Background and Objectives: General self-efficacy (GSE) encourages health-promoting behaviors in older adults. It is unsurprising then that older adults receiving health care services are reported to have a greater risk of low GSE than older adults who are not. Despite this, there is currently limited evidence investigating whether the effect differs based on the environment in which care is received. This review aims to determine whether the GSE of older adults is affected by the receipt of health care services and whether GSE varies based on the setting in which care is received. Research Design and Methods: In accordance with PRISMA guidelines (PROSPERO registration number CRD42018092191), a systematic search was undertaken across 7 databases. Standardized mean differences (SMD) and mean General Self-Efficacy Scale scores, with 95% confidence intervals (CI), were pooled for meta-analysis. Results: A total of 40 studies were identified, they consisted of 33 population cohorts that were included in the meta-analysis. Older adults receiving health care services were found to be at greater risk of having lower GSE than those who do not (SMD = −0.62; 95% CI: −0.96 to −0.27, p < .0001). Following identification of sources of heterogeneity, older adults receiving acute inpatient care were more likely to have lower GSE than those receiving care in other health care settings. Discussion and Implications: Older adults receiving inpatient care have a greater risk of lower GSE, and consequently, poorer health-promoting behaviors. Further research is recommended that focuses on the GSE of older adults and health outcomes following discharge from inpatient care.
(Edited publisher abstract)
Background and Objectives: General self-efficacy (GSE) encourages health-promoting behaviors in older adults. It is unsurprising then that older adults receiving health care services are reported to have a greater risk of low GSE than older adults who are not. Despite this, there is currently limited evidence investigating whether the effect differs based on the environment in which care is received. This review aims to determine whether the GSE of older adults is affected by the receipt of health care services and whether GSE varies based on the setting in which care is received. Research Design and Methods: In accordance with PRISMA guidelines (PROSPERO registration number CRD42018092191), a systematic search was undertaken across 7 databases. Standardized mean differences (SMD) and mean General Self-Efficacy Scale scores, with 95% confidence intervals (CI), were pooled for meta-analysis. Results: A total of 40 studies were identified, they consisted of 33 population cohorts that were included in the meta-analysis. Older adults receiving health care services were found to be at greater risk of having lower GSE than those who do not (SMD = −0.62; 95% CI: −0.96 to −0.27, p < .0001). Following identification of sources of heterogeneity, older adults receiving acute inpatient care were more likely to have lower GSE than those receiving care in other health care settings. Discussion and Implications: Older adults receiving inpatient care have a greater risk of lower GSE, and consequently, poorer health-promoting behaviors. Further research is recommended that focuses on the GSE of older adults and health outcomes following discharge from inpatient care.
(Edited publisher abstract)
Subject terms:
older people, hospitals, residential care, self-determination, self-concept;
Providing appropriate, sustainable care to older people for the coming decades is a challenge that all EU member states are facing, because of demographic changes, cost containment and empowerment. An increasing number of older people have long-term, complex needs which may require support from any combination of primary, residential or acute hospital care, as well as social care and practical support. A key solution to this challenge is integrated care – a well-planned and well-organised set of services and care processes, targeted at the multidimensional needs and problems of an individual client, or at a group of people with similar needs or problems. Members of the integrated care team work closely to offer timely detection, appropriate assessment, treatment and care, so that the older person‘s health and well-being might be significantly enhanced. This resource book for managers provides guidelines for those involved in the development of integrated care services, focusing on the management of integrated care at the client level, the organisation level and the system level, this book will be invaluable to managers and professionals in the health and social care field.
Providing appropriate, sustainable care to older people for the coming decades is a challenge that all EU member states are facing, because of demographic changes, cost containment and empowerment. An increasing number of older people have long-term, complex needs which may require support from any combination of primary, residential or acute hospital care, as well as social care and practical support. A key solution to this challenge is integrated care – a well-planned and well-organised set of services and care processes, targeted at the multidimensional needs and problems of an individual client, or at a group of people with similar needs or problems. Members of the integrated care team work closely to offer timely detection, appropriate assessment, treatment and care, so that the older person‘s health and well-being might be significantly enhanced. This resource book for managers provides guidelines for those involved in the development of integrated care services, focusing on the management of integrated care at the client level, the organisation level and the system level, this book will be invaluable to managers and professionals in the health and social care field.
