Screening in the elderly

It has been known for some years that elderly people have unreported health problems and screening as a means of earlier detection and treatment has been advocated in the past. More recently there has been a renewed interest in this type of preventive health care for elderly people. Conventional screening for early asymptomatic disease is often termed secondary prevention, but in the case of elderly people, screening more closely resembles tertiary prevention. Regular call and recall or consultation-based opportunistic screening are alternative ways of organising screening of elderly people in primary care. Each approach has particular problems but the increased workload for staff resulting from screening is common to both. Selective screening has been tried to resolve this issue. It has taken two forms; the 'at-risk' group approach and the use of postal questionnaires. Neither of these approaches is entirely satisfactory. The published randomised controlled screening trials are too small to show any significant effect on measures of disability levels, social functioning or psychological well-being in old people, although one study demonstrated decreased mortality in the intervention group. Larger evaluative studies are needed before any form of screening for elderly people can be recommended.     

Successful linkage of medical care and community services for HIV-positive offenders being released from prison

Human immunodeficiency virus (HIV) infection is more prevalent among the incarcerated than the general population. For many offenders, incarceration is the only time that they may access primary care. Project Bridge is a federally funded demonstration project that provides intensive case management for HIV-positive exoffenders being released from the Rhode Island state prison to the community. The program is based on collaboration between colocated medical and social work staff. The primary goal of the program is to increase continuity of medical care through social stabilization; it follows a harm reduction philosophy in addressing substance use. Program participants are provided with assistance in accessing a variety of medical and social services. The treatment plan may include the following: mental illness triage and referral, substance abuse assessment and treatment, appointments for HIV and other medical conditions, and referral for assistance to community programs that address basic survival needs. In the first 3 years of this program, 97 offenders were enrolled. Injection drug use was reported by 80% of those enrolled. There were 90% followed for 18 months, 7% moved out of state or died, and 3% were lost to follow-up. Reincarceration happened to 48% at least once. Of those expressing a need, 75% were linked with specialty medical care in the community, and 100% received HIV-related medical services. Of those expressing a need for substance abuse treatment, 67% were successful in keeping appointments for substance abuse treatment within the community. Project Bridge has demonstrated that it is possible to maintain HIV-positive ex-offenders in medical care through the provision of ongoing case management services following prison release. Ex-offenders will access HIV-related health care after release when given adequate support. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the Health Resources and Services Administration, the Special Projects of National Significance program, or other sponsors.     

Evaluating Child Protection Referrals from Southern Education & Library Board Schools

This research project set out to evaluate the experiences of staff in schools within the Southern Education & Library Board when making referrals to Social Services about child protection concerns during 1999/2000. In June 2001 data were gathered from questionnaires and interviews conducted with those who had made referrals. The pre-referral consultation process with the senior social worker was seen as a necessary and important provision in supporting staff when considering a referral. The report concluded that staff believed the process mostly protected the children and young people about whom they had concerns. However, some stated that they did not receive sufficient information and feedback from Social Services about the investigation and ongoing work, which they viewed as necessary in helping them support these young people appropriately during this traumatic and disruptive time.     

Social activation of the elderly: A social experiment

Social isolation and understimulation are considered to be major problems among institutionalized aged. This article describes an ‘activation’ program for elderly people living in a senior citizen apartment building. The intention of the research team was to devise a program together with the elderly and the staff, the goals being to increase social activation and self-dependence among the alderly. The program devised was implemented within the apartment's existing financial framework, involving no additional costs, overtime work or external resources. The program was designed in such a way as to allow for measurement of social activation in both the experimental and control groups. This report focuses primarily on the problems which arose in the personnel group in conjunction with the program. Evaluation of these problems was carried out by means of tape-recorded personnel meetings. This paper presents the analysis of these recordings. It was of major importance to the program that any organizational changes be enacted only on the initiative of the elderly and the staff themselves. The results show that it is possible, with relatively simple and inexpensive methods, to stimulate the elderly's interests and counteract social isolation and understimulation.     

