Search results for ‘Subject term:"older people"’ Sort:
Results 1 - 10 of 31
Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis
- Authors:
- BLOM J.W., et al
- Journal article citation:
- Age and Ageing, 47(5), 2018, pp.705-714.
- Publisher:
- Oxford University Press
Purpose: To support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: Individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: Primary care sector. Interventions: Combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main: Outcome activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: Quality of life (visual analogue scale 0–10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: Intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: Included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was −0.01 (95% confidence interval −0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: Compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective. (Publisher abstract)
Early intervention in dementia care in an Asian community: lessons from a dementia collaborative project
- Authors:
- SEABROOKE Viniti, MILNE Alisoun
- Journal article citation:
- Quality in Ageing, 10(4), December 2009, pp.29-36.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
The number of older Asians in the UK, and therefore at risk of developing dementia is increasing. The emerging need to address early diagnosis is especially prominent in areas where Asian communities are long established. Set up under the auspices of the South East Dementia Services Collaborative, this pilot project aimed to raise awareness of memory problems and facilitate access to early intervention for older Asians in North West Kent. Using an evaluation methodology adopted by the Collaborative and working through a multi-agency steering group, the project identified an appropriate primary care practice, established a link with a specially trained Asian nurse and devised a set of project materials. By inviting older Asian patients with memory problems to make an appointment with the nurse, and enclosing a culturally relevant information leaflet, older people were encouraged to come forward. The project outcomes include significantly increased referral rates from black and minority ethnic communities to specialist services and greater awareness of dementia-related issues in both primary care and Asian care services. Overall, the evaluation suggests that by engaging with a committed primary care practice it is possible to engage a hitherto marginal group of older people in early intervention in dementia and raise awareness about its benefits.
The limited utility of the Mini-Mental State Examination in screening people over the age of 75 years for dementia in primary care
- Authors:
- WHITE Nia, et al
- Journal article citation:
- British Journal of General Practice, 52(485), December 2002, pp.1002-1003.
- Publisher:
- Royal College of General Practitioners
The Mini-Mental State Examination (MMSE) is used widely to assess cognitive status, and has also been recommended for use in primary care to detect dementia. This article uses data from a larger study to evaluate the utility of the MMSE to detect dementia. The results of the study raised concerns regarding the utility of the MMSE as a screening instrument for dementia in primary care.
Social work's contribution to integrated primary health care teams in the UK for older adults with complex needs
- Authors:
- BAILEY Di, MUTALE Gabriella Jennifer
- Journal article citation:
- Journal of Integrated Care, 30(3), 2022, pp.263-275.
- Publisher:
- Emerald
Purpose: This study examined the contribution of adult social work in integrated teams in the UK. Design/methodology/approach: The study design was realist, evaluation research using a mixed methods approach. Data collection methods included interviews and focus groups. Types of social work activities were extracted from older adults' case records and used to calculate costs of care. The presence or absence of indicators of care quality was recorded using the same sample of case records. Data were collected from three primary care teams in which social work was integrated. They were compared with data from three social-work-only teams in the same districts. Narrative data was analysed thematically. Inferential and descriptive statistics were used to compare costs and care quality. Findings: When social work was embedded or attached to a primary care team, costs of care delivery were lower than in their social-work-only team and more indicators of good quality care outcomes were recorded. Results suggest that embedding social work in integrated primary care teams contributes to cost-effective, quality care for older people if certain conditions for integration are met. Originality/value: This is the first study to triangulate three data sources to quantify the social work contribution to integrated primary health care teams for older adults. (Edited publisher abstract)
Community volunteers and primary care providers supporting older adults in system navigation: a mixed methods study
- Authors:
- GABER Jessica, et al
- Journal article citation:
- International Journal of Integrated Care, 22(1), 2022, p.18. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: Primary care providers and community volunteers have important roles in supporting patient system navigation and utilization of community-based health and social services (CBHSS). This study aimed to explore the experiences and impacts of system navigation in a complex intervention supporting older adults. Methods: this study used a convergent mixed methods design. Participants included primary care team members (n = 67), community volunteers (n = 38), and programme clients (n = 128) across six communities in Ontario, Canada. Data sources included focus groups, interviews, system navigation function survey for volunteers, CBHSS use survey for clients, and implementation data on CBHSS recommended by providers and volunteers and used by clients. Results: Results showed the different patterns of how CBHSS categories were recommended and ultimately used. Exercise-related CBHSS were both recommended and used, independence-related CBHSS were mostly only recommended with less uptake, and chronic health condition and diet/nutrition CBHSS were most often used by clients. Discussion: Primary care teams’ practice of system navigation was impacted by programme participation, including through learning about local CBHSS. However, volunteers felt more confident in tasks that did not include connecting to CBHSS. The programme did seem to result in many referrals, though the actual client uptake tended to be to more clinical rather than healthy lifestyle resources. (Edited publisher abstract)
A mixed methods study of the experience of older adults with multimorbidity in a Care Coordination Program
- Authors:
- MELLUM Jean Scholz, et al
- Journal article citation:
- International Journal of Care Coordination, 21(1-2), 2018, pp.36-46.
