The role of telematics in assisting family carers and frail older people at home

The overall aim of the ACTION research project (Assisting Carers using Telematic Interventions to meet Older person's Needs) is to maintain or enhance the autonomy, independence and quality of life of frail older and disabled people and their family carers by providing information, advice and support in the home. The authors report on the first phase of evaluation conducted using a case-study approach to test the ACTION system in several family carers' homes in Sheffield, England. The results reflect the realities of conducting an applied research technology project and are discussed with reference to the government's recent national strategy for carers. The authors acknowledge the need for further evaluation studies to explore the key issues raised within this preliminary evaluation phase.     

Preventive home visits to older home‐dwelling people in Denmark: are invitational procedures of importance?

Since 1998 all municipalities in Denmark have been required by law to offer two annual preventive home visits to all home‐dwelling citizens aged 75 or over. The influence of invitational procedures on acceptance rates has not been investigated. The aim of this study was to describe and investigate whether different invitational procedures were associated with first preventive home visit acceptance rates. The study was based on secondary analyses of data from the Danish Intervention Study on Preventive Home Visits. Data were collected from 1998 to 2002. Of the 4060 participants in the main study, 3245 reported receiving an offer for an identifiable preventive home visit, of whom 2399 (73.9%) provided complete data for the main analyses in the present study. Invitational procedures were categorised as: (1) a letter with a proposed date and time for the visit, (2) a visitor telephone call, and (3) a letter with encouragement to phone the visitor for appointment (letter without a proposed date). Covariates included sex, age, experience with preventive interventions, functional ability, self rated health, social relations and psychosocial characteristics. Statistical analyses included chi‐square tests, and bi‐ and multivariable logistic regression analyses. Different invitational procedures were associated with first preventive home visit acceptance rates. Significantly more men (75.1%) than women (62.8%) declined the first preventive home visit regardless of the invitational procedure. Compared to ‘letter with a proposed date’, men had an odds ratio of 1.78 (95% CI: 1.16–2.74) for declining visits when ‘telephone call’ was used and an odds ratio 2.81 (95% CI: 1.79–4.40) when ‘letter without a proposed date’ was used as the invitational procedure. In women the odds ratios were 1.23 (95% CI: 0.91–1.68) and 1.87 (95% CI: 1.37–2.55), respectively.     

Formal support of stroke survivors and their informal carers in the community: a cohort study

This cohort study, aims to explore formal care provision to stroke survivors and their informal carers in the community in the UK. An initial cohort of 105 cohabitant carers of first-time stroke patients was recruited while the stroke patient was in hospital. Structured face-to-face interviews were carried out with carers prior to discharge of the stroke patient home, at 6 weeks after discharge, and 15 months after stroke. Questionnaires included measures of psychological health (CIS-R), physical health (self-rated health), social well-being (relationship quality and Sarason's social support questionnaire), handicap of the stroke survivor (Oxford Handicap Scale) and formal community support (amount of formal support and carer satisfaction). Multiple services were involved with most survivor-carer pairs (mean 5.4; range 2-9; SD = 1.7), and 74% of carers were satisfied with formal support provided. Number of services decreased with time (5.5 versus 4.1, t = 4.201, d.f. = 52, P < 0.001, 95% confidence interval: 0.71-2.01) but not time allocated. Using stepwise linear regression, service provision early after discharge was predicted by: level of handicap, recruitment centre, carer self-rated health, number of informal supporters and other care commitments. Satisfaction was predicted by quality of informal support and activity restriction. Fifteen months after stroke, predictors of formal care were: level of handicap, quality of informal support and previous caring experience. Predictors of satisfaction were: quality of the relationship between the stroke survivor and carer, age and mood. Quality of services was good, but carers lacked information, had insufficient help and were not consulted enough. Carer distress is common, yet not currently a factor influencing support provision. Formal care provided adapts with time reflecting the importance of quality of support from friends and family rather than quantity of informal supporters. These factors should be taken into consideration when planning and providing formal support for stroke survivors and their carers.     

The general practitioner and older people: strategies for more effective home visits?

This paper is based on findings from a pilot research project funded by the Primary Health Care Development Fund in Scotland. The researcher's remit was to examine home visiting patterns by general practitioners (GPs) to older people on Tayside following the community care reforms. Fieldwork was conducted in three general practices on Tayside, using an anthropological perspective. This research confirms that community care changes have not to date effected a significant shift in GP perceptions, which are that the probable destiny of frail older people is to enter some kind of residential setting. The researcher examines how and why GPs label certain patients as a “problem” and uses this categorization process to suggest that such patients are seen by GPs as having a “moral career”. It is argued that GPs may also see some older patients as a “problem”, the solution to which may be to recommend that the patient enter residential or nursing home care. The research identifies a point in the career of the older “problem” patient at which doctors could usefully refer to other agencies. A model for communication or collaboration is posited as a way of enabling GPs to continue to provide sensitive and individually appropriate care for frail older patients in collaboration with appropriate others. Funding has been obtained to pilot this model in selected general practices on Tayside in 1996/97.     

