Care homes provide personal care and support for older people who can no longer be supported in the community. As part of a larger study of integrated working between the NHS and care homes we asked older people how they accessed health... more
Care homes provide personal care and support for older people who can no longer be supported in the community. As part of a larger study of integrated working between the NHS and care homes we asked older people how they accessed health care services. Our aim was to understand how older people resident in care homes access health services using the Andersen model of health care access. Case studies were conducted in six care homes with different socio-economic characteristics, size and ownership in three study sites. Residents in all care homes with capacity to participate were eligible for the study. Interviews explored how residents accessed NHS professionals. The Andersen model of health seeking behaviour was our analytic framework. Thirty-five participants were interviewed with an average of 4 different conditions. Expectations of their health and the effectiveness of services to mitigate their problems were low. Enabling factors were the use of intermediaries (usually staff, bu...
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Guidelines recommend walking to increase moderate to vigorous physical activity (MVPA) for health benefits. To assess the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention in inactive adults,... more
Guidelines recommend walking to increase moderate to vigorous physical activity (MVPA) for health benefits. To assess the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention in inactive adults, delivered postally or through dedicated practice nurse physical activity (PA) consultations. Parallel three-arm trial, cluster randomised by household. Seven London-based general practices. A total of 11,015 people without PA contraindications, aged 45-75 years, randomly selected from practices, were invited. A total of 6399 people were non-responders, and 548 people self-reporting achieving PA guidelines were excluded. A total of 1023 people from 922 households were randomised to usual care ( = 338), postal intervention ( = 339) or nurse support ( = 346). The recruitment rate was 10% (1023/10,467). A total of 956 participants (93%) provided outcome data. Intervention groups received pedometers, 12-week walking programmes advising participants to grad...
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A recent controversy in vitamin D research is a "U-shaped association", with elevated disease risks at both high and low 25-hydroxyvitamin D (25 (OH) D) levels. This is a cross-sectional study of 238 male nursing home veterans... more
A recent controversy in vitamin D research is a "U-shaped association", with elevated disease risks at both high and low 25-hydroxyvitamin D (25 (OH) D) levels. This is a cross-sectional study of 238 male nursing home veterans in Hawaii. Classification and regression tree (CART) analysis identified groups based on 25 (OH) D and vitamin D supplementation for frailty risk. Characteristics were examined and compared across the groups using logistic regression and receiver operating characteristic (ROC) curve analyses. CART analysis identified three distinct groups: vitamin D supplement users (n = 86), non-users with low vitamin D (n = 55), and non-users with high vitamin D (n = 97). Supplement users were the most frail, but had high mean 25 (OH) D of 26.6 ng/mL, which was compatible with 27.1 ng/mL in non-users with high vitamin D, while mean 25 (OH) D of non-users with low vitamin D was 11.7 ng/mL. Supplement users and non-users with low vitamin D were significantly more lik...
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Most mid-life and older adults are not achieving recommended physical activity (PA) targets and effective interventions are needed to increase and maintain PA long-term for health benefits. The Pedometer And Consultation Evaluation... more
Most mid-life and older adults are not achieving recommended physical activity (PA) targets and effective interventions are needed to increase and maintain PA long-term for health benefits. The Pedometer And Consultation Evaluation (PACE-UP) trial, a three-armed primary care pedometer-based walking intervention in those aged 45-75 years, demonstrated increased PA levels at 12 months. A three-year follow-up was conducted to evaluate long-term PA maintenance, including a qualitative component. Aim To examine facilitators and barriers to PA maintenance in mid-life and older adults previously involved in a PA trial. Semi-structured telephone interviews were conducted with 60 PACE-UP participants across all study arms. Interviews were audio-recorded, transcribed verbatim and coded independently by researchers, prior to thematic analysis. Findings Two-thirds of participants felt since the PACE-UP trial they had an awareness of PA, with the pedometer reported as 'kick-starting' reg...