The implementation cost of a safety‐net hospital program addressing social needs in Atlanta

ObjectiveTo describe the cost of integrating social needs activities into a health care program that works toward health equity by addressing socioeconomic barriers.Data Sources/Study SettingCosts for a heart failure health care program based in a safety‐net hospital were reported by program staff for the program year May 2018–April 2019. Additional data sources included hospital records, invoices, and staff survey.Study DesignWe conducted a retrospective, cross‐sectional, case study of a program that includes health education, outpatient care, financial counseling and free medication; transportation and home services for those most in need; and connections to other social services. Program costs were summarized overall and for mutually exclusive categories: health care program (fixed and variable) and social needs activities.Data CollectionProgram cost data were collected using a activity‐based, micro‐costing approach. In addition, we conducted a survey that was completed by key staff to understand time allocation.Principal FindingsProgram costs were approximately $1.33 million, and the annual per patient cost was $1455. Thirty percent of the program costs was for social needs activities: 18% for 30‐day supply of medications and addressing socioeconomic barriers to medication adherence, 18% for mobile health services (outpatient home visits), 53% for navigating services through a financial counselor and community health worker, and 12% for transportation to visits and addressing transportation barriers. Most of the program costs were for personnel: 92% of the health care program fixed, 95% of the health care program variable, and 78% of social needs activities.DiscussionHistorically, social and health care services are funded by different systems and have not been integrated. We estimate the cost of implementing social needs activities into a health care program. This work can inform implementation for hospitals attempting to address social determinants of health and social needs in their patient population.     

Community care staff attitudes towards delivering a falls prevention exercise intervention to community care clients

Millions of older people world-wide receive community care services in their home to assist them to live independently. These services often include personal care, domestic assistance and social support which are delivered by non-university trained staff, and are frequently long term. Older people receiving community care services fall 50% more often than individuals of similar age not receiving services. Yet, few ongoing community care services include exercise programs to reduce falls in this population. We conducted an earlier study to examine the feasibility of community care staff delivering a falls prevention program. A critical finding was that while some of the assessment and support staff responsible for service delivery delivered the falls prevention exercise program to one or two clients, others delivered to none. Therefore, the aim of this qualitative sub-study was to understand reasons for this variation. Semi-structured interviews were conducted with 25 participating support staff and assessors from 10 community care organisations. Staff who had successfully delivered the intervention to their clients perceived themselves as capable and that it would benefit their clients. Older clients who were positive, motivated and wanted to improve were perceived to be more likely to participate. Staff who had worked at their organisation for at least 5 years were also more likely to deliver the program compared to those that had only worked up to 2 years. Staff that did not deliver the intervention to anyone were more risk averse, did not feel confident enough to deliver the program and perceived their clients as not suitable due to age and frailty. Experienced staff who are confident and have positive ageing attitudes are most likely to deliver falls prevention programs in a home care organisation.     

Challenges, benefits and weaknesses of intermediate care: results from five UK case study sites

The authors explore the views of practitioners and managers on the implementation of intermediate care for elderly people across England, including their perceptions of the challenges involved in its implementation, and their assessment of the main benefits and weaknesses of provision. Qualitative data were collected in five case study sites (English primary care trusts) via semistructured interviews (n = 61) and focus group discussions (n = 21) during 2003 to 2004. Interviewees included senior managers, intermediate care service managers, clinicians and health and social care staff involved in the delivery of intermediate care. The data were analysed thematically using an approach based on the 'framework' method. Workforce and funding shortages, poor joint working between health and social care agencies and lack of support/involvement on the part of the medical profession were identified as the main challenges to developing intermediate care. The perceived benefits of intermediate care for service-users included flexibility, patient centredness and the promotion of independence. The 'home-like' environment in which services were delivered was contrasted favourably with hospitals. Multidisciplinary teamworking and opportunities for role flexibility were identified as key benefits by staff. Insufficient capacity, problems of access and awareness at the interface between intermediate care and 'mainstream' services combined with poor co-ordination between intermediate care services emerged as the main weaknesses in current provision. Despite reported benefits for service-users and staff, the study indicates that intermediate care does not appear to be achieving its full potential for alleviating pressure within health and social care systems. The strengthening of capacity and workforce, improvements to whole systems working and the promotion of intermediate care among doctors and other referrers were identified as key future priorities.     

Citizens Advice Bureaux in general practice: an illuminative evaluation

A number of Citizens Advice Bureaux (CAB) have entered into partnerships with Health Authorities in order to provide advice in general practice surgeries as part of the health care services offered by the primary health care team. This illuminative evaluation has involved an exploration of the impacts of the service from the perspective of its users, the CAB advisers and the referral agents. Data was collected from questionnaires, individual interviews and focus group interviews from participants in both a rural and urban setting. The findings of the study suggest that locating CAB advisers in GP surgeries facilitates access for people who would otherwise be effectively excluded by reason of age, poor health, poverty or lack of transport. Overall, consultations with the CAB advisers were perceived very positively. This study would suggest that Citizens Advice Bureaux in GP surgeries are a viable and useful adjunct to primary health care teams in terms of information-giving, social support, up-take of benefits and co-ordination of services.     

运用ServQual量表评价医院医疗服务质量

目的 测评医院患者和职工的感知服务质量,了解患者就诊和职工工作满意程度,提升医疗服务质量。方法 根据ServQual量表5个维度定义设计患者组与职工组两套量表,每套量表共设22个问项的问卷调查表,分别对医院门诊、住院患者和职工发放问卷,并让职工填写患者卷自评对患者提供的服务质量,用数据SPSS20.0统计分析。结果 患者卷和职工自评卷5个维度感受满意。职工卷有形性感受满意,移情性和可靠性感受性差,保证性与响应性感受性次之。女职工较男职工感受性好,30～49岁组职工感受性差,临床一线职工感受性差,其中以医技人员和医生为突出。结论 医院应保护职工利益、需求,合理安排工作时间与强度。提升职工感知服务质量更能提升患者感知的医疗服务质量。     

Cornerstone: Illinois' approach to service integration.

Cornerstone is a management information system developed and implemented by the Illinois Department of Public Health as a mechanism to facilitate maternal and child health service integration. Its design features combined program registration, standardized risk assessment, automated care plan development, and consolidated referral and scheduling. Cornerstone is a flexible, PC- and local area network-based system, allowing portability across program applications and geographic areas. A wide-area network enables local agencies to share data about clients. Development of Cornerstone was a collaborative effort by potential Cornerstone users and statewide administrative staff. The standard for equipment is set at a one-to-one ratio of workstations to case managers.     

Dying in long-term care facilities: support needs of other residents, relatives, and staff

This paper explores the support needs of residents, relatives, and care staff when someone dies in a facility for older people. The authors draw on the qualitative findings from an English study, which investigated the case for applying the principles and practices of palliative care to people dying in these settings. Relatives need practical as well as emotional support, which is often not met adequately by nursing home staff. Managers varied in the extent to which they recognized other residents' emotional needs or supported relatives. Care staff members acknowledged needing practical and emotional support, but management was often unable to deliver it. Lack of training in recognizing and addressing needs in addition to financial and staffing constraints were factors that prevented managers from providing support for staff, residents, and relatives.     

What is the perceived nature of parental care and support for young people with cystic fibrosis as they enter adult health services?

The majority of those diagnosed with cystic fibrosis (CF) now live to adulthood. In response to increased survival age, transition services have been developed to ensure smooth transfer from paediatric to adult specialist healthcare, although the majority of treatment and care continues to be delivered in the home. However, little is known about how young adults and staff conceptualise the nature of the parental role after young people have left paediatric care. The aim of this study is to explore the nature of parental support that is perceived to be available at this time. As part of a larger study of transitional care, semi‐structured interviews were conducted with 50 young people with CF aged 13–24 years (32 with experience of transition and/or adult CF services) and 23 specialist healthcare professionals (14 working in adult care) across two CF centres in Southeast England. Interviews took place in young people’s homes or within CF services, using a topic guide and were recorded, transcribed and analysed thematically. Four domains of perceived parental support were identified by the young people interviewed, with varying degrees of continuity into adult care: (1) Providing non‐clinical practical and emotional support; (2) Acting as ‘troubleshooters’ in times of health‐related crisis; (3) Working in partnership with offspring in ongoing disease management in the home and clinic; (4) Acting as ‘protectors’ of their children. Young people and service staff expressed tensions in managing parental involvement in post‐paediatric consultations and the degree to which parents should be aware of their offspring’s deteriorating health and social concerns. Parental anxiety and over‐involvement was perceived by many young people and staff as unsupportive. We suggest that although health and social care providers are mindful of the tensions that arise for those leaving paediatric services, the place of parental support in adult care is currently contentious for these ‘new’ ageing populations.     

