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Outcomes in social care practice: outcomes in community care practice; number seven
- Editors:
- QURESHI Hazel, (ed.)
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 2001
- Pagination:
- 213p.,tables,bibliog.
- Place of publication:
- York
The final report of a research project investigating practical ways in which a focus on the results of services could be used to improve social care for older people and disabled people. It describes five practical projects, each investigating a different approach to improving services through a focus on outcomes. Each project was undertaken by a social services department working jointly with SPRU.
Quality indicators for community care for older people: a systematic review
- Authors:
- JOLING K.J., et al
- Journal article citation:
- PLoS ONE, 13(1), 2018, Online only
- Publisher:
- Plos Publications
- Place of publication:
- San Francisco, CA
Background: Health care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality. Methods: Relevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality. Results: Searches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain ‘Additional evidence, formulation and usage’ (51%), followed by ‘Scientific evidence’ (39%) and ‘Stakeholder involvement’ (28%). Conclusion: A substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes. (Publisher abstract)
Residential outcomes for nursing facility applicants who have been diverted: where are they 5 years later
- Authors:
- CHAPIN Rosemary, et al
- Journal article citation:
- Gerontologist, 49(1), February 2009, pp.46-56.
- Publisher:
- Oxford University Press
The purpose of this longitudinal study was to determine the length of community tenure for adults aged 60 and older after application for nursing facility (NF) admission and to examine the proportion of older adults who lost community tenure due to either (a) death while a community resident or (b) permanent NF admission. In this 5-year prospective study, older adults who had applied for NF admission and were diverted (residing in the community 30 days later) were tracked. Four waves of NF applicants (N = 2,882) were identified, and those diverted (n = 599) were tracked for 60 months at 3-month intervals. Sixty months after diversion, 18.0% of older adults (n = 108) were residing in the community, 39.2% died as community residents (n = 235), and 42.7% (n = 256) became permanent NF residents. In all, 414 diverted older adults (69.1%) died during the 5 years following NF application, with the majority of deaths occurring while older adults were community residents.
High prevalence of central nervous system medications in community-dwelling older adults with dementia over a three-year period
- Authors:
- FICK D., KOLANOWSKI A., WALLER J.
- Journal article citation:
- Aging and Mental Health, 11(5), September 2007, pp.588-595.
- Publisher:
- Taylor and Francis
Few recent studies have investigated the prevalence and outcomes for central nervous system (CNS)-active medication use in older persons with dementia (PWD) who live in the community. Thus, the purpose of this study was to describe the health outcomes and patterns of use of CNS-active drugs in PWD living in the community. Using a retrospective study design from a southeastern managed care organization (MCO), claims data were collected for three years on all identified cases with dementia and included age, gender, medical diagnoses for each claim (International Classification of Disease [ICD-9 code]) and prescription drugs (National Drug Code [NDC]). Individuals (N = 960) were selected who were continuously enrolled and had prescription drug coverage. Over 79% of PWD in this sample were on a CNS-active medication during the three-year period and 35% were on a benzodiazepine. The highest number of drug-related problems (DRPs) within 45 days after receiving a CNS drug prescription were for syncope, fatigue, altered level of consciousness, delirium, constipation, falls and fractures. This study illustrates the need to further examine inappropriate CNS-active medication use in PWD and to test non-pharmacologic therapies for the clinical problems that initiate their use in PWD.
Effectiveness of home based support for older people: systematic reviews and meta-analysis
- Authors:
- ELKAN Ruth, et al
- Journal article citation:
- British Medical Journal, 29.9.01, 2001, pp.719-724.
- Publisher:
- British Medical Association
Evaluates the effectiveness of home visiting programmes that offer health promotion and preventive care to older people. Uses a systematic review and meta-analysis of 15 studies of home visiting. Outcome measures include mortality, admission to hospital, admission to institutional care, functional status, and health status. Results found that home visits to older people can reduce mortality and admission to long term institutional care.
Learning from older community care clients
- Author:
- SOCIAL POLICY RESEARCH UNIT
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 2000
- Pagination:
- 4p.
- Place of publication:
- York
Reports on a project conducted jointly by the Social Policy Research Unit (SPRU) and Bradford Social Services Elderly Division to obtain older people's views about outcomes. Home interviews with a small random cross-section of older community care clients were conducted by senior social services managers. The implementation of a programme of "customer visits" to enable senior managers to see first hand the outcomes of services and directly discuss them with service users.
