An estimate of post-acute intermediate care need in an elderly care department for older people

There is an expectation that intermediate care services for older people will be widely introduced in England. The planning of such services should be based on an understanding of required capacity. The present study provides a needs estimate for post-acute intermediate care. Older patients admitted acutely to an elderly care department in a district general hospital serving a large city in northern England were followed prospectively by a research team until medical stability had occurred in the opinion of the senior ward nurses and the responsible consultant. The clinical staff then determined if the patient had continuing post-acute care needs or if imminent discharge was possible. Out of 1211 acutely admitted patients, 997 became medically stable and 312 [25.8% of admissions; 95% confidence interval (CI) = 23.3-28.2%] were considered to require post-acute care, and of these, 251 (20.7% of admissions; 95% CI = 18.4-23.0%) needed post-acute rehabilitation care. In conclusion, the present authors suggest that intermediate care services providing post-acute care for older people should have a capacity to address the needs of up to one-quarter of acute admissions to a district general hospital elderly care department.     

A Multilevel Analysis of the determinants of emergency care visits by the elderly in France

BackgroundRising numbers of visits to emergency departments (EDs), especially amongst the elderly, is a source of pressure on hospitals and on the healthcare system. This study aims to establish the determinants of ED visits in France at a territorial level with a focus on the impact of ambulatory care organisation on ED visits by older adults aged 65 years and over.MethodsWe use multilevel regressions to analyse how the organisation of healthcare provision at municipal and wider ‘department’ levels impacts ED utilisation by the elderly while controlling for the local demographic, socioeconomic and health context of the area in which patients live.ResultsED visits vary significantly by health context and economic level of municipalities. Controlling for demand-side factors, ED rates by the elderly are lower in areas where accessibility to primary care is high, measured as availability of primary care professionals, out-of-hours care and home visits in an area. Proximity (distance) and size of ED are drivers of ED use.ConclusionHigh rates of ED visits are partly linked to inadequate accessibility of health services provided in ambulatory settings. Redesigning ambulatory care at local level, in particular by improving accessibility and continuity of primary and social care services for older adults could reduce ED visits and, therefore, improve the efficient use of available healthcare resources.     

Partnership working by default: district nurses and care home staff providing care for older people

Older people residents in care homes that only offer residential care rely on primary healthcare services for medical and nursing needs. Research has investigated the demands that care homes staff and residents make on general practice, but not the involvement of other members of the primary healthcare team. This paper describes two consecutive studies completed in 2001 and 2003 that involved focus groups and survey methods of enquiry conducted in two settings: an England shire and inner London. The research questions that both studies had in common were (1) What is the contribution of district nursing and other primary care services to care homes that do not have on‐site nursing provision? (2) What strategies promote participation and collaboration between residents, care home staff and NHS primary care nursing staff? and (3) What are the current obstacles and aids to effective partnership working and learning? A total of 74 community‐based nurses and care home managers and staff took part in 10 focus groups, while 124 care home managers (73% of the171 surveyed) and 113 district nurse team leaders (80% of the 142 surveyed) participated in the surveys. Findings from both studies demonstrated that nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working. Findings indicate that there is a need for community‐based nursing services to adopt a more strategic approach that ensures older people in care homes can access the services they are entitled to and receive equivalent health care to older people who live in their own homes.     

Factors determining the use of social support services among elderly people living in a city environment in Poland

Ageing populations entail important social issues. The population of Lodz is characterised by the highest ageing ratio in Poland (17.2% people aged 65 or above). The aim of our study was to present factors determining the use of social support services in the subpopulation of elderly people in a city environment. The study, conducted between 2011 and 2012 with the use of a survey questionnaire, included 466 respondents aged 65 or older, who were looked after by the Municipal Social Welfare Centre, Lodz‐Polesie. The response rate was 93.2%. Most beneficiaries were women (77.9%). The respondents were mostly widows (73.9% of women) or widowers (43.7% of men). Most respondents applied for nursing services (79.7%), while 28.3% asked for financial help. In Lodz as a whole, these percentages were 81.0% and 19.0%. A chronic disease was the most common cause of the application for help (73.4%). In 4.1% of applicants, the cause was a low income per capita. Multivariate logistic regression analysis indicated that the variables which contributed to receiving financial support included being a man, aged 65–69 years, being single and receiving a monthly salary per capita below 500.0 PLN (Polish New Zlotys). The variables which contributed to receiving social care service in the form of nursing services included being a woman, aged 85 years or older, receiving a monthly salary per capita between 1001.0 and 1500.0 PLN, suffering from a chronic disease, which was a reason for applying for social support service, a result on the Activities of Daily Living scale confirming disability and a very negative self‐evaluation of health. The results of the study have shown that the poor health condition of elderly people is the most frequent reason for applying for social services. Identifying reasons for applying for social care by elderly people might facilitate the introduction of workable solutions in the social and healthcare policy.     

