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Patient-centeredness in older adults with multimorbidity: results of an online expert delphi study
- Authors:
- KIVELITZ Laura, et al
- Journal article citation:
- Gerontologist, 61(7), 2021, pp.1008-1018.
- Publisher:
- Oxford University Press
Background and Objectives: Older adults suffering from multimorbidity represent a priority target group for patient-centeredness (PC). We aimed to investigate the transferability of an existing integrated model of PC comprising 15 dimensions on the care of older adults with multimorbidity from an expert perspective. Research Design and Methods: A total of 242 experts were invited to participate in a 2-round online Delphi study. In round 1, they were asked to (a) individually rate relevance and clarity of the dimensions, (b) add missing dimensions, and (c) prioritize the dimensions. In round 2, experts received results of round 1 and were asked to rerate their ratings. Results: Forty-eight experts participated in round 1 and 39 in round 2. Ten dimensions were rated as sufficiently relevant and clear, including one new dimension (“prognosis and life expectancy, burden of treatment”). Four dimensions were rated as relevant but insufficiently clear. One dimension failed to reach our validation threshold on both criteria. The 5 dimensions rated as most important were: “patient as a unique person,” “clinician–patient communication,” “patient involvement in care,” “physical, cognitive, and emotional support,” and “involvement of family and friends.” Discussion and Implications: The experts’ ratings were higher regarding relevance than regarding clarity, which emphasizes the still existing conceptual uncertainty of PC. Our results give further directions regarding the operationalization of PC in older adults with multimorbidity, which is essential for its implementation in routine care. Further refined using focus groups with geriatric patients, our adapted model serves as a basis for a systematic review of assessment instruments. (Edited publisher abstract)
Identification of needs of older adults with intellectual disabilities
- Authors:
- ALBUQUERQUE Cristina P., CARVALHO Ana Cristina
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 17(2), 2020, pp.123-131.
- Publisher:
- Wiley
Information regarding individual needs of older adults with intellectual disabilities (IDs) is scarce although it is very important both from a person‐centered planning perspective and from a proactive service system perspective. This study has three main aims: (1) to identify and describe staff perceptions of the needs of a large group of adults aged 45 or over with IDs; (2) to analyze the perceived needs as function of age, gender, and level of disability; (3) to present information about the development and the psychometric properties of the assessment instrument used. The participants were 232 Portuguese older adults with IDs (mean age = 52), predominantly male (n = 129). There were 66 staff members who assessed the needs of the IDs participants through the Inventory of Identification of Needs (IIN). The IIN demonstrated satisfactory psychometric properties (e.g., internal consistency, interrater reliability, construct validity). The unmet needs were numerous and diverse, but those that were perceived as more prevalent were: literacy, handling of money, information on rights, self‐care, information on services, communication, occupation at holidays, occupation at weekends, general physical health, cognitive rehabilitation, and daytime activities. The needs were influenced by the disability level: regarding Literacy/Information and Occupation/Community, needs were significantly more common in persons with a moderate and/or severe disability. The influence of age was registered only in Mental Health. The needs identified should guide the planning and development of service provision. These should offer literacy learning experiences, information about the rights of persons with disabilities, information about the services available, self‐care assistance or training in self‐care skills; and meaningful activities during regular time periods, weekends and holidays. (Publisher abstract)
Home care: commissioning for older people with complex needs
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2014
- Place of publication:
- London
This film highlights the challenges of commissioning home care for older people. It shows examples of providing good quality, person centred home care for older people with complex needs. The St Monica's trust approach to high quality person centred home care is built on the recruitment of the right staff and support , training and partnership working. This resource is aimed at commissioners of home care for older people, commissioners, care providers and carers. (Edited publisher abstract)
Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis
- Authors:
- BUNN Frances, et al
- Journal article citation:
- BMC Geriatrics, 18(165), 2018, Online only
- Publisher:
- BioMed Central Ltd
Background: Health care systems are increasingly moving towards more integrated approaches. Shared decision making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; particularly for older people with complex needs. The aim of this review was to provide a context relevant understanding of how interventions to facilitate SDM might work for older people with multiple health and care needs, and how they might be applied in integrated care models. Methods: Iterative, stakeholder driven, realist synthesis following RAMESES publication standards. It involved: 1) scoping literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, 2) systematic searches for evidence to test and develop the theories, and 3) validation of programme theory/ies with stakeholders (n = 11). We searched PubMed, The Cochrane Library, Scopus, Google, Google Scholar, and undertook lateral searches. All types of evidence were included. Results: We included 88 papers; 29 focused on older people or people with complex needs. We identified four context-mechanism-outcome configurations that together provide an account of what needs to be in place for SDM to work for older people with complex needs. This includes: understanding and assessing patient and carer values and capacity to access and use care, organising systems to support and prioritise SDM, supporting and preparing patients and family carers to engage in SDM and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that allow older people to feel that they are respected and understood, and that engender confidence to engage in SDM. Conclusions: To embed SDM in practice requires a radical shift from a biomedical focus to a more person-centred ethos. Service providers will need support to change their professional behaviour and to better organise and deliver services. Face to face interactions, permission and space to discuss options, and continuity of patient-professional relationships are key in supporting older people with complex needs to engage in SDM. Future research needs to focus on inter-professional approaches to SDM and how families and carers are involved. (Edited publisher abstract)
Improving personalisation in care homes
- Authors:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE, THINK LOCAL ACT PERSONAL
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2019
