary. Discharge summary availability was associated with a lower risk of 30-day readmission (adjusted odds ratio [95% CI] = 0.25 [0.07–0.91]). Conclusions: compliance with the French guidelines on hospital-to-home transitions is insufficient. (Edited publisher abstract)
Regulating the delivery of cash‐for‐care payments across Europe
- Authors:
- GORI Cristiano, LUPPI Matteo
- Journal article citation:
- Social Policy and Administration, 53(4), 2019, pp.567-578.
- Publisher:
- Wiley
The article aims to understand how governments across Europe have modified the regulation of the delivery of cash‐for‐care schemes (CfCs) to dependent older people since the beginning of the century. In our terminology, the regulation of the CfCs delivery defines the norms, rules, and practices that public actors adopt to manage how beneficiaries can use the benefits. To discuss the regulation of CfCs delivery, an original framework is employed that take three analytical dimensions into account: the degrees of freedom in benefits' utilization (“CfCs utilization” dimension), the provision of information/orientation/advices/counselling to older people and families (“professional support” dimension), and the relationship between the delivery of CfCs and the delivery of the other publicly funded long‐term care inputs (“care system” dimension). The analysis adopts a comparative perspective, looking at six countries—Italy, Austria, the Netherlands, France, Germany, and England. Among various findings, the main one consists in showing that there has been a shared and increased interest in consolidating the regulation of CfCs delivery. This trend has been mostly directed towards the new policy aim of strengthening the professional support, a goal underestimated in the past, when this dimension was not a major topic of both debate and practice concerning CfCs across Europe. (Edited publisher abstract)
The family accompaniment of persons with dementia seen through the lens of the capability approach
- Authors:
- LE GALES Catherine, BUNGENER Martine
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(1), 2019, pp.55-79.
- Publisher:
- Sage
Using the capability approach initially developed by A Sen as a theoretical framework, this paper analyses both what people with dementia and their families do in response to difficulties in their daily life brought about by the disease, and the reasons they give for acting as they do. Individual and collective interviews and ethnographic observations with 15 persons with dementia and one or more of their family members were conducted. Follow-up interviews were possible for nine families. Results highlight a great diversity in ways of doing things and in accompaniment by family members. Daily adjustments are often hidden or minimized, at least at the onset of the dementia. Later, they become more frequent, repetitive and indispensable but remain influenced by the social and gender roles that existed prior to the illness. The inventiveness of families, in a context marked by various kinds of constraints, is primarily motivated by their desire to maintain the apparently intact abilities of the person with dementia but especially to preserve forms of liberty and what counted for the person, what that person valued before the disease. There are some ways of living with dementia, even when accompanied, which may long remain preferable to others, which better answer to the past and present aspirations of persons with dementia and the purposes of the accompanying persons. It is thus essential that health professionals, as well as society in general, recognize and address this issue. (Edited publisher abstract)
An international comparison of long-term care funding and outcomes: insights for the social care green paper
- Author:
- INCISIVE HEALTH
- Publisher:
- Incisive Health
- Publication year:
- 2018
- Pagination:
- 49
- Place of publication:
- London
This report, commissioned by Age UK, highlights different approaches to long-term care taken by five countries in the developed world, and looks at how they compare to the system in England. These five countries have very different systems, but face similar demographic and financial challenges to those in England. The countries are France, Germany, Spain, Italy and Japan. The report compares the approaches in relation to: service structures, funding levels, funding models, and outcomes. The findings suggest that creating a sustainable social care system fit for a rapidly ageing population is a challenge in every one of these countries. However, it finds that the financial deal for citizens with care needs is often more generous in other countries in comparison to England, with other nations generally either providing some non-means tested basic level of support, and/or cap the amount of co-payment to be made, and/or use a more gradual means-test. Profiles for each of the five countries are also included. (Edited publisher abstract)
Satisfaction and difficulties of French professional home caregivers in supporting older people with Alzheimer's disease or alcohol misuse
- Authors:
- MOSCATO Alba, VARESCON Isabelle
- Journal article citation:
- Health and Social Care in the Community, 26(1), 2018, pp.27-34.
