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Older and bolder: involving older people in health and community care; a report of the workshop on 16th and 17th September 1996
- Author:
- LABYRINTH TRAINING AND CONSULTANCY
- Publisher:
- Labyrinth Training and Consultancy
- Publication year:
- 1996
- Pagination:
- 8p.
- Place of publication:
- Haworth
Papers from a workshop on involving older people in health and community care services.
Person-centredness in the community care of older people: a literature-based concept synthesis
- Author:
- WILBERFORCE Mark
- Journal article citation:
- International Journal of Social Welfare, 26(1), 2017, pp.86-98.
- Publisher:
- Wiley
‘Person-centredness’ is a ubiquitous term, employed in modern care services to signify policies and practices that attend to the uniqueness of each individual user. Despite being highly regarded in older adult community care services, there is much ambiguity over its precise meaning. Existing reviews of person-centredness and its attributes have tended to focus on the medico-nursing literature, neglecting other interpretations, such as those relevant to community social care. A new literature-based concept synthesis reported here identified 12 common attributes within the broad themes of ‘understanding the person’, ‘engagement in decision-making’ and ‘promoting the care relationship’. The review also contrasts how these attributes are applied across different interpretations of person-centredness. The article argues that not all attributes necessarily pull in the same direction, and that older adults may require them to be delivered in different ways than they are to younger people. Thus, a ‘one-size-fits-all’ approach should be discouraged in community care. (Publisher abstract)
People dependent of support in daily activities perceives reduced self-determination – a cross-sectional study with community-dwelling older people
- Authors:
- HAMMAR Isabelle Ottenvall, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 16(4), 2015, pp.208-221.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the relationship of self-determination with degree of dependence in daily activities among community-dwelling persons aged 80 years and older. Design/methodology/approach: This cross-sectional study focused on community-dwelling people 80 years or older with varied degree of dependence in daily activities. Self-determination in daily life was assessed with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O), and degree of dependence in daily activities was assessed with the activities of daily living (ADL) staircase. Data were analysed using Fisher’s exact test, and the relative risk with a 95 per cent confidence interval was used to explore the risk of perceiving reduced self-determination in daily life. Findings: Compared to the independent persons, the perceived self-determination was significantly lower among persons dependent in instrumental activities of daily living (I-ADL), and persons dependent in personal activities of daily living (P-ADL). Reduced self-determination was most pronounced in persons requiring help with P-ADL. Practical implications: Following key features could be applied to strengthen the community-dwelling older people’s self-determination; incorporating a dialogue where self-determined questions are raised; adopting a person-centred approach between the persons involved; acknowledging older people’s capabilities – what they are able to do and to be, and what they value. Originality/value: This study highlights the need of integrating a self-determined dialogue into healthcare where the older person and the professional focus on self-determined questions. (Publisher abstract)
Social work decision-making: need factors of older adults that affect outcomes of home- and community-based services
- Author:
- JOOSTEN Dawn Marie
- Journal article citation:
- Health and Social Work, 40(1), 2015, pp.34-42.
- Publisher:
- Oxford University Press
This study examines social work decision-making outcomes of home- and community-based services (HCBS) referrals provided to older adults with unmet physical and psychosocial needs discharged from acute care to a community setting, and to understand older adults' (N = 247) responses to receiving referrals for HCBS. Older adults with inadequately or marginally met basic needs was a statistically significant predictor of the number of HCBS referrals home health social workers provided to older adult clients. The adapted three-step models were statistically significant: activities of daily living model and instrumental activities of daily living model. Most older adults accepted the HCBS referrals provided to them at the time of the social work home visit. Implications for practice were suggested for clinical social workers and case managers providing HCBS referrals to older adults with unmet physical and psychosocial needs discharged from acute care or skilled care to community settings. (Edited publisher abstract)
Ethical decision making in situations of self-neglect and squalor among older people
- Author:
- MCDERMOTT Shannon
- Journal article citation:
- Ethics and Social Welfare, 5(1), March 2011, pp.52-71.