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Program Evaluation, Primary Health Care, Physical Activity, Qualitative Research, Medicine, and 15 moreMotivation, Humans, Qualitative, Maintenance, Female, Male, Psychological Intervention, Exercise, Aged, Middle Aged, Public health systems and services research, Pedometer, barriers and facilitators, Interviews as topic, and Referral and consultation
Japan's population is aging more rapidly than that of any other country. Frailty has recently been recognized as an important priority. Understanding the basic epidemiology of frailty in Japan, which is an example of a rapidly aging... more
Japan's population is aging more rapidly than that of any other country. Frailty has recently been recognized as an important priority. Understanding the basic epidemiology of frailty in Japan, which is an example of a rapidly aging society, will be beneficial for Japan as well as other countries expecting an aging population. A systematic literature search of 11 electronic databases was conducted in March 2016 using a comprehensive set of Medical Subject Heading and text terms for any studies published in 2000 or later that report the prevalence of frailty among Japanese community-dwelling older people aged 65 years or older. A total of 1529 studies were identified in the systematic search, of which five studies were included in this review. The pooled prevalence of frailty, prefrailty, and robustness was 7.4% (95% confidence interval [CI], 6.1%-9.0%), 48.1% (95% CI, 41.6%-54.8%), and 44.4% (95% CI, 37.2%-51.7%), respectively. A significant degree of heterogeneity was observed....
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Regular physical activity reduces falls, hip fractures, and all-cause mortality, but physical activity levels are low in older age groups. To evaluate two exercise programmes promoting physical activity among older people. Pragmatic... more
Regular physical activity reduces falls, hip fractures, and all-cause mortality, but physical activity levels are low in older age groups. To evaluate two exercise programmes promoting physical activity among older people. Pragmatic three-arm, parallel-design cluster randomised controlled trial involving 1256 people aged ≥65 years (of 20 507 invited) recruited from 43 general practices in London, Nottingham, and Derby. Practices were randomised to the class-based Falls Management Exercise programme (FaME), the home-based Otago Exercise Program (OEP), or usual care. The primary outcome was the proportion reaching the recommended physical activity target 12 months post-intervention. Secondary outcomes included falls, quality of life, balance confidence, and costs. In total, 49% of FaME participants reached the physical activity target compared with 38% for usual care (adjusted odds ratio 1.78, 95% confidence interval [CI] =1.11 to 2.87, P = 0.02). Differences between FaME and usual ca...
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General Practice, Health Promotion, Primary Health Care, Quality of life, Medicine, and 12 moreEngland, Physical Therapy, London, Humans, Feasibility Studies, Exercise, Aged, Public health systems and services research, Randomized Controlled Trial, Odds ratio, Confidence Interval, and Surveys and Questionnaires
Although available evidence is modest, exercise could be beneficial in reducing behavioural and psychological symptoms of dementia. We aim to evaluate the cost-effectiveness of a dyadic exercise regimen for individuals with dementia and... more
Although available evidence is modest, exercise could be beneficial in reducing behavioural and psychological symptoms of dementia. We aim to evaluate the cost-effectiveness of a dyadic exercise regimen for individuals with dementia and their main carer as therapy for behavioural and psychological symptoms of dementia. Cost-effectiveness analysis within a two-arm, pragmatic, randomised, controlled, single-blind, parallel-group trial of a dyadic exercise regimen (individually tailored, for 20-30 min at least five times per week). The study randomised 131 community-dwelling individuals with dementia and clinically significant behavioural and psychological symptoms with a carer willing and able to participate in the exercise regimen; 52 dyads provided sufficient cost data for analyses. Mean intervention cost was £284 per dyad. For the subsample of 52 dyads, the intervention group had significantly higher mean cost from a societal perspective (mean difference £2728.60, p = 0.05), but co...
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Psychology, Cognitive Science, Dementia, Quality of life, Exercise therapy, and 15 moreMedicine, Physical Therapy, Humans, Female, Male, Cost effectiveness, Clinical Sciences, Geriatric Psychiatry, Aged, Quality adjusted life years, Randomized Controlled Trial, Cost Benefit Analysis, Cost of Illness, Health Care Costs, and Regimen
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Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive physical activity aimed at improving physical fitness) may reduce fear... more
Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive physical activity aimed at improving physical fitness) may reduce fear of falling by improving strength, gait, balance and mood, and reducing the occurrence of falls. To assess the effects (benefits, harms and costs) of exercise interventions for reducing fear of falling in older people living in the community. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2013), the Central Register of Controlled Trials (CENTRAL 2013, Issue 7), MEDLINE (1946 to July Week 3 2013), EMBASE (1980 to 2013 Week 30), CINAHL (1982 to July 2013), PsycINFO (1967 to August 2013), AMED (1985 to August 2013), the World Health Organization International Clinical Trials Registry Platform (accessed 7 August 2013) and Current Controlled Trials (accessed 7 August 2013). We applied no language restrictions. We ha...
