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Right time, right place: urgent community-based care for older people
- Author:
- BRITISH GERIATRICS SOCIETY
- Publisher:
- British Geriatrics Society
- Publication year:
- 2021
- Pagination:
- 7
- Place of publication:
- London
This document aims to describe the role of urgent care within the ecosystem of older people’s care and details some examples of how urgent care can be provided outside the hospital environment. It provides tips for BGS members who want to start providing this type of care to their older patients and calls on commissioners and governments to make the provision of care at or near to home easier for healthcare professionals and patients. The document outlines the offers and services currently delivered across the country in pursuit of a broadly similar aim to provide appropriate, timely, high-quality care when an older person experiences a crisis or urgent need. Options for alternatives to hospital include: Hospital at Home (H@H); urgent community response (UCR); Same Day Emergency Care (SDEC); Frailty Assessment Units (FAUs); Virtual wards. (Edited publisher abstract)
Predicting falls in community-dwelling older adults: a systematic review of prognostic models
- Authors:
- GADE Gustav Valentin, et al
- Journal article citation:
- BMJ Open, 11(5), 2021, p.e044170. Online only
- Publisher:
- BMJ Publishing Group
Objective To systematically review and critically appraise prognostic models for falls in community-dwelling older adults. Eligibility criteria Prospective cohort studies with any follow-up period. Studies had to develop or validate multifactorial prognostic models for falls in community-dwelling older adults (60+ years). Models had to be applicable for screening in a general population setting. Information source MEDLINE, EMBASE, CINAHL, The Cochrane Library, PsycINFO and Web of Science for studies published in English, Danish, Norwegian or Swedish until January 2020. Sources also included trial registries, clinical guidelines, reference lists of included papers, along with contacting clinical experts to locate published studies. Data extraction and risk of bias Two authors performed all review stages independently. Data extraction followed the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. Risk of bias assessments on participants, predictors, outcomes and analysis methods followed Prediction study Risk Of Bias Assessment Tool. Results After screening 11 789 studies, 30 were eligible for inclusion (n=86 369 participants). Median age of participants ranged from 67.5 to 83.0 years. Falls incidences varied from 5.9% to 59%. Included studies reported 69 developed and three validated prediction models. Most frequent falls predictors were prior falls, age, sex, measures of gait, balance and strength, along with vision and disability. The area under the curve was available for 40 (55.6%) models, ranging from 0.49 to 0.87. Validated models’ The area under the curve ranged from 0.62 to 0.69. All models had a high risk of bias, mostly due to limitations in statistical methods, outcome assessments and restrictive eligibility criteria. Conclusions An abundance of prognostic models on falls risk have been developed, but with a wide range in discriminatory performance. All models exhibited a high risk of bias rendering them unreliable for prediction in clinical practice. Future prognostic prediction models should comply with recent recommendations such as Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis. (Edited publisher abstract)
A contextual analysis and logic model for integrated care for frail older adults living at home: the INSPIRE project
- Authors:
- YIP Olivia, et al
- Journal article citation:
- International Journal of Integrated Care, 21(2), 2021, p.9. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: Implementation science methods and a theory-driven approach can enhance the understanding of whether, how, and why integrated care for frail older adults is successful in practice. In this study, we aimed to perform a contextual analysis, develop a logic model, and select preliminary implementation strategies for an integrated care model in newly created information and advice centers for older adults in Canton Basel-Landschaft, Switzerland. Methods: We conducted a contextual analysis to determine factors which may influence the integrated care model and implementation strategies needed. A logic model depicting the overall program theory, including inputs, core components, outputs and outcomes, was designed using a deductive approach, and included stakeholders’ feedback and preliminary implementation strategies. Results: Contextual factors were identified (e.g., lack of integrated care regulations, existing community services, and a care pathway needed). Core components of the care model include screening, referral, assessment, care plan creation and coordination, and follow-up. Outcomes included person-centred coordinated care experiences, hospitalization rate and symptom burden, among others. Implementation strategies (e.g., nurse training and co-developing educational materials) were proposed to facilitate care model adoption. Conclusion: Contextual understanding and a clear logic model should enhance the potential for successful implementation of the integrated care model. (Edited publisher abstract)
"More than just a few kind words!": reshaping support in sheltered housing: a good practice guide for housing providers and local authorities
- Author:
- NATIONAL HOUSING FEDERATION
- Publisher:
- National Housing Federation
- Publication year:
- 2010
- Pagination:
- 31p.
