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Older persons’ experiences and perspectives of receiving social care: a systematic review of the qualitative literature
- Authors:
- JOSE Jose de Sao, et al
- Journal article citation:
- Health and Social Care in the Community, 24(1), 2016, pp.1-11.
- Publisher:
- Wiley
This article presents and discusses a systematic review of relevant qualitative research-based evidence on the older persons’ experiences and perspectives of receiving social care published between 1990 and September 2014. This review aimed to obtain answers to the following questions: How is the reception of social care experienced by the older persons? What are the negative and positive aspects of these experiences? What are the factors which influence the experiences? The synthesis of the findings of reviewed papers identified six analytical themes: asking for care as a major challenge; ambivalences; (dis)engagement in decisions concerning care; multiple losses as outcomes of receiving social care; multiple strategies to deal with losses originated by the ageing process; and properties of ‘good care’. These themes are discussed from the point of view of their implications for theory, care practice and social policy, and future research. (Edited publisher abstract)
Advancing the evidence base for social work in long-term care: the disconnect between practice and research
- Authors:
- SIMONS Kelsey, SHEPHERD Nancy, MUNN Jean
- Journal article citation:
- Social Work in Health Care, 47(4), 2008, pp.392-415.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This systematic review examines primarily North American literature on social work practice in long term care settings for older people: nursing homes; hospitals; home health care; and primary care. It also looks at the literature in terms of care mode: case or care management; Geriatric Evaluation and Management (GEM) teams; and Program of All-Inclusive Care of the Elderly (PACE). Particular efforts had been made to identify studies on GEM and PACE. The evidence supports the efficacy of social work services in these interdisciplinary models of intervention and in the context of community-based case management. However, there is less robust evidence on the value of social work within nursing homes and hospitals. The implications for social work practice in nursing homes are discussed.
Does older adults’ use of social care influence their healthcare utilisation? A systematic review of international evidence
- Authors:
- SPIERS Gemma, et al
- Journal article citation:
- Health and Social Care in the Community, 27(5), 2019, pp.e651-e662.
- Publisher:
- Wiley
This systematic review aimed to synthesise evidence on the relationship between older adults’ use of social care and their healthcare utilisation. Ten databases were searched for international literature on social care (exposure), healthcare use (outcome) and older adults (population). Searches were carried out in October 2016, and updated May 2018. Studies were eligible if they were published after 2000 in a high income country, examined the relationship between use of social care and healthcare utilisation by older adults (aged ≥60 years), and controlled for an indicator of need. Study quality and bias were rated using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. Study data were extracted and a narrative synthesis was conducted. Data were not suitable for quantitative synthesis. Thirteen studies were identified from 12,065 citations. Overall, the quality and volume of evidence was low. There was limited evidence to suggest that longer lengths of stay in care homes were associated with a lower risk of inpatient admissions. Residents of care homes with onsite nursing had fewer than expected admissions to hospital, compared to people in care homes without nursing, and adjusting for need. Evidence for other healthcare use outcomes was even more limited and heterogeneous, with notable gaps in primary care. The authors conclude that older adults’ use of care homes may moderate inpatient admissions. In particular, the presence of registered nurses in care homes may reduce the need to transfer residents to hospital. However, further evidence is needed to add weight to this conclusion. Future research should build on this evidence and address gaps regarding the influence of community based social care on older adults’ healthcare use. A greater focus on primary care outcomes is imperative. (Edited publisher abstract)
Australian social work research on ageing and aged care: a scoping review
- Authors:
- HUGHES Mark, BIGBY Christine, TILBURY Clare
- Journal article citation:
- Journal of Social Work, 18(4), 2018, p.431–450.
- Publisher:
- Sage
Summary: Little is known about the quantity, nature and range of Australian social work research on ageing and aged care. This scoping review involved a comprehensive search of seven online bibliographic databases. The review identified 108 peer-reviewed journal articles, published between January 2007 and June 2014, that reported Australian social work research on ageing and aged care. Findings: The average number of authors per paper was 2.10 with most social work researchers co-authoring papers with non-social workers. The main topics of research focus were health and rehabilitation, elder abuse, asset management, community services and caregiving, housing and residential aged care, and ageing with an intellectual disability. The findings highlight the contribution social work researchers make to multidisciplinary gerontological research, and to understanding the lived experiences of older people and the provision of services. However, they also point to the relative paucity of research focusing on direct social work practice with older people, and the little evidence of the participation of older people and carers in the design and delivery of research. Applications: The findings indicate the need for capacity-building strategies, such as developing networks of Australian social work researchers on ageing and aged care, to improve research outputs in this area. (Edited publisher abstract)
Barriers and facilitators for male carers in accessing formal and informal support: a systematic review
- Authors:
- GREENWOOD Nan, SMITH Raymond
- Journal article citation:
- Maturitas, 82(2), 2015, pp.162-169.
