Search results for ‘Subject term:"older people"’ Sort:
Results 1 - 10 of 11
Chronic medical problems and distressful thoughts of suicide in primary care patients: mitigating role of happiness
- Authors:
- HIRSCH Jameson K., DUBERSTEIN Paul R., UNUTZER Jurgen
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(7), July 2009, pp.671-679.
- Publisher:
- Wiley
Chronic medical problems might amplify suicide risk in later life. Feelings of happiness may reduce this risk. The authors tested the hypothesis that happiness attenuates the association between number of self-reported chronic diseases and suicidal distress. A sample of 1,801 depressed, primary care patients, 60 years of age or older, entering a clinical trial, were assessed for the presence of positive emotion, suicidal distress and self-reported chronic medical problems. Results showed that chronic medical problems are associated with suicide ideation and, as hypothesised, happiness attenuates the relationship between self-reported diseases and suicidal distress. Decreased risk for distressing thoughts of suicide in the context of medical illness is predicted by the presence of positive emotions. The results suggest that treatments designed to help older primary care patients identify sources of joy and enhance happiness might decrease suicide risk.
Guided care for multimorbid older adults
- Authors:
- BOYD Cynthia M., et al
- Journal article citation:
- Gerontologist, 47(5), October 2007, pp.697-704.
- Publisher:
- Oxford University Press
The purpose of this study was to test the feasibility of a new model of health care designed to improve the quality of life and the efficiency of resource use for older adults with multimorbidity in the United States. Guided Care enhances primary care by infusing the operative principles of seven chronic care innovations: disease management, self-management, case management, lifestyle modification, transitional care, caregiver education and support, and geriatric evaluation and management. To practice Guided Care, a registered nurse completes an educational program and uses a customized electronic health record in working with two to five primary care physicians to meet the health care needs of 50 to 60 older patients with multimorbidity. For each patient, the nurse performs a standardized comprehensive home assessment and then collaborates with the physician, the patient, and the caregiver to create two comprehensive, evidence-based management plans: a Care Guide for health care professionals, and an Action Plan for the patient and caregiver. Based in the primary care office, the nurse then regularly monitors the patient's chronic conditions, coaches the patient in self-management, coordinates the efforts of all involved health care professionals, smoothes the patient's transitions between sites of care, provides education and support for family caregivers, and facilitates access to community resources. A 1-year pilot test in a community-based primary care practice suggested that Guided Care is feasible and acceptable to physicians, patients, and caregivers.
What works in managing complex conditions in older people in primary and community care? A state‐of‐the‐art review
- Authors:
- FROST Rachael, et al
- Journal article citation:
- Health and Social Care in the Community, 28(6), 2020, pp.1915-1927.
- Publisher:
- Wiley
The number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however, there is mixed evidence on their value and they include multiple overlapping components. This study aimed to synthesise the evidence to learn what works for managing complex conditions in older people in primary and community care. This study carried out a state‐of‐the‐art review of systematic reviews. The researchers searched three databases (January 2009 to July 2019) for models of primary and community care for long‐term conditions, frailty, multimorbidity and complex neurological conditions common to older people such as dementia. This study narratively synthesised review findings to summarise the evidence for each model type and identify components which influenced effectiveness. Out of 2,129 unique titles and abstracts, 178 full texts were reviewed and 54 systematic reviews were included. This study found that the models of care were more likely to improve depressive symptoms and mental health outcomes than physical health or service use outcomes. Interventions including self‐management, patient education, assessment with follow‐up care procedures, and structured care processes or pathways had greater evidence of effectiveness. The level of healthcare service integration appeared to be more important than inclusion of specific professional types within a team. However, more experienced and qualified nurses were associated with better outcomes. These conclusions are limited by the overlap between reviews, reliance on vote counting within some included reviews and the quality of study reports. In conclusion, primary and community care interventions for complex conditions in older people should include: (a) clear intervention targets; (b) explicit theoretical underpinnings; and (c) elements of self‐management and patient education, structured collaboration between healthcare professionals and professional support. Further work needs to determine the optimal intensity, length, team composition and role of technology in interventions. (Edited publisher abstract)
A qualitative study of nurses’ clinical experience in recognising low mood and depression in older patients with multiple long-term conditions
- Authors:
- WATERWORTH Susan, et al
- Journal article citation:
- Journal of Clinical Nursing, 24(17-18), 2015, pp.2562-2570.