- Place of publication:
- London
As society is ageing, a better range of choices are needed to enable people to live fuller lives into old age. In addition to developing new buildings and new service models, existing resources must be used effectively. As part of the Ministerial Working Group on Sheltered Housing, the National Housing Federation were commissioned to produce a good practice guide on reshaping support in sheltered housing for housing providers and local authorities. Launched at a meeting of the group in January, this document promotes good practice in the delivery of varied support models for older people and in the implementation of any changes to current services. This document, broken into ten parts includes sections on: drivers for change; recognising the ongoing potential in sheltered housing; managing change; future directions for future housing services; developing the service structure; developing the service content; developing a strategy for remodelling support services in sheltered housing; and re-commissioning sheltered housing services.
Securing good care for older people: taking a long-term view
- Author:
- DAVIES Bleddyn
- Journal article citation:
- Ageing Horizons, 6, 2007, Online only
- Publisher:
- Oxford Institute of Ageing
- Place of publication:
- Oxford
The paper aims to explain and evaluate two key features of Securing Good Care for Older People, the Wanless Report on alternative mechanisms for funding long-term care of older people. The first is the new elements of the methodology for evaluating the alternatives. The paper argues that more successfully than previously and analyses in other countries, these elements focus attention on what are really the core issues: the means and ends which are the unique foci of long-term care, and estimates of the consequences of alternatives for them. By doing so, the report faces the politicians and policy analysis and research communities with a formidable challenge, to master and contribute to the development of the new framework and evidence. Failure to meet the challenge will increases the risk that the policy system will reinforce rather than weaken causes of gross inequity and inefficiency caused by the under-funding of long-term care seemingly unanswerably demonstrated by the report. The second key feature is the type of funding model the Report recommends given expected changes in the balance between demands and public expenditure. It is argued that the report’s analysis as successfully transforms the state of the argument about this as much as about the framework, methodology and evidence for evaluating alternatives, demonstrating the relative weakness of models widely advocated a decade ago. Part 2 discusses how to build on the Report. It discusses the framing of issues and the analysis of evidence for each of the key foci of the report’s main contribution to evaluation methodology. Finally the paper discusses whether the recommended model would be the wisest choice given the environment likely during the next few decades.
Comparing models of housing with care for later life
- Author:
- JOSEPH ROWNTREE FOUNDATION
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2007
- Pagination:
- 4p.
- Place of publication:
- York
Interest is growing in the role of housing schemes for older people that combine independent living with relatively high levels of care. This comparative study of seven schemes in England examines different models of housing with care for older people.
An older person friendly city centre: report from a working group
- Author:
- ELDERS COUNCIL OF NEWCASTLE
- Publisher:
- Elders Council of Newcastle
- Publication year:
- 2007
- Pagination:
- 48p.
- Place of publication:
- Newcastle upon Tyne
This practical report has been produced by the Elders Council of Newcastle-upon-Tyne. It provides a useful model for both planners and other local groups who want to make sure that their town or city centre is designed to make it welcoming and accessible to all generations.
A qualitative study and preliminary model of living with dementia and incontinence at home: beyond containment
- Authors:
- MURPHY Catherine, et al
- Journal article citation:
- Age and Ageing, 51(1), 2022, p.afab221.
