Proactive, targeted benefits advice for older people in general practice: a feasibility study

The aim of the present project was to assess a welfare benefits and advice screening programme offered in a systematic and inclusive way to all patients aged 80 years and over registered with a single general practice. The setting was an inner-city National Health Service group practice with a total of seven full-time general practitioners (GPs) and a list size of 12 000 patients. A total of 280 patients were identified as aged 80 years and over. Using a combination of telephone calls, surgery attendances and home visits, an advice worker contacted as many of these patients as possible. A wide range of advice and assistance of both a statutory and non-statutory nature was offered. Follow-up contacts and liaison with the patients' own GPs were arranged as necessary. Contact was made with a total of 206 patients. In total, the adviser made 98 home visits and carried out 82 consultations in the surgery, as well as undertaking 109 interviews over the phone. The findings indicate that an overall total of pound 137 819 was gained in increased annual income amongst the screened patients; in addition, a further pound 11 433 was awarded in one-off payments. A wide range of other benefits and help, including referral to other services and organisations, was gained. Elderly patients within the practice were under-claiming benefits and had many previously unidentified needs. Adopting a proactive and inclusive approach to offering welfare and advice takes time and expense, but the resulting benefits make it worthwhile. Primary care is an effective base from which advice can be delivered and the development of closer working relationships between primary care and advice services can be an effective and efficient way of helping patients.     

Providing welfare advice in general practice: referrals, issues and outcomes

General practices in the UK are increasingly hosting welfare advice services on their premises to address patients' social and economic needs. In this paper, the authors present the outcomes of a service providing welfare advice across 30 general practices in inner-city Bradford. A retrospective study of all patients referred for advice during the initial 24 months of the project was conducted. The following information was collected: patient demographics, source of referrals, advice issues raised and income generated through benefit claims. The advice workers saw 2484 patients dealing with over 4000 welfare advice issues. Demand for the service varied widely across practices, reflecting practice list size and engagement with the service by practice staff. The main source of referrals was general practitioners (28%), and disability-related welfare benefits constituted the largest category of advice issues. Sixty-nine per cent of patients seen for advice were of south Asian ethnic origin. The advice workers raised pound sterling 2,389,255 in welfare benefit claims for patients, primarily through disability-related benefits. Approximately one in four patients referred for advice benefited financially. It is concluded that the service is an excellent strategy by which primary care organisations address the social, economic and environmental influences on the health of their population.     

Welfare benefits advice in primary care: evidence of improvements in health

It is not uncommon for welfare benefits advice organisations to offer services in primary care settings. Given the link between deprivation and poor health, the maximising of individual income in this way may also be expected to improve health. However, such improvement has hitherto not been successfully measured. This paper reports on a small study of such a service, provided by the local Citizens Advice Bureau. Statistically significant increases in SF-36 scores were measured for those whose income increased as a result of receiving advice, despite the prevalence in the group (average age 56 y) of chronic disabling conditions such as arthritis and sensory impairment. These findings suggest that 'prescribing advice' is a health intervention which is appropriately situated in primary care.     

Examining day centre provision for older people in the UK using the Equality Act 2010: findings of a scoping review

This article reports the findings from a literature review of day care services undertaken during March–June 2012 and repeated in May 2013. The databases searched included AgeInfo, Embase, Medline, PsycINFO, Social Care Online, Web of Science and the publication platform Ingenta Connect as well as specialist older people's sites. It discusses these findings in the context of services for older people in the UK, defined as those aged 65 years and over. The aim of the scoping review was to identify what is known about how day services (here confined to congregate day care or day centres) will meet the challenges posed by the Equality Act 2010 in supporting different user groups, such as lesbian, gay, bisexual and transgender older people or older people from minority ethnic groups. The review found that research on all aspects of day services was limited and that information about older people using such services was often provided context‐free. It concludes that those funding or evaluating day services' support to diverse groups of older people need to urgently address matters such as differential access and differential views about specific services.     

Defining roles, relationships, boundaries and participation between elderly people and nurses within the home: an ethnographic study

Recently there has been a marked shift in the location of nursing care in the UK from the hospital setting to the community and more particularly the home, with elderly people identified as key recipients of care in this setting. A number of commentators have highlighted the particular situation of elderly people with regard to care provision, illuminating the often disempowering nature of care interactions between nurses and elderly people. However, although there is clear evidence from a number of settings that care for elderly people has been less than optimal, to date there is little comparable evidence available regarding elderly people's experiences of nursing care within the home environment. Utilising an ethnographic approach, incorporating participant observation and semistructured interviews with nurses and elderly people (aged 65 years and over), the aim of this study was to explore the nature of the care relationship within the home setting. Thirteen elderly people who were receiving nursing care within the home and 16 community nurses within one Primary Care Trust in the UK took part in the study and data were collected over a period of 1 year. Three themes emerged from the data: the location of care; the nature of nurse–patient relationships; and the meaning of health and illness. These offer an account of the ways in which roles and relationships are constructed, negotiated and experienced by nurses and elderly people in the home, illuminating the centrality of relationships between nurses and elderly people in defining the experiences and perceptions of both groups of the quality of care overall. As the location of care continues to move closer to home, it is crucial that the implicit qualities that are valued within nurse–patient relationships in this context are recognised and made more explicit at both the organisational and policy level.     