- Publisher:
- Wiley
In France, few studies have examined home care when it comes to ageing support and even fewer have considered alcohol misuse in this context. The studies also show that being old and having alcohol use disorders are two unfavourable conditions for receiving help, whereas for the Alzheimer's disease, there is a clear need for optimal care. In this article, the authors study professional home caregiver's perceptions of their job along with their difficulties and satisfactions in supporting older people with Alzheimer's disease or alcohol misuse. Out of the 23 professionals approached, 17 took part in a research interview from October 2013 to January 2014. All interviews were recorded, fully transcribed and lexically analysed with Alceste® software. Among the five classes that were identified from 63% of the initial data, the main themes that emerged illustrate the nature of the associated pathologies, the perceptions and satisfactions related to the profession, their adaptive skills, the difficulties related to the life context of the older person, and the wine consumption of the latter. The lexical discourse analysis shows that the professional home caregivers are involved in looking after not only people with Alzheimer's disease but also those with alcohol misuse. However, despite the difficulties and satisfactions encountered, adaptation to the older people seems to be their priority and one of the many skills that they have acquired during their professionalisation. Most of the older people who are helped are women and the difficulties mentioned by their caregivers usually arise at the time of their death. Lastly, when caring for alcohol misusers, they describe negative attitudes in their support. Although research in this area is rare while home care for the older person, whatever the pathology, is increasing, professionals need to be supported by the associations or companies that employ them and should be trained to help them provide the appropriate care. (Edited publisher abstract)
Analysing equity in the use of long-term care in Europe
- Authors:
- RODRIGUES Ricardo, ILINCA Stefania, SCHMIDT Andrea
- Publisher:
- European Commission
- Publication year:
- 2014
- Pagination:
- 39
- Place of publication:
- Brussels
There are significant differences across social protection systems in Europe in the scope, breadth and depth of coverage of the risk to need long-term care in old-age. Together with other factors, such as education, household structure or societal values regarding care for frail older people, these differences can have a significant impact on the use of long-term care. Using SHARE data, this Research Note compares differences between European countries in the use of long-term care across income groups, for older people living at home. It analyses not only inequalities in the use of long-term care, but also differences in use that persist after differences in need have been taken into consideration, i.e. horizontal inequity. For this purpose, concentration indices, concentration curves and horizontal inequity indices are estimated for home care services and informal care. The countries analysed here are Austria, Germany, Sweden, the Netherlands, Spain, Italy, France, Denmark, Greece, Belgium and Czech Republic. The findings suggest that differences in use of home care services across income groups mostly reflect differences in need between those same groups. For informal care, the differences in use persist even after accounting for needs, and less affluent individuals are much more likely to use informal care. Some possible causes for these differences and policy implications are considered.
Home environments and adaptations in the context of ageing
- Authors:
- RENAUT Sylvie, et al
- Journal article citation:
- Ageing and Society, 35(6), 2015, pp.1278-1303.
- Publisher:
- Cambridge University Press
‘Ageing in place’ initiatives form an important part of broader ‘ageing well’ strategies that are being developed in response to demographic change. Increasingly, it is acknowledged that it is important to understand how individuals shape and modify the space within their own home and immediate environment to facilitate flexible solutions in the event of a loss of independence. This research, carried out in France, aims to understand how individuals construct the space both within their own home and their immediate surroundings and how this construction is linked to their own perception of ageing and growing old. A thematic analysis of 28 qualitative interviews resulted in two differentiated responses in relation to home adaptations: those respondents who had acted to modify their home and environment and those who instead sought to delay or ‘put off’ any modifications. The results demonstrate the multi-dimensional experience of ageing, the diversity of types of home environment, and the interplay between compensatory solutions and the social contexts within which they take place. The need for a more holistic approach that takes into account factors such as an individual's experience of ageing is suggested in order to understand the use of space in home environments and the adaptations that are made to them. Policy initiatives for ‘ageing in place’ can be reinforced by closer user involvement. (Edited publisher abstract)
Direct and indirect relationships between physical activity and happiness levels among older adults: a cross-sectional study
- Author:
- de SOUTO BARRETO Philipe
- Journal article citation:
- Aging and Mental Health, 18(7), 2014, pp.861-868.
- Publisher:
- Taylor and Francis
Objectives: The purposes of this study were to examine if physical activity (PA) is associated to happiness and to investigate if social functioning and health status mediate this association. Method: Participants of this cross-sectional study were 323 men and women, age 60 or over, who were covered by the medical insurance of the French National Education System, France. They received by mail a self-report questionnaire that asked for information about general health, PA, and happiness. Results: In multinomial logistic regressions, the total volume of PA was associated to higher levels of happiness, but this association disappeared in the presence of social functioning. A structural equation modelling (SEM) showed an indirect association between PA and happiness, which was mediated by participants’ health status and social functioning; in this SEM model, social functioning was the only variable directly associated to happiness. Conclusion: Complex associations among PA, health status, and social functioning appear to determine happiness levels in older adults. (Publisher abstract)
Measuring social-work activities with older people
- Authors:
- DELLI-COLLII Nathalie, et al
- Journal article citation:
- Practice: Social Work in Action, 25(5), 2013, pp.281-296.
- Publisher:
- Taylor and Francis
The aim of this pilot study was to obtain accurate and valid data on how much time social workers spend on their different activities in the home-care programme. Data collection required two steps. Beginning with a list of social-work activities was developed and validated. The final list consisted of 75 activities in four main categories: direct activities, indirect activities, non-clinical activities and personal time. The list was programmed in TEDDI (French acronym for clinician time and motion) a software running on a handheld computer to carry out continuous-time-and-motion through self-reporting. Secondly, eight social workers used TEDDI for 12 days: 2632 activities and 94 working days were analysed. Analysis revealed that 68% of the total time was allocated to direct (19%) and indirect activities (49%), 16% to non-clinical activities and 16% to personal time. The social workers spent 14.3% of their time with the older person and 4.5% with the older person’ families; 14.2% of social worker time was allocated to record keeping, which was the most time-consuming activity. This study documented the nature of tasks carried out as well as the time used to perform them. (Publisher abstract)