- Place of publication:
- London
An action planning tool to help managers and owners of care homes for older people to build a shared understanding of what personalisation means and plan practical improvements to make care homes more personalised. Care home managers will be able to use the tool to support good conversations with residents and staff, and identify the improvements that will make the most difference to people’s quality of life. The tool covers: transition; choice and control; identity and purpose; community capacity; co-production; person-centred approaches; positive culture; end of life care; reviewing progress; and forward planning. The tool has been designed to also be used for wider groups of people including those with complex conditions. Originally published in 2017 and updated in 2019. The updated version includes new videos. (Edited publisher abstract)
Older people and quality of life: better life in residential care
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2014
- Pagination:
- 4 minutes 11 seconds
- Place of publication:
- London
This video shows older people with high support needs who live in a care home. They talk about what is important in their lives and how they like to be treated. It is based around the Joseph Rowntree Foundation's (JRF) A Better Life programme, and attempts to convey a set of key messages for practitioners. These include: seeing and treating older people with high support needs as individuals and helping them to do the things they want to do; building positive relationships with the people practitioners work with; looking for the strengths and assets each person has and supporting them to play an active role in the development and provision of services; and being open to doing things in new ways. This resource is aimed at anyone involved in providing services to older people with high support needs – commissioners, managers, social workers, care workers and educators – and older people with high support needs and their families and carers. (Edited publisher abstract)
Better life for older people with high support needs: the role of social care
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2014
- Place of publication:
- London
This briefing summarises the seven challenges set out by the Joseph Rowntree Foundation’s (JRF) A Better Life programme which will help older people with high support needs achieve a better quality of life. It identifies key SCIE resources that will support people working in social care address each of the challenges in their practice and relationships with older people with high support needs and achieve the overall aim of supporting choice, control and quality in their lives. The challenges cover: encouraging positive images of ageing; taking a person centred approach to care; encouraging importance of meaningful relationships; treating older people as equal stakeholders in their care and support services; allowing older people with high support needs to make decisions; and being open to innovative and new approaches of providing care and support. (Original abstract)
Designing a person-centred integrated care programme for people with complex chronic conditions: a case study from Catalonia
- Authors:
- MAS Miquel A., et al
- Journal article citation:
- International Journal of Integrated Care, 21(4), 2021, p.22. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: The prevalence of people with complex chronic conditions is increasing. This population’s high social and health needs require person-centred integrated approaches to care. Methods: To collect data about experiences with the health system and identify priorities for care, this study conducted 2 focus groups and 15 semi-structured interviews involving patients with multimorbidity and advanced conditions, caregivers, and representatives of patients’ associations. To design the programme, this study combined this information with evidence-based recommendations from local healthcare and social care professionals. Results: Patients’ and caregivers’ main priorities were to ensure (a) comprehension of information provided by healthcare professionals; (b) coordination between patients, caregivers, and professionals; (c) access to social services; (d) support to caregivers in managing situations; (e) perceived support throughout the healthcare process; (f) home care, when available; and (d) a patient-centred approach. These dimensions were included in 37 of 63 clinical actions of the programme to cover the whole care trajectory: identifying high needs, defining, and providing care plans, managing crises, and providing transitional care and end-of-life care. Conclusion: the researchers developed an evidence-based integrated care programme tailored to high-need patients combining input from patients, caregivers, and healthcare and social care professionals. (Edited publisher abstract)
Impact assessment of an innovative integrated care model for older complex patients with multimorbidity: the CareWell Project
- Authors:
- MATEO-ABAD Maider, et al
- Journal article citation:
- International Journal of Integrated Care, 20(2), 2020, Online only
- Publisher:
- International Foundation for Integrated Care
Objectives: To evaluate the impact in terms of use of health services, clinical outcomes, functional status, and patient´s satisfaction of an integrated care program, the CareWell program, for complex patients with multimorbidity, supported by information and communication technology platforms in six European regions. Data Sources: Primary data were used and the follow-up period ranged between 8 and 12 months. Study design: A quasi-experimental study, targeting chronic patients aged 65 or older, with 2 or more conditions – one of them necessarily being diabetes, congestive heart failure or congestive obstructive pulmonary disease. The intervention group received the integrated care program and the control group received usual care. Generalized mixed regression models were used. Data collection: Data were obtained from individual interviews and electronic clinical records. Principal Findings: Overall, 856 patients were recruited (475 intervention and 381 control). In the intervention group, the number of visits to emergency rooms was significantly lower, and the number of visits to the general practitioners and primary care nurses was higher than in the control group. Conclusion: The CareWell program resulted in improvements in the use of health services, strengthening the role of PC as the cornerstone of care provision for complex patients with multimorbidity. (Publisher abstract)
Comprehensive geriatric assessments in integrated care programs for older people living at home: a scoping review
- Authors:
- STOOP Annerieke, et al
- Journal article citation:
- Health and Social Care in the Community, 27(5), 2019, pp.e549-e566.
- Publisher:
- Wiley
In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person‐centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006–2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty‐seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty‐one different CGAs were identified, of which the EASYcare instrument, RAI‐HC/RAI‐CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person‐centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter‐)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel. (Publisher abstract)