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Formal home-care utilisation by older adults in Ireland: evidence from the Irish Longitudinal Study on Ageing (TILDA)
- Authors:
- MURPHY Catriona M., WHELAN Brendan J., NORMAND Charles
- Journal article citation:
- Health and Social Care in the Community, 23(4), 2015, pp.408-418.
- Publisher:
- Wiley
The aim of this study was to provide a population-based estimate of the utilisation of publicly financed formal home care by older adults in Ireland and to identify the principal characteristics of those utilising formal home care. Data were collected through computer-aided personal interviews from a representative sample of community living older adults in Ireland. The interviews were conducted between 2009 and 2011 as part of the first wave of the Irish Longitudinal Study on Ageing (TILDA). The study is cross-sectional in design and limited to participants aged 65 years and older (n = 3507). Results reveal that 8.2% of participants utilised publicly financed formal home care in the form of home help and/or personal care. Key determinants of formal home-care utilisation were Instrumental Activity of Daily Living (IADL) difficulty, older age and living alone. Almost half of those utilising formal care did not self-report an Activity of Daily Living (ADL) difficulty or an IADL difficulty. Government policy aims to reduce the need for long-term residential care by providing formal home care for older adults with low to moderate levels of dependency. This requires an increasing emphasis on personal care provision in the home. No evidence was found in this study to suggest that a shift in emphasis from formal domestic to personal care is taking place in Ireland. The absence of standardised assessment and eligibility criteria are deemed to be barriers to reorientation of the system. From a health services perspective, the current situation is not sustainable into the future and requires a focused policy response. (Edited publisher abstract)
Only the lonely: a randomized controlled trial of a volunteer visiting programme for older people experiencing loneliness
- Authors:
- LAWLOR Brian, et al
- Publisher:
- Age Friendly Ireland
- Publication year:
- 2015
- Pagination:
- 60
- Place of publication:
- Dublin
Loneliness is a significant problem among older people living in Ireland. The negative effects of loneliness on physical and emotional health are well documented in the literature. This study was established in the context of a dearth of effective interventions to alleviate loneliness. A peer visiting intervention for community dwelling older adults experiencing loneliness was designed and subjected to the rigour of a randomised controlled trial. It consisted of ten home visits to the intervention participants from a volunteer, themselves an older person. The volunteer built up a rapport with the participant and encouraged them to identify a social connection they wished to establish. Several participants made new social connections outside their home while most continued to receive visits from their volunteer following the end of the study period. The main study finding was very positive. The primary outcome, loneliness, decreased in the intervention group at one month and three month follow up. Potential benefits for the volunteers were also identified, in particular a decrease in loneliness. Both participants and volunteers reported that they enjoyed the intervention. The intervention is low cost and could be incorporated into existing support services or non-government organisations caring for community dwelling older adults. It is a potentially scalable model to deal with the major societal challenge of loneliness. (Edited publisher abstract)
Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition
- Authors:
- TIMMONS Suzanne, et al
- Journal article citation:
- Age and Ageing, 44(6), 2015, pp.993-999.
- Publisher:
- Oxford University Press
Background: Previous studies have indicated a prevalence of dementia in older admissions of : p∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. Objective: To determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. Methods: Six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. Results: Of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. Conclusion: Dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital. (Publisher abstract)
CASP-19 special section: how does chronic disease status affect CASP quality of life at older ages? examining the WHO ICF disability domains as mediators of this relationship
- Authors:
- SEXTON E., et al
- Journal article citation:
- Aging and Mental Health, 19(7), 2015, pp.622-633.
- Publisher:
- Taylor and Francis
Objectives: The effect of chronic disease status on quality of life (QoL) has been well established. However, less is known about how chronic diseases affect QoL. This article examines impairment in three domains of the WHO International Classification of Functioning, Health and Disability (ICF) – body function, activity and participation, as well as affective well-being, – as potential mediators of the relationship between chronic disease and QoL. Method: A cross-sectional sample (n = 4961) of the general Irish community-dwelling population aged 50+ years was obtained from the Irish Longitudinal Study of Ageing (TILDA). The CASP measure of QoL was examined as two dimensions – control/autonomy and self-realisation/pleasure. Structural equation modelling was used to test the direct and indirect effects of chronic disease on QoL, via variables capturing body function, activity, participation and positive affect. Results: A factor analysis showed that indicators of body function and activity loaded onto a single overall physical impairment factor. This physical impairment factor fully mediated the effect of chronic disease on positive affect and QoL. The total effect of chronic disease on control/autonomy (−0.160) was primarily composed of an indirect effect via physical impairment (−0.86), and via physical impairment and positive affect (−0.45). The decomposition of effects on self-realisation/pleasure was similar, although the direct effect of physical impairment was weaker. The model fitted the data well (RMSEA = 0.02, TLI = 0.96, CFI = 0.96). Conclusion: Chronic disease affects QoL through increased deficits in physical body function and activity. This overall physical impairment affects QoL both directly and indirectly via reduced positive affect. (Publisher abstract)
The case management approach to protecting older people from abuse and mistreatment: lessons from the Irish experience
- Authors:
- O'DONNELL Deirdre, et al
- Journal article citation:
- British Journal of Social Work, 45(5), 2015, pp.1451-1468.
- Publisher:
- Oxford University Press
The aim of this paper is to inform the development of social work practice and policy by applying a practice-based evidence perspective to the experiential knowledge of social workers responsible for managing cases of elder abuse in Ireland. The study adopted a qualitative descriptive research design. Semi-structured interview data were collected from a purposive sample of eighteen senior case workers and inductive thematic analysis was undertaken. The findings are presented according to three themes: elder abuse case management, practice strategies for overcoming challenges and augmenting protective practice. By examining practice in the context of wider socio-political and legislative contexts, the paper provides learning in key areas for the protection of older people. The challenges to case management practice and the strategies employed to respond to these challenges are discussed in terms of adult protective service policy development and its relationship to practice. While recognising the imperative to respect a client's right to self-determination, increased statutory authority for the duty of the state to protect older people from abuse as well as the role of the case worker to act on behalf of the state to implement protective interventions is important for the future development of the service. (Publisher abstract)