- Publisher:
- Elsevier
Unpaid, informal carers play a vital role in supporting people with long-term conditions. Being a carer can be challenging and carers may need support but they frequently fail to access it. Compared to research investigating the experiences of female carers, research with male carers is underdeveloped. The available evidence suggests male and female carers have many experiences in common but some research suggests that compared to females, male carers are even less likely to access services. The aim of this systematic review was to synthesise research investigating adult male carers’ experiences of accessing formal and informal support focussing on the barriers and facilitators. Nine health and social care electronic databases were searched (e.g. PubMed, PsychINFO, CINAHL Plus, Social Policy and Practice, Scopus). Seven studies (five qualitative and two quantitative) fitting the inclusion criteria were identified. All came from North America and most focussed on older carers caring for people with dementia. All seven studies described barriers to accessing support and three highlighted facilitators. Male carers felt committed to their role, seeing it as their responsibility but were often ambivalent about seeking help. Insufficient service information was frequently emphasised. Participants highlighted positive past experiences and professional or voluntary sector support in providing information and helping access services. Research into male carers’ experiences in accessing support remains underdeveloped. Research that distinguishes between, for example, the experiences of spouses and sons and with direct comparisons between male and female carers is needed. Whether gender specific services would benefit male carers remains undetermined. (Publisher abstract)
A systematic review of different models of home and community care services for older persons
- Authors:
- LOW Lee-Fay, YAP Melvyn, BRODATY Henry
- Journal article citation:
- BMC Health Services Research, 11(93), 2011, pp.1-15. Online only
- Publisher:
- BioMed Central Ltd
Background: Costs and consumer preference have led to a shift from the long-term institutional care of aged older people to home and community based care. The aim of this review is to evaluate the outcomes of case managed, integrated or consumer directed home and community care services for older persons, including those with dementia. Methods: A systematic review was conducted of non-medical home and community care services for frail older persons. MEDLINE, PsycINFO, CINAHL, AgeLine, Scopus and PubMed were searched from 1994 to May 2009. Two researchers independently reviewed search results. Results: Thirty five papers were included in this review. Evidence from randomised controlled trials showed that case management improves function and appropriate use of medications, increases use of community services and reduces nursing home admission. Evidence, mostly from non-randomised trials, showed that integrated care increases service use; randomised trials reported that integrated care does not improve clinical outcomes. The lowest quality evidence was for consumer directed care which appears to increase satisfaction with care and community service use but has little effect on clinical outcomes. Studies were heterogeneous in methodology and results were not consistent. Conclusions: The outcomes of each model of care differ and correspond to the model’s focus. Combining key elements of all three models may maximise outcomes. (Edited publisher abstract)
Modernising social care services for older people: scoping the United Kingdom evidence base
- Authors:
- JACOBS Sally, et al
- Journal article citation:
- Ageing and Society, 29(4), May 2009, pp.497-538.
- Publisher:
- Cambridge University Press
In common with other developed countries at the end of the 20th century, modernising public services was a priority of the United Kingdom (UK) Labour administration after its election in 1997. The modernisation reforms in health and social care exemplified their approach to public policy. The authors were commissioned to examine the evidence base for the modernisation of social care services for older people, and for this purpose conducted a systematic review of the relevant peer-reviewed UK research literature published from 1990 to 2001. Publications that reported descriptive, analytical, evaluative, quantitative and qualitative studies were identified and critically appraised under six key themes of modernisation: integration, independence, consistency, support for carers, meeting individuals' needs, and the workforce. This paper lists the principal features of each study, provides an overview of the literature, and presents substantive findings relating to three of the modernisation themes (integration, independence and individuals' needs). The account provides a systematic portrayal both of the state of social care for older people prior to the modernisation process and of the relative strengths and weaknesses of the evidence base. It suggests that, for evidence-based practice and policy to become a reality in social care for older people, there is a general need for higher quality studies in this area.
Self assessment of health and social care needs by older people: a multi-method systematic review of practices, accuracy, effectiveness and experience
- Authors:
- GRIFFITHS Peter, et al
- Publisher:
- National Co-ordinating Centre for NHS Service Delivery and Organisation
- Publication year:
- 2005
- Pagination:
- 272p.
- Place of publication:
- London
- Edition:
- Rev. ed.
