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Proactive, targeted benefits advice for older people in general practice: a feasibility study
- Authors:
- TOEG Daniel, at al
- Journal article citation:
- Health and Social Care in the Community, 11(2), March 2003, pp.124-128.
- Publisher:
- Wiley
Aimed to assess a welfare benefits and advice screening programme offered in a systematic and inclusive way to all patients aged 80 and over registered with an inner-city NHS group practice with 7 full-time GPs and a list of 12,000 of whom 280 were identified as 80 and over. Using a combination of telephone calls, surgery attendances and home visits, an advice worker contacted as many of these as possible. A wide range of advice and assistance of both a statutory and non-statutory nature was offered. Follow-up contacts and liaison with the patients' own GPs were arranged as necessary. Contact was made with 206. The adviser made 98 home visits, carried out 82 consultations in the surgery and did 109 telephone interviews. Findings indicate a total of £137,819 was gained in increased annual income amongst the screened patients and a further £11,433 was awarded in one-off payments. A wide range of other benefits and help, including referral to other services and organisations, was gained. Elderly patients within the practice were under-claiming benefits and had many previously unidentified needs. Adopting a proactive and inclusive approach to offering welfare and advice takes time and expense, but the resulting benefits make it worthwhile. Primary care is an effective base from which advice can be delivered and the development of closer working relationships between it and advice services can be an effective and efficient way of helping patients.
A portrait of district nursing: its contribution to primary health care
- Authors:
- GOODMAN Claire, te al
- Journal article citation:
- Journal of Interprofessional Care, 17(1), February 2003, pp.97-108.
- Publisher:
- Taylor and Francis
Explores the role and contribution of district nursing within primary health care. Uses examples of how this service is organised within different health care systems (Australia, the USA and Far East) to discusses the context-dependent nature and challenges of the work. Argues that significance and potential of district nursing services are frequently overlooked. Recommends that a research strategy for district nursing should build on the profession's comprehensive understanding of the needs and families and communities and should aim to provide evidence for practice that will further improve patient and client outcomes.
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.
A multi-centre survey among informal carers who manage medication for older care recipients: problems experienced and development of services
- Authors:
- SMITH Felicity, et al
- Journal article citation:
- Health and Social Care in the Community, 11(2), March 2003, pp.138-145.
- Publisher:
- Wiley
The UK Government has highlighted the need to develop appropriate information and support services for informal carers. Previous research has found that managing medication is one aspect of the role that presents its own problems; however, these have not been subject to detailed examination. The objective of this paper is to report the number and type of problems experienced by informal carers when managing medication for older care recipients and relate these to measures of coping and health. This was a cross-sectional survey undertaken in one district in each of 4 randomly selected health authority areas in England. Structured interviews, comprising closed and open questions, with 184 informal carers and 93 associated older care recipients were conducted in participants' own homes. Data were gathered on the number and type of medication-related problems experienced in relation to the informal caring role, and the impact of these from carers' perspectives in terms of coping and health. Problems with at least one medication-related activity were reported by 67% of carers. Problems were associated with all types of medication-related activities and experienced by carers providing different levels of care for older people. Four themes were identified from carers' accounts which illustrated a diversity of practical problems and anxieties: maintaining continuous supplies of medication in the home, assisting with administration, making clinical judgments and communicating with care recipients and health professionals. Carers reporting greater numbers of medication-related problems were more likely to experience higher levels of carer strain and poorer mental health status. The findings provide insights to inform the development of primary care services to support informal carers in the management of medication for older people.
Older victims of burglary and distraction burglary: recommendations for practitioners
- Author:
- GREAT BRITAIN. Home Office
- Publisher:
- GREAT BRITAIN. Home Office, Research, Development and Statistics Directorate
- Publication year:
- 2003
- Pagination:
- 4p.
- Place of publication:
- London
This report provides guidelines and recommendations for practitioners working with older people who are vulnerable to becoming a victim or who have been the victim of burglary and, in particular, distraction burglary. The suggestions raised here are relevant to practitioners dealing with older people and vulnerable groups on a day-to-day basis, and those who come into contact with older victims following a crime incident. In particular, these recommendations may be of special interest to the police, CDRPs, local authorities, other housing providers, Primary Care Trusts and organisations in the voluntary and charity sectors.
