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Frailty and incident depression in community-dwelling older people: results from the ELSA study
- Authors:
- VERONESE Nicola, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.e141-e149.
- Publisher:
- Wiley
Objective: Frailty and pre-frailty are two common conditions in the older people, but whether these conditions could predict depression is still limited to a few longitudinal studies. In this paper, we aimed to investigate whether frailty and pre-frailty are associated with an increased risk of depression in a prospective cohort of community-dwelling older people. Methods: Four thousand seventy-seven community-dwelling men and women over 60 years without depression at baseline were included from the English Longitudinal Study of Ageing. Frailty status was defined according to modified Fried's criteria (weakness, weight loss, slow gait speed, low physical activity and exhaustion) and categorized as frailty (≥3 criteria), pre-frailty (1–2 criteria) or robustness (0 criterion). Depression was diagnosed as ≥4 out of 8 points of Center for Epidemiologic Studies Depression Scale, after 2 years of follow-up. Results: Over a 2-year follow-up, 360 individuals developed depression. In a logistic regression analysis, adjusted for 18 potential baseline confounders, pre-frailty (odds ratio (OR) = 0.89; 95% confidence interval (CI), 0.54–1.46; p = 0.64) and frailty (OR = 1.22; 95% CI, 0.90–1.64; p = 0.21) did not predict the onset of depression at follow-up. Among the criteria included in the frailty definition, only slow gait speed (OR = 1.82; 95% CI, 1.00–3.32; p = 0.05) appeared to predict a higher risk of depression. Conclusions: Among older community dwellers, frailty and pre-frailty did not predict the onset of depression during 2 years of follow-up, when accounting for potential confounders, whilst slow gait speed considered alone may predict depression in the older people. (Publisher abstract)
Elder abuse screening tools: a systematic review
- Authors:
- McCARTHY Louise, CAMPBELL Susan, PENHALE Bridget
- Journal article citation:
- Journal of Adult Protection, 19(6), 2017, pp.368-379.
- Publisher:
- Emerald
Purpose: Elder abuse results in high rates of morbidity and mortality. It has longstanding physical and psychological effects and is difficult to detect. Due to fear or embarrassment, victims may make attempts to hide it rather than to disclose and professionals are often reluctant to report it as they may worry about worsening a situation. If detected early enough, serious harm can be prevented and lives saved. Screening and screening tools can assist health and social care practitioners to detect abuse. This review of screening tools was undertaken as part of an MSc in clinical research, funded by the National Institute for Health Research; the purpose of this paper is to report on the review and its findings. Design/methodology/approach: This was a systematic review with eligibility inclusion and exclusion criteria decided in advance. Keywords and their synonyms were combined and then used to search health and social care databases. Data items were collected from the included studies. The preferred reporting item for systematic reviews and meta-analysis was followed for the reporting of the results. A narrative synthesis approach was applied to the analysis. Findings: A total of 34 full text studies were downloaded, read and analysed. In all, 11 met the inclusion criteria and were included in the final analysis. Of these, three studies reported sensitivity and specificity, with the remainder reporting validity and reliability testing. In total, 12 tools of varying length and quality were found. The length and characteristics of tools affects the efficacy of their use. The clinical environment will determine choice of screening tool to be used. Screening tools should be used within an overall system of detection and management of abuse. Research limitations/implications: The synthesis of results was challenging due to the lack of homogeneity between the included studies. The variations in tool characteristics and qualities added to this challenge. A further limitation was the lack of a gold standard tool in elder abuse. Originality/value: This systematic review highlights a lack of robust evidence in the development and validation of screening tools to detect elder abuse. Though there is an increasing awareness and knowledge about elder abuse, its detection remains problematic and the lack of research in this area is worth emphasising. Specific tools, centred on the clinical setting in which they are used, are recommended (Publisher abstract)
Adverse childhood experiences and substance use history among vulnerable older adults living in public housing
- Authors:
- LARKIN Heather, et al
- Journal article citation:
- Journal of Gerontological Social Work, 60(6-7), 2017, pp.428-442.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Previous research shows strong correlations between adverse childhood experiences (ACE) and later life health. The current study examines the relationship between ACEs and substance use among older adults living in public housing. Results show that about one-third of participants had four or more ACEs, and ACE score predicted likelihood of substance use history. Over half of older adults with four or more ACEs experienced substance abuse in their lifetime compared to one out of ten older adults with less than four ACEs. Findings shed light on a vulnerable group and point to next steps in research and practice. (Publisher abstract)
Psychological vulnerability and gambling in later life
- Authors:
- DENNIS Cory B., et al
- Journal article citation:
- Journal of Gerontological Social Work, 60(6-7), 2017, pp.471-486.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objectives: Because behavioural problems often emerge from maladaptive coping methods, the authors investigated whether unmet basic psychological needs evolve toward a level of psychological vulnerability that puts older adults who gamble at risk for becoming problem gamblers. Methods: Data from a community sample of 379 adults ages 60 and above were analysed using structural equation modelling. Participants responded to items regarding their demographics, gambling frequency, engagement in at-risk gambling behaviours, and the extent to which their basic psychological needs were met. Results: Satisfaction of basic psychological needs among older adults who gamble was negatively associated with their being at risk for developing a gambling problem. Satisfaction of basic psychological needs also mediated the negative effect of socioeconomic status on at-risk gambling behaviour. Conclusion: Social workers should become mindful of how older adults, who are confronting psychological vulnerabilities in later life, might well turn to gambling as a maladaptive coping mechanism (Edited publisher abstract)