Satisfaction and difficulties of French professional home caregivers in supporting older people with Alzheimer's disease or alcohol misuse

In France, few studies have examined home care when it comes to ageing support and even fewer have considered alcohol misuse in this context. The studies also show that being old and having alcohol use disorders are two unfavourable conditions for receiving help, whereas for the Alzheimer's disease, there is a clear need for optimal care. In this article, we study professional home caregiver's perceptions of their job along with their difficulties and satisfactions in supporting older people with Alzheimer's disease or alcohol misuse. Out of the 23 professionals approached, 17 took part in a research interview from October 2013 to January 2014. All interviews were recorded, fully transcribed and lexically analysed with Alceste^® software. Among the five classes that were identified from 63% of the initial data, the main themes that emerged illustrate the nature of the associated pathologies, the perceptions and satisfactions related to the profession, their adaptive skills, the difficulties related to the life context of the older person, and the wine consumption of the latter. The lexical discourse analysis shows that the professional home caregivers are involved in looking after not only people with Alzheimer's disease but also those with alcohol misuse. However, despite the difficulties and satisfactions encountered, adaptation to the older people seems to be their priority and one of the many skills that they have acquired during their professionalisation. Most of the older people who are helped are women and the difficulties mentioned by their caregivers usually arise at the time of their death. Lastly, when caring for alcohol misusers, they describe negative attitudes in their support. Although research in this area is rare while home care for the older person, whatever the pathology, is increasing, professionals need to be supported by the associations or companies that employ them and should be trained to help them provide the appropriate care.     

Trust in older persons: A quantitative analysis of alignment in triads of older persons,informal carers and home care nurses

Self‐management by older persons could be influenced by the level of trust found in triads of informal carers, formal care providers and care recipient, the older person. Little research has been done on care providers’ trust in older persons. This study aims to explore the level of trust that informal carers and home care nurses have in older persons, the extent of alignment in triads and the relationship between trust in older persons and self‐management. We conducted a cross‐sectional survey study in the Netherlands, sampling 133 older persons, 64 informal carers and 72 nurses, which resulted in 39 triads. Alignment level was analysed through Intraclass Correlation Coefficient 1 scores and absolute and mean difference scores. Correlation analysis and one‐way analysis of variance measured the relationship between trust and self‐management. The results show that triads contain both alignment and misalignment. Misalignment occurs mostly when informal carers and nurses have little trust in the older person while this person views their own behaviour towards their caregivers positively. Care providers’ trust levels relate significantly to their perception of the person's ability to self‐manage, but not to the person's self‐rated ability. This could be explained by care providers not communicating their intrinsic trust in the older person to them. Trust building could be enhanced by organising discussions of mutual expectations of trust and both formal and informal care providers could benefit from compassionate assessment training, to learn how to openly express their trust in the older person.     

Residential status and depression among Korean elderly people: a comparison between residents of nursing home and those based in the community

The purposes of this study were: (i) to compare the extent of depression in the nursing home and community-dwelling elderly people, and (ii) to find the variables including residential status and other related variables explaining depression in Korea. Two sets of secondary data were combined and used to achieve the objectives of this study. One data set relating to elderly people in nursing homes was from a part of 2002 Kyunggi Long-term Care System Construction Study by Kyunggi Research Institute, Kyunggi province, Korea. The other data set for community-dwelling elderly people was from a part of 2001 National Long-term Care Study by Korea Institute for Health and Social Affairs. The data set for this study included 307 elderly people living in nursing homes and 166 elderly people living in the community. Depression was measured and determined using the geriatric depression scale-short form (GDS-SF) Korean version, with scores of 8 or higher to indicate possible depression. A total of 39.3%[95% confidence interval (CI); 32.1-46.9%] of the sample in the community elderly showed symptoms of depression, higher than the rate found in the nursing home elderly (24.0%) (95% CI; 19.5-29.2%). The mean (standard deviation) GDS-SF score for the elderly in the nursing home was 6.1 (3.4), and 7.4 (4.3) for elderly in the community, the difference being statistically significant [t (275.5) = -3.33; P < 001]. As a result of multiple logistic regression analysis, residential status has appeared as an important predictor after controlling other related variables. The adjusted odds ratio of depression associated with the nursing home residents in residential status, all other factors being equal, was 3.14 (95% CI; 1.30-7.58). Community-dwelling elderly people have higher odds of depression. These findings suggest that there is a need to provide adequate health-related care services for the elderly people in the community.     