Vehicle crashworthiness and the older motorist
- Authors:
- MORRIS Andrew, et al
- Journal article citation:
- Ageing and Society, 23(4), July 2003, pp.395-409.
- Publisher:
- Cambridge University Press
This study examines the relationship between age and the injury outcomes for belted drivers in road vehicle crashes in the United Kingdom. The sample of 1,541 drivers was divided into three age groups: 889 drivers were aged 17-39 years (young drivers); 515 were 40-64 years (middle-aged), and 137 aged 65-84 years (older drivers). Both frontal and side impact crashes in which the vehicles sustained sufficient damage to be towed away from the scene are considered. In-depth information obtained from examinations of the crashed vehicles was combined with clinical data obtained from hospitals to throw light on the mechanisms that led to the injuries. Results show that in crashes of approximately equal severity, older drivers were significantly more likely than middle-aged and young drivers to be fatally injured in both frontal (p<0.001) and side (p<0.05) impact crashes. The results also show that older drivers sustained more injuries to the chest (p<0.0001) and that this body region is particularly problematic. The main sources of the chest injuries were found to be the seat belt in frontal crashes and the door in side impact crashes. As the number of older car users will increase rapidly in most OECD countries in the coming decades, the results suggest that vehicle re-designs are required, including in-vehicle crashworthiness systems, to take into account older people's relatively low tolerance of crash impacts.
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.
Intermediate care: what do we know about older people's experiences?
- Author:
- PETCH Alison
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2003
- Pagination:
- 37p.,bibliog.
- Place of publication:
- York
Traditionally ‘intermediate care’ has often been used to refer to a range of services at the boundary of primary and secondary care, although there have been differing assumptions as to the goal of intermediate care, the intensity of support provision and the appropriate target groups. Confusingly, intermediate care has also been used within the hospital as a term for units located between the intensive care unit and the general ward. The current form of intermediate care provision started to shape up with the NHS Plan. This proposed a range of intermediate care services designed to bridge between hospital and home and to: help people recover and regain independence more quickly; bring about swifter hospital discharge when people are ready to leave; and avoid unnecessary long-term care.
Changing places: report on the work of the Health and Social Care Change Agent Team 2002/03
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2003
- Pagination:
- 36p.
- Place of publication:
- London
This is the first annual report on the work of the Health and Social Care Change Agent Team (CAT). ‘Delayed discharges’ are people, quite often frail and vulnerable older people whose future care is uncertain. An acute hospital is not a good place to be whilst waiting for care arrangements to be made. Hospitals make people more dependent and there is an increased risk of acquiring an infection. While older, vulnerable people are away from home, their care networks may break down and the longer the time spent away from home, the more difficult it is to set these up again. Sometimes, had the right services been in place in the community, the person need not have gone into hospital in the first place. If people are waiting in hospital beds, other people’s admissions for planned surgery such as a hip replacement may be delayed. About 60% of all people in acute hospitals are over 65 years, so many of the people waiting to come into hospital are likely to be older people. The more medically fit people waiting in hospital beds, the fewer beds are available for emergency admissions, leading to longer waits on trolleys in the Accident & Emergency department (A&E) or the Medical Assessment Unit (MAU).
Identification of psychological morbidity in older people in primary care by practice nurses
- Authors:
- CAPE J., et al
- Journal article citation:
- Aging and Mental Health, 7(6), November 2003, pp.446-451.
- Publisher:
- Taylor and Francis
Older people with psychological morbidity generally first present to health services in primary care, where they are increasingly seen by primary care nurses. In order to evaluate primary care nurses' identification of psychological morbidity, 190 older patients attending eight practice nurses completed the General Health Questionnaire (GHQ) and the practice nurses made an assessment as to the presence or absence of psychological problems. The practice nurses identified only 26% of probable cases of psychological morbidity identified by the GHQ. Their threshold for identification was high, rating only 12% of patients as experiencing psychological problems compared to 29% probable cases identified by the GHQ, and their accuracy was low (kappa for agreement between GHQ and nurse ratings = 0.23). Likelihood of identification depended on length and type of visit. The findings suggest that it may be unrealistic to expect practice nurses, without additional training and reorganisation of their work, to identify more than a minority of older patients with psychological morbidity in the course of their routine work.