Can we bridge the gap between goals and practice through a common vision? A study of politicians and managers' understanding of the provisions of elderly care services

The objective of this study was to identify and describe how local politicians and managers experience and understand problems and goals regarding the structures and processes involved in the care of the elderly. Qualitative methodology of a conceptual modelling workshop was used. Participants were health care politicians, local municipal politicians, and executive care managers. The main result was that all participants agreed on four key visions for the health care of the elderly: see the person, see the individual's resources, see the encounter, and see yourself. Other findings indicated that (a) care of older persons was governed by diverse interests, (b) the organisation lacked clear leadership and comprehensive goals, (c) the organisation was fragmented, and (d) there was a lack of skilled staff members to meet patient needs. Older persons were regarded as passive receivers of care or as objects that did not take an active part in health care decisions that affect them.     

Beyond the definition of formal care: Informal care arrangements among older swedes who are not family

This study explores care practices of older people outside formal care and without appealing to predefined relationships. We conducted interviews with 30 independent‐living men and women aged 67–93 in three municipalities in Sweden. The interviews explored how they cared for themselves and other older people who were not family. Interviews were conducted between December 2017 and May 2018 and later transcribed and analysed using grounded theory. Our paper presents one of the first studies on informal care practices among older people that looks beyond the definition of formal care to understand how such care complements formal care services. The findings show that older people participate in several care arrangements to care for themselves as well as for others. The arrangements feature different types of mutuality and include distant relations to other older people and larger more or less formalised groups. The findings highlight the importance of looking beyond conceptualisations of care based on understandings of formal care and specific relationships as a frame for understanding informal care. To promote older people's health by cultivating and supporting older people's care for themselves and others, research and healthcare practitioners need to explore and acknowledge the significance and complexity of older people's everyday care practices.     

The elderly in five nations: the importance of universal coverage

This paper reports 1999 survey results on the population age sixty-five and older in five nations--Australia, Canada, New Zealand, the United Kingdom, and the United States. The majority of respondents were generally satisfied with the quality, affordability, and availability of health services in their nations. In many measures of access to and cost of care, the United States looks much like the other nations surveyed. However, as the elderly view their health systems, the direction they have taken in recent years with respect to caring for the elderly, and the future affordability of care in old age, U.S. respondents tended to be more pessimistic than were those in other nations.     

Product Service Platform to improve care systems for elderly living at home

BackgroundPopulation aging is inducing governments to redesign their healthcare models. One policy measure aimed at reducing healthcare expenditures and improving services is to encourage people to age-in-place. Scientific research has been trying to find ICT-enabled solutions to the growing problem of elderly home care. However, such research is often technology-oriented and neglects the end-user perspective. It does not consider the real needs of older people and all stakeholders involved in their healthcare.MethodA user-centered design approach was adopted with the involvement of older people, experts dealing with the aging population, and the whole stakeholders’ chain. Through surveys, focus groups, and brainstorming sessions, it was possible to determine the main features of the product service platform.ResultsStarting from a large-scale survey of elderly people living in Italy, this paper presents the requirements and the architecture of a product service platform aimed at improving the independence and elderly quality of life. This work proposes an elderly-centered platform that works as an aggregation point of an articulated social health system, provides multiple tailored services, and optimizes the use of local resources.ConclusionsThe involvement of the end-user and all the stakeholders allowed for the consideration of different perspectives and the creation of a value network that aggregates existing services, resources, and information with new opportunities to achieve common benefits. This work provides guidelines on how to develop this type of platform by exploiting the potential of each stakeholder without creating new barriers. Technology, caregivers, and society are combined synergistically to provide tailored services able to satisfy specific users’ needs.