Outcomes in community care practice number five: overview: outcomes of social care for older people and carers
- Authors:
- QURESHI Hazel, PATMORE Charles, NICHOLAS Elinor, BAMFORD Claire
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 1998
- Pagination:
- 34p.,bibliog.
- Place of publication:
- York
This report, part of the first phase of a longer term outcomes programme, explores the views of older service users, carers and staff at different levels in selected social services departments to discover what they would identify as outcomes of social care for older people, and to investigate possible ways of collecting and using outcome information. This knowledge is then to be used as a basis for developing methods of collecting outcome information for trial use in the given department.
Evaluation of continuing care accommodation for elderly people: vol. 3; a multiple case study of NHS hospital wards and nursing homes; some aspects of structure and outcome
- Authors:
- BOND Senga, BOND John
- Publisher:
- University of Newcastle upon Tyne. School of Health Care Sciences
- Publication year:
- 1989
- Pagination:
- 204p.,tables,bibliog.
- Place of publication:
- Newcastle upon Tyne
Report of an evaluation of 3 experimental National Health Service nursing homes set up by the Department of Health and Social Security in 1983 and 1984.
Characteristics of older Australian community aged care clients who fall: incidents reported by care staff
- Authors:
- BRETT Lindsey, et al
- Journal article citation:
- Health and Social Care in the Community, 30(2), 2022, pp.469-475.
- Publisher:
- Wiley
Falls are the leading cause of injury and hospitalisation for older adults (aged 65 years or older) worldwide. Data collected by community aged care providers are an underutilised source of information about precipitating risk factors and consequences of falls for older adults living in the community. The objective of this longitudinal, observational study was to describe and compare the characteristics of older Australians who did and did not have falls reported by community aged care staff. This study analysed 19 months of routinely collected care management and incident data for 1,596 older clients from a large Australian community care provider. Differences in sociodemographic characteristics, care needs and community care service use were compared between those who had one or more reported falls and those who had none. Fall-related outcomes (injuries, hospitalisations, relocation to residential aged care) were examined. The average age of clients was 82 years and most were women (66%). Seventy-seven (4.8%) clients had one or more reported falls over the study period (total falls = 92). Clients who had falls reported by care staff were more likely to be older adults, male and use more hours of community care services per week. There were 38 falls-related injuries, 5 falls-related hospitalisations and 20 clients relocated to residential aged care after a reported fall. This study demonstrates the potential for using routinely collected community aged care data to understand risk factors and monitor longitudinal outcomes for a population at high risk of falls. (Edited publisher abstract)
A systematic scoping review of community-based interventions for the prevention of mental ill-health and the promotion of mental health in older adults in the UK
- Authors:
- LEE Caroline, et al
- Journal article citation:
- Health and Social Care in the Community, early cite May 2021,
- Publisher:
- Wiley
Background: Mental health concerns in older adults are common, with increasing age-related risks to physical health, mobility and social isolation. Community-based approaches are a key focus of public health strategy in the UK, and may reduce the impact of these risks, protecting mental health and promoting wellbeing. This study conducted a review of UK community-based interventions to understand the types of intervention studied and mental health/wellbeing impacts reported. Method: This study conducted a scoping review of the literature, systematically searching six electronic databases (2000–2020) to identify academic studies of any non-clinical community intervention to improve mental health or wellbeing outcomes for older adults. Data were extracted, grouped by population targeted, intervention type, and outcomes reported, and synthesised according to a framework categorising community actions targeting older adults. Results: In total, 1,131 full-text articles were assessed for eligibility and 54 included in the final synthesis. Example interventions included: link workers; telephone helplines; befriending; digital support services; group social activities. These were grouped into: connector services, gateway services/approaches, direct interventions and systems approaches. These interventions aimed to address key risk factors: loneliness, social isolation, being a caregiver and living with long-term health conditions. Outcome measurement varied greatly, confounding strong evidence in favour of particular intervention types. Conclusion: The literature is wide-ranging in focus and methodology. Greater specificity and consistency in outcome measurement are required to evidence effectiveness – no single category of intervention yet stands out as ‘promising’. More robust evidence on the active components of interventions to promote older adult's mental health is required. (Edited publisher abstract)