Mental capacity and deprivation of liberty: the Law Commission’s review of the deprivation of liberty safeguards
- Author:
- SPENCER-LANE Tim
- Journal article citation:
- Journal of Adult Protection, 19(4), 2017, pp.220-227.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide a brief overview of the Law Commission’s final report and recommendations on the reform of the deprivation of liberty safeguards under the Mental Capacity Act. Design/methodology/approach: Summary Findings: The proposals contained in the Law Commision Review and proposals for law reform are outlined. (Publisher abstract)
What’s in a word? The importance of the concept of “values” in the prevention of abuse of older people in care homes
- Author:
- MOORE Steve
- Journal article citation:
- Journal of Adult Protection, 19(3), 2017, pp.130-145.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to present some of the findings from an empirical, mixed methods research project that reveal the importance of the personal value frameworks held by individual staff in the prevention of abuse of older people in private sector care homes. Design/methodology/approach: Semi-structured interviews were undertaken with a sample of 36 care home personnel, including proprietors, care managers and care staff. Findings: A significant number of respondents identified the importance of personal value frameworks among staff providing care as a potential contributory factor in the prevention of abuse of older people. Research limitations/implications: Though the research draws upon the experiences of only 36 care home personnel through interviews, data suggest that the personal evaluations of staff towards those in their care is a significant contributory factor to the occurrence of abuse. Originality/value: The research has identified individual staff value frameworks as a causal factor in the occurrence of abuse. The research also confirms that the perceptions of “values” among respondents directly involved in the provision of care are at odds with common understanding of “values” often cited elsewhere in connection with staff recruitment and training as a means of preventing the occurrence of abuse. (Publisher abstract)
Only available to a selected few? Is it feasible to rely on a volunteer workforce for complex intervention delivery?
- Authors:
- MOUNTAIN Gail, et al
- Journal article citation:
- Health and Social Care in the Community, 25(1), 2017, pp.177-184.
- Publisher:
- Wiley
This paper recounts the process of undertaking a randomised controlled trial which was designed to examine the effectiveness of an intervention for socially isolated older people aged 75 years and over. It describes the reasons for early cessation of the study and raises the implications of this outcome for policy, practice and research. The intervention under investigation was designed to alleviate loneliness and foster companionship. It involves participants being linked with a small group of others through a teleconferencing system with each group being facilitated by trained volunteers. There was a requirement to recruit and train a minimum of 30 and a maximum of 60 volunteers over 1 year to facilitate 20 friendship groups to meet the number of older people required to be recruited to the study. Problems with recruiting and retaining the volunteer workforce by the voluntary sector organisation, who were commissioned to do so, led to the study closing even though older people were recruited in sufficient numbers. The paper draws upon analysis of various data sources from the study to identify the potential reasons. The discussion raises considerations regarding the extent of infrastructure required to deliver community services to vulnerable user groups at scale, identifies some of the issues that need to be addressed if such volunteer-initiated services are to be successful and informs future research programmes in this area. (Publisher abstract)
Helping or hindering in adult safeguarding: an investigation of practice
- Authors:
- STEVENS Martin, MARTINEAU Stephen, NORRIE Caroline, MANTHORPE Jill
- Publisher:
- King's College London. Social Care Workforce Research Unit
- Publication year:
- 2017
- Pagination:
- 104
- Place of publication:
- London
Examines current safeguarding practice in England where access to an adult at risk is obstructed by a third party and explores views about whether social workers (and others) need more legal powers. This study focused on adults who are able to make decisions – people who have ‘mental capacity’ – as there are laws covering people who are not able to make decisions. The study found that while problems with getting to talk to adults who appeared to be at risk of harm were common, most are resolved by good social work practice, creativity and persistence. However, in a small number of cases, gaining any access proves very difficult and sometimes impossible. In these cases, legal intervention is sometimes required, but sometimes, no access is achieved. Most of the social workers and older and disabled people who were interviewed or surveyed thought that, on balance, there should be additional legal powers for social workers, including a power of entry. The study concluded that without greater knowledge about the size and nature of the problem – and therefore the costs to local authorities and the outcomes for those involved – policy options may be limited. One option proposed was to ask local authorities to count the number of cases of sustained obstruction. This would need to define terms like sustained obstruction or serious problems. Increasing the scope of current practice guidance, particularly in relation to multi-agency working, was another policy option outlined by the research. (Edited publisher abstract)