Interagency collaborative care for young people with complex needs: Front‐line staff perspectives

Worldwide, a growing burden of health and social issues now affect young people. Interagency collaboration and the “integration” of health and social care services are advocated to address the increasingly complex needs of at‐risk youth and to reduce barriers to accessing care. In New Zealand, Youth‐One‐Stop‐Shops (YOSSs) provide integrated health and social care to young people with complex needs. Little is known about how YOSSs facilitate collaborative care. This study explored the collaboration between YOSSs and external agencies between 2015 and 2017 using a multiple case study method. This paper reports qualitative focus group and individual interview data from two of four case sites including six YOSS staff and 14 external agency staff. Results showed participants regarded collaboration as critical to the successful care of high needs young people and were positive about working together. They believed YOSSs provided effective wraparound collaborative care and actively facilitated communication between diverse agencies on behalf of young people. The main challenges participants faced when working together related to the different “world views” and cultures of agencies which can run contrary to collaborative practice. Despite this, some highly collaborative relationships were apparent and staff in the different agencies perceived YOSSs had a lead role in co‐ordinating collaborative care and were genuinely valued and trusted. However without the YOSS involvement, collaboration between agencies in relation to young people was less frequent and rarely went beyond limited information exchange. Establishing and maintaining trusting interpersonal relationships with individual staff was key to successfully negotiating agency differences. The study confirms that collaboration when caring for young people with high needs is complex and challenging, yet agencies from diverse sectors value collaboration and see the YOSS integrated wraparound approach as an important model of care.     

Carriage of Neisseria meningitidis in residents and staff at a residential home for elderly people following a case of invasive disease

A study of the carriage of Neisseria meningitidis among staff and residents of a 'closed community' (a residential home for elderly people) was conducted after a resident developed invasive meningococcal disease. All 39 other residents and 49 staff who worked at the home during the previous seven days were offered a throat swab and 38 residents and 49 staff consented. Two residents (none in the index case's social group) and one staff member were found to be carrying N. meningitidis, all phenotypically distinct from the infecting isolate. Thus, all four individuals carried different organisms and the index case was sporadic. Our findings suggest that residents or staff in long stay residential settings where a sporadic case occurs need not be offered meningococcal prophylaxis unless they fulfil the existing definition of 'close personal contacts' of the case.     

Development and evaluation of an occupational therapy program for refugee high school students

Background: Adolescents from refugee backgrounds experience challenges participating in their new school environments. This study aimed to describe and discuss the development of an occupational therapy program to facilitate school participation of high school students from refugee backgrounds. Methods: Three cycles of action research were used to develop a program over 18 months in collaboration with two high schools. Data were collected from four occupational therapists, seven school staff members and two school principals using in‐depth interviews, questionnaires and review of documents. Results: The program changed significantly over the three cycles from a focus on individual task mastery in the classroom environment to development of social competence through an activity‐based group program. Conclusions: Building capacity for social competence helped create better alignment between the roles of occupational therapist and teacher within the school context and was perceived to contribute to refugee students’ overall availability for learning in their new environments. Action research is useful in collaboratively developing programs in emerging areas of practice.     

Housing for frail elderly people.

A national survey followed by an evaluation has recently been undertaken of very sheltered housing for elderly people. This enhanced sheltered housing usually provides 24-hour warden cover, meals and help with domiciliary and personal tasks. It is increasingly being provided by local authorities and housing associations. The evaluation took into account the views of management, staff, elderly people and cost. It was a successful form of housing but more expensive than staying at home with a package of care. In some cases elderly people had moved from institutional care to very sheltered housing. There were, however, people in the schemes who neither wanted nor needed to be there. There were also some problems such as doctors' unrealistic expectations of the schemes and unqualified staff being involved in medication.     

