The impact of community care services on the preference for ageing in place in urban China

This paper examines the relationship between community care services and ageing in place in urban China. Using data from the 2010 Sample Survey on Aged Population in Urban/Rural China, and within the framework of a revised version of Andersen's model, the paper applies multilevel models and analyses the effects of community care on the preference between ageing in place and institutional care, and reveals that ageing in place is preferred even in urban China. However, the existence of community care services had no significant effect on the preference for ageing in place. The paper concludes by arguing that China needs to develop its community care services and promote the idea of community care in both culture and policy. Realising ageing in place also requires a multidisciplinary approach. A model of shared care, between family and state, is particularly appropriate for China.     

Understanding help‐seeking in older people with urinary incontinence: an interview study

The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with UI on the process of seeking help. Older people with UI were recruited to the study from three continence services in the north of England: a geriatrician‐led hospital outpatient clinic (n = 18), a community‐based nurse‐led service (n = 22) and a consultant gynaecologist‐led service specialising in surgical treatment (n = 10). Participants took part in semi‐structured interviews, which were transcribed and underwent thematic content analysis. Three main themes emerged: Being brushed aside, in which participants expressed the feeling that general practitioners did not prioritise or recognise their concerns; Putting up with it, in which participants delayed seeking help for their UI due to various reasons including embarrassment, the development of coping mechanisms, perceiving UI as a normal part of the ageing process, or being unaware that help was available; and Something has to be done, in which help‐seeking was prompted by the recognition that their UI was a serious problem, whether as a result of experiencing UI in public, the remark of a relative, the belief that they had a serious illness or the detection of UI during comprehensive geriatric assessment. Greater awareness that UI is a treatable condition and not a normal part of ageing is needed in the population and among health professionals. Comprehensive geriatric assessment appeared an important trigger for referral and treatment in our participants. Screening questions by healthcare professionals could be a means to identify, assess and treat older people with UI.     

Costs and economic consequences of a help‐at‐home scheme for older people in England

Solutions to support older people to live independently and reduce the cost of an ageing population are high on the political agenda of most developed countries. Help‐at‐home schemes offer a mix of community support with the aim to address a range of well‐being needs. However, not much is currently known about the costs, outcomes and economic consequences of such schemes. Understanding their impact on individuals’ well‐being and the economic consequences for local and central government can contribute to decisions about sustainable long‐term care financing. This article presents results from a mixed‐methods study of a voluntary sector‐provided help‐at‐home scheme in England for people of 55 years and older. The study followed a participatory approach, which involved staff and volunteers. Data were collected during 2012 and 2013. Social care‐related quality of life was measured with the Adult Social Care Outcomes Toolkit for 24 service users (59% response rate) when they started using the scheme and 4–6 months later. A customised questionnaire that captured resource use and well‐being information was sent to 1064 service users (63% response rate). The same tool was used in assessment with service users who started using the scheme between November 2012 and April 2013 (100% response rate). Costs of the scheme were established from local budget and activity data. The scheme was likely to achieve a mean net benefit of £1568 per person from a local government and National Health Service (NHS) perspective and £3766 from the perspective of the individual. An expenditure of £2851 per person accrued to central government for the additional redistribution of benefit payments to older people. This article highlights the potential contribution of voluntary sector‐run help‐at‐home schemes to an affordable welfare system for ageing societies.     

Communicating risk in dementia care: Survey of health and social care professionals

Supporting people to live at home in line with community care policies requires increasing attention to assessing, communicating and managing risks. There is a challenge in supporting client choices that include risk‐taking while demonstrating professional accountability. Risk communication becomes increasingly important with the need to engage clients and families in meaningful shared decision‐making. This presents particular challenges in dementia services. This survey of risk communication in dementia care was administered to all health and social care professionals in community dementia services in Northern Ireland: June–September 2016. Of 270 professionals, 70 questionnaires were fully completed, with 55 partial completions. Scores on the Berlin Numeracy Test plus Schwartz items was low‐moderate (mean 2.79 out of 7). This study did not find a significant association between numeracy and accurate perceptions of risk likelihoods in practice‐based scenarios. Although 86% reported using numeric information in practice (mostly from assessment tools), respondents rarely communicated themselves using numbers. As in other domains, participants’ responses were widely variable on numeric estimates of verbal terms for likelihood. In relation to medication side effects, few participants provided responses that were concordant with those in the guidance of the European Union. The risks most commonly encountered in practice were (in rank order): falls, depression, poor personal hygiene, medicines mismanagement, leaving home unsupervised, financial mismanagement, malnutrition, swallowing difficulties, abuse from others, risks to others, home appliance accidents and refusing equipment. Respondents generally overestimated the likelihood of serious harmful events by approximately 10‐fold (having a missing person's report filed with the police; having a fall resulting in hospitalisation) and by approximately double (being involved in a car accident; causing a home fire), and with wide variation between respondents. There is potential in icon arrays for communicating risks. Risk literacy among dementia care practitioners needs to be developed.     

What evidence should guidelines take note of?

The Guidelines Challenge Conference on which this special issue builds asked as the first of its “further relevant questions”: “How do we incorporate more types of causally relevant information in guidelines?” This paper first supports the presupposition of this question—that we need further kinds of evidence—by pointing out that the randomized controlled trial, touted as the best source of evidence on effectiveness, can do so little for us. Second, it outlines a number of other good ways to learn what will work that the medical community, and much of the public health community, is not making much use of.     

Measuring the quality of skin cancer management in primary care: A scoping review

Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited.