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Valuing the ICECAP capability index for older people
- Authors:
- COAST Joanna, et al
- Journal article citation:
- Social Science and Medicine, 67(5), September 2008, pp.874-882.
- Publisher:
- Elsevier
This paper reports the first application of the capabilities approach to the development and valuation of an instrument for use in the economic evaluation of health and social care interventions. The ICECAP index of capability for older people focuses on quality of life rather than health or other influences on quality of life, and is intended to be used in decision making across health and social care in the UK. The measure draws on previous qualitative work in which five conceptual attributes were developed: attachment, security, role, enjoyment and control. This paper details the innovative use within health economics of further iterative qualitative work in the UK among 19 informants to refine lay terminology for each of the attributes and levels of attributes used in the eventual index. For the first time within quality of life measurement for economic evaluation, a best-worst scaling exercise has been used to estimate general population values (albeit for the population of those aged 65+ years) for the levels of attributes, with values anchored at one for full capability and zero for no capability. Death was assumed to be a state in which there is no capability. The values obtained indicate that attachment is the attribute with greatest impact but all attributes contribute to the total estimation of capability. Values that were estimated are feasible for use in practical applications of the index to measure the impact of health and social care interventions.
Costs and health outcomes of intermediate care: results from five UK case study sites
- Authors:
- KAAMBWA Billingsley, et al
- Journal article citation:
- Health and Social Care in the Community, 16(6), December 2008, pp.573-581.
- Publisher:
- Wiley
The objectives of this study were to explore the costs and outcomes associated with different types of intermediate care (IC) services, and also to examine the characteristics of patients receiving such services. Five UK case studies of 'whole systems' of IC were used, with data collected on a sample of consecutive IC episodes between January 2003 and January 2004. Statistical differences in costs and outcomes associated with different IC services and patient groups were explored. Factors associated with variation in IC episode outcomes were explored using an econometric framework. Data were available for 2253 episodes of IC. In terms of Department of Health criteria, a large proportion of patients (up to 47% of those for whom data were available) in this study were inappropriately admitted to IC services. As regards service function, compared to supported discharge, admission avoidance services were associated with both lower costs and greater health and functional gains. These gains appear to be driven, in part, by illness severity (more dependent patients tended to gain most benefit). In addition, these gains appear to be larger where the admission was appropriate. This study suggests a need for the development and application of robust and reliable clinical criteria for admission to IC, and close co-operation between hospital and community service providers over selection of patients and targeting of IC and acute care services to meet defined clinical need.
Evidence-based interventions with older adults: concluding thoughts
- Authors:
- KROPF Nancy P., CUMMINGS Sherry M.
- Journal article citation:
- Journal of Gerontological Social Work, 50(S1), 2008, pp.345-355.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This paper summarises the findings of the systematic reviews of psychosocial interventions reported in this issue of the journal, identifying effective intervention approaches for physical health problems, mental health problems and particular social roles (end of life care, family carers, grandparent carers, people with developmental disabilities and their carers). Problems with psychosocial intervention research are noted, including the small size and methodological weakness of many studies, a failure to report the details of an intervention and its implementation, and lack of consensus over which outcomes should be measured. Future research studies need to be larger, more robustly designed and with long term follow-up. They also need to cover more diverse populations (e.g. ethnic minority groups) and more diverse topics in addition to the problems of functional decline. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Outcome-focused services for older people from minorities
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Journal article citation:
- Community Care, 3.7.08, 2008, pp.34-35.
- Publisher:
- Reed Business Information
Focusing on outcomes helps to ensure that services meet the needs of the people who use them rather than the people that run them. This article highlights the outcomes seen as important by minority ethnic older people.
Cheers!?: a project about older people and alcohol
- Authors:
- WARD Lizzie, BARNES Marian, GAHAGAN Beatrice
- Publisher:
- University of Brighton. Health and Social Policy Research Centre
- Publication year:
- 2008
- Pagination:
- 82p., bibliog.
- Place of publication:
- Brighton
This was a partnership project led by Age Concern Brighton, Hove & Portslade and included Brighton & Hove City Council, Brighton & Hove Primary Care Trust, the Drug and Alcohol Action Team and the University of Brighton. Aware that there was a gap in local research evidence on alcohol use by older people in the city, the agencies commissioned a scoping study which mapped current practitioner knowledge in a discrete area of the city. Following on from this, further research was undertaken which examined the issues from older people's perspectives. The research explored the circumstances in which older people drink, the meaning that drinking alcohol has for them and the impact it has, acknowledging that this can be a pleasurable and positive experience, as well as something that can have adverse health, financial, personal and interpersonal impacts. The project used a participative approach and involved older people in designing and carrying out the research as co-researchers and as members of an older people's reference group. Working as a team we were able to draw on our different knowledge, experience and expertise to create contexts in which older people could talk about their experiences of drinking in ways that made sense to them and to construct their own ideas about the place of alcohol in their lives.
Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analysis
- Authors:
- HEYN P. C., JOHNSON K. E., KRAMER A. F.
- Journal article citation:
- Journal of Nutrition Health and Aging, 12(6), 2008, pp.401-409.
- Publisher:
- Springer
Nursing home residents are often viewed as too frail or cognitively impaired to be able to participate in or benefit from exercise rehabilitation, and those with a Mini Mental State Examination (MMSE) score of under 25 are frequently excluded from such programmes. This systematic review and meta-analysis identifies 41 randomised trials of exercise programmes: 21 conducted with cognitively impaired individuals (defined as MMSE scores of less than 25); and 20 with cognitively intact individuals (MMSE scores over 25). Moderate to large effect sizes were found for both groups, with no statistically significant differences between the two in respect of strength or endurance outcomes. The paper concludes that cognitively impaired people should not be excluded from exercise rehabilitation programmes.
How do you feel about...? Health outcomes in late life and self-perceptions of health and well-being
- Author:
- BLAZER Dan G.
- Journal article citation:
- Gerontologist, 48(4), August 2008, pp.415-422.
- Publisher:
- Oxford University Press
Research has shown over the years that the self-perceptions of older adults about their health and well-being may be at least as important as objective data for predicting the course of their health over time. The author reviews a series of studies that span 30 years in which older adults in the community have been asked about their self-rated health and well-being across a spectrum of parameters, including self-rated health, social support, and mood (both negative and positive), and about whether their basic needs are being met. The social environment shapes perceptions of health and well-being, as does the body. Feelings, such as feelings about health and well-being, are therefore a key (but not the only) psychological–behavioural bridge between the body (genome and physiology) and society (environmental stressors and social context). Following a review of these studies, the author attempts to place these perceptions of health and well-being in a social context, a context critical to understanding the consistency and strength of these studies documenting the association between answers to the question "How do you feel about...?" and health outcomes over time.
Cardiac conditions
- Authors:
- PECK Michel D., AI Amy L.
- Journal article citation:
- Journal of Gerontological Social Work, 50(S1), 2008, pp.13-44.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Cardiovascular disease (CVD) is the leading cause of death in the USA, and the incidence of age-related CVD will inevitably increase with an aging population. There is increasing evidence of co-morbid mental health conditions in CVD patients, especially depression and anxiety, and this systematic review explores the empirical literature on psychosocial treatments. This identified three meta-analyses and 11 additional randomised controlled trials. The meta-analyses provide positive evidence for the benefits of psychosocial treatments on some primary health outcomes but these are less clear in subsequent trials. Further research is required. The paper concludes with a ‘treatment resource appendix’ directed at US practitioners. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Arthritis pain
- Authors:
- YOON Eunkyung, DOHERTY John B.
- Journal article citation:
- Journal of Gerontological Social Work, 50(S1), 2008, pp.79-103.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Arthritic pain is a common and disabling condition for many older people in the USA, and is often under-treated despite its significant negative impact on quality of life. This systematic review examines the empirical literature on psychosocial interventions, including cognitive-behavioural treatments and psycho-educational interventions. The former has been shown to have a major positive impact on pain control, while the latter has contributed to better understanding and self-treatment. The paper concludes with a ‘treatment resource appendix’ directed at US practitioners. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Physical performance characteristics of assisted living residents and risk for adverse health outcomes
- Authors:
- GIULIANI Carol A., et al
- Journal article citation:
- Gerontologist, 48(2), April 2008, pp.203-212.
- Publisher:
- Oxford University Press
This article aims to (a) describe the functional characteristics of residential care/assisted living (RC/AL) residents, (b) examine the relationships between resident- and facility-level characteristics and physical performance, and (c) determine the predictive value of physical performance for adverse outcomes. Data came from 1,791 residents in 189 RC/AL facilities participating in the Collaborative Studies of Long-Term Care in the US. At baseline, residents were tested on four performance measures (grip strength, chair rise, balance, and walking speed), and other resident- and facility-level information was collected. Adverse outcomes were measured over 1 year. Multivariable analyses showed that more cognitive and functional impairment, depressive symptoms and comorbid conditions, and for-profit ownership were associated with poorer physical performance. Controlling for individual characteristics, it was found that better performance on the four physical performance measures was associated with a reduced risk of nursing home placement, fracture, and decline in function over 1 year. Simple performance measures identify modifiable functional deficits and suggest targeted interventions to prolong independent mobility and aging in place in RC/AL facilities.