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Ergonomics, Human Factors, Fear, Injury Prevention, Medicine, and 15 morePhysical Therapy, Independent Living, Humans, Female, Male, Resistance Training, Psychological Intervention, Exercise, Aged, Occupational Safety, Postural Balance, Fear of falling, Randomized Controlled Trials as Topic, Accidental falls, and Medical and Health Sciences
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Nursing, Gerontology, Dementia, Culture, Informed Consent, and 15 moreHealth Services Research, Medicine, London, Humans, Nursing Homes, Female, Male, Health Professionals, Aged, Longitudinal Studies, Longitudinal Study, Mixed Method, Geriatrics and Gerontology, Mental Competency, and Medical and Health Sciences
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Family carers provide more care than the combined efforts of the NHS and social services departments, and their value to the economy is estimated to be around £34 billion a year (Hirst, 1999). However, many carers have health problems of... more
Family carers provide more care than the combined efforts of the NHS and social services departments, and their value to the economy is estimated to be around £34 billion a year (Hirst, 1999). However, many carers have health problems of their own. Using three standardised measures to screen for activity limitation (ADLs), depression (GHQ-28) and health related quality of life (HRQoL) (SF36), a study of carers of people aged 75 and over referred consecutively to social services departments in adjacent inner city areas showed a high prevalence of limitations in activities of daily living (ADLs), that a substantial proportion (42 per cent) had GHQ-28 scores high enough to suggest depression and their scores on the SF-36 showed that many carers were low in vitality and tired. Co-resident carers had poorer psychological health and more difficulties with social functioning than non-resident carers, and were older, but were not significantly different in self-reported physical health. Whe...
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Research Interests:
Primary Care, General Practice, Research Ethics, Dementia, Medicine, and 14 moreQuality of Care, Recruitment, Clinical Practice, Case Study, Psychological Intervention, Research Method, Sample Size, Public health systems and services research, Randomized Controlled Trial, Neurodegenerative Disease, Large Scale, Research Methods, Dementia Research, and Time pressure
This article describes a consultation event held as part of the process of reviewing the qualitative evidence for the National Institute for Clinical Excellence (NICE) and Social Care Institute for Excellence Guidelines (SCIE) on dementia... more
This article describes a consultation event held as part of the process of reviewing the qualitative evidence for the National Institute for Clinical Excellence (NICE) and Social Care Institute for Excellence Guidelines (SCIE) on dementia (2006). It shows how events such as these can provide valuable information to be included in systematic reviews but also help identify research priorities for the future.
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General Practice, Communication, Dementia, Family Practice, Medicine, and 15 moreLondon, Continuing Medical Education, Elderly, Humans, Age, Female, Diagnosis, Male, Awareness, Clinical Sciences, Aged, Clinical Competence, Cross Sectional Studies, Cooperative Behavior, and interprofessional relations
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SummaryMany practitioners will sympathise with Claire Hilton's views of the National Dementia Strategy. However, implementation of healthcare policies is frequently a long drawn out and messy process. There is no guarantee that its... more
SummaryMany practitioners will sympathise with Claire Hilton's views of the National Dementia Strategy. However, implementation of healthcare policies is frequently a long drawn out and messy process. There is no guarantee that its proposals will be implemented, given the vagaries of economies and the frailty of political will, but all of them could be. We should aim for gradual changes that produce qualitative shifts in the standards of dementia care.
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Frailty is a state of increased vulnerability to poor resolution of homeostasis as a consequence of age-related decreased physiological reserves. Although physical frailty and cognitive impairment have been shown to be associated,... more
Frailty is a state of increased vulnerability to poor resolution of homeostasis as a consequence of age-related decreased physiological reserves. Although physical frailty and cognitive impairment have been shown to be associated, evidence on the prevalence of frailty in Alzheimer's disease is scarce. To conduct a systematic review on the prevalence of frailty and to combine the data to synthesize the pooled prevalence of physical frailty among patients with Alzheimer's disease. Five electronic databases (Embase, MEDLINE, CINAHL Plus, PsycINFO, and the Cochrane Library) were searched for studies providing cross-sectional data on physical frailty among patients with Alzheimer's disease published from 2000 to January 2016. Of 2,564 studies identified through the systematic review, five studies incorporating 534 patients with Alzheimer's disease were included for the meta-analysis. The prevalence of frailty varied with a wide range from 11.1% to 50.0% and the pooled pre...
