Support networks for Chinese older immigrants accessing English health and social care services: the concept of Bridge People.

Perceived Need for Mental Health Care and Service Use Among Adults in Western Europe: Results of the ESEMeD Project

The family is the key for survival and success of the 4.6 million older immigrants in the United States. It is also an overlooked context to understand older immigrants' health service utilisation. Most prior studies on this topic either focus on individual or institutional factors that affect how older immigrants use formal health services. Using data from 2011 Population Study of Chinese Elderly in Chicago (N=3,159), this study examined potential linkages between family relationships and health service utilisation among US Chinese elderly. Negative binomial and logistic regressions were carried out to investigate whether health service use of these older immigrants are related to positive family relations, negative family relations, and health-related communications among family members. The findings showed that positive spousal or family relations were not associated with either physician visits or hospital stays. However, respondents with more negative family relations had more doctor visits (β=0.065, p<0.05) and were marginally more likely to use inpatient services (OR=1.15, CI: 0.88-1.04, p=0.08). Respondents who talked to their spouse for medical concerns were less likely to use inpatient services (OR=0.68, CI: 0.46-0.99, p<0.05). The findings showed that family relations play a role in Chinese older immigrants' health service use. In addition, family conflict seems to be more influential than close family relations in predicting service use. Practitioners need to thoroughly assess family dynamics to fully understand the resources and barriers for health service utilisation among the older immigrant populations.

BackgroundThere is co-morbidity between parental depression and childhood conduct disorder. The Incredible Years (IY) parenting programmes reduce both conduct disorder in children and depression in their parents. Recent U.K. and Ireland trials of the effectiveness and cost-effectiveness of IY parenting programmes have assessed children’s health and social care service use, but little is known about the programme’s impact on parental service use. This paper explores whether an above clinical cut-off score on the Beck Depression Inventory II (BDI II) is associated with high or low parental health and social care service use in high-risk families receiving the IY Basic Programme.MethodsThis is a secondary analysis of a subsample (N = 119) from the first U.K. community-based randomised controlled trial of the 12-week IY Basic Programme (N = 153). Parents with children at risk of developing conduct disorder were randomised to receive the programme or to a waiting-list control group. BDI II total and BDI II clinical depression cut-off scores were compared to frequencies and costs of parents’ service use, at baseline, six, twelve and eighteen months post-baseline for the intervention group and at baseline and six months post-baseline for the control group.ResultsIntervention group parents who scored above the clinical cut-off on the BDI II at baseline used more health and social care services than those who scored below at baseline, six and eighteen months. Significant reductions in service use frequencies were found for the intervention group only.ConclusionParents with higher levels or depression used more health and social care service and parenting programmes have been shown to reduce parental depression and also health and social service use. However, further exploration of depressed parents’ service use and the cost implications for publically funded health and social care services is needed.Trial registrationRegistration of the original RCT of the IY Basic Parenting Programme - Current Controlled Trials ISRCTN46984318

BackgroundHealth concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation.We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture.MethodsThis is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age ≥ 65) and 300 persons with a recent hip fracture (age ≥ 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried’s frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant’s home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant’s home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months.DiscussionOur trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services.Trial registrationClinicalTrials.gov Identifier: NCT02305433, Registered Nov 28, 2014.

Older adults and people with dementia were anticipated to be particularly unable to use health and care services during the lockdown period following the COVID-19 pandemic. To better prepare for future pandemics, we aimed to investigate whether the use of health and care services changed during the pandemic and whether those at older ages and/or dementia experienced a higher degree of change than that observed by their counterparts. Data from the Norwegian Trøndelag Health Study (HUNT4 70 + , 2017-2019) were linked to two national health registries that have individual-level data on the use of primary and specialist health and care services. A multilevel mixed-effects linear regression model was used to calculate changes in the use of services from 18months before the lockdown, (12 March 2020) to 18months after the lockdown. The study sample included 10,607 participants, 54% were women and 11% had dementia. The mean age was 76years (SD: 5.7, range: 68-102years). A decrease in primary health and care service use, except for contact with general practitioners (GPs), was observed during the lockdown period for people with dementia (p < 0.001) and those aged ≥ 80years without dementia (p = 0.006), compared to the 6-month period before the lockdown. The use of specialist health services decreased during the lockdown period for all groups (p ≤ 0.011), except for those aged < 80years with dementia. Service use reached levels comparable to pre-pandemic data within one year after the lockdown. Older adults experienced an immediate reduction in the use of health and care services, other than GP contacts, during the first wave of the COVID-19 pandemic. Within primary care services, people with dementia demonstrated a more pronounced reduction than that observed in people without dementia; otherwise, the variations related to age and dementia status were small. Both groups returned to services levels similar to those during the pre-pandemic period within one year after the lockdown. The increase in GP contacts may indicate a need to reallocate resources to primary health services during future pandemics. The study is registered at ClinicalTrials.gov, with the identification number NCT04792086.

