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Admission to long-stay residential care and mortality among people with and without dementia living at home but on the boundary of residential care: a competing risks survival analysis
- Authors:
- CARTER L, et al
- Journal article citation:
- Aging and Mental Health, 25(10), 2021, pp.1869-1876.
- Publisher:
- Taylor and Francis
Background: Health policy in many countries is underpinned by a commitment to support dependent older people to remain in their own home for as long as possible and practicable. This study explores factors affecting both admission to long-stay residential care (LSRC) and mortality among people with and without dementia who are currently living at home with intensive formal care support. Methods: This is a cross-sectional study based on administrative data collected on 429 dependent older people in Ireland, 269 of whom were people with dementia. A cause-specific hazard model was used to investigate the hazard of admission to LSRC, while accounting for mortality as a competing risk and vice versa. Results: Admission to LSRC was higher for people with dementia relative to people without and for those receiving lower amounts of informal care. The hazard of mortality was significantly higher for older people aged 85+, whereas it was lower for individuals with a medium level of dependency relative to those with high levels of dependency. The hazard of mortality was also influenced by the amount of informal care provision. Conclusion: People with dementia are more likely to be admitted to LSRC than people without. Care for people with dementia needs to be more specialised and personal, and intensity of provision should not be equated to the number of care hours on offer. Informal care provision may help to prevent admission to LSRC. Advanced age, physical dependency and informal care provision affect mortality, raising interesting issues in relation to resource allocation. (Edited publisher abstract)
Exploring older people’s experiences of shielding during the COVID-19 pandemic
- Authors:
- PHELAN Amenda, DALY Louise, KEOGH Brian
- Publisher:
- Trinity College Dublin. School of Nursing and Midwifery
- Publication year:
- 2021
- Pagination:
- 108
- Place of publication:
- Dublin
The aim of this study was to identify older people’s experiences of shielding during the COVID19 pandemic; to explore older people’s experiences of shielding as a public health measure; to identify the personal circumstances of shielding (i.e. alone/family); to identify facilitators and challenges within the period of shielding; to elicit any consequences of shielding (physical/psychological/social); and to consider any lessons which are important considerations if shielding of older people is necessary as a future public health measure. A total of 20 interviews were conducted ranging between 15 to 52 minutes. Participants included 8 males and 12 females ranging in age from 59 years to 92 years. The study found that older people made substantial changes to their daily lives to comply with the COVID-19 shielding guidance; COVID-19 had significant impacts on the health of older people in the community; social capital was demonstrated as compensatory measures were adopted to daily lives; older people reported a general stoic approach to living in the pandemic and they demonstrated resilience in multiple ways; the use of technology assisted in managing social and practical activities, however, its use, satisfaction and familiarity differed within the participants in the study; older people need more integrated support systems which maintain their personal, health and social needs; consideration needs to be given to pandemic related information to avoid information fatigue, misinformation, and confusion; post-pandemic rehabilitation will be required to focus on restoring lost physical ability and address the consequences of social isolation and loneliness; there is a need to ensure that ageist approaches do not underpin guidance; the rights of autonomy and self-determination need to be central considerations in future similar crises. (Edited publisher abstract)
The nature and quality of friendship for older adults with an intellectual disability in Ireland
- Authors:
- McCAUSLAND Darren, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 34(3), 2021, pp.763-776.
- Publisher:
- Wiley
Background: Friendship is important to quality of life, yet people with intellectual disability have more restricted social networks and fewer friends outside family and support staff. Method: Data from a nationally representative longitudinal study of older adults with intellectual disability (aged >40) examined rates and types of friends. Factors associated with having a best friend and friendship quality were explored. Results: A large majority (92.4%) had friends but just over half (52%) had a best friend. Co‐resident friends (71.8%) were more common than non‐resident friends (62%), while staff friendships (62.5%) were important. The majority of best friends were peers with intellectual disability (63.2%), carer/service providers (15.9%) or family (8.4%). Challenging behaviour and communication difficulty were associated with reduced likelihood of having a best friend. A best friend with intellectual disability was associated with lower friendship quality scores. Conclusion: Limited choice and social opportunity may result in a precarious form of friendship for older people with intellectual disability that undermines their quality of life. (Edited publisher abstract)
Implementing integrated care in practice – learning from MDTS driving the integrated care programme for older persons in Ireland
- Journal article citation:
- International Journal of Integrated Care, 21(1), 2021, p.15. Online only
- Publisher:
- International Foundation for Integrated Care
The importance of multidisciplinary teams (MDTs) as critical implementation drivers emerged from this case study conducted with three pioneer sites implementing integrated care for older persons in Ireland as part of the Integrated Care Programme for Older Persons (ICPOP). We describe the practices of MDTs learning to deliver integrated care in service delivery settings, including the framework, resourcing, strategies, challenges and barriers they encounter. The study was conducted by a team of researchers in collaboration with ICPOP at both national programme and pioneer site levels. Qualitative methods of participant observation, workshopping, and documentary analysis were used to build a rich description, and using organisational and systems lenses identification of critical factors as both themes and resources for learning. The case study suggests the MDT is an essential driver of integrated care delivery. For example, ICPOP MDTs working across pioneer sites develop new service models and care opportunities, troubleshoot and challenge the systemic status quo, and disrupt professional silos. However, they also deliver on programme goals. Nonetheless, progress is constrained by organisational factors including fragmented funding structures, high turnover of senior level decision-makers, a lack of multiannual funding and complex professional arrangements. This study finds ICPOP offers practical and timely insight to inform health system reform. It embraces the complexity of delivery at national, local and community levels. The MDT emerges as an essential mechanism to manage such complexity and deliver on wider reform goals such as patient-centredness and timely access. (Edited publisher abstract)
Social work, mental health, older people and COVID-19
- Authors:
- BRENNAN John, et al
- Journal article citation:
- International Psychogeriatrics, 32(10), 2020, pp.1205-1209.