Extended abstract:
Author:NIES Henk, BERMAN Philip C., eds. Title: Integrating services for older people: a resource book for managers Publisher: European Health Management Association, 2004
Summary
This resource book for managers provides guidelines for those involved in the development of integrated care services, focusing on the management of integrated care at the client level, the organisation level and the system level.
Context
Providing appropriate, sustainable care to older people for the coming decades is a challenge that all EU member states are facing, because of demographic changes, cost containment and empowerment. An increasing number of older people have long-term, complex needs which may require support from any combination of primary, residential or acute hospital care, as well as social care and practical support. A key solution to this challenge is integrated care – a well-planned and well-organised set of services and care processes, targeted at the multidimensional needs and problems of an individual client, or at a group of people with similar needs or problems. Members of the integrated care team work closely to offer timely detection, appropriate assessment, treatment and care, so that the older person‘s health and well-being might be significantly enhanced.
Contents
The editors' foreword gives the background, discusses definitions and terminology and implementing the concept, and explains how the book developed, that it users should mainly be managers of care-providing organisations and managers and officials responsible for commissioning long-term care for older people, how to use it, topics covered, the geographical spread of content, and how to get involved. Chapter 1 discusses the concepts and background of integrated care. Chapter 2 considers integrated organisational structures. Chapter 3 is on involvement, empowerment and advocacy. Needs assessment is covered by Chapter 4. Chapter 5 covers care pathways. Case management is the theme of Chapter 6. Chapter 7 is about integrated teams. The workforce is discussed in Chapter 8 and cultural change in Chapter 9. Leadership is the theme of Chapter 10. Chapter 11 considers strategic planning. Information management is discussed in Chapter 12, and quality management in Chapter 13. Almost all chapters have sections on definitions, implementation, objectives and intended outcomes, models and approaches, the implementation process, staff, monitoring and evaluation, staff, barriers, supports, references and further reading, and sometimes a conclusion. Some also give web links. Much information is given in figures and tables.
352 references
Subject terms:
hospitals, intermediate care, older people, primary care, residential care;
Pressures to discharge patients too soon and a shortage of intermediate care beds are among the problems Sweden has faced. Looks at what the UK can learn.
Pressures to discharge patients too soon and a shortage of intermediate care beds are among the problems Sweden has faced. Looks at what the UK can learn.
Subject terms:
hospitals, older people, hospital discharge, residential care, care planning;
MCC Building Knowledge for Integrated Care, 10(6), December 2002, pp.15-21.
Publisher:
Pavilion
The third in a series of articles about trying to develop better evidence for a service on the health/social care interface. All are based on experiences of carrying out a comparative study of residential rehabilitation for older people. Previous articles dealt with methodology and implementation, this article reflects on the completion of the project and the first stages of dissemination.
The third in a series of articles about trying to develop better evidence for a service on the health/social care interface. All are based on experiences of carrying out a comparative study of residential rehabilitation for older people. Previous articles dealt with methodology and implementation, this article reflects on the completion of the project and the first stages of dissemination.
Subject terms:
hospitals, intermediate care, older people, rehabilitation, residential care, evidence-based practice, health;
British Journal of Learning Disabilities, 23(4), 1995, pp.143-146.
Publisher:
Wiley
The people with learning disabilities originating from Westminster, England who were aged over 61 years in 1984 were compared with those in the same age group in 1994. Over the decade there had been a significant change in the nature of the residential provision; the proportion resident in hospitals fell and that in 'community care' increased. There was a significant increase in the proportion assessed as having behaviour problems. A significant number of people were less able to feed themselves. Implications for service provision are discussed.
