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Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care
- Authors:
- MAS Miquel A., et al
- Journal article citation:
- Age and Ageing, 46(6), 2017, pp.925-931.
- Publisher:
- Oxford University Press
Objective: To analyse the clinical impact of a home-based Intermediate Care model in the Catalan health system, comparing it with usual bed-based care. Design: Quasi-experimental longitudinal study. Setting: Hospital Municipal de Badalona and El Carme Intermediate Care Hospital, Badalona, Catalonia, Spain. Participants: Older patients with medical and orthopaedic disabling health crises in need of Comprehensive Geriatric Assessment (CGA) and rehabilitation. Methods: A CGA-based hospital-at-home Integrated Care Programme (acute care and rehabilitation) was compared with a propensity score matched cohort of contemporary patients attended by usual inpatient hospital care (acute care plus intermediate care hospitalisation), for the management of medical and orthopaedics processes. Main outcomes measures were: (a) Health crisis resolution (referral to primary care at the end of the intervention); (b) functional resolution: relative functional gain and (c) favourable crisis resolution (health + functional) = a + b. The article compared between-groups outcomes using uni/multivariable logistic regression models. Results: Clinical characteristics were similar between home-based and bed-based groups. Acute stay was shorter in home group: 6.1 (5.3–6.9) versus 11.2 (10.5–11.9) days, P < 0.001. The home-based scheme showed better results on functional resolution and on favourable crisis resolution, with shorter length of intervention, with a reduction of −5.72 (−9.75 and −1.69) days. Conclusions: In the study, the extended CGA-based hospital-at-home programme was associated with shorter stay and favourable clinical outcomes. Future studies might test this intervention to the whole Catalan integrated care system. (Edited publisher abstract)
Effect of anxiety on memory for emotional information in older adults
- Authors:
- HERRERA Sara, MONTORIO Ignacio, CABRERA Isabel
- Journal article citation:
- Aging and Mental Health, 21(4), 2017, pp.362-368.
- Publisher:
- Taylor and Francis
Background: Several studies have shown that anxiety is associated with a better memory of negative events. However, this anxiety-related memory bias has not been studied in the elderly, in which there is a preferential processing of positive information. Objectives: To study the effect of anxiety in a recognition task and an autobiographical memory task in 102 older adults with high and low levels of trait anxiety. Method: Negative, positive and neutral pictures were used in the recognition task. In the autobiographical memory task, memories of the participants’ lives were recorded, how they felt when thinking about them, and the personal relevance of these memories. Results: In the recognition task, no anxiety-related bias was found toward negative information. Individuals with high trait anxiety were found to remember less positive pictures than those with low trait anxiety. In the autobiographical memory task, both groups remembered negative and positive events equally. However, people with high trait anxiety remembered life experiences with more negative emotions, especially when remembering negative events. Individuals with low trait anxiety tended to feel more positive emotions when remembering their life experiences and most of these referred to feeling positive emotions when remembering negative events. Conclusions: Older adults with anxiety tend to recognise less positive information and to present more negative emotions when remembering life events; while individuals without anxiety have a more positive experience of negative memories. (Edited publisher abstract)
Lifetime abuse and quality of life among older people
- Authors:
- FRAGA Silvia, et al
- Journal article citation:
- Health and Social Work, 42(4), 2017, pp.215-222.
- Publisher:
- Oxford University Press
Few studies have evaluated the impact of lifetime abuse on quality of life (QoL) among older adults. By using a multinational study authors aimed to assess the subjective perception of QoL among people who have reported abuse during the course of their lifetime. The respondents (N = 4,467; 2,559 women) were between the ages of 60 and 84 years and living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden). Lifetime abuse was assessed by using a structured questionnaire that allowed to assess lifetime experiences of abuse. QoL was assessed with the World Health Organization Quality of Life-Old module. After adjustment for potential confounders, authors found that to have had any abusive experience decreased the score of sensory abilities. Psychological abuse was associated with lower autonomy and past, present, and future activities. Physical abuse with injuries significantly decreased social participation. Intimacy was also negatively associated with psychological abuse, physical abuse with injury, and sexual abuse. The results of this study provide evidence that older people exposed to abuse during their lifetime have a significant reduction in QoL, with several QoL domains being negatively affected. (Publisher abstract)
Promoting social capital to alleviate loneliness and improve health among older people in Spain
- Author:
- COLL-PLANAS Laura
- Journal article citation:
- Health and Social Care in the Community, 25(1), 2017, pp.145-157.
- Publisher:
- Wiley
Loneliness is especially frequent among older people in Southern Europe. Furthermore, promoting social capital to tackle loneliness and its health effects is an understudied intervention strategy. Therefore, a complex intervention was piloted in Spain in a pre–post study with a 2-year follow-up. Its aims were to explore the feasibility of the intervention and its short- and long-term effects. It was conducted in one mixed rural–urban and two urban areas of diverse socioeconomic levels from 2011 to 2012. The intervention framework was based on social capital theory applying a behaviour change model and care co-ordination. The intervention comprised: (i) a co-ordinated action aimed at building a network between primary healthcare centres and community assets in the neighbourhood and (ii) a group-based programme, which promoted social capital among lonely older people, especially social support and participation. Older people active in senior centres volunteered as gatekeepers. The main outcome domain was loneliness. Secondary outcome domains were participation, social support, self-perceived health, quality of life, depressive symptoms and use of health resources. Pre–post changes were assessed with t-test, Wilcoxon signed-rank test and McNemar's test. Differences between the three time points were assessed with a one-way ANOVA with repeated measures. Social workers and nurses were successfully involved as group leaders, 10 volunteers took part and 38 participants were included. After the intervention, loneliness decreased while social participation and support significantly increased. Furthermore, the number of visits to nurses increased. Exactly 65.8% of the participants built social contacts within the group and 47.4% became engaged in new activities. Two years later, social effects were maintained and depressive symptoms had decreased. Exactly 44.7% of the participants continued to be in contact with at least one person from the group and 39.5% continued participating. The intervention contributes a novel and feasible social capital-based approach for alleviating loneliness among older adults while prompting meaningful changes in their lives. (Publisher abstract)