- Publisher:
- Sage
Introduction: Care Coordination Programs are designed to streamline services for older adults with multimorbidity. The Triple Aim, a conceptual model for the design and evaluation of healthcare models, stipulates that a balance of three aims—reducing costs, improving population health, and improving patient experience—are needed for high-quality, value-based care. Research is beginning to show that coordinating care across the continuum of care reduces costs and improves the health of the multimorbid older adult population. Yet little is known about older adults’ experience of care and their overall assessment of interactions with healthcare providers across the length of time of these interactions in a Care Coordination Program. Methods: To gain a deeper understanding of older adults’ experience with a Care Coordination Program, this concurrent mixed methods research study analyzed 201 older adults’ assessment of their chronic illness care using the Patient Assessment of Chronic Illness Care (PACIC+). A subset of 30 older adults also participated in a telephone interview to collect qualitative data. Results: The experience of older adults with multimorbidity in a Care Coordination Program was related to two factors: (1) professional actions and (2) professional attitudes. Actions that improved patients’ experience of care were communication, coordination, and addressing fundamental problems. Professional attitudes that improved their experience of care included being compassionate, knowledgeable and professional, mutually respectful, and positive and encouraging. Discussion: To improve patient experience, Care Coordination Programs must design and measure their efforts related to the actions and the attitudes of their care team, especially primary care physicians and care coordinators. (Edited publisher abstract)
Transforming health care in nursing homes: an evaluation of a dedicated primary care service in outer east London
- Authors:
- SHERLAW-JOHNSON Chris, et al
- Publisher:
- Nuffield Trust
- Publication year:
- 2018
- Pagination:
- 53
- Place of publication:
- London
This report evaluates a primary care service piloted in four nursing homes in the London Borough of Havering and assesses the impact of the new service on hospital attendance. It also details the experiences and views of staff in the nursing homes and health care professionals delivering the new service. The main features of the service included the assignment of a single GP practice to all residents; access to health care professionals with expertise in caring for older people with complex needs; extended access beyond normal GP hours; care guidance to nursing home staff; improved medicines management; and new approaches for managing people who are at the end of life. The evaluation analysed changes in use of hospital services by 431 residents in the four nursing homes and interviewed 14 nursing home staff, managers and GPs. Improvements mentioned by staff following the introduction of the service included: better access GPs and to clinical advice; improved care quality due to GPs spending more face to face time with residents; and improved approaches to risk sharing. These improvements also coincided with a reduction in emergency hospital admissions. The results suggest that there are benefits in providing proactive primary care for nursing homes, delivered by a consistent GP within a service that specialises in older people with complex care needs. (Edited publisher abstract)
Evercare evaluation: final report
- Authors:
- BOADEN Ruth, et al
- Publisher:
- National Primary Care Research and Development Centre
- Publication year:
- 2006
- Pagination:
- 211p., bibliog.
- Place of publication:
- Manchester
Evercare is a form of case management for frail elderly people which originated in the United States and was introduced in 9 pilot primary care trusts in England in 2003 (Airedale, Bexley, Bristol North, Bristol South and West, Halton, Luton, South Gloucestershire, Walsall, and Wandsworth). This document is the final report of an independent evaluation of the Evercare project carried out between 2003 and 2005, which aimed to assess changes in primary and secondary care for older people resulting from the Evercare model, whether the model promoted good clinical practice, and how key stakeholders evaluated the model. The evaluation involved case studies in Evercare sites, including interviews with nurses, GPs, patients, carers and managers, and analysis of documents and Hospital Episode Statistics. The report describes the methodology and sets out the findings and conclusions of the evaluation; it also discusses the policy implications of the project. The key points highlighted were that the Evercare approach to case management provided additional contacts, monitoring and treatment options that were highly valued by patients and their carers, and that although individual examples of avoided hospital admissions were found, there was no overall effect on emergency hospital admissions.
Integrating mental health services for older people in England - from rhetoric to reality
- Authors:
- TUCKER Sue, et al
- Journal article citation:
- Journal of Interprofessional Care, 23(4), July 2009, pp.341-354.
- Publisher:
- Taylor and Francis
The provision of integrated, person-centred care is particularly important for older people with mental health problems. Nevertheless, a series of reports at the end of the last century highlighted unacceptable differences in collaborative working practices in England, variations that a national service framework specifically aimed to address. This study utilised a cross-sectional survey of old age psychiatrists to explore the extent to which, some three years after the publication of this guidance, structures to deliver integrated care across the interfaces between specialist old age mental health and primary, acute and social care services were in place. Three hundred and eighteen (72%) consultants responded. Measures to facilitate integrated practice were generally poorly developed: many areas missed targets to agree protocols for the management of older people with mental health problems with primary care; more than 45% of respondents reported the presence of fewer than two of four indicators of integration with the acute sector; and approaching 30% of respondents reported the presence of fewer than four of 13 markers of integration with social care. The implications of these findings and the challenges inherent in providing integrated care for this client group are discussed.
Using mixed methods to evaluate the use of a caregiver strain measure to assess outcomes of a caregiver support program for caregivers of older adults
- Authors:
- HYUCK Magaret Hellie, AYALON Liat, YODER Judy
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(2), February 2007, pp.160-165.
- Publisher:
- Wiley
Many assessment tools have been developed for evaluating caregiving programs, but the majority are too cumbersome for ongoing use. This study reports on a brief assessment tool used to monitor strain among family members caring for an impaired elder. Participants were enrolled in the SeniorCare program, a program funded by the Administration on Aging to provide care to family caregivers. The Caregiver Risk Screen (CRS) is a 12-item measure of strain, initially developed as part of an in-home assessment procedure. Its utility for use in practice settings over time was assessed using both quantitative and qualitative methodology. Chronbach alpha levels for the CRS were 0.85 at intake and 0.84 at first follow-up. At the first follow-up, the overall index score and five of the 12 items showed statistically significant lessened strain. In subsequent follow-up evaluations, the average improvements were maintained but there was no additional decrease in strain. Individual variations in changes over time were identified by combining quantitative and qualitative information. Themes that emerged in qualitative data served to modify the measure for future use. The brief Caregiver Risk Screen tool appears to be a reliable and valid tool for use in practice settings. It is acceptable to clients and professional staff. Modifications have been made that may further enhance the suitability of this measure for other settings.