Explores the meaning and significance of 'self-assessment' in the literature, a term that is increasingly being used in relation to developments affecting community practice. Self-assessment for health and social care needs has been used over a considerable period of time and for purposes as diverse as case finding for depression to assessment of housing options. Self-assessment has usually involved the use of short scales and questionnaires, but it can involve the use of physiological tests (such as testing urine for glucose) or complex, computerized decision-support systems. Although often explored as a simple means for extending the 'reach' of professional assessments (e.g. mass screening) and ensuring 'appropriate' use of health services (e.g. self-care algorithms), self-assessment is increasingly being advocated as a means of actively involving and empowering service users. However, this review of the topic revealed the complexity of the topic and the pitfalls of a simplistic approach to self-assessment, which those engaged in developing the process should bear in mind.
Studies of the cost-effectiveness of social work services in aging: a review of the literature
- Authors:
- RIZZO Victoria M., ROWE Jeannine M.
- Journal article citation:
- Research on Social Work Practice, 16(1), January 2006, pp.67-73.
- Publisher:
- Sage
The American population aged 65 years and older is growing rapidly, creating an increased demand for social workers. Reimbursement structures of Medicare and Medicaid present significant barriers for aging individuals seeking social work services as well as social workers wanting to provide services to the elderly. To build a case for the modification of these reimbursement structures, a review of studies of social work services in aging was conducted to (a) make explicit the current knowledge of the efficacy and cost-effectiveness of these services, (b) identify current gaps in knowledge, (c) promote a research agenda to address the gaps, and (e) assure that the knowledge identified addresses payers ‘needs to understand the value of social work services in aging. The results indicate that social work interventions can have a positive impact on the health care costs, the use of health care services, and the quality of life of older Americans.
Service delivery models to maximize quality of life for older people at the end of life: a rapid review
- Authors:
- EVANS Catherine J., et al
- Journal article citation:
- Milbank Quarterly, 97(1), 2019, pp.113-175.
- Publisher:
- Wiley
Policy Points: This study identified two overarching classifications of integrated geriatric and palliative care to maximize older people's quality of life at the end of life. Both are oriented to person-centred care, but with differing emphasis on either function or symptoms and concerns. Policymakers should both improve access to palliative care beyond just the last months of life and increase geriatric care provision to maintain and optimize function. This would ensure that continuity and coordination for potentially complex care needs across the continuum of late life would be maintained, where the demarcation of boundaries between healthy aging and healthy dying become increasingly blurred. Our findings highlight the urgent need for health system change to improve end-of-life care as part of universal health coverage. The use of health services should be informed by the likelihood of benefits and intended outcomes rather than on prognosis. CONTEXT: In an era of unprecedented global aging, a key priority is to align health and social services for older populations in order to support the dual priorities of living well while adapting to a gradual decline in function. This study aimed to provide a comprehensive synthesis of evidence regarding service delivery models that optimize the quality of life (QoL) for older people at the end of life across health, social, and welfare services worldwide. METHODS: This study conducted a rapid scoping review of systematic reviews. This study searched MEDLINE, CINAHL, EMBASE, and CDSR databases from 2000 to 2017 for reviews reporting the effectiveness of service models aimed at optimizing QoL for older people, more than 50% of whom were older than 60 and in the last one or two years of life. This study assessed the quality of these included reviews using AMSTAR and synthesized the findings narratively. RESULTS: Of the 2,238 reviews identified, this study included 72, with 20 reporting meta-analysis. Although all the World Health Organization (WHO) regions were represented, most of the reviews reported data from the Americas (52 of 72), Europe (46 of 72), and/or the Western Pacific (28 of 72). This study identified two overarching classifications of service models but with different target outcomes: Integrated Geriatric Care, emphasizing physical function, and Integrated Palliative Care, focusing mainly on symptoms and concerns. Areas of synergy across the overarching classifications included person-centred care, education, and a multiprofessional workforce. The reviews assessed 117 separate outcomes. A meta-analysis demonstrated effectiveness for both classifications on QoL, including symptoms such as pain, depression, and psychological well-being. Economic analysis and its implications were poorly considered. CONCLUSIONS: Despite their different target outcomes, those service models classified as Integrated Geriatric Care or Integrated Palliative Care were effective in improving QoL for older people nearing the end of life. Both approaches highlight the imperative for integrating services across the care continuum, with service involvement triggered by the patient's needs and likelihood of benefits. To inform the sustainability of health system change this study encourages more economic analyses that span health and social care and that examines all sources of finance to understand contextual inequalities. (Edited publisher abstract)