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Formal home-care utilisation by older adults in Ireland: evidence from the Irish Longitudinal Study on Ageing (TILDA)
- Authors:
- MURPHY Catriona M., WHELAN Brendan J., NORMAND Charles
- Journal article citation:
- Health and Social Care in the Community, 23(4), 2015, pp.408-418.
- Publisher:
- Wiley
The aim of this study was to provide a population-based estimate of the utilisation of publicly financed formal home care by older adults in Ireland and to identify the principal characteristics of those utilising formal home care. Data were collected through computer-aided personal interviews from a representative sample of community living older adults in Ireland. The interviews were conducted between 2009 and 2011 as part of the first wave of the Irish Longitudinal Study on Ageing (TILDA). The study is cross-sectional in design and limited to participants aged 65 years and older (n = 3507). Results reveal that 8.2% of participants utilised publicly financed formal home care in the form of home help and/or personal care. Key determinants of formal home-care utilisation were Instrumental Activity of Daily Living (IADL) difficulty, older age and living alone. Almost half of those utilising formal care did not self-report an Activity of Daily Living (ADL) difficulty or an IADL difficulty. Government policy aims to reduce the need for long-term residential care by providing formal home care for older adults with low to moderate levels of dependency. This requires an increasing emphasis on personal care provision in the home. No evidence was found in this study to suggest that a shift in emphasis from formal domestic to personal care is taking place in Ireland. The absence of standardised assessment and eligibility criteria are deemed to be barriers to reorientation of the system. From a health services perspective, the current situation is not sustainable into the future and requires a focused policy response. (Edited publisher abstract)
A jam-jar model of life expectancy and limits to life
- Authors:
- MAYHEW Les, SMITH David
- Publisher:
- International Longevity Centre UK
- Publication year:
- 2015
- Pagination:
- 18
- Place of publication:
- London
This paper presents a new method for forecasting life expectancy based on decomposition techniques, focusing on trends in life expectancy within specified age intervals. It imagines each decade of life as a 'jam-jar' which fills to the brim with life years, with extra life years being added to the each decade's jam-jars at different rates, filling the early ones first, until all are full. The key advantages of this approach are more certainty over which age groups are affected and more accurate information about possible limits to life. Results are presented for England and Wales and the implications discussed. A concluding section briefly compares this approach with other methods. The study suggests a systematic shift in survival at higher ages. Most future growth in life expectancy in retirement will come between ages 70 and 100. Life expectancy beyond 100 years of age is increasing very slowly and so will not contribute as much as was thought. Age at death will tend to increasingly cluster in early 90s as the age of death of men and women converge. The paper argues that as a result government policies must be durable, especially anything to do with pensions, health and social care, or housing. (Edited publisher abstract)
Health survey for England 2014: chapter 6 social care provision
- Authors:
- ROONEY Keeva, DARTON Robin, WITTENBERG Raphael
- Publisher:
- Health and Social Care Information Centre
- Publication year:
- 2015
- Pagination:
- 11
- Place of publication:
- Leeds
This chapter presents results from the Health Survey for England 2014 about the provision of unpaid social care by adults aged 16 and over. This is defined as help or support provided to someone because of long-term physical or mental ill-health, a disability or problems relating to old age and excludes any help given in a professional capacity or as part of a job. The findings show that 17 per cent of adults provided unpaid help or support to other people, with women more likely than men to do so (20 per cent and 14 per cent respectively). Prevalence of providing unpaid care was lowest among those in higher income households and increased with decreasing income. Care was most commonly provided to a parent and men were more likely than women to provide help or support for a spouse or partner, with just under a fifth doing so. Most commonly, those who provided help and support said that they did so for between 1-9 hours in the last week. However, a substantial proportion of men and women provided more care, with 27 per cent providing 10 or more hours in the last week. (Edited publisher abstract)
Passive suicide ideation: an indicator of risk among older adults seeking aging services?
- Authors:
- VAN ORDEN Kimberly A., et al
- Journal article citation:
- Gerontologist, 55(6), 2015, pp.972-980.