- Publisher:
- Oxford University Press
Background: most people living with dementia (PLWD) will develop incontinence problems with associated harmful consequences. Well-contained incontinence is often the main treatment goal. It would therefore be expected that poorly contained incontinence would have a negative impact. Aim: to investigate differences in how well-contained or poorly contained incontinence impacts on the experience of living with incontinence for PLWD at home and their carers. Design: secondary analysis of a qualitative study. Methods: semi-structured interviews were undertaken with PLWD, carers and healthcare professionals (continence or dementia nurses). PLWD and carers were recruited via www.joindementiaresearch.nihr.ac.uk and via dementia/carer groups. Nurses were recruited via their employers. Interviews were recorded and transcribed verbatim. Framework analysis was used. Results: forty-five people (twenty-six carers, two PLWD, nine continence nurses and eight dementia nurses) participated. Despite poorly contained incontinence, some PLWD/carer dyads appeared relatively unaffected by incontinence. Conversely, one or both members of some dyads who achieved good containment found incontinence care highly challenging. Four themes were identified, together forming a preliminary model of incontinence containment and impact, as follows: Well-contained incontinence, lower negative impact; Well-contained incontinence, higher negative impact; Poorly contained incontinence, higher negative impact; and Poorly contained incontinence, lower negative impact. Conclusion: reliable containment is an important goal for PLWD living at home and their carers, but it is not the only goal. Other factors, such as behaviours that challenge or carer coping strategies, can mean that even well-contained incontinence can have a negative impact. This paper proposes a preliminary model for evaluation. (Edited publisher abstract)
The imperative to reimagine assisted living
- Authors:
- ZIMMERMAN Sheryl, et al
- Journal article citation:
- Journal of the American Medical Directors Association, 23(2), 2022, pp.225-234.
- Publisher:
- Elsevier (for the American Medical Directors Association)
Assisted living (AL) has existed in the United States for decades, evolving in response to older adults’ need for supportive care and distaste for nursing homes and older models of congregate care. AL is state-regulated, provides at least 2 meals a day, around-the-clock supervision, and help with personal care, but is not licensed as a nursing home. The key constructs of AL as originally conceived were to provide person-centred care and promote quality of life through supportive and responsive services to meet scheduled and unscheduled needs for assistance, an operating philosophy emphasizing resident choice, and a residential environment with homelike features. As AL has expanded to constitute half of all long-term care beds, the increasing involvement of the real estate, hospitality, and health care sectors has raised concerns about the variability of AL, the quality of AL, and standards for AL. These tensions have resulted in a model of care that is not as intended, and which must be reimagined if it is to be an affordable care option truly providing quality, person-centred care in a suitable environment. Toward that end, 25 stakeholders representing diverse perspectives conferred during 2 half-day retreats to identify the key tensions in AL and discuss potential solutions. This article presents the background regarding those tensions, as well as potential solutions that have been borne out, paving the path to a better future of assisted living. (Edited publisher abstract)
Rural old-age social exclusion: a conceptual framework on mediators of exclusion across the lifecourse
- Authors:
- WALSH Kieran, O'SHEA Eamon, SCHARF Thomas
- Journal article citation:
- Ageing and Society, 40(11), 2020, pp.2311-2337.
- Publisher:
- Cambridge University Press
Social exclusion amongst rural-dwelling older adults and the role of the diversity of people and places in mediating the construction of that exclusion has not been adequately investigated or conceptualised in the international literature. Consequently, how ageing in a rural community can function to disadvantage or protect older people remains poorly understood. With the aim of advancing conceptual understanding on rural old-age social exclusion, this article explores how exclusion is manifest in the lifecourse experiences of rural-dwelling older adults and the role of mediating factors in the construction of exclusion in different kinds of rural places. The analysis draws on ten rural case-study sites across Ireland and Northern Ireland, encompassing five kinds of rural communities: dispersed rural; remote rural; island rural; village rural; and near-urban rural. Data come from 106 interviews with older people ranging in age from 59 to 93 years. Rural old-age social exclusion is confirmed as a multi-dimensional construct, involving: social relations; service infrastructure; transport and mobility; safety, security and crime; and financial and material resources. This analysis demonstrates that social exclusion for rural-dwelling older people is multi-layered, and its prevalence and form is shaped by four mediating factors: individual capacities; lifecourse trajectories; place; and macro-economic forces. The findings are used to present a conceptual framework that emphasises the role of mediating forces on rural old-age social exclusion. (Edited publisher abstract)