The people with learning disabilities originating from Westminster, England who were aged over 61 years in 1984 were compared with those in the same age group in 1994. Over the decade there had been a significant change in the nature of the residential provision; the proportion resident in hospitals fell and that in 'community care' increased. There was a significant increase in the proportion assessed as having behaviour problems. A significant number of people were less able to feed themselves. Implications for service provision are discussed.
Subject terms:
hospitals, learning disabilities, older people, residential care, social care provision, community care;
Describes a study which compares the proportions of patients discharged to private residential and nursing homes or elsewhere from a department of geriatric medicine in Bath, Avon before and after the implementation of the NHS and community care act in April 1993. Also gives the lengths of time patients had spent in hospital before their discharge.
Describes a study which compares the proportions of patients discharged to private residential and nursing homes or elsewhere from a department of geriatric medicine in Bath, Avon before and after the implementation of the NHS and community care act in April 1993. Also gives the lengths of time patients had spent in hospital before their discharge.
Subject terms:
hospitals, nursing homes, older people, hospital discharge, private sector, residential care, community care;
Argues that the advocates of community care ignore some of the important functions undertaken by hospital long term care, which may include rehabilitation and be more attuned to the wishes and needs of elderly people.
Argues that the advocates of community care ignore some of the important functions undertaken by hospital long term care, which may include rehabilitation and be more attuned to the wishes and needs of elderly people.
Subject terms:
hospitals, long term care, older people, rehabilitation, residential care, social policy, community care;
International Journal of Care Coordination, 22(2), 2019, pp.69-80.
Publisher:
Sage
Introduction: Multiple care organisations, such as home care services, nursing homes and hospitals, are responsible for providing an appropriate response to the palliative care needs of older people admitted into long-term care facilities. Integrated palliative care aims to provide seamless and continuous care. A possible organisational strategy to help realise integrated palliative care for this population is to create a network in which these organisations collaborate. The aim is to analyse the collaboration processes of the various organisations involved in providing palliative care to nursing home residents. Method: A sequential mixed-methods study, including a survey sent to 502 participants to evaluate the collaboration between home and residential care, and between hospital and residential care, and additionally three focus group interviews involving a purposive selection among the survey participants. Participants are key persons from the nursing homes, hospitals and home care organisations that are part of the 15 Flemish palliative care networks dispersed throughout the region of Flanders, Belgium. Results: Survey data were gathered from 308 key persons (response rate: 61%), and 16 people participated in three focus group interviews. Interpersonal dimensions of collaboration are rated higher than structural dimensions. This effect is statistically significant. Qualitative analyses identified guidelines, education, and information-transfer as structural challenges. Additionally, for further development, members should become acquainted and the network should prioritise the establishment of a communication infrastructure, shared leadership support and formalisation. Discussion: The insights of key persons suggest the need for further structuration and can serve as a guideline for interventions directed at improving inter-organisational collaboration in palliative care trajectories for nursing home residents.
(Edited publisher abstract)
Introduction: Multiple care organisations, such as home care services, nursing homes and hospitals, are responsible for providing an appropriate response to the palliative care needs of older people admitted into long-term care facilities. Integrated palliative care aims to provide seamless and continuous care. A possible organisational strategy to help realise integrated palliative care for this population is to create a network in which these organisations collaborate. The aim is to analyse the collaboration processes of the various organisations involved in providing palliative care to nursing home residents. Method: A sequential mixed-methods study, including a survey sent to 502 participants to evaluate the collaboration between home and residential care, and between hospital and residential care, and additionally three focus group interviews involving a purposive selection among the survey participants. Participants are key persons from the nursing homes, hospitals and home care organisations that are part of the 15 Flemish palliative care networks dispersed throughout the region of Flanders, Belgium. Results: Survey data were gathered from 308 key persons (response rate: 61%), and 16 people participated in three focus group interviews. Interpersonal dimensions of collaboration are rated higher than structural dimensions. This effect is statistically significant. Qualitative analyses identified guidelines, education, and information-transfer as structural challenges. Additionally, for further development, members should become acquainted and the network should prioritise the establishment of a communication infrastructure, shared leadership support and formalisation. Discussion: The insights of key persons suggest the need for further structuration and can serve as a guideline for interventions directed at improving inter-organisational collaboration in palliative care trajectories for nursing home residents.
