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Applying community-oriented primary care methods in British general practice: a case study
- Authors:
- ILIFFE Steve, et al
- Journal article citation:
- British Journal of General Practice, 52(481), August 2002, pp.646-651.
- Publisher:
- Royal College of General Practitioners
Health assessments for older people have become an increasing priority with the NSF for Older People. In response to low level of activity in primary care around health assessment for older people, Camden and Islington Health Authority initiated a project in 1996-97 to develop innovative primary care for older people. This article reports on the study which was conducted in four general practices. Results found all four practices identified problems needing attention in the older population, developed different projects focused on particular needs among older people, and tested them in practice. Patient and public involvement were central to the design and implementation process in only one practice. Innovations were sustained in only one practice, but some were adopted by primary care group and others extended to a wider group of practices by the health authority.
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.
Aging with HIV: psychological, social, and health issues
- Authors:
- NICOLS Janice E., et al
- Publisher:
- Academic Press
- Publication year:
- 2002
- Pagination:
- 386p.,bibliog.
- Place of publication:
- London
In 1998, approximately 30 million people worldwide were living with HIV/AIDS, about 5 million of whom became infected that year. The epidemic continues to expand, with an estimated doubling time of 10 years, making AIDS the leading infectious cause of death ahead of tuberculosis and malaria. Even in the U.S.A. where the death rate from AIDS is declining as a result of effective drug therapies, HIV infection rates continue to climb in several population groups. The prevalence of AIDS among people over the age of 50 is steadily increasing, and most older people are unprepared to address it for a number of reasons, including the widespread discomfort with matters sexual and homosexual and the belief that elderly people are not sexually active and therefore not at risk. This guide for care providers seeks to educate and inform readers about the difficulties and complications that accompany the disease in older people. Thus, while the appendix includes technical descriptions of methodology, data, and results, the narratives in the chapters describing the findings and their practical implications are written in layman's language. Topics covered include biomedical aspects, demographics, sexuality, stressors, mental health, older women, and patient care, all of which are supported by case studies.
Implementation of the national service framework and intermediate care seen from geriatricians' and older people's perspectives: results of two national surveys; reasons for optimism, reasons for concern
- Authors:
- AGE CONCERN, BRITISH GERIATRICS SOCIETY
- Publishers:
- Age Concern, British Geriatrics Society
- Publication year:
- 2002
- Pagination:
- 5p.
- Place of publication:
- London
Both organisational authors were concerned to find that a significant number of hospital beds previously used for acute or rehabilitation care had been switched to intermediate care. Local intermediate care services appear to remain fragmented. On the medical side there is significant lack of specialist input into clinical management. The significant increase in workload generated by the National Service Framework (NSF) for Older People may not be sustainable without further resources.
Primary care for elderly people: why do doctors find it so hard?
- Authors:
- ADAMS Wendy, et al
- Journal article citation:
- Gerontologist, 42(6), December 2002, pp.835-842.
- Publisher:
- Oxford University Press
Many primary care physicians find caring for elderly patients difficult. The goal of this study was to develop a detailed understanding of why physicians find primary care with elderly patients difficult. Three major domains of difficulty emerged: medical complexity and chronicity, personal and interpersonal challenges, and administrative burden. The greatest challenge occurred when difficulty in more than one area was present. Contextual conditions, such as the practice environment and the physician's training and personal values, shaped the experience of providing care and how difficult it seemed.
Domiciliary clinics: a cost minimisation analysis
- Authors:
- ANDERSON David, AQUILINA Carmelo
- Journal article citation:
- International Journal of Geriatric Psychiatry, 17(10), October 2002, pp.945-949.
- Publisher:
- Wiley
This article compares the cost of assessing new referrals to an old age psychiatry service at the patient's home or a hospital-based clinic. An old age psychiatry service in Liverpool where routine referrals were assessed at home (domiciliary clinic) was compared to an adjacent service which assessed people in an outpatient clinic. Activity levels for four years of the service were collected and analysed. The domiciliary clinic was marginally cheaper than outpatient assessment (£48 compared to £50 per successful assessment). The most important variables in determining the cost effectiveness of the service were non-attendance rates, the grade of doctor seeing the patient and the time spent traveling for the home assessment.
Acute hospitals and older people in Australia
- Author:
- McCORMACK John
- Journal article citation:
- Ageing and Society, 22(5), September 2002, pp.637-646.
- Publisher:
- Cambridge University Press
The Australian health care system is frequently portrayed as being in crisis, with reference to either large financial burdens in the form of hospital deficits, or declining service levels. Older people, characterised as a homogeneous category, are repeatedly identified as a major contributor to the crisis, by unnecessarily occupying acute beds while they await a vacancy in a residential facility. Several enquiries and hospital taskforce management groups have been set up to tackle the problem. This article reviews their findings and strategic recommendations, particularly as they relate to older people. Short-term policy responses are being developed which specifically target older people for early discharge and alternative levels of care, and which, while claiming positive intentions, may introduce new forms of age discrimination into the health system.
Social skills
- Author:
- BANYARD Richard
- Journal article citation:
- Health Service Journal, 112(5820), August 2002, pp.24-25.
- Publisher:
- Emap Healthcare
This article argues that attaching social workers to general practices can improve older people's access to services.
Would older people use psychological services?
- Authors:
- AREAN Patricia A., et al
- Journal article citation:
- Gerontologist, 42(3), June 2002, pp.392-398.
- Publisher:
- Oxford University Press
This article examines older patient preferences for psychological services, including the types of services they would be interested in and who should provide them. Seventy-nine percent of the sample surveyed said they would use any of the psychological services which were presented to them. Seventy-two percent preferred to talk to their primary care provider, and 46% of the sample indicated that they would also speak with a mental health worker or nurse about their problems. Few older people said they would attend group psychotherapy, but 69% said they would attend psychoeducational classes. Implications: Our findings suggest that older adults would be amenable to psychosocial services, particularly individual services and psychoeducational programming.
How can we improve GPs' response to dementia
- Authors:
- DOWNS Murna, et al
- Journal article citation:
- Journal of Dementia Care, 10(3), May 2002, pp.18-19.
- Publisher:
- Hawker
Provides an overview of a study which evaluates three kinds of educational intervention to help improve primary care for people with dementia and their families. Discusses the use of small-group practice-based learning; a CD-ROM; and a Computer Decision Support System (CDSS).