Falling in older people at home: Transfer limitations and environmental risk factors

A case control study was undertaken to examine the prevalence of transfer limitations and home risk factors for falls in 50 men and women aged 60 years and over who had been admitted to an acute hospital due to a fall in the previous year, and 45 age and sex matched non-fallers who were recruited from community organizations. The assessments were carried out in the homes of each subject using standardized protocols. Subjects who had fallen in the home reported significantly more difficulties with transfers than subjects who had fallen outside or non-fallers (Chi-squared = 33.9, d.f=2, P<0.001). In contrast, no significant differences were found in total home hazard scores among the home fallers (mean=2.8 hazards, s.d.=1.3), outside fallers (mean=3.4, s.d.=1.70), and non-fallers (mean=3.2, s.d.=1.70), and only one hazard (lack of a bedside light) was significantly more prevalent among the home fallers compared with the non-fallers. The findings suggest that a non-specific approach to environmental risk factors in the homes of older people may be an ineffective public health measure. Alternative strategies that include the targeting of home hazard identification and home modification for older people with physiological impairments and transfer limitations may be more effective for preventing falls. Such approaches may complement other interventions aimed at maximizing balance and mobility.     

Correlates of wellbeing of spousal and children carers of disabled people over 65 in Spain

BACKGROUND: The aim of this study was to evaluate the associations between carer's wellbeing and stressors and to assess if these associations are different for spousal and children carers of disabled elderly. METHODS: Information was collected by home interviews of a population sample of carers (N = 195), who were providing assistance in activities of daily living to a community-dwelling population over 65. Associations between indicators of wellbeing (number of depressive symptoms, number of physical symptoms, self-perceived health and life satisfaction) and caring stressors were examined, controlling for carer's socio-economic characteristics and health status. Hierarchical logistic regressions were used to fit the data. Religion and social support were included as resources and spousal and children differential associations were tested. RESULTS: The four indicators of wellbeing are moderately correlated, indicating a common underlying concept. Spousal carers have lower socio-economic status, poorer health and lower levels of wellbeing than children carers. However, children carers bear a significantly greater burden. In the multivariate analysis of the associations between wellbeing and stressors, the similarities between spouse and adult child carers are more striking than the differences. Emotional support was consistently associated with higher levels of wellbeing while the associations of religiosity and instrumental support with wellbeing did not reach statistical significance. CONCLUSION: As formal care services are being developed in Spain, their ability to work in a supportive way with family networks should be taken into account. Research should be carried out on patterns of formal care interventions that use the resources in the natural support network of the family.     

家庭功能对老年人家庭访视护理需求影响

目的探讨社区老年人家庭功能、家庭访视护理需求状况及两者之间的关系,为社区医护人员实施家庭访视护理提供依据。方法采取便利抽样入户调查方法,选取宁夏自治区银川市妇幼保健院永丰社区医疗卫生服务站管辖的2个居委会660户家庭,应用家庭关怀度指数问卷和自制的社区老年人家庭访视护理服务需求问卷进行调查。结果家庭功能总分为（5.50±2.503）分,家庭功能良好占34.8%,家庭功能障碍占65.2%;家庭功能障碍组老年人的家庭访视护理总需求及生活护理、健康促进和护理服务需求得分分别为（139.76±30.083）、（27.75±6.491）、（33.42±5.577）、（78.59±19.006）分,均高于家庭功能良好组的（133.95±34.451）、（26.38±7.502）、（32.43±6.536）、（75.14±21.347）分（P均<0.05）;且社区老年人家庭功能与家庭访视护理需求呈负相关（r=-0.135,P<0.01）,其中家庭功能障碍与家庭访视护理需求的生活护理、健康促进、护理服务各维度均呈负相关（r=-0.142~-0.166,P均<0.01）。结论社区老年人的家庭功能有待进一步改善,家庭功能与家庭访视护理需求密切相关。     

The role of family carers in the use of personal budgets by people with mental health problems

Personal budgets aim to increase choice and independence for people with social care needs but they remain underused by people with mental health problems compared to other disability groups. The use of personal budgets may impact on families in a variety of ways, both positive and negative. This paper draws on interviews, undertaken in 2012–2013 with 18 family carers and 12 mental health service users, that explored experiences of family involvement in accessing and managing personal budgets for a person with mental health‐related social care needs. The sample was drawn from three sites across England, with additional carers being recruited via voluntary sector networks. Our findings show that for many people with severe mental health needs who lack motivation and confidence to negotiate access to personal budgets, carers may provide the necessary support to enable them to benefit from this form of social care support. We illustrate the role carers may play in initiating, pursuing and maximising the level of support available through personal budgets. However, some carers interviewed considered that personal budget funding was reduced because of practitioners’ assumptions about carers’ willingness and ability to provide support. We also report perceived tensions between family carers and practitioners around appropriate involvement in decision‐making. The study findings have implications for local authorities, practitioners and family carers in supporting the involvement of family carers in support for people with severe mental health problems.     