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People with dementia have been described as the 'disadvantaged dying' with poor end-of-life care. Towards the end of life, people with dementia cannot report on the care they receive. It is therefore important to talk to... more
People with dementia have been described as the 'disadvantaged dying' with poor end-of-life care. Towards the end of life, people with dementia cannot report on the care they receive. It is therefore important to talk to caregivers; however, few have explored the views about end-of-life care from the caregivers' perspective. The majority of research on family caregivers has focussed on the burden and psychological impact of caring for a relative with dementia. This study aimed to explore the views of family caregivers about quality end-of-life care for people with dementia. Qualitative study using in-depth interviews and analysed using thematic analysis. Purposive sampling from a third sector organisation's caregiver network was used to recruit 47 caregivers in England (2012-2013), consisting of (1) family caregivers of someone who had recently received a diagnosis of dementia, (2) family caregivers currently caring for someone with dementia and (3) bereaved family c...
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Dementia, Palliative Care, Quality of life, Qualitative Research, Medicine, and 15 morePalliative Medicine, Thematic Analysis, Humans, Dignity, End of life care, Female, Male, Attitude, Caregivers, Aged, Middle Aged, Public health systems and services research, Family caregivers, Terminal care, and Interviews as topic
This study investigated the effects of carer attributions on help-seeking behaviour for people with dementia using interviews with 84 carers recruited through general practice. Memory loss was the most commonly reported first symptom but... more
This study investigated the effects of carer attributions on help-seeking behaviour for people with dementia using interviews with 84 carers recruited through general practice. Memory loss was the most commonly reported first symptom but psychological and behavioural symptoms were also common at onset. In over a third of individuals help-seeking was delayed for a mean of 25 months (range 6–69, SD 19.3). Help-seeking between those who attributed symptoms to dementia, or to unknown causes, and those who attributed symptoms to personality, ageing, life events or other illnesses was statistically significant ( p < 0.001). No statistically significant associations between help-seeking and patient or carer characteristics were found. There is a need to raise public awareness about the range of symptoms suggestive of dementia. Assumptions that age and other conditions may be the likely cause of an individual’s cognitive decline needs to be challenged by practitioners. Attribution of sym...
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Purpose – The purpose of this paper is to explore common usage and understanding of the term “frailty”, which is increasingly used in health care debates in England. Design/methodology/approach – This is a commentary from the perspectives... more
Purpose – The purpose of this paper is to explore common usage and understanding of the term “frailty”, which is increasingly used in health care debates in England. Design/methodology/approach – This is a commentary from the perspectives of health and social care researchers. Recent policy and research are drawn upon in the arguments presented. Findings – Most research on the subject of frailty comes from clinical practice although a parallel sociological or gerontological critique of the social construction is emerging. The public is likely to come across the term frailty through the media’s adoption of the term. Different definitions of frailty mean that estimates of the numbers of “frail people” will vary. Research limitations/implications – The commentary draws on material in the English language and on policy, commentary, and research material. Practical implications – The commentary may prompt reflection in practice and policy development on the usage of the term frailty and ...
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The National Service Frameworks for Older People and for Mental Health are setting standards for services in areas where problems are complex and solutions limited. Primary Care Trusts seeking to raise the quality of primary care for... more
The National Service Frameworks for Older People and for Mental Health are setting standards for services in areas where problems are complex and solutions limited. Primary Care Trusts seeking to raise the quality of primary care for older people and commission specialist services rationally face many challenges. Specialists in old age medicine and old age psychiatry will find themselves working closely with primary care practitioners to develop services and extend professional skills, for it is uncertain that specialist services will be able to deal with the scale of the clinical and social problems unaided.
