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Obstacles to improving visual health in older people
- Authors:
- ILIFFE Steve, KHARICHA Kalpa, MYERSON Sybil
- Publisher:
- Thomas Pocklington Trust
- Publication year:
- 2009
- Pagination:
- 7p.
- Place of publication:
- London
This publication summarises findings from research which aimed to explore the obstacles to improving visual health in an ageing population, and why screening does not lead to greater improvement. A mixed methodological approach was taken. Data from earlier health promotion studies was used and qualitative data were collected from older people. The conclusions include a proposal for an educational intervention. The research was funded by Thomas Pocklington Trust and carried out at the Research Department of Primary Care and Population Health, University College London.
Primary care-based interventions addressing social isolation and loneliness in older people: a scoping review
- Authors:
- GALVEZ-HERNANDEZ Pablo, PAZ Luis Gonzalez-de, MUNTANER Carles
- Journal article citation:
- BMJ Open, 12(2), 2022, Online only
- Publisher:
- BMJ Publishing Group
Objectives: Primary care is well positioned to identify and address loneliness and social isolation in older adults, given its gatekeeper function in many healthcare systems. This study aimed to identify and characterise loneliness and social isolation interventions and detect factors influencing implementation in primary care. Design: Scoping review using the five-step Arksey and O’Malley Framework. Data sources: MEDLINE, CINAHL, EMBASE, COCHRANE databases and grey literature were searched from inception to June 2021. Eligibility criteria: Empirical studies in English and Spanish focusing on interventions addressing social isolation and loneliness in older adults involving primary care services or professionals. Data extraction and synthesis: The researchers extracted data on loneliness and social isolation identification strategies and the professionals involved, networks and characteristics of the interventions and barriers to and facilitators of implementation. This study conducted a thematic content analysis to integrate the information extracted. Results:32 documents were included in the review. Only seven articles (22%) reported primary care professionals screening of older adults’ loneliness or social isolation, mainly through questionnaires. Several interventions showed networks between primary care, health and non-healthcare sectors, with a dominance of referral pathways (n=17). Two-thirds of reports did not provide clear theoretical frameworks, and one-third described lengths under 6 months. Workload, lack of interest and ageing-related barriers affected implementation outcomes. In contrast, well-defined pathways, collaborative designs, long-lasting and accessible interventions acted as facilitators. Conclusions: There is an apparent lack of consistency in strategies to identify lonely and socially isolated older adults. This might lead to conflicts between intervention content and participant needs. This study also identified a predominance of schemes linking primary care and non-healthcare sectors. However, although professionals and participants reported the need for long-lasting interventions to create meaningful social networks, durable interventions were scarce. Sustainability should be a core outcome when implementing loneliness and social isolation interventions in primary care. (Edited publisher abstract)
Exploring the scope for normalisation process theory to help evaluate and understand the processes involved when scaling up integrated models of care: a case study of the scaling up of the Gnosall memory service
- Authors:
- CLARK Michael, et al
- Journal article citation:
- Journal of Integrated Care, 29(1), 2021, pp.3-21.
- Publisher:
- Emerald
Purpose: The scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a (pilot) locality can often leave us some way from understanding how the innovation worked and what was crucial about the context to achieve the goals evidenced when applied to other localities. Even unpacking the “black box” of the innovation can still leave gaps in understanding with regard to scaling it up. Theory-led approaches are increasingly proposed as a means of helping to address this knowledge gap in understanding implementation. Our particular interest here is exploring the potential use of theory to help with understanding scaling up integration models across sites. The theory under consideration is Normalisation Process Theory (NPT). Design/methodology/approach: The article draws on a natural experiment providing a range of data from two sites working to scale up a well-thought-of, innovative integrated, primary care-based dementia service to other primary care sites. This provided an opportunity to use NPT as a means of framing understanding to explore what the theory adds to considering issues contributing to the success or failure of such a scaling up project. Findings: NPT offers a framework to potentially develop greater consistency in understanding the roll out of models of integrated care. The knowledge gained here and through further application of NPT could be applied to inform evaluation and planning of scaling-up programmes in the future. Research limitations/implications: The research was limited in the data collected from the case study; nevertheless, in the context of an exploration of the use of the theory, the observations provided a practical context in which to begin to examine the usefulness of NPT prior to embarking on its use in more expensive, larger-scale studies. Practical implications: NPT provides a promising framework to better understand the detail of integrated service models from the point of view of what may contribute to their successful scaling up. Social implications: NPT potentially provides a helpful framework to understand and manage efforts to have new integrated service models more widely adopted in practice and to help ensure that models which are effective in the small scale develop effectively when scaled up. Originality/value: This paper examines the use of NPT as a theory to guide understanding of scaling up promising innovative integration service models. (Edited publisher abstract)
Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis
- Authors:
- BLOM J.W., et al
- Journal article citation:
- Age and Ageing, 47(5), 2018, pp.705-714.