居家不出老年人居家养老服务需求影响因素分析

目的 探讨居家不出老年人居家养老服务需求的现状及其影响因素,为更好的开展居家养老服务和提高老年人的生活质量提供理论依据。方法 采取随机整群抽样方法在河北省唐山市路北区抽取2个社区860名≥60岁老年人进行居家不出状况筛查,对筛查出的居家不出老年人进行问卷调查。结果 860名老年人中共筛查出居家不出老年人149人,居家不出发生率为17.4%;对于养老服务的需求,有70.5%和77.2%的居家不出老年人选择日常生活照料养老服务和医疗保健养老服务,仅有11.4%的居家不出老年人选择精神慰藉养老服务;多因素非条件 logistic 回归分析结果显示,女性、患≥2种慢性病、不能自理是居家不出老年人日常生活照料养老服务需求的影响因素;患≥2种慢性病是居家不出老年人医疗保健养老服务需求的影响因素。结论 居家不出老年人更愿意选择日常生活照料和医疗保健养老服务;性别、患慢性病数量、自理能力是日常生活照料和医疗保健养老服务需求的影响因素。     

Rethinking respite in Australia: A naturalistic effect study of a multicomponent community program to promote respite knowledge,attitudes and behaviours of carers of people with dementia

‘Rethink Respite’ was a prospective, naturalistic cohort study conducted in the Illawarra-Shoalhaven (NSW, Australia) to improve knowledge, attitudes and uptake of respite strategies in carers of people with dementia. A convenience sample of n = 70 carers were recruited in 2014–15 to establish a baseline for knowledge, attitudes and use of respite for a cohort of carers in the region. Carer perceived need for respite, burden and self-efficacy were also assessed. A co-designed multi-component community-based intervention was subsequently rolled at in the region from 2015 to 2016. The intervention supported: awareness raising media; carer education sessions; access to web and print respite information resources; and an option to participate in a tailored one-on-one in-home coaching program. At program completion, a follow-up survey was administered to the cohort, with n = 44/70 responding. All n = 44 respondents reported participation in and exposure to ‘Rethink Respite’ media, information and education during the intervention period. Eighteen of the 44 also self-selected to receive the active tailored coaching support. At follow-up, few positive results were reported on the assessed carer variables for the cohort over time. However, post hoc sub-group analyses found those who also self-selected to receive active support (provided through coaching) (n = 18), showed improvements to their respite knowledge, attitudes and self-efficacy (p < .05). Intention to use respite, and levels of personal gain from caring in this sub-group also increased (p < .05). In contrast, carers who only participated in the informational/educational aspects of the program (and did not self-select to the respite coaching), experienced negative changes over time to their respite beliefs and ‘role captivity’. Overall, this pilot study suggests that passive respite information and educational strategies are insufficient, without more active supports (tailored respite coaching) to address observed carer decline over time. Future research should seek to replicate these results using a larger sample and an experimental design.     

Carers' reflections on nursing home and NHS long-stay care for elderly patients

The aim of this study was to compare the perceptions of carers of elderly long-stay care patients who are now in nursing homes in three health districts in a former Regional Health Authority and in remaining long-stay geriatric National Health Service (NHS) wards. One hundred and ninety-eight nursing home carers (78%) and 128 NHS carers (83%) were interviewed by telephone, using a semi-structured questionnaire and open questions. The impact of caring at home was shown to be greater on NHS than on nursing home carers. Most were satisfied with the care, staff and atmosphere of the nursing home or hospital. Nursing homes were perceived to offer better ‘hotel’ facilities and a more pleasant environment. They were seen as better at respecting patients' privacy. The NHS was regarded as superior in offering clinical and rehabilitative services. Most participants thought the institution was the right place for their relative, although in general, it was thought to be better to care for elderly people at home. ‘Care in the community’ was supported, but carers were realistic about alternatives when informal care ceased to be a reasonable option. There was little ‘choice’ between public and private sector care. For many patients, entry into the institution followed directly from an acute hospital admission. The only choice was between care in a long-stay facility or remaining at home, with the patient becoming increasingly dependent and the carer becoming increasingly unable to cope. The formal aspect of community care should be to be organized rationally and accepted as a valid response to the needs of some dependent elderly patients and their carers.     