- Publisher:
- John Wiley and Sons
Aims and objectives: To explore how nurses’ recognise depression in older patients with multiple long-term conditions and the strategies they use to support the patient. Background: Depression decreases an older person's quality of life and sense of wellness, and increases functional impairment. The positive role of nurses working with patients with long-term conditions is now being recognised internationally; however, there is a gap in the research about how nurses recognise depression in older patients and how this impacts on their practice. Design: This is a qualitative study informed by a constructivist grounded theory approach. Methods: In-depth telephone interviews were conducted with 40 nurses working in geographically diverse areas in New Zealand. Results: Having the conversation with older patients about their low moods, or specifically about depression was not something that all the nurses had, or felt they could have. While some nurses knew they could provide specific advice to patients, others believed this was not their responsibility, or within the scope of their role. Conclusion: Faced with an increasing number of older people with long-term conditions, one of which maybe depression itself or as a result of living with other long-term conditions, ongoing monitoring and support pathways are necessary to prevent further decline in the older person's quality of life and well-being. Relevance to clinical practice: Nurses in primary health care can build on current knowledge and skills to increase their capability to promote ‘ageing well’ with older people who have long-term conditions and depression. (Publisher abstract)
Integration and continuity of primary care: polyclinics and alternatives – a patient-centred analysis of how organisation constrains care co-ordination
- Authors:
- SHEAFF Rod, et al
- Journal article citation:
- Health and Social Care Delivery Research, 3(35), 2015, Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- London
Many NHS patients, especially frail older people, have what we call ‘complex needs’, that is, many and varied long-term conditions that need treatment and care from more than one service at once (general practice, community nursing, social services, etc.). The better co-ordinated these services are, the more likely it is that these patients will be aware of, and able to use, the range of support needed to maintain their health. This helps people to avoid further illness and hospital admissions and to continue living in their own homes. In recent years the NHS has introduced new organisations and ways of working in order to improve the care of people with complex health needs. These approaches include general practitioner-led health centres, ‘case management’ (where a community matron or similar co-ordinates patients’ care) and (especially in London) ‘polyclinics’. This study explores how these approaches compare in terms of improving the co-ordination of patient care across the range of services. It is based on interviews with patients with complex health-care needs, their carers (where appropriate) and their health/social care workers to find out what helps to co-ordinate the care that patients receive and what creates difficulties. The study also looked at the Swedish health system to find out how that goes about integrating and co-ordinating care for patients with complex care needs. The paper concludes that combining general practice and community health services into one organisation is likely to co-ordinate care better than the current separation between general practice and other health services. (Edited publisher abstract)
The critical role of social workers in home-based primary care
- Authors:
- RECKREY Jennifer M., et al
- Journal article citation:
- Social Work in Health Care, 53(4), 2014, pp.330-343.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care programme in New York City, has a vibrant social work programme that is integrated into the routine care of homebound patients. The authors describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers’ individualised care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programmes is essential in the interdisciplinary care of the most needy patients. (Edited publisher abstract)
Quality of chronic disease care for older people in care homes and the community in a primary care pay for performance system: retrospective study
- Authors:
- SHAH Sunil M., et al
- Journal article citation:
- British Medical Journal, 12.3.11, 2011, p.587.
- Publisher:
- British Medical Association
Using Retrospective analysis of the Health Improvement Network (THIN), a large primary care database, this study describes the quality of care for chronic diseases among older people in care homes compared with the community in a pay for performance system (the Quality and Outcomes Framework). Participants were 10,387 residents of care homes and 403,259 residents in the community aged 65 to 104 and registered for 90 or more days with their general practitioner. A total of 326 English and Welsh general practices were included. After adjustment for age, sex, dementia, and length of registration, attainment of quality indicators was significantly lower for residents of care homes than for those in the community for 14 of 16 indicators. Attainment was lower in nursing homes than in residential homes. The study concludes that there is scope for improving the management of chronic diseases in care homes, but high attainment of some indicators shows that pay for performance systems do not invariably disadvantage residents of care homes compared with those living in the community. High use of exception reporting may compromise care for vulnerable patient groups.
Effects of guided care on family caregivers
- Authors:
- WOLFF Jennifer L., et al
- Journal article citation:
- Gerontologist, 50(4), August 2010, pp.459-470.
- Publisher:
- Oxford University Press
Guided Care (GC) for multi-morbid older people is provided by a registered nurse who works with the patients’ primary care physician (PCP). This study determined whether GC improves patients’ primary caregivers’ depressive symptoms, strain, productivity, and perceptions of the quality of care recipients’ chronic illness care. A randomised controlled trial of GC was conducted within 14 PCP teams. Participants included 196 primary caregivers who completed baseline and 18-month surveys and whose care recipients remained alive and enrolled in the GC study for 18 months. Caregiver outcomes included the following: depressive symptoms; strain; the quality of care recipients’ chronic illness care; and personal productivity. Findings revealed that between-group differences in depression, strain, work productivity, and regular activity productivity were not statistically significant after 18 months, but GC caregivers reported the overall quality of their recipients’ chronic illness care to be significantly higher. Quality was significantly higher in 4 of 5 Patient Assessment of Chronic Illness Care subscales, reflecting goal setting, coordination of care, decision support, and patient activation. The authors concluded that GC improved the quality of chronic illness care received by multi-morbid care recipients but did not improve caregivers’ depressive symptoms, affect, or productivity.
Improving health care for assisted living residents
- Authors:
- KANE Robert L., MACH John R.
- Journal article citation:
- Gerontologist, 47(3), December 2007, pp.100-109.
- Publisher:
- Oxford University Press
The purpose of this article is to explore how medical care is delivered to older people in assisted living (AL) settings and to suggest ways for improving it. It draws on a review of the limited research available on health care for older AL residents and on building testable models of better ways to organize primary health care and other health services for AL residents. Results found AL residents are frequently frail older persons who need good chronic care. The predominant care models today do not respond adequately to this challenge. Medical care for AL residents is currently practiced very much like that for persons living in the community. The potential for using the aggregation of patients has not been effectively tapped. The authors review some managed care models from other elements of long-term care, including the Evercare model, to look for ways that might be adapted. However, the current funding approach emphasizes living settings rather than inherent client characteristics. A research agenda might include ways to improve communication between AL and medical providers and to get AL staff more actively involved in daily care. Research support might produce the data necessary to entice the Centers for Medicare and Medicaid Services into changing its current reimbursement policies to create a climate better suited to delivering good chronic disease care in AL facilities.
National service frameworks: a practical aid to implementation in primary care; funding streams
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2002
- Pagination:
- 2p.
- Place of publication:
- London
The following funds have been announced directly to support the NSFs: chronic heart disease, cancer, mental health, and older people.