- Publisher:
- Oxford University Press
Objectives: This study examines patterns of endorsements of active suicide ideation (SI), passive SI (synonymous with death ideation), and psychological distress (i.e., depressive and anxious symptomatology) in a sample of vulnerable older adults. Methods: Data were collected via in-home interviews with ageing services care management clients aged 60 years and older (n = 377). The Paykel scale for suicide measured the most severe level of suicidality over the past year, and the ninth item of the Patient Health Questionnaire (PHQ-9) measured current passive/active SI. The remaining items from the PHQ (i.e., PHQ-8) and the Goldberg Anxiety scale measured distress. Results: Latent class analysis revealed a four-class model: a group with mild distress and no active SI, a group with high distress and no ideation, a group with mild distress and both passive and active SI, and a group with high distress and both passive and active SI. Discussion: Results indicate that passive SI rarely presents in vulnerable older adults in the absence of significant risk factors for suicide (i.e., psychological distress or active SI). Thus, the desire for death and the belief that life is not worth living do not appear to be normative in late life. (Edited publisher abstract)
Community mental health teams for older people: variations in case mix and service receipt (I)
- Authors:
- TUCKER Sue, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(6), 2015, pp.595-604.
- Publisher:
- Wiley
Objectives: The study sought to identify the characteristics of community-dwelling older people supported by community mental health teams (CMHTs) in England and, in particular, to determine whether there is a common threshold for CMHT entry and/or a core client group. Methods: Data were collected about a random sample of 15 CMHTs' caseloads, including information about their sociodemographic characteristics, physical health, dependence, mental health, risks and service receipt. The sample was divided into 16 subgroups of people with similar needs for care (case types), and differences between teams were explored. Results: Information was obtained for 1396 patients. Just under half had a functional mental health problem, slightly over a third an organic disorder, seven per cent both, and nine per cent no diagnosis. Considerable variation was found in teams' caseloads, and there was no evidence of a common caseload threshold. Two of the commonest case types represented people with functional diagnoses who were independent in activities of daily living (ADL) and had no/low levels of challenging behaviour. Another representing people with organic/mixed diagnoses, ADL dependence, challenging behaviour and at least one medium risk was also fairly common. The two case types that represented patients with the most complex needs accounted for more than a quarter of some teams' caseloads but less than a tenth of others. Conclusions: It is wrong to assume that CMHTs all have similar caseloads. Commissioners must ensure that the network of services provided can meet the needs of all eligible patients, whilst more research is required on who such teams should target. (Publisher abstract)
Community mental health teams for older people: variations in case mix and service receipt (II)
- Authors:
- WILBERFORCE Mark, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(6), 2015, pp.605-613.
- Publisher:
- Wiley
Objectives: To determine the extent to which services provided to older people via community mental health teams (CMHTs) vary in duration, composition and intensity. In particular, to identify the degree to which differences between teams are due to casemix. Methods: Data were collected about the services provided to a random sample of patients from 15 CMHT caseloads, including contact with CMHT staff, other specialist mental health and social care services. The relationship between patients' needs and service receipt was explored. Results: Information was obtained for 1396 patients. Average time on CMHT caseloads was 11.6 months, but there were marked between-team differences. The proportion of re-referrals also varied from under a tenth to over half. People with functional mental health problems and complex needs were most likely to be long-term CMHT clients. The proportion of patients seen by a consultant in the previous 6 months ranged from approximately a fifth to almost all. Differences with respect to contact with other qualified practitioners were less marked. Older people with functional disorders, challenging behaviour and at least one medium risk had the most regular contact with CMHT staff. Risk of self-harm, delusions and paranoia increased the likelihood of consultant involvement. Support workers were more likely to see people at risk of self-neglect. The receipt of other services, including day hospitals and inpatient care varied greatly. Conclusions: Considerable diversity was found in the length, nature and frequency of services provided to patients with different needs. Differences between teams were not wholly explained by case mix. (Publisher abstract)
Prioritising care services: do the oldest users lose out?
- Authors:
- GAUTUN Heidi, GRODEM Anne Skevik
- Journal article citation:
- International Journal of Social Welfare, 24(1), 2015, pp.73-80.