Dimensions of choice in the assessment and care management process: the views of older people, carers and care managers

The aim of promoting the maximum possible choice for service users and carers is - together with the goal of greater independence - central to recent community care policies. This paper sets out a typology of those key choices which users and carers are expected to be able to make within each stage of the assessment and care management process: choices about what services, when to receive them (i.e. at what times and for what duration) and from whom (i.e. which provider organization and which individual care worker). Drawing on interviews with 28 older service users, 20 informal carers and 22 care managers across four local authority areas in England, the paper goes on to describe the extent to which such choices - both at the strategic/macro and operation/micro level - have increased or decreased in practice. The evidence confirms that of other recent studies that the gap between the 'ideal' of user and carer involvement and the 'reality' of everyday practice is still considerable.     

Alcohol misuse in older people: heavy consumption and protean presentations

BACKGROUND: Alcohol misuse, especially binge drinking in young people, and alcoholic liver disease are major public health concerns. However, alcohol misuse in older people is underestimated and often goes undetected. OBJECTIVE: To document alcohol consumption and clinical presentation of alcohol misuse in hospital inpatients aged >or=60 years. METHODS: 208 inpatients aged >or=60 years, referred to the alcohol liaison nurse between 1998 and 2003 at the Royal Bolton Hospital, Bolton, UK, were assessed for sex, alcohol intake, primary and secondary reasons for admission, and other concurrent health problems and death. RESULTS: 90% of men drank >21 units weekly and 93% of women drank >14 units weekly. Median weekly alcohol intake was 78.5 units for men and 47 units for women. Acute intoxication, falls, circulatory problems and alcoholic liver disease were the main primary reasons for admission. Neglect or malnutrition, alcoholic liver disease and hypertension were the main secondary reasons and concurrent health problems. 30% of patients died between 1998 and 2003. CONCLUSION: In inpatients aged >or=60 years who were referred to the alcohol liaison nurse in a district general hospital, heavy alcohol consumption, often to very high levels, was characteristic in both men and women and was associated with a wide variety of primary and secondary clinical presentations, including death.     

A national survey of adult placement schemes in England: recruitment and retention of adult placement carers

Adult placement (AP) schemes and the carers they support have been, up to now, a largely invisible part of the social care workforce. Carers in particular fail to appear in workforce statistics. They provide a unique form of care to vulnerable people, under-pinned by values of extended family ('kinship') support. Little is known about the range of current activities of AP schemes and the carers they support. This study of AP schemes in England aimed to provide baseline data about the workforce, care provision, qualification levels, training and support issues, and recruitment and retention problems. Questionnaires were sent to all known schemes in England in both statutory and independent sectors. A final database of 130 schemes was compiled and of these, 124 contributed to the survey with complete or partial information. Variables relating to carers, and recruitment and retention problems experienced by schemes were analysed in detail. Age, gender and ethnic profiles of AP carers were described. Anecdotal evidence had suggested that the current regulatory system was leading to a loss of AP carers and/or an increasingly unregulated sector. Results from analyses supported this as the major reason given by schemes for the problems they had experienced in the last 12 months. Estimates of both the current level of registration and the numbers of carers cancelling their registration in the previous 12 months were made. Recently agreed regulatory changes aim to shift the burden of regulation from individual carers to AP schemes, and thereby ensure a consistent standard of assessment, training and support across England. Evidence from the survey provided support for such a move.     

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.     

Becoming at home in residential care for older people: a material culture perspective

Residential homes encourage new residents to bring belongings with them, so that they can personalise their room and ‘feel at home’. Existing literature on material culture in residential homes views objects as symbols and repositories of home and identity, which can facilitate a sense of belonging in residents through their display in residents' rooms. I suggest that this both misunderstands the processual and fluid nature of home and identity, and conceptualises objects as essentially passive. This article uses ethnographic data and theories of practice and relationality to argue that rather than the meaning of home being inherent in objects, or felt subjectively by residents, meaning is generated through ongoing, everyday interactions between the two. I show that residents became at home by acquiring new things –as well as displaying existing possessions – and also through interacting with mundane objects in everyday social and relational practices such as cleaning and hosting. I conclude that being at home in older people's residential homes need not be so different from being at home at other stages of the life course and in other settings. This challenges conceptualisations of older people's homes – and older age itself – as somehow unknowable and unfamiliar.