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Medication in extra care housing
- Author:
- OPUS PHARMACY SERVICES
- Publisher:
- Care Services Improvement Partnership. Housing Learning and Improvement Network
- Publication year:
- 2008
- Pagination:
- 16p.
- Place of publication:
- London
The handling of medicines in Extra Care Housing (ECH) can be difficult to manage because of a lack of guidance relating specifically to this particular environment. Care homes are completely different from extra care housing. A comparable model of care is a domiciliary care agency. If personal care is provided within an ECH scheme, this must be provided by a registered provider, hence the Care Standards Act 2000, National Minimum Standards for Domiciliary Care and the Commission for Social Care Inspection (CSCI) published guidance are all relevant. Any support with medication should incorporate the principles of safe practice set out in the guidance published by the Royal Pharmaceutical Society of Great Britain ‘The Handling of Medicines in Social Care’. This factsheet is aimed at practitioners, commissioners, care services managers and housing managers in extra care housing, an environment not specifically referred to in any guidance on the handling of medicines.
Older prisoners in England and Wales: a follow-up to the 2004 thematic review by HM Chief Inspector of Prisons
- Author:
- HM INSPECTORATE OF PRISONS
- Publisher:
- HM Inspectorate of Prisons
- Publication year:
- 2008
- Pagination:
- 37p.
- Place of publication:
- London
This report is based on the published findings from 29 full inspections of adult establishments in England and Wales conducted during the 12-month period between September 2006 and the beginning of September 2007. It summarises findings in the areas of environment; management; regimes and relationships; health services and resettlement.
How to keep residents active
- Author:
- SALE Anabel Unity
- Journal article citation:
- Community Care, 4.12.08, 2008, pp.30-31.
- Publisher:
- Reed Business Information
Ashley House care home in Borden, Hampshire provides a wide range of activities for residents - both formally structured events and spontaneous activities. This article reports on their practice and the benefits for residents.
Prevalence of depression and anxiety symptoms in elderly patients admitted in post-acute intermediate care
- Authors:
- YOHANNES A. M., BALDWIN R. C., CONNOLLY M. J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(11), November 2008, pp.1141-1147.
- Publisher:
- Wiley
Depression and anxiety symptoms are common in medically ill older patients. This study investigated the prevalence and predictors of depression and anxiety symptoms in older patients admitted for further rehabilitation in a post acute intermediate care unit, in the North West of England. One hundred and seventy-three older patients (60 male), aged mean (SD) 80 (8.1) years, referred for further rehabilitation to intermediate care. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale, and severity of depression examined by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended ADL Scale and quality of life by the SF-36. Sixty-five patients (38%) were identified with depressive symptoms, 29 (17%) with clinical depression, 73 (43%) with anxiety symptoms, and 43 (25%) with clinical anxiety. 15 (35%) of the latter did not have elevated depression scores (9% of the sample). Of those with clinical depression, 14 (48%) were mildly depressed and 15 (52%) moderately depressed. Longer stay in the unit was predicted by severity of depression, physical disability, low cognition and living alone. Clinical depression and anxiety are common in older patients admitted in intermediate care. Anxiety is often but not invariably secondary to depression and both should be screened for. Depression is an important modifiable factor affecting length of stay. The benefits of structured management programmes for anxiety and depression in patients admitted in intermediate care are worthy of evaluation.
Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90
- Authors:
- FLEMING Jane, BRAYNE Carol
- Journal article citation:
- British Medical Journal, 29.11.08, 2008, pp.1279-1282.
- Publisher:
- British Medical Association
This study describes the incidence and extent of lying on the floor for a long time after being unable to get up from a fall among people aged over 90; and to explore their use of call alarm systems in these circumstances. The design used a 1 year follow-up of participants in a prospective cohort study of ageing, using fall calendars, phone calls, and visits. Participants were 90 women and 20 men aged over 90 (n=110), surviving participants of the Cambridge City over-75s Cohort, a population based sample. In one year’s intensive follow-up, 54% (144/265) of fall reports described the participant as being found on the floor and 82% (217/265) of falls occurred when the person was alone. Of the 60% who fell, 80% (53/66) were unable to get up after at least one fall and 30% (20/66) had lain on the floor for an hour or more. Difficulty in getting up was consistently associated with age, reported mobility, and severe cognitive impairment. Cognition was the only characteristic that predicted lying on the floor for a long time. Lying on the floor for a long time was strongly associated with serious injuries, admission to hospital, and subsequent moves into long term care. Call alarms were widely available but were not used in most cases of falls that led to lying on the floor for a long time. Comments from older people and carers showed the complexity of issues around the use of call alarms, including perceptions of irrelevance, concerns about independence, and practical difficulties. Lying on the floor for a long time after falling is more common among the "oldest old" than previously thought and is associated with serious consequences. Factors indicating higher risk and comments from participants suggest practical implications. People need training in strategies to get up from the floor. Work is needed on access and activation issues for design of call alarms and information for their effective use. Care providers need better understanding of the perceptions of older people to provide acceptable support services.
Challenges, benefits and weaknesses of intermediate care: results from five UK case study sites
- Authors:
- REGEN Emma, et al
- Journal article citation:
- Health and Social Care in the Community, 16(6), December 2008, pp.629-637.
