Search results for ‘Subject term:"older people"’ Sort:
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Equity in health and social care
- Authors:
- EVANDROU Maria, et al
- Publisher:
- London School of Economics. Suntory-Toyota International Centre for Economics an
- Publication year:
- 1990
- Pagination:
- 70p.,tables,bibliogs.
- Place of publication:
- London
Studies equity in the distribution of primary health care and domiciliary care for elders.
Evaluating the impact of integrated health and social care teams on older people living in the community
- Authors:
- BROWN Louise, TUCKER Christine, DOMOKOS Teresa
- Journal article citation:
- Health and Social Care in the Community, 11(2), March 2003, pp.85-94.
- Publisher:
- Wiley
Although it is perceived wisdom that joint working must be beneficial there is little evidence to support this. Evaluates 2 integrated co-located health and social care teams established in a rural county to meet the needs of older people and their carers. Identifies that patients from 'integrated teams' may self-refer more and are assessed more quickly, maybe indicating the 'one-stop shop' approach is having an impact on service delivery. Findings also suggest that in integrated teams the initial stages of the process of seeking help and being assessed for a service may have improved through better communication, understanding and exchange of information among professional groups. However, the degree of 'integration' seen within these teams does not appear sufficiently well developed to have had an impact on clinical outcomes for patients/users. It appears unlikely from available evidence that measures such as co-location go far enough to produce changes in outcomes for older people. If the Department of Health wishes to see benefits in process progress to benefits to users more major structural changes will be required. The process of changing organisational structures can be enhanced where there is evidence that changes will produce better outcomes. At present this evidence does not exist, although this study suggests that benefits might be forthcoming if greater integration can be achieved. Nevertheless, until social services and NHS trusts develop more efficient and compatible information systems it will be impossible to evaluate what impact any further steps towards integration might have on older people without significant external resources.
Primary health care for elderly people from black and minority ethnic communities
- Author:
- PHAROAH Catherina
- Publisher:
- HMSO/Age Concern Institute of Gerontology
- Publication year:
- 1995
- Pagination:
- 153p.,tables,bibliog.
- Place of publication:
- London
Research study looking at the extent to which GPs address the particular needs of older people from black and minority ethnic communities.
Care transitions as street-level work: providers' perspectives on the dilemmas and discretions of older people’s transitions across acute, sub-acute and primary care
- Authors:
- FOSTER Michele, et al
- Journal article citation:
- Journal of Integrated Care, 25(3), 2017, pp.196-207.
- Publisher:
- Emerald
Purpose: Quality care transitions of older people across acute, sub-acute and primary care are critical to safety and cost, which is the reason interventions to improve practice are a priority. Yet, given the complexity of providers and services involved it is often difficult to know the types of tensions that arise in day-to-day transition work or how front-line workers will respond. To that end, this innovative study differs from the largely descriptive studies by conceptualising care transitions as street-level work in order to capture how transition practice takes shape within the complexities and dynamics of the local setting. The paper aims to discuss these issues. Design/methodology/approach: Data were collected from 23 hospital health professionals and community service providers across primary, sub-acute and acute care through focus groups. A thematic analysis and interrogation of themes using street-level concepts derived three key themes. Findings: The themes of risk logics and dilemmas of fragmentation make explicit both the local constraints and opportunities of care transitions and how these intersect to engender a particular logic of practice. By revealing the various discretionary tactics adopted by front-line providers, the third theme simultaneously highlights how discretionary spaces might represent both possibilities and problematics for balancing organisational and patient needs. Originality/value: The study contributes to the knowledge of street-level work in health settings and specifically, the nature of transition work. Importantly, it benefits policy and practice by uncovering mechanisms that could facilitate and impede quality transitions in discrete settings.
Which factors are associated with fear of falling in community-dwelling older people?
- Authors:
- KUMAR Arun, et al
- Journal article citation:
- Age and Ageing, 43(1), 2014, pp.76-84.
- Publisher:
- Oxford University Press
Background: Fear of falling (FOF) is common in older people and associated with serious physical and psychosocial consequences. Identifying those at risk of FOF can help target interventions to both prevent falls and reduce FOF. Objective: To identify factors associated with FOF. Study design: Cross-sectional study in 1,088 community-dwelling older people aged ≥65 years. Methods: Data were collected on socio-demographic characteristics, self-perceived health, exercise, risk factors for falls, FOF (Short FES-I), and functional measures. Logistic regression models of increasing complexity identified factors associated with FOF. Results: High FOF (Short FES-I ≥11) was reported by 19%. A simpler model (socio-demographic + falls risk factors) correctly classified as many observations (82%) as a more complex model (socio-demographic + falls risk factors + functional measures) with similar sensitivity and specificity values in both models. There were significantly raised odds of FOF in the simpler model with the following factors: unable to rise from a chair of knee height (OR: 7.39), lower household income (OR: 4.58), using a walking aid (OR: 4.32), difficulty in using public transport (OR: 4.02), poorer physical health (OR: 2.85), black/minority ethnic group (OR: 2.42), self-reported balance problems (OR: 2.17), lower educational level (OR: 2.01) and a higher BMI (OR: 1.06). Conclusions: A range of factors identify those with FOF. A simpler model performs as well as a more complex model containing functional assessments and could be used in primary care to identify those at risk of FOF, who could benefit from falls prevention interventions. (Publisher abstract)
Home visits for frail older people: a qualitative study on the needs and preferences of frail older people and their informal caregivers
- Authors:
- KEMPEN Janneke A. L. van, et al
- Journal article citation:
- British Journal of General Practice, 62(601), August 2012, pp.417-418.
