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Direct and indirect influences of socio-economic position on the wellbeing of older adults: a structural equation model using data from the first wave of the Irish longitudinal study on ageing
- Authors:
- PRATSCHKE Jonathan, HAASE Trutz, MCKEOWN Kieran
- Journal article citation:
- Ageing and Society, 37(9), 2017, pp.1770-1797.
- Publisher:
- Cambridge University Press
The authors use Structural Equation Modelling techniques to analyse the determinants of wellbeing amongst older adults using data from the first wave of the Irish Longitudinal Study on Ageing (TILDA), a rich source of data on people aged over 50 and living in private households. The analysis uses a two-group linear statistical model to explore the influence of socio-economic position on the wellbeing of men and women, with Full Information Maximum Likelihood estimation to handle missing data. The fit indices for the final model are highly satisfactory and the measurement structure is invariant by gender and age. The results indicate that socio-economic position has a significant direct influence on wellbeing and a strong indirect influence which is mediated by health status and lifestyle. The total standardised effect of Socio-economic Position on Socio-emotional Wellbeing is statistically significant (p ⩽ 0.05) and equal to 0.32 (men) and 0.43 (women), a very strong influence which risks being underestimated in standard multivariate models. The authors conclude that health, cognitive functioning and wellbeing reflect not just the ageing process, but also the impact of social inequalities across the lifecourse and how they are transmitted across different life spheres. These results can help to orient future research on factors which mediate between socio-economic position and wellbeing, an important policy-related issue. (Publisher abstract)
What makes a nursing home a home? Insights from family members and friends
- Authors:
- WEEKS Lori, CHAMBERLAIN Stephanie, KEEFE Janice
- Journal article citation:
- Housing Care and Support, 20(4), 2017, pp.152-163.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the concept of homelikeness from the perspective of family members and friends of nursing home residents across different models of nursing homes. Design/methodology/approach: This mixed-methods study examined survey data collected from 397 family members and friends of residents living in 23 nursing homes representing three models of care (traditional, new augmented, and full scope). Participants completed a homelikeness scale and a measure of the importance of nursing home spaces to family members and friends. This study also involved conducting three focus groups with 20 family members and friends to provide further insights into the findings. Findings: Analysis of survey data indicated quite high levels of homelikeness overall. Significant differences did emerge between traditional model nursing homes compared to new full-scope and new augmented models for all items in the homelikeness scale and for many items about nursing home spaces. Qualitative results provided insights into how homelikeness can be fostered through public and private spaces and through care and relationships. Research limitations/implications: As this study was conducted in one Canadian province, the results may not be applicable to other geographic areas. In addition, there are limitations in survey response rate. Practical implications: Homelikeness can be supported across models of care by fostering relationships between residents and staff, ensuring that that family and friends feel welcome, and creating public and private physical spaces that are conducive to new and ongoing relationships. Originality/value: The results provide evidence to nursing home decision makers about how to foster a homelike environment in various models of nursing homes. (Publisher abstract)
Being with a person in our care: person-centered social work practice that is authentically person-centered
- Authors:
- WASHBURN Allyson, M., GROSSMAN Melanie
- Journal article citation:
- Journal of Gerontological Social Work, 60(5), 2017, pp.408-423.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Person-centred care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualisations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centred. In addition to integrating traditional social work values and practice, social work’s PCC should be grounded in the principles of classical Rogerian person-centred counsellings and an expanded conceptualisation of personhood that incorporates Kitwood’s concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centred. (Edited publisher abstract)
Impact of the Village model: results of a national survey
- Authors:
- GRAHAM Carrie L., SCHARLACH Andrew E., STARK Bradford
- Journal article citation:
- Journal of Gerontological Social Work, 60(5), 2017, pp.335-354.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Villages are a relatively new, consumer-directed model that brings together older adults in a community who have a mutual interest in ageing in place. These membership organisations provide social and civic engagement opportunities, volunteer provided support services, and referral to vetted community providers to achieve their primary goals of promoting independence and preventing undesired relocations. This cross sectional survey of 1,753 active Village members from 28 Villages across the US measured members’ perceived impacts in the areas of social connection, civic engagement, service access, health and well-being, and ability to age in place. Results showed that involvement in the Village was a key factor associated with greater perceived impacts. Over half of members perceive that the Village has improved their sense of connection to others and their feeling that they have someone to count on. Though younger members in better health were more likely to perceive impacts in social connections, results suggest older women, living alone with some disability may be the most likely to experience improved health, quality of life, and mobility. The implications for social work practice are discussed. (Edited publisher abstract)