(Edited publisher abstract)
Subject terms:
home care, nursing homes, collaboration, interagency cooperation, hospitals, palliative care, long term care, residential care, older people, integrated care;
An update of a review first published in 2010 and updated in 2012, to assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. Search methods: The authors searched the healthcare literature for reports of randomised controlled trials relevant to this review up to August 2017. Study characteristics: The review included 95 randomised controlled trials involving 138,164 participants. Seventy-one trials (40,374 participants) were in care facilities, and 24 (97,790 participants) in hospitals. Key results: There was evidence, often from single studies, for a wide range of interventions used for preventing falls in both settings. This review summarises the falls outcomes for four key interventions in care facilities and three key interventions in hospitals. In relation to care facilities, the authors are uncertain of the effect of exercise on the rate of falls (very low-quality evidence) and it may make little or no difference to the risk of falling (low-quality evidence). General medication review may make little or no difference to the rate of falls (low-quality evidence) or the risk of falling (low-quality evidence). Prescription of vitamin D probably reduces the rate of falls (moderate-quality evidence) but probably makes little or no difference to the risk of falling (moderate-quality evidence). The population included in these studies appeared to have low vitamin D levels. The authors are uncertain of the effect of multifactorial interventions on the rate of falls (very low-quality evidence). They may make little or no difference to the risk of falling (low-quality evidence). In relation to hospitals: the authors are uncertain whether physiotherapy aimed specifically at reducing falls in addition to usual rehabilitation in the ward has an effect on the rate of falls or reduces the risk of falling (very low-quality evidence). The authors are uncertain of the effect of bed alarms on the rate of falls or risk of falling (very low-quality evidence). Multifactorial interventions may reduce the rate of falls, although this is more likely in a rehabilitation or geriatric ward setting (low-quality evidence). The authors are uncertain of the effect of these interventions on risk of falling.
(Edited publisher abstract)
An update of a review first published in 2010 and updated in 2012, to assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. Search methods: The authors searched the healthcare literature for reports of randomised controlled trials relevant to this review up to August 2017. Study characteristics: The review included 95 randomised controlled trials involving 138,164 participants. Seventy-one trials (40,374 participants) were in care facilities, and 24 (97,790 participants) in hospitals. Key results: There was evidence, often from single studies, for a wide range of interventions used for preventing falls in both settings. This review summarises the falls outcomes for four key interventions in care facilities and three key interventions in hospitals. In relation to care facilities, the authors are uncertain of the effect of exercise on the rate of falls (very low-quality evidence) and it may make little or no difference to the risk of falling (low-quality evidence). General medication review may make little or no difference to the rate of falls (low-quality evidence) or the risk of falling (low-quality evidence). Prescription of vitamin D probably reduces the rate of falls (moderate-quality evidence) but probably makes little or no difference to the risk of falling (moderate-quality evidence). The population included in these studies appeared to have low vitamin D levels. The authors are uncertain of the effect of multifactorial interventions on the rate of falls (very low-quality evidence). They may make little or no difference to the risk of falling (low-quality evidence). In relation to hospitals: the authors are uncertain whether physiotherapy aimed specifically at reducing falls in addition to usual rehabilitation in the ward has an effect on the rate of falls or reduces the risk of falling (very low-quality evidence). The authors are uncertain of the effect of bed alarms on the rate of falls or risk of falling (very low-quality evidence). Multifactorial interventions may reduce the rate of falls, although this is more likely in a rehabilitation or geriatric ward setting (low-quality evidence). The authors are uncertain of the effect of these interventions on risk of falling.
(Edited publisher abstract)
Subject terms:
falls, systematic reviews, intervention, prevention, hospitals, residential care, care homes, older people, randomised controlled trials;