- Publisher:
- Royal College of General Practitioners
Despite continuing interest from professionals in home visits for older people, reports on older people's needs and preferences for such visits are scarce. This qualitative study investigated the views and needs of 11 community-dwelling older people living in the area of Nijmegen, the Netherlands, concerning home visits. Most participants felt home visits would give older people the personal attention they used to receive from GPs. Most stated that this would give them more trust in GPs. Participants stated that trust was one of the most important factors in a good patient-professional relationship. Further, participants preferred home visits to focus on the psychosocial context of the patient. They stated that more knowledge of the psychosocial context and a good patient-professional relationship would enable the professional to provide better and more patient-centred care. The authors concluded that future studies on home visits should involve patients in the development of home visiting programmes.
Continuity in palliative care
- Authors:
- MUNDAY D., SHIPMAN C.
- Publisher:
- Royal College of General Practitioners
- Publication year:
- 2007
- Pagination:
- 300p.
- Place of publication:
- London
A practical text to help primary care teams provide palliative care for patients and carers, faced with life-threatening diseases. It looks at achieving continuity in palliative care, from the perspective of patients, their carers and health care. There are chapters on the following topics: perspectives from primary, specialist and secondary care; continuity of care for the elderly; continuity of care for people with non-malignant disease; spiritual care; PCTs and organisational issues; end-of-life initiatives; patient-held records and IT systems; and ethical issues. The final chapter discusses palliative care provision in the context of health service reforms, outlining the continuing relevance of continuity in the face of these changes.
Understanding and increasing help-seeking in older men
- Authors:
- MANSFIELD Abigail K., et al
- Journal article citation:
- Generations, 32(1), Spring 2008, pp.15-20.
- Publisher:
- American Society on Aging
Research has shown that men do not use available physical and mental health services to the degree that their physical and mental health status would warrant. This article discusses possible ways to increase mens help-seeking behaviour. Strategies such as motivational enhancement and integrated primary care can help men to gain access to help they need and resolve ambivalence about treatment.
The development of a short instrument to identify common unmet needs in older people in general practice
- Authors:
- ILIFFE Steve, et al
- Journal article citation:
- British Journal of General Practice, 54(509), December 2004, pp.914-918.
- Publisher:
- Royal College of General Practitioners
No structured needs assessment tool appropriate for older people and also suitable for use in routine general practice consultations exists. This study aimed to engage older people in the development of a brief, valid, practical and acceptable instrument to help identify common unmet needs suitable for use in routine clinical practice in primary care by user involvement in a multi-stages approach to heuristic development in general practices, voluntary groups and community organisations in north and central London. Subjects included patients 65 and over in purposively selected practices, voluntary organisations for older people, community organisations involving older people, GPs and community nurses. Data were collected through mixed methodology interviews using a structured assessment tool, a postal questionnaire, and focus groups. Synthesis and interpretation was done through a consensus conference followed by a Delphi process involving primary care professionals. Five domains of unmet need were identified as priority areas by all 3 methods, the consensus conference, and the Delphi process: senses (vision and hearing), physical ability (mobility and falls), incontinence, cognition, and emotional distress (depression and anxiety). Concludes that public involvement in the design of clinical tools allowed the development of a brief assessment instrument that could potentially identify common, important and tractable unmet needs in older people.
Quality of care for elderly residents in nursing homes and elderly people living at home: controlled observational study
- Authors:
- FAHEY Tom, et al
- Journal article citation:
- British Medical Journal, 15.3.03, 2003, pp.580-583.
- Publisher:
- British Medical Association
Reports on the results of a research study which examined three general practices with registered patients resident in four Bristol nursing homes. In each practice four patients who lived in their own homes were also selected to act as controls. The study compared and evaluated the quality of clinical care given to patients in both settings. The results of the study suggested that the quality of medical care that patients received in the study was inadequate, particularly in the nursing homes. Suggests that better coordinated care would avoid the problems of overuse of unnecessary drugs, underuse of beneficial drugs, and poor monitoring of chronic disease.