- Publisher:
- Oxford University Press
Purpose: To support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: Individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: Primary care sector. Interventions: Combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main: Outcome activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: Quality of life (visual analogue scale 0–10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: Intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: Included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was −0.01 (95% confidence interval −0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: Compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective. (Publisher abstract)
Prognostic factors, course, and outcome of depression among older primary care patients: the PROSPECT study
- Authors:
- BOGNER Hillary R., et al
- Journal article citation:
- Aging and Mental Health, 16(4), May 2012, pp.452-461.
- Publisher:
- Taylor and Francis
Major depression describes a clinically diverse set of people; while some patients may respond quickly to treatment, others may have a slower road to recovery. The aim of this study was to examine whether there are patterns of evolving depression symptoms among older primary care patients that are related to prognostic factors and long-term clinical outcomes. The study used data from the PROSPECT study, a multi-site, collaborative study of depression treatment in primary care settings for elderly patients. Primary care practices were randomly assigned to usual care or to an intervention consisting of a depression care manager offering algorithm-based depression care. For this study, 599 adults aged 60 years and older meeting criteria for major depression or clinically significant minor depression were randomly selected. Analysis revealed 3 patterns of change in depression symptoms over 12 months: high persistent course (19.1%); high declining course (14.4%); and low declining course (66.5%). Being in the intervention condition was more likely to be associated with a course of high and declining depression symptoms than high and persistent depression symptoms. Patients with a course of high and persistent depression symptoms were much more likely to have a diagnosis of major depression at 24 months compared with patients with a course of low and declining depression symptoms.
Management of depression in older people: why this is important in primary care
- Authors:
- GRAHAM Carolyn Chew, et al
- Publisher:
- Forum for Mental Health in Primary Care
- Publication year:
- 2011
- Pagination:
- 4p.
- Place of publication:
- London
This factsheet provides an overview of the role of primary care in the management of depression in older people. It covers the prevalence of depression; diagnosis and barriers to diagnosis; management of depression in primary care; different management options, including mediation, psychological and talking therapies, psycho-social interventions; culturally sensitive interventions; prevention and mental health promotion. The factsheet has been produced by a number of different organisations.
Care management for depression and osteoarthritis pain in older primary care patients: a pilot study
- Authors:
- UNUTZER Jurgen, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(11), November 2008, pp.1166-1171.
- Publisher:
- Wiley
This study aimed to establish the feasibility of and to generate preliminary evidence for the efficacy of a care management program addressing both physical and emotional pain associated with late-life depression and osteoarthritis. Treatment development pilot study in three university affiliated primary care clinics in the United States. Participants were patients 60 years or older with depression and osteoarthritis pain. The intervention entailed a nurse administered care management program supporting depression and arthritis treatment by primary care physicians. Outcomes include depression, pain severity and functional impairment from pain assessed at baseline and 6 months. Fourteen patients participated in the pilot program. Between baseline and 6 months, mean HSCL-20 depression scores, pain intensity scores and pain interference scores dropped. Patients also experienced improvements in self efficacy, in satisfaction with depression care, and in timed 8-m walk and transfer tests. The combined intervention was feasible and well-received by patients. Preliminary outcomes are promising and comparisons to an earlier trial of care management for depression alone suggest that the combined program may be equally effective for depression but more effective for pain.
Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis
- Authors:
- GATES S., et al
- Journal article citation:
- British Medical Journal, 19.01.08, 2008, pp.130-133.
- Publisher:
- British Medical Association
This systematic review aimed to evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings. Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007 were used, reference lists of included studies, and previous reviews. Eligible studies were randomised or quasi-randomised trials that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors. Outcomes were number of fallers, fall related injuries, fall rate, death, admission to hospital, contacts with health services, move to institutional care, physical activity, and quality of life. Methodological quality assessment included allocation concealment, blinding, losses and exclusions, intention to treat analysis, and reliability of outcome measurement. Nineteen studies, of variable methodological quality, were included. The combined risk ratio for the number of fallers during follow-up among 18 trials was 0.91 (95% confidence interval 0.82 to 1.02) and for fall related injuries (eight trials) was 0.90 (0.68 to 1.20). No differences were found in admissions to hospital, emergency department attendance, death, or move to institutional care. Subgroup analyses found no evidence of different effects between interventions in different locations, populations selected for high risk of falls or unselected, and multidisciplinary teams including a doctor, but interventions that actively provide treatments may be more effective than those that provide only knowledge and referral. Evidence that multifactorial fall prevention programmes in primary care, community, or emergency care settings are effective in reducing the number of fallers or fall related injuries is limited. Data were insufficient to assess fall and injury rates.
An intervention to improve depression care in older adults with COPD
- Authors:
- SIREY Jo Anne, RAUE Patrick J., ALEXOPOLOUS George S.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(2), February 2007, pp.154-159.
- Publisher:
- Wiley
The aim was to describe an intervention for older persons with Major Depressive Disorder (MDD) and Chronic Obstructive Pulmonary Disease (COPD) to improve adherence to psychiatric, medical, and rehabilitation recommendations. The intervention supplements antidepressant therapy for depression with an individualized care manager who targets psychological barriers that interfere with treatment participation. Description of intervention development, training, and barriers to care, and illustration with case example. Depression and its associated lack of motivation, helplessness, and lack of energy can obstruct active participation in rehabilitation exercises recommended for COPD. Additionally, depressed older adults perceive the benefits of depression treatment; however they also fear side effects, addiction to antidepressants and have concerns about stigma. The intervention elucidates individual attitudes and beliefs that may become barriers. The care manager works with the older adult to address the barriers and improve treatment participation. Augmentation of traditional pharmacotherapy for depression with a care manager can improve adherence to both depression and COPD treatment. This improved adherence may lessen the physical, psychological, and functional costs of both diseases.
The feasibility of a GP led screening intervention for depression among nursing home residents
- Authors:
- DAVIDSON Sandra, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(11), November 2006, pp.1026-1030.
- Publisher:
- Wiley
The aim was to examine the feasibility of a brief intervention training general practitioners (GPs) in the administration of a depression screening instrument for use among nursing home residents. GPs attended a single education session on late-life depression and were trained in the use of the Cornell Scale for Depression in Dementia. Following the intervention GPs reviewed their patients for depression. Diagnosis of depression pre and post intervention; changes in antidepressant medications post intervention. Ten GPs and 38 patients completed all components of the study. GPs identified that 24% of their patients had Cornell Scores indicative of probable major depression that was either unrecognised or inadequately treated. 88% of these patients had been previously diagnosed with depression. A further 32% of patients exhibited depression symptoms, half (50%) of whom had a previous diagnosis of depression. Reviewing patients had an effect on antidepressant prescribing for patients with probable major depression, with GPs making changes to the antidepressant medication of 29% of patients. The high rate of residents presenting with probable major depression despite being prescribed antidepressants indicate that depression symptoms are inadequately recognised and treated in nursing homes. This study demonstrated that a single education session on late-life depression was feasible and was associated with an improvement in GPs' recognition of depression among nursing home patients.