- Publisher:
- Wiley
Population ageing is a major concern in most European countries. Demands for health- and care services will increase, as older people typically have a higher need for such services. Older users increasingly compete with younger users for the same limited care resources. By interviewing decision-makers in Norwegian municipalities, this study examines how staff in the Norwegian care sector make decisions regarding the allocation of services to younger and older users. Despite providing for equal rights to services, laws allow for an interpretation of needs and this can result in the unequal distribution of services. The study indicates that needs are defined differently for younger and older users, which affects the amount, type and content of the services allocated to younger and older people. (Edited publisher abstract)
The determinants of receiving social care in later life in England
- Authors:
- VLACHANTONI A., et al
- Journal article citation:
- Ageing and Society, 35(2), 2015, pp.321-345.
- Publisher:
- Cambridge University Press
Demographic change and policy changes in social care provision can affect the type of social care support received by older people, whether through informal, formal state or formal paid-for sources. This paper analyses the English Longitudinal Study of Ageing data (wave 4) in order to examine the relationship between demographic and socio-economic characteristics, and the receipt of support from different sources by older people who report difficulty with daily activities. The research outlines three key results with implications for the future organisation of social care for older people. Firstly, the number of instrumental activities of daily living (IADLs) an older person reports having difficulty with, followed by the number of activities of daily living (ADLs) are the strongest determinants of receiving support from any source. Secondly, there are significant gender differences in the factors associated with receiving support from different sources; for example, physical health is a strong determinant of informal support receipt by men, while mental health status is a strong determinant of informal support receipt by women. Finally, the research shows that different kinds of impediments in everyday life are associated with receiving support from different sources. This 'link' between particular types of difficulties and support receipt from particular sources raises questions about the way social care provision can or should be organised in the future. (Publisher abstract)
Predictors of the availability and variety of social care services for older adults: comparison of Central European countries
- Authors:
- LEHMANN Stepanka, HAVLIKOVA Jana
- Journal article citation:
- Journal of Social Service Research, 41(1), 2015, pp.113-132.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The ageing of the European population represents a challenge for the current systems of social care services and in particular for the availability of individualised formal social care for older people. This article looks at 8 Central European countries and explores the contextual factors that boost or inhibit the development of these services, identifies the most important among them, and describes the specific contexts that are conducive to the development of social care services for older adults. Qualitative and quantitative data from Eurostat and the international project Housing and Home Care for the Elderly and Vulnerable People and Local Partnership Strategies in Central European Cities were analysed using multidimensional scaling and multiple correspondence analysis. The results indicate that the availability and variety of social care services are above all linked to economic indicators, the age structure of the population, and un/employment rates. Moreover, the contextual factors tend to have a combined influence on the social care system. These findings imply that before restructuring the systems of social care services, local governments should take into consideration the simultaneous effect of multiple factors. However, the exploratory results of this study need to be verified in a larger number of diverse countries. (Edited publisher abstract)
Health survey for England 2014: chapter 5 social care: need for and receipt of help
- Authors:
- MAPLETHORPE Natalie, DARTON Robin, WITTENBERG Raphael
- Publisher:
- Health and Social Care Information Centre
- Publication year:
- 2015
- Pagination:
- 14
- Place of publication:
- Leeds
This chapter presents information about the need for and receipt of social care among adults aged 65 and over, examining whether they receive care and how it is provided. Most of the chapter is based on Health Survey for England 2014 data but where bases are too small for robust analysis, 2013 and 2014 data have been combined. The HSE does not cover people in care homes and, within the community, it focuses on older people, who constitute by far the largest group receiving care. The findings show that 24 per cent of men and 33 per cent of women aged 65 and over needed help with at least one Activity of Daily Living (ADL) and 21 per cent and 34 per cent respectively needed help with at least one Instrumental Activity of Daily Living (IADL). There was variation according to household income, with greatest need and highest proportions receiving help in the lowest income tertile. Among people who had received help with ADLs in the last month, 82 per cent of men and 75 per cent of women had received this solely from unpaid helpers, including relatives, friends and neighbours and the picture was similar for IADLs. (Edited publisher abstract)