Providing enhanced healthcare in care homes: a guide to replicating our model
- Author:
- NHS NEWCASTLE GATESHEAD CLINICAL COMMISSIONING GROUP
- Publisher:
- NHS Newcastle Gateshead Clinical Commissioning Group
- Publication year:
- 2017
- Pagination:
- 13
- Place of publication:
- Newcastle upon Tyne
Outlines the Enhanced Health in Care Home model (EHCH) operating in the Newcastle Gateshead Clinical Commissioning Group area, which uses a virtual ward multi-disciplinary approach to delivering health care in care homes, with rapid access to specialist health services. It provides details of the service, what is required to set it up and the benefits it can provide. Benefits cited include a reduction in avoidable hospital admissions, reduced A&E attendances, and reduced GP home visits. It also shares potential problems and solutions, successes and dangers. The guide will be useful for local service providers and clinical commissioning groups (CCGs) are considering establishing an Enhanced Health in Care Home model (EHCH) in their own area. (Edited publisher abstract)
Community elder mistreatment intervention with capable older adults: toward a conceptual practice model
- Author:
- BURNES David
- Journal article citation:
- Gerontologist, 57(3), 2017, pp.409-416.
- Publisher:
- Oxford University Press
Community-based elder mistreatment response programs (EMRP), such as adult protective services, that are responsible for directly addressing elder abuse and neglect are under increasing pressure with greater reporting/referrals nationwide. Our knowledge and understanding of effective response interventions represents a major gap in the EM literature. At the center of this gap is a lack of theory or conceptual models to help guide EMRP research and practice. This article develops a conceptual practice model for community-based EMRPs that work directly with cognitively intact EM victims. Anchored by core EMRP values of voluntariness, self-determination, and least restrictive path, the practice model is guided by an overarching postmodern, constructivist, eco-systemic practice paradigm that accepts multiple, individually constructed mistreatment realities and solutions. Harm-reduction, client-centred, and multidisciplinary practice models are described toward a common EMRP goal to reduce the risk of continued mistreatment. Finally, the model focuses on client–practitioner relationship-oriented practice skills such as engagement and therapeutic alliance to elicit individual mistreatment realities and client-centered solutions. The practice model helps fill a conceptual gap in the EM intervention literature and carries implications for EMRP training, research, and practice. (Edited publisher abstract)
A community hub approach to older people’s housing
- Authors:
- EVANS Simon, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 18(1), 2017, pp.20-31.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the potential of housing with care schemes to act as community hubs. The analysis highlights a range of benefits, barriers and facilitators. Design/methodology/approach: Data are presented from the Adult Social Services Environments and Settings project which used a mixed methods approach including a review of the literature, surveys and in-depth case study interviews. Findings: Most housing with care schemes have a restaurant or café, communal lounge, garden, hairdresser, activity room and laundrette, while many also have a library, gym, computer access and a shop. Many of these facilities are open not just to residents but also to the wider community, reflecting a more integrated approach to community health and adult social care, by sharing access to primary health care and social services between people living in the scheme and those living nearby. Potential benefits of this approach include the integration of older people’s housing, reduced isolation and increased cost effectiveness of local services through economies of scale and by maximising preventative approaches to health and wellbeing. Successful implementation of the model depends on a range of criteria including being located within or close to a residential area and having on-site facilities that are accessible to the public. Originality/value: This paper is part of a very new literature on community hub models of housing with care in the UK. In the light of new requirements under the Care Act to better coordinate community services, it provides insights into how this approach can work and offers an analysis of the benefits and challenges that will be of interest to commissioners and providers as well as planners. This was a small scale research project based on four case studies. Caution should be taken when considering the findings in different settings. (Publisher abstract)
Police and partners: new ways of working together in Montreal
- Authors:
- BEAULIEU Marie, COTE Michelle, DIAZ Luisa
- Journal article citation:
- Journal of Adult Protection, 19(6), 2017, pp.406-417.