- Publisher:
- Wiley
The authors explore the views of practitioners and managers on the implementation of intermediate care for elderly people across England, including their perceptions of the challenges involved in its implementation, and their assessment of the main benefits and weaknesses of provision. Qualitative data were collected in five case study sites (English primary care trusts) via semi structured interviews (n = 61) and focus group discussions (n = 21) during 2003 to 2004. Interviewees included senior managers, intermediate care service managers, clinicians and health and social care staff involved in the delivery of intermediate care. The data were analysed thematically using an approach based on the 'framework' method. Workforce and funding shortages, poor joint working between health and social care agencies and lack of support/involvement on the part of the medical profession were identified as the main challenges to developing intermediate care. The perceived benefits of intermediate care for service-users included flexibility, patient centeredness and the promotion of independence. The 'home-like' environment in which services were delivered was contrasted favourably with hospitals. Multidisciplinary team working and opportunities for role flexibility were identified as key benefits by staff. Insufficient capacity, problems of access and awareness at the interface between intermediate care and 'mainstream' services combined with poor co-ordination between intermediate care services emerged as the main weaknesses in current provision. Despite reported benefits for service-users and staff, the study indicates that intermediate care does not appear to be achieving its full potential for alleviating pressure within health and social care systems. The strengthening of capacity and workforce, improvements to whole systems working and the promotion of intermediate care among doctors and other referrers were identified as key future priorities.
Rural areas and personalisation
- Author:
- MANTHORPE Jill
- Journal article citation:
- Community Care, 23.10.08, 2008, p.34, 36.
- Publisher:
- Reed Business Information
Findings from a recent study to investigate how individual budgets have fared in country areas are summarised. The study sought the views of lead officers, mainly social service managers, from rural local authorities where individual budgets (IBs) were piloted. It also included the views of providers and service users in rural areas of England. The results highlight the importance of the local context of personalisation, and the need to consider specific rural issues.
Impact of late-life self-reported emotional problems on Disability-Free Life Expectancy: results from the MRC Cognitive Function and Ageing Study
- Authors:
- PERES Karine, JAGGER Carol, MATTHEWS Fiona E.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(6), June 2008, pp.643-649.
- Publisher:
- Wiley
Depression in old age is a major public health problem though its relationship to onset of disability and death is not well understood. The authors' aim was to quantify the impact of late-life self-reported depression and emotional problems on both the length and quality of remaining life by means of a longitudinal analysis of 11,022 individuals from the MRC Cognitive Function and Ageing Study multi-centre longitudinal study on ageing in individuals aged 65 and older living in England and Wales. Individuals have been followed at intermittent time intervals over ten years. Subjects reporting at baseline that they had consulted about emotional problems for the first time since the age of 60 years were considered, along with a subgroup where a GP suggested depression. Disability was defined as an Instrumental Activities of Daily Living or Activities of Daily Living disability that required help at least once a week. Total and Disability-Free Life Expectancy (TLE and DFLE) were calculated using multi-state models, separately by gender, and with presence of emotional problems/depression and multimorbidity as covariates. The results showed that emotional problems had a greater impact on DFLE than TLE, reducing DFLE by 1.8 years, but TLE by only 0.5 years at age 65 with the effect increasing with age. The effect was most marked in older people reporting other co-morbidities where emotional problems in addition resulted in a reduction of 0.9 years in total and 2.6 years disability-free. It was concluded that although emotional problems were only self-reported, these results highlight the burden of late-life depression on the quality of remaining years of life.
Care planning systems in care homes for older people
- Authors:
- WORDEN Angela, CHALLISS David
- Journal article citation:
- Quality in Ageing, 9(2), June 2008, pp.28-38.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
The National Minimum Care Standards in England now require that all residents in care homes have a service users plan. This study examined the format and content of 117 blank care plan documents used in Manchester and Cheshire care homes in 2001/02. Sixty-eight per cent of homes used a problem-orientated care plan document, 25% used a problem-orientated care plan with assessment domains defined, 15% used standard care plans and five per cent used daily care plans. Although the government had stressed the importance of involving the users in the care planning process, only 16% of the homes had a care plan that specifically asked for a resident's signature or agreement. There were also differences in content of care plans by home type, which may reflect the professional background and training of staff in nursing homes. The variety in types and format of care plans suggests that the interpretation and recording of care planning may not be uniform across homes and there is need for further detailed work in this area using interviews or observational approaches.
Are patients' attitudes towards and knowledge of electroconvulsive therapy transcultural? A multi-national pilot study
- Authors:
- BUSTIN Julian, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(5), May 2008, pp.497-503.
- Publisher:
- Wiley
This study aimed to compare the attitudes and knowledge of electroconvulsive therapy (ECT) among older adults depressed patients across three culturally different populations and to explore the relationship between culture, knowledge and attitudes. The study was conducted in one centre in each country. A semi-structured survey was used which included three sections: demographics characteristics, attitudes towards and knowledge of ECT. A total of 75 patients were recruited in this study: 30 patients from England; 30 patients from Argentina; and 15 patients from Canada. There was a significant difference in knowledge about ECT across the three countries. No significant difference was found in terms of attitudes. Knowledge was poor in all three countries. The most influential factor shaping subjects' attitudes and knowledge of ECT differed for the three countries. A weak correlation was found between knowledge of and attitudes towards ECT across all patients from the three different countries. No evidence was found that a particular cultural background affects attitudes towards ECT.