- Publisher:
- Taylor and Francis
- Place of publication:
- Abingdon
Ethical decision making in situations of self-neglect and squalor is usually discussed within a framework of 4 ethical principles of autonomy, beneficence, non-maleficence, and justice. Professionals are required to uphold each of these prima facie duties individually, and if they conflict it is assumed that the dilemma can be resolved through rational decision making. However, there are limitations to this approach to professional ethics; some situations of self-neglect and squalor among older people lead to conflict between 2 or more of these ethical duties and require the professional to make a decision between alternatives, both of which may cause harm to those involved. This paper explores these limitations through an empirical study that examined the ethical dilemmas facing professionals in their work with older people who were self-neglecting or living in squalor in Sydney, Australia. The research comprised 125 hours of observation of client and coordinator interactions in assessments and home visits over a 5 month period, and interviews with 18 professionals working with situations of self-neglect and squalor in the community. The research uncovered that professionals in health-focused organisations and other community organisations interpreted autonomy in different ways. When faced with difficult ethical dilemmas, the participants agreed that the most satisfactory responses involved strategies that closely mirrored elements of alternative approaches to ethics, particularly the ethics of care and virtue ethics.
Are persons with cognitive impairment able to state consistent choices?
- Authors:
- FEINBERG Lynn Friss, WHITLATCH Carol J.
- Journal article citation:
- Gerontologist, 41(3), June 2001, pp.374-382.
- Publisher:
- Oxford University Press
This American study examines the decision-making capacity of persons with cognitive impairment with respect to their everyday care preferences and choices. This is the first in a series of articles to report on findings from a larger study that examines choice, decision making, values, preferences, and practices in everyday care for community-dwelling persons with cognitive impairment and their family caregivers. Fifty-one people with cognitive impairment and their carers were interviewed. All persons with cognitive impairment were interviewed twice within a week using a parallel interview to determine stability and accuracy of responses. The family caregiver was interviewed once. Persons with mild to moderate cognitive impairment are able to respond consistently to questions about preferences, choices and their own involvement in decisions about daily living, and to provide accurate and reliable responses to questions about demographics. Concludes that including the perspective of persons with cognitive impairment in both research and practice has the potential to enhance their autonomy and improve their quality of life.
Influencing the health agenda
- Author:
- WILLIS Jenine
- Journal article citation:
- Nursing Times, 19.11.97, 1997, pp.62-64.
- Publisher:
- Nursing Times
Older people have an important part to play in the development of services for the next generation. Discusses how they can make their voices heard.
Testing legal muscle of 'care in the community'
- Author:
- LETTS Penny
- Journal article citation:
- Community Living, 9(1), July 1995, pp.10-11.
- Publisher:
- Hexagon Publishing
The High Court ruling obliging Gloucestershire County Council to review its decision to withdraw services for five elderly people has shown that the law relating to community care is cumbersome, complicated and inconsistent, full of incompatible principles and irreconcilable contradictions. Asks if the judiciary will find a solution to this mess.
Home sweet home
- Author:
- HIRST Rob
- Journal article citation:
- Community Care, 1.6.95, 1995, pp.24-25.
- Publisher:
- Reed Business Information
Explains the findings of a study in Wiltshire which examines how elderly people choose between sheltered accommodation or remaining in their own homes.
Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial)
- Authors:
- KNAPP Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1205-1216.
- Publisher:
- Wiley
Objective: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. The authors examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients. Methods: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial. A total of 295 community-dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine. Results: Continuing donepezil for 52 weeks was more cost-effective than discontinuation, considering cognition, activities of daily living and health-related quality of life. Starting memantine was more cost-effective than donepezil discontinuation. Donepezil–memantine combined is not more cost-effective than donepezil alone. Conclusions: Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. (Edited publisher abstract)