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Living with ageing and dying: palliative care and end of life care for older people
- Editors:
- GOTT Merryn, INGLETON Christine, (eds.)
- Publisher:
- Oxford University Press
- Publication year:
- 2011
- Pagination:
- 304p.
- Place of publication:
- Oxford
This book identifies ways of improving the end of life experiences of older people by taking an interdisciplinary and international approach. It brings together contributions from leading international experts from different disciplinary backgrounds. Ageing populations mean that end of life care for older people needs to be given greater priority. In particular, there is a perceived need to improve the experiences of older people at the end of life; those that have been identified as the 'disadvantaged dying'. Most current models of care are underpinned by the ideals of specialist palliative care services which were developed to meet the needs of predominantly 'young old' people, and evidence suggests these may not be adequate for the older group. The contributions provide a synergy between the currently disparate literature of gerontology and palliative care. Some authors take a theoretical focus, others a very practical approach rooted in clinical and research experience. The issues covered are diverse and related to a wide range of geographical settings. The book is aimed at both academics and practitioners (doctors and nurses) in palliative care, geriatrics, and gerontology but is also expected to be of interest to social workers, policy makers and anyone with an interest in older people in relation to public health.
Home care in London
- Author:
- BRADLEY Laura
- Publisher:
- Institute for Public Policy Research
- Publication year:
- 2011
- Pagination:
- 40p.
- Place of publication:
- London
Like the rest of the UK, London’s over-80 population is increasing; the Greater London Authority estimates it will rise by 40% over the next 30 years. Public services must adapt to the challenge that this poses. Home-based care has the potential to reduce the pressure on more costly public services such as hospital beds and care home places, and can enable older people to remain in their homes for longer. This paper explores the issue of home-based social care in London. It aims to provide policymakers and commissioners with a clearer idea of what makes for good quality home-based care, the challenges that exist for delivering it, and how the increasing demand can be met. Research undertaken for this paper involved analysis of secondary information as well as 50 semi-structured interviews conducted with service providers, carers and service users. The paper starts by outlining the current context for home-based care in the UK, looking at where it fits within the overall approach to social care and the current financial environment. It then covers home-based care in London by giving an analysis of the home care market and some characteristics unique to London. Three key tests are provided that ensure home care is of good quality, and it is considered whether home care in London is successfully meeting each of these tests. Recommendations to address the emerging issues are provided.
A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’
- Authors:
- CONROY Simon Paul, et al
- Journal article citation:
- Age and Ageing, 40(4), July 2011, pp.436-443.
- Publisher:
- Oxford University Press
A systematic review on models of care for elderly people following admission to acute medical units, or emergency departments, and early discharge. Five, highly varied, randomised controlled trials were included in the systematic review. There was no firm evidence that either of the forms of comprehensive geriatric assessment (CGA) examined, whether nurse-led or geriatrician-led, has any effect on the outcomes reported – including mortality and readmission. Although there is no clear evidence of benefit with CGA in this population, due to the small number of trials identified, further well-designed research is justified.
The meaning of community-based care for frail Mexican American elders
- Author:
- DONLAN William
- Journal article citation:
- International Social Work, 54(3), May 2011, pp.388-403.
- Publisher:
- Sage
In the United States, the Hispanic population now accounts for over 15% of the total population. While 37% of non-institutionalised individuals aged 65 and over, have a disability, the rates for Mexican-origin individuals are 44%. This qualitative case study integrated in-depth interviewing and participant observation to identify how a theoretically sampled collection of frail Mexican American elders socially constructed the meaning of community-based care they received. Findings indicated significant variance in how Mexican American cultural identity systems attribute meaning to the eldercare context. The strong intertwined presence of cultural themes involving Latino/Hispanic familism, gender identity constructs, and religious belief systems demonstrated the importance for service providers to take minority cultures into consideration in the development of more consumer-directed older people policies and programmes. Participants also reported high levels of satisfaction in sharing their views, indicating practitioners should advocate for families to encourage older relatives to share their stories in order to promote intergenerational learning.
Are terminal decline and its potential indicators detectable in population studies of the oldest old?
- Authors:
- MUNIZ-TERRERA Graciela, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(6), June 2011, pp.584-592.
- Publisher:
- Wiley
The terminal decline hypothesis states that individuals experience a decline in cognitive function before death, particularly in the last 3 to 8 years of life. The aim of this study was to discover whether this decline, measured using the MMSE, could be detected in a sample of participants from the Cambridge City Over 75s Cohort; a virtually extinct study in which 99% of participants had died. Potential risk profiles were also examined. Decline and acceleration of this decline were detectable in the period before death. Some between person variation was detected in this pattern, which included differences in cognitive performance by age at death, sex, initial cognitive impairment and mobility; in rate of decline by age at death, sex, initial cognitive impairment, and mobility; and differences in change in rate of decline by sex, initial cognitive impairment, and mobility. The data clearly demonstrate the phenomenon of decline in global cognition measurements with the proximity of death as well as potential variables that could influence that pattern. Further work is required on how to detect the onset of the acceleration of this decline in each individual together with the factors that could allow clinicians to distinguish between the normal and preterminal phases of change in extreme old age.
Clinical issues in old age: the challenges of geriatric medicine
- Author:
- BAYER Anthony
- Journal article citation:
- Quality in Ageing and Older Adults, 12(1), March 2011, pp.44-49.