- Publisher:
- Emerald
The purpose of this paper is to present an inter-agency practice integrated within a police intervention model which was developed for police officers and their partners in Montréal. Design/methodology/approach: The Integrated Police Response for Abused Seniors (IPRAS) action research project (2013-2016) developed, tested, and implemented a police intervention model to counter elder abuse. Two linked phases of data collection were carried out: a diagnostic of police practices and needs (year 1) and an evaluation of the implementation of the intervention model and the resulting effects (years 2 and 3). Findings: The facilitating elements to support police involvement in inter-agency practices include implementing a coordination structure regarding abuse cases as well as designating clear guidelines of the roles of both the police and their partners. The critical challenges involve staff turnover, time management and the exchange of information. It was recognised by all involved that it is crucial to collaborate while prioritising resource investment and governmental support, with regards to policy and financing, as well as adequate training. Practical implications: The IPRAS model is transferable because its components can be adapted and implemented according to different police services. A guideline for implementing the model is available. Originality/value: In the scientific literature, inter-agency collaboration is highly recommended but only a few models have been evaluated. This paper presents an inter-agency approach embedded in an evaluated police intervention model. (Publisher abstract)
Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care
- Authors:
- TONG Thaison, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1392-1400.
- Publisher:
- Wiley
Introduction: The authors estimated the cost effectiveness of different cognitive screening tests for use by General Practitioners (GPs) to detect cognitive impairment in England. Methods: A patient-level cost-effectiveness model was developed using a simulated cohort that represents the elderly population in England (65 years and older). Each patient was followed over a lifetime period. Data from published sources were used to populate the model. The costs include government funded health and social care, private social care and informal care. Patient health benefit was measured and valued in Quality Adjusted Life Years (QALYs). Results: Base-case analyses found that adopting any of the three cognitive tests (Mini-Mental State Examination, 6-Item Cognitive Impairment Test or GPCOG (General Practitioner Assessment of Cognition)) delivered more QALYs for patients over their lifetime and made savings across sectors including healthcare, social care and informal care compared with GP unassisted judgement. The benefits were due to early access to medications. Among the three cognitive tests, adopting the GPCOG was considered the most cost-effective option with the highest Incremental Net Benefit (INB) at the threshold of £30 000 per QALY from both the National Health Service and Personal Social Service (NHS PSS) perspective (£195 034 per 1000 patients) and the broader perspective that includes private social care and informal care (£196 251 per 1000 patients). Uncertainty was assessed in both deterministic and probabilistic sensitivity analyses. Conclusions: The analyses indicate that the use of any of the three cognitive tests could be considered a cost-effective strategy compared with GP unassisted judgement. The most cost-effective option in the base-case was the GPCOG. (Edited publisher abstract)
Using the social determinants of health as a framework to examine and address predictors of depression in later life
- Authors:
- CROSS-DENNY Bronwyn, ROBINSON Michael A.
- Journal article citation:
- Ageing International, 42(4), 2017, pp.393-412.
- Publisher:
- Springer
- Place of publication:
- New York
Depression in later life is an important public health concern. Comprehensive assessments incorporating all key areas of the social determinants of health (SDOH) framework can assist in developing effective interventions to ensure mental health for the increasing older adult population. This study uses the SDOH model for identifying, evaluating, and addressing risk factors that contribute to depression in older adults. Secondary data analysis of the Health and Retirement Study was used to conduct a hierarchical multiple regression analysis to examine predictors of depression in later life. The SDOH key areas were used as a framework for the regression model. The main findings showed predictors of depression were health and social support, emphasising the importance of ageing in place. Implications for practice include the provision of services within the home, neighbourhood, and community to maintain older adults within the least restrictive environments where they can maximise healthy living and continue to maintain connections with their social support networks. (Edited publisher abstract)