Fitting dietary advice for oral health into the roles of food for elderly, mentally ill people

Aim: To identify the roles of food in a day-centre for elderly, mentally ill people, so that dietary recommendations for optimal oral health are made within the overall philosophies of the day-centre. Method: A qualitative approach was adopted. It comprised an observational study of the daily routine and a semistructured interview to examine the attitudes, beliefs and knowledge of the care-staff related to diet, general health and oral health. Results: The use of food was pivotal to the functioning of the centre. Food was used for nutrition, as a focus for communal activities, to express love and caring, and to maintain cognitive, daily living and social skills. All staff considered oral health important and appreciated the link between oral health, general health and diet (primarily sugar consumption). Despite this, one-third of carers considered tooth loss an inevitable consequence of ageing. Sugar was generally regarded as detrimental to general health, but attitudes towards use of sweeteners as an alternative were mixed. However, it was believed that elderly people can adapt to dietary changes. Conclusion: Dietary advice for oral health would be acceptable if put in the context of general health and the changes take account of the overall philosophies of the centre. To this end a ‘Healthy Eating Resource Pack’ was produced for use in the centre.     

Establishing a welfare advice service in family practices: views of advice workers and primary care staff

BACKGROUND: The placement of welfare advice services in family practice to assist patients with health-related social and economic issues (e.g. disability benefits) has gathered momentum over the last decade in the UK. This expansion of primary care raises a number of issues for practices hosting these services. OBJECTIVES: To gain the views of advice workers and primary care staff about the issues raised in hosting a welfare advice service across 30 practices in inner city Bradford. METHODS: Views were obtained through focus groups with six advice workers, and primary care staff in 14 practices. A questionnaire was also posted to all practice managers asking their opinions about the service. RESULTS: The focus groups highlighted a number of advantages for patients, including improvements in health and quality of life through increased income and reduced stress from social and economic issues. For practice staff, the service provided a resource to refer patients for welfare advice, reducing the time spent dealing with welfare issues, thereby reducing workload. This was confirmed in the questionnaire to practice managers where 72% said the service had saved time for GPs and reception/office staff. The advice workers raised concerns about the perceived level of commitment to the service from some staff at some practices. Practice staff were particularly concerned about the need for feedback about referrals. CONCLUSION: Providing welfare advice in family practice can act as a valuable resource for primary care staff helping to address their patients health-related social and economic needs.     

'It's a small world': mental health policy under welfare capitalism since 1945

Much sociological theorising about community care in mental health universalises from Anglo-American contexts. So do assessments of policy shifts towards deinstitutionalisation, whose tendency towards negativity largely reflects the downsized mental health care systems that have emerged in welfare regimes, strongly influenced by neoliberal political ideology. Drawing on the framework of Esping-Anderson (1990), the article seeks to theorise from a wider range of welfare regimes, including Sweden and Italy, where political influences on policy provide more support for a degree of optimism. It also seeks to demonstrate in outline the advantages of analysing global influences on mental health policy under welfare capitalism, as key factors shaping policy throughout the whole post-1945 period.     

Assessing the health benefits of advice services: using research evidence and logic model methods to explore complex pathways

Poverty is positively associated with poor health; thus, some healthcare commissioners in the UK have pioneered the introduction of advice services in health service locations. Previous systematic reviews have found little direct evidence for a causal relationship between the provision of advice and physical health and limited evidence for mental health improvement. This paper reports a study using a broader range of types of research evidence to construct a conceptual (logic) model of the wider evidence underpinning potential (rather than only proven) causal pathways between the provision of advice services and improvements in health. Data and discussion from 87 documents were used to construct a model describing interventions, primary outcomes, secondary and tertiary outcomes following advice interventions. The model portrays complex causal pathways between the intervention and various health outcomes; it also indicates the level of evidence for each pathway. It can be used to inform the development of research designed to evaluate the pathways between interventions and health outcomes, which will determine the impact on health outcomes and may explain inconsistencies in previous research findings. It may also be useful to commissioners and practitioners in making decisions regarding development and commissioning of advice services.     

社区老年人社会隔离与抑郁症状的纵向研究

目的 采用交叉滞后分析模型探讨社区老年人社会隔离与抑郁症状的纵向关联。方法 采用分层整群抽样法对济南市789名社区老年人在2019年10月至2020年8月进行为期10个月的纵向追踪调查,使用Lubben社会网络量表简化版和老年抑郁量表简化版进行两次测量（T1和T2）。结果 社区老年人社会隔离与抑郁症状均具有一定稳定性;2个时间点的社会隔离与抑郁症状均呈负相关（r=-0.429,-0.327,P<0.001）。交叉滞后回归分析显示,在控制T1抑郁症状后,T1社会隔离显著预测T2抑郁症状（β=-0.136,P<0.001）;控制T1社会隔离后,T1抑郁症状对T2社会隔离的预测作用无统计学意义（β=-0.012,P=0.750）。结论 社会隔离是老年人抑郁症状的前因变量,社会隔离可以显著预测抑郁症状。