- Publisher:
- Emerald
Geriatric medicine is the branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness in older people. Rather than being defined by some arbitrary cut-off in chronological age, it recognises that most older people, especially the ‘young-old’, are in good health for most of the time. They are likely to benefit from standard medical management by generalists. Geriatricians focus on the more challenging patients – those older people who are physically and cognitively frail, many of whom will be among the growing numbers of the ‘old-old’. This population is characterised by non-specific presentation of illness, functional dependency and a need for a multi-disciplinary approach to care and cautious use of drug therapy. Drawing on publications from the department of geriatric medicine in Cardiff, this article illustrates important aspects of clinical care of older people and highlights the need for better recognition and prevention, better assessment and diagnosis and better therapeutic tools to manage acute and chronic illness in old age.
Affect and loneliness among centenarians and the oldest old: the role of individual and social resources
- Authors:
- MARGRETT Jennifer A., et al
- Journal article citation:
- Aging and Mental Health, 15(3), April 2011, pp.385-396.
- Publisher:
- Taylor and Francis
Affect and loneliness are important indicators of mental health and well-being in older adulthood. Negative affect appears to be related to psychological distress and depression. Positive affect is associated with optimism, adaptive coping responses, and lower depression. The aim of this study was to examine the ability of individual and social resources in predicting positive and negative affect and loneliness within a sample of oldest-old individuals including centenarians. Data collection was done as part of the Georgia Centenarian Study, Phase 3, 2001-2008. The eligible sample for this study included 55 octogenarians aged 81-90 years and 77 centenarians and near centenarians aged 98-109 years, all of whom scored 17 or more on the Mini-Mental Status Exam. The participants completed demographics and multiple indicators of mental health, functional ability, cognition, social functioning, and personality. Hierarchical regression analyses demonstrated that, within this sample of cognitively intact oldest old, measures of executive control and cognitive functioning demonstrated limited association with mental health. Personality, specifically neuroticism, was strongly related to mental health indicators for both age groups and social relations were particularly important associates of centenarians' mental health.
Is aging in place a resource for or risk to life satisfaction?
- Authors:
- OSWALD Frank, et al
- Journal article citation:
- Gerontologist, 51(2), April 2011, pp.238-250.
- Publisher:
- Oxford University Press
Given age-related health restrictions, the importance of environmental characteristics in the home and the neighbourhood for life satisfaction may increase in later life. This study investigated the impact of objective and perceived physical and social environmental factors on the life satisfaction of young–old (aged 65 to 79 years) and old–old (aged 80 to 94 years) community-dwelling individuals. A population-based sample of 381 community-dwelling individuals aged 65–94 years in the city of Darmstadt, Germany reported on their sociophysical environment and life satisfaction using questionnaires. The results showed that, on average, young–old differ from old–old in indoor physical environmental indicators but not in neighbourhood characteristics or social aspects of housing. Regression analyses revealed that apartment size, perceived neighbourhood quality, and outdoor place attachment explained life satisfaction independently, whereas social housing aspects played only a minor role. Separate analyses for both age groups revealed age differential explanation patterns. Apartment size was positively related to life satisfaction in the young–old but was negatively related in the old–old. For the old–old, perceived neighbourhood quality and outdoor place attachment were more important than for the young–old. Living with others was positively related to life satisfaction only for the young–old.
Developing and leading telephone groups
- Authors:
- TOSELAND Ronald W., LARKIN Heather
- Journal article citation:
- Social Work with Groups, 34(1), January 2011, pp.21-34.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Telephone conference calls are increasingly used for meeting the support needs of clients, such as older and very old people, who cannot get to face-to-face groups or who prefer the convenience of meeting by phone. This short paper details the specific knowledge and skills needed by professionals to plan, develop and lead the implementation and maintenance of such social, telephone groups. These range from choosing the most suitable clients and understanding the value they attach to this type of support, to using the most appropriate technology such as Skype (a type of computer-initiated voice over Internet protocol, or VOIP). Reliably resourcing funding for reimbursement of telephone group members is stated as a key skill, by these authors. They also focus on the clinical adaptations needed when leading discussions and support-giving by telephone as opposed to face-to-face, by referring to examples from the field heard during caregiver psycho-educational and support groups in the USA. For example, topics such as timing and length of meetings, maintaining structure and agendas and conducting group ‘go-arounds’ take on different significance in telephone led meetings.
Older adults' own reasoning for their alcohol consumption
- Authors:
- IMMONEN Sirpa, VALVANNE Jaakko, PITKALA Kaisu H.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(11), November 2011, pp.1169-1176.
- Publisher:
- Wiley
Compared to younger age groups, relatively little is known about the reasons older people drink. Data were collected using a postal survey of a random sample of 2100 elderly people (≥65 years) living in the medium-sized city of Espoo, Finland. Of the 71.6% who responded, 868 said that they use alcohol and 831 gave reasons for their drinking. “At-risk users” were defined as consuming more than 7 drinks per week, or 5 or more drinks on a typical drinking day, or using 3 drinks or more several times per week. The main reasons for alcohol consumption were “having fun or celebration” (58.7%), “social reasons” (54.2%), “using alcohol for medicinal purposes” (20.1%), and “with meals” (13.8%). Younger age groups more often reported using alcohol for “having fun or celebration” and “for social reasons.” The older age groups more often used “alcohol for medicinal purposes”. Men used alcohol more often than women “as a pastime” or “as a sauna drink”. “At-risk users” reported using alcohol because of “meaningless life,” for “relieving depression,” “relieving anxiety,” and “relieving loneliness.” The authors conclude that older adults have diverse alcohol consumption habits like other age groups. However the oldest group reported using alcohol for medicinal purposes and ‘at-risk users” admitted that they use alcohol because of a meaningless life, and relieving depression, anxiety, and loneliness.