- Publisher:
- Cambridge Journals
This commentary explores the work of social work in Ireland in addressing the impact of the coronavirus 2019 (COVID-19) crisis on older people in general, and older people who have an enduring mental illness. (Edited publisher abstract)
The prioritisation of choice in eldercare: the case of Ireland
- Author:
- LOLICH Luciana
- Journal article citation:
- International Journal of Care and Caring, 3(4), 2019, pp.517-530.
- Publisher:
- Policy Press
In recent decades, there has been a prioritisation of choice in eldercare in many Western countries. In many policy documents, choice is framed as giving older adults the choice to be cared for at home. The article draws on secondary sources to trace the impact of a logic of choice in eldercare in Ireland. It situates the analysis within the re-conceptualisation of care as a commodity and the home-care worker as the most ‘efficient’ option. The article examines the limitations of choice and questions whether choice should be the most important aspect of care in old age. (Publisher abstract)
Participant perspectives on home visitation services for older people
- Author:
- QUIRKE Michael
- Journal article citation:
- Irish Social Worker, Autumn 2012, pp.7-12.
- Publisher:
- Irish Association of Social Workers
The CONNECT project aim to alleviate loneliness among older people in Ireland. The project trains volunteers to carry out weekly one hour home visits where the volunteer talks and listens to older people. This research investigated the CONNECT home visitation project from the perspective of the service users. Interviews were conducted with 6 older people. Participants expressed high levels of satisfaction with the support they received. The project was perceived as making an important contribution to the lives of older adults in the area of social interaction. Based on the findings, the author presents six recommendations for the project.
Depression: a modifiable factor in fearful older fallers transitioning to frailty?
- Authors:
- MHAOLÁIN Aine M. Ni, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(7), July 2012, pp.727-733.
- Publisher:
- Wiley
It is suggested that fear of falling, one of the most common fears among community-dwelling older people, is as serious a health problem as the falls themselves. It often leads to activity avoidance. The authors believe that understanding fear of falling may help to identify strategies to reduce concern in the vulnerable old. This cross sectional study evaluated the psychological factors associated with fear of falling in a group of fallers transitioning to frailty compared with robust or non-frail fallers. A total of 301 fallers (mean age 75 years) underwent assessment. Fear of falling was measured using the Modified Falls Efficacy Scale, and frailty using the Biological Syndrome Model. Psychological assessment included anxiety, depression, loneliness, personality factors and cognition. Frailer fallers had increased fear of falling compared to robust fallers. Age, female gender and lower cognitive scores were associated with greater fear of falling in the robust group. For frailer fallers, higher depression score was the only factor associated with fear of falling. The odds ratio of having case level depressive disorder if a frail faller was significantly higher than if robust. The authors conclude that fallers at a transitional level of frailty may be particularly vulnerable group psychologically and would benefit most from interventional strategies focussing on depressive symptoms.
Psychological distress as a key component of psychosocial functioning in community-dwelling older people
- Authors:
- SCHNITTGER Rebecca I. B., et al
- Journal article citation:
- Aging and Mental Health, 16(1-2), January 2012, pp.199-207.
- Publisher:
- Taylor and Francis
Psychological distress is a critical issue affecting the quality of life in older adults with implications for both mental and physical health. The aim of this study was to explore the key components of psychosocial functioning in older adults with a focus on identifying the constituents of psychological distress. Another aim was to examine the relationship between these components and health outcomes such as frailty. The study was conducted at the Technology Research for Independent Living Clinic, a comprehensive geriatric assessment facility in Dublin. As part of a structured clinical assessment, 579 participants completed 9 primary psychosocial measures as well as a broad range of health and demographic secondary assessments. Principal factor analysis identified 3 core dimensions of the construct of psychosocial functioning. The first is related to a core internal component of psychological distress. The 2 other components are related to external and physiological functioning, specifically social support networks and sleep. These components, particularly psychological distress, were found to be associated with health outcomes associated with frailty.
Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults
- Authors:
- GALLAGHER Damien, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(10), October 2010, pp.981-987.
- Publisher:
- Wiley
Late onset depression is often associated with acquired organic pathology, with patients less likely to report a family history of depression. The majority of previous studies have been in hospital populations. This study addressed this question in a sample of community dwelling older adults. Participants included 89 subjects with GMS-AGECAT depression who were identified from a sample of 1,231 community dwelling adults aged 65 and over. Subjects were analysed across a range of aetiological and phenomenological variables according to age of onset of first depressive episode. Findings indicated that subjects with late onset depression were significantly less likely to report a family history of depression, were less likely to report previous hospitalisation for depression and had greater cognitive impairment. Late onset subjects were also less likely to report feelings of guilt or thoughts that life was not worth living in the previous month. While patients with late onset depression differed from early onset patients according to certain aetiological risk factors, there was not a distinctive profile of depressive symptomatology which might be considered clinically useful – findings consistent with previous hospital-based studies.