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Primary Health Care, Evidence Based Medicine, Dementia, Quality of life, Medicine, and 13 moreContinuing Medical Education, Humans, Needs Assessment, Psychological Intervention, Clinical Sciences, Aged, Patient Care Team, Trials, Geriatric Assessment, Clinical Competence, Community health services, Cardiovascular medicine and haematology, and Medical prescription
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Primary Health Care, Dementia, Randomization, Medicine, Humans, and 14 moreFemale, Male, Psychological Intervention, Data Collection, Sample Size, Clinical Sciences, Aged, Middle Aged, Adult, Randomized Controlled Trial, Trials, Guidance and Counseling Intervention Programs, Outcome assessment (Health care), and Cardiovascular medicine and haematology
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This article explores anxiety states among older people and how they may overlap with depression. It discusses prevalence, symptoms and treatment, and aims to help nurses to develop appropriate intervention strategies and to know when... more
This article explores anxiety states among older people and how they may overlap with depression. It discusses prevalence, symptoms and treatment, and aims to help nurses to develop appropriate intervention strategies and to know when they should refer patients to other health practitioners.
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Nursing, Anxiety Disorders, Medicine, Anxiety, Helping Behavior, and 15 moreInformation Services, Humans, Needs Assessment, Geriatric Nursing, Female, Male, Depressive Disorder, Mental health services, Geriatric Psychiatry, Aged, Geriatric Assessment, ANXIETY, Internet, Health services for the aged, and mass Screening
This article explores dementia and depression, the relationship between them and ways of distinguishing between them in older patients. It also suggests ways in which nurses can offer support to people affected by both conditions.
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Psychology, Nursing, Depression, Long Term Care, Dementia, and 15 moreFamily Practice, Medicine, Comorbidity, Problem Solving, Humans, Disclosure, Geriatric Nursing, Nursing Homes, Female, Differential Diagnosis, Aged, Nurse Practitioners, Geriatric Assessment, Nursing Assessment, and attitude to health
New models of interprofessional working are continuously being proposed to address the burgeoning health and social care needs of older people with complex and long-term health conditions. Evaluations of the effectiveness of these models... more
New models of interprofessional working are continuously being proposed to address the burgeoning health and social care needs of older people with complex and long-term health conditions. Evaluations of the effectiveness of these models tend to focus on process measures rather than outcomes for the older person. This discussion paper argues that the concept of frailty, and measures based on it, may provide a more user-centred tool for the evaluation of interprofessional services - a tool that cuts across unidisciplinary preoccupations and definitions of effectiveness. Numerous frailty scales have been developed for case identification and stratification of risk of adverse outcomes. We suggest that they may also be particularly suitable for evaluating the effectiveness of interprofessional working with community-dwelling older people. Several exemplars of frailty scales that might serve this purpose are identified, and their potential contributions and limitations are discussed. Further work is required to establish which is the most suitable scales for this application. The development of an appropriate frailty scale could provide an opportunity for interprofessional debate about the forms of care and treatment that should be prioritised to improve the health and well-being of this population.
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Health Care, Aging, Medicine, Humans, Older people, and 11 moreFemale, Male, Aged, InterProfessional Education in Health Care, Public health systems and services research, Age Factors, Geriatric Assessment, Frail elderly, health status indicators, interprofessional relations, and Community health services
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Cognitive Science, Nursing, Geriatrics, Primary Care, Gerontology, and 15 morePrimary Health Care, Long Term Care, Dementia, Health Education, Health Services Research, Medicine, Information, Humans, Case Management, Caregivers, Clinical Sciences, Geriatric Psychiatry, Geriatric, Cognitive Reframing, and Delivery of Health Care
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Primary Care, Perception, Social Work, Typology, Primary Health Care, and 14 moreDementia, Focus Groups, Social Perception, Medicine, Professional Role Socialization, Humans, Focus Group, Nursing Home, Great Britain, Professional Practice, Theoretical Models, Public health systems and services research, Multidisciplinary Approach, and Professional Role
English This article reports on an innovatory partnership between regulatory bodies and researchers to assess progress in improving NHS, local authority and other services for older people in 10 different parts of England. It discusses... more
English This article reports on an innovatory partnership between regulatory bodies and researchers to assess progress in improving NHS, local authority and other services for older people in 10 different parts of England. It discusses how consultation exercises held as part of local inspections that fed into a national review of the National Service Framework for Older People may enlarge the evidence base for planning and service improvement purposes. The results provide an example of the need for greater debate about different sources of evidence in health and social care. There is comparatively little recent UK research-based evidence on what people with dementia and their carers think about the services they receive and policy makers may need to draw on wide-ranging sources of evidence if they are to make necessary service improvements and to develop policy initiatives.