Quantitative and qualitative assessment of a case management program for cancer patients.

An oncology social work case management model of intervention is described quantitatively and qualitatively. Sixty-nine newly diagnosed breast cancer patients followed by telephone for one year required 374 hours of the social worker's time in providing reassurance, information, and referral to existing community resources. This process took less than one-half hour per patient per month. Case examples provide insight into the clinical aspects of the social worker's efforts. This telephone-based model was found to be highly effective and cost-efficient in addressing the rehabilitation needs of cancer patients. It also is a generic model that can be used with cancer patients with any disease site or phase of illness.     

Living areas considered by healthy elderly people living in the suburbs of a metropolitan area

PURPOSE: The purpose of this study was to identify living areas perceived by healthy elderly people living in A, a Metropolitan city. The study also focused on the influences of age, gender, and family structures, residence period, the level of instrumental activities of daily living (the IADL), and frequency of weekly outing of the elderly upon their perceptions. METHODS: The inclusion criteria for the study subjects were: (1) elderly people aged 65 and over living in A city, and (2) not receiving Long-Term Insurance services. The survey period was between January and February in 2005. Self-administered questionnaires were sent to 4,000 randomly selected elderly people by mail and 3,070 (77.0%) questionnaires were returned. 2,692 (67.3%) of these could be analyzed. RESULTS: The majority of respondents perceived the entire area of A city and the local center's area as living areas. Junior high school districts and primary school districts were stated by less than 3% of all respondents as within their living areas. Regarding gender, men were more likely to respond that the local center's area was their living area, whereas women considered that the whole area of A city was included. However, there was no statistically significant difference. In terms of age, respondents aged under 79 included the whole area of A city, whereas those aged 80 and under stated that their areas of self-governing body/neighborhood association were their living areas, indicating reduction in living areas with aging. Regarding the family structure of the respondents, the most frequent answer was the entire K city in subjects in all types of households except those consisting of the subject and parents, who most frequently regarded local center's as the living area. Respondents who were living 10 years and over in K city perceived that the whole area of the city was included, but respondents residing for under 10 years perceived the local center's area to be their living area. With regard to the level of the IADL, independent elderly responded the entire city, whereas dependent elderly responded the local center's area. Moreover, the living areas of respondents became smaller with decrease in the frequency of weekly outing. CONCLUSION: The living areas perceived by elderly people differ depending on their attributes, including age and gender, IADL, frequency of weekly outing, and the period of residence. In order to provide support to facilitate the elderly staying at home, we need to consider their backgrounds and thoughts. Further investigation is necessary to identify the influences of the characteristics and environments of communities upon the elderly perception of living areas.     

Evaluating parent support initiatives: lessons from two case studies

This study describes the characteristics of clients referred to two UK parent support initiatives — Newpin and Home-Start — and documents key aspects of the referral process and clients' responses to the help provided. Data were collected from referral records on 214 families referred during 1992 to four Newpin centres and 349 families referred between April 1994 and March 1995 to four Home-Start schemes. Families were sent questionnaires. Qualitative interview data were collected from a sub-sample of families and from staff and referrers in the Newpin study; volunteers and referrers completed questionnaires in the Home-Start study. Socially disadvantaged families were less likely to return the study questionnaires. The kinds of families and problems referred to the two organizations were very similar. Mothers' loneliness and low emotional well-being were the main reasons for referral; children at risk represented a small part of the caseload. Both Newpin and Home-Start respondents had low levels of support from family and friends. Most referrals were made by health visitors, and there was a significant problem of non use among referred families. Most users of Newpin and Home-Start were enthusiastic about the help provided. Common difficulties in family life, such as poverty, stress and low social support, make up an increasing part of the workload of health professionals and social workers, and of voluntary sector initiatives for supporting parents. This study raises questions about the claims such initiatives may make about their effectiveness in reaching and providing help to 'at risk' families. Further evaluation of such schemes is needed to provide a sound evidence-base for policy and purchasing decisions.