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Primary Care, Dementia, Clinical Trial, General Internal Medicine, Ethnic minorities, and 15 moreMedicine, Population, Humans, Consensus, Case Study, Female, Cost effectiveness, Confidentiality, Caregivers, Accuracy, Great Britain, Ethnic Minorities, Alzheimers Disease, Patient selection, and Field Test
Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy... more
Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were i...
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Nursing, Health Care, Quality of Mental Health Care, Health Services Research, Medicine, and 10 moreNursing Research, Library and Information Studies, Text, Psychological Intervention, Patient Care Team, Public health systems and services research, Integrated Care, Home Care Services, Health services for the aged, and Quality of health care
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Primary Care, Primary Health Care, Dementia, English language, Qualitative Research, and 15 moreCritical Appraisal, Medicine, Humans, Psychological Intervention, Training and Education, Qualitative Study, Medline, Empirical Study, Systematic review, Early Detection, English Language, Disease Management, Early Diagnosis, Financial Constraint, and Time constraint
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care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. a realist evaluation using qualitative and quantitative data from case... more
care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioner...
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Care home residents in England have variable access to health care services. There is currently no coherent policy or consensus about the best arrangements to meet these needs. The purpose of this review was to explore the evidence for... more
Care home residents in England have variable access to health care services. There is currently no coherent policy or consensus about the best arrangements to meet these needs. The purpose of this review was to explore the evidence for how different service delivery models for care home residents support and/or improve wellbeing and health-related outcomes in older people living and dying in care homes. We conceptualised models of health care provision to care homes as complex interventions. We used a realist review approach to develop a preliminary understanding of what supported good health care provision to care homes. We completed a scoping of the literature and interviewed National Health Service and Local Authority commissioners, providers of services to care homes, representatives from the Regulator, care home managers, residents and their families. We used these data to develop theoretical propositions to be tested in the literature to explain why an intervention may be effe...
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Nursing, Health Informatics, Health Care, Public Health, Health Administration, and 12 moreMedicine, England, Nursing Research, Library and Information Studies, Humans, Geriatric Nursing, Aged, Public health systems and services research, Terminal care, Homes for the Aged, Health Services Accessibility, and Quality of health care
BackgroundThe needs of people with dementia and their carers are inadequately addressed at all key points in the illness trajectory, from diagnosis through to end-of-life care. The EVIDEM (Evidence-based Interventions in Dementia)... more
BackgroundThe needs of people with dementia and their carers are inadequately addressed at all key points in the illness trajectory, from diagnosis through to end-of-life care. The EVIDEM (Evidence-based Interventions in Dementia) research and development programme (2007–12) was designed to help change this situation within real-life settings.ObjectivesThe EVIDEM projects were (1) evaluation of an educational package designed to enhance general practitioners’ (GPs’) diagnostic and management skills; (2) evaluation of exercise as therapy for behavioural and psychological symptoms of dementia (BPSD); (3) development of a toolkit for managing incontinence in people with dementia living at home; (4) development of a toolkit for palliative care for people with dementia; and (5) development of practice guidance on the use of the Mental Capacity Act (MCA) 2005.DesignMixed quantitative and qualitative methods from case studies to large database analyses, including longitudinal surveys, rand...
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Population aging, escalating costs in pensions, health care and long-term care have prompted the emergence of a new policy agenda for active aging and quality of life in old age across the European Union. In the UK, the government has... more
Population aging, escalating costs in pensions, health care and long-term care have prompted the emergence of a new policy agenda for active aging and quality of life in old age across the European Union. In the UK, the government has made a commitment to improve services for older people through combating age discrimination, engaging with older people, better decision-making for services for older people, better meeting of older people&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s needs and promoting a strategic and ‘joined-up’ approach. A raft of policy initiatives not only sets the tone for service reconfiguration but also specifies objectives and time scales.
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General Practice, Evidence Based Medicine, Dementia, Family Practice, England, and 15 moreDecision support system, Continuing Medical Education, Humans, Design method, Caregivers, IS success, Clinical Sciences, Concordance, Clinical Competence, Clinical Decision Support Systems, Detection Rate, Early Diagnosis, Guideline Adherence, Decision Support Techniques, and Cardiovascular medicine and haematology
Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This... more
Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service m...