Older immigrants are at risk of developing mental illness. This study aims to examine mental health service utilization among older Chinese immigrants, using a mixed-method design. Andersen's Behavioral Model of Health Services Use informed an examination of predictors of mental health services utilization, and semi-structured individual interviews were conducted to illuminate these findings. Participants who were younger, had less than a high school education, and had a higher level of depressive symptoms were more likely to use mental health services. Stressors of psychological distress included breakdown of support system, language barriers, and financial hardships. Factors influencing mental health services use included information from family/friends, referrals from primary care physicians, perceived needs for help, mental health stigma, and culturally competent mental health professionals. Understanding the factors associated with seeking mental health services for older Chinese immigrants could help health care providers to develop early screening programs and culturally sensitive interventions.

The Link Between Homeless Women's Mental Health and Service System Use

The aim of this study, conducted in the Region of Lazio, Italy, in 2008-2010, was to describe the use, over a one-year period, of health and social care services in a cohort of 712 patients with a diagnosis of dementia. These patients had never previously used such services. We evaluated the association between the patients' sociodemographic and clinical characteristics and their use of services. Sociodemographic and clinical data were collected at baseline using validated instruments, while the use of services was investigated at the end of the one-year follow-up through a structured (questionnaire-based) interview with the caregiver. We found that 11.9% of patients used health or social care services. The most frequent diagnoses were: Alzheimer's disease (72.1%), mixed dementia (20.5%), and vascular dementia (9.7%). A higher probability of use of services was observed in patients with: more than five years of schooling (OR=1.79; 95%CI:1.08-2.96); one or more comorbidity (OR=4.87; 95%CI:2.05- 11.57); severe (OR=4.78; 95%CI:1.75-13.06) or moderate dementia (OR=2.08; 95%CI:0.98-4.40). The low health and social care service use among dementia patients in this study could be explained by a lack of availability of services. Public health authorities should plan adequate networks of services, considering both patients and caregivers' needs.

BackgroundThe increasing prevalence of Alzheimer’s disease (AD) will substantially impact health and social care systems worldwide. In this study, we aimed to estimate the real‐world use and cost of health and social care services in a large cohort of AD patients in the United Kingdom.MethodWe conducted a retrospective cohort study using Discover‐NOW, a real‐world database containing linked primary and secondary care electronic health records of people living in North‐West London, England. A total of 18,116 patients diagnosed with AD were followed from first observed AD diagnosis to end of patient follow up, within the time window from 1 January 2010 to 31 December 2021. The baseline prevalence of 33 comorbidities, survival duration, health and social care resource utilisation and total direct health and social care costs (in 2019 terms) were estimated.ResultOf 18,116 patients with AD, 8,970 (50%) used social care after diagnosis. Most patients using social care were female (65% vs 62% in the general AD population) and were a similar age at diagnosis (median 82 years) compared to those who did not. Of the patients with social care utilisation, 5,248 (59%) resided in care homes and 2,636 (29%) received domiciliary care at home. Annual direct social and health care costs for each patient receiving social care were £25,664 and £6,248 respectively, constituting an annual total cost of £31,912. Median survival from time of AD diagnosis was 4.9 years in the general AD population and 1.9 years after care home admission. Patients who entered care homes, entered at a median age of 85 years and had higher baseline prevalence of stroke (11% vs 7%), chronic kidney disease (40% vs 35%), and atrial fibrillation (17% vs 13%) than the general AD population.ConclusionIn AD patients who used social care, social care costs were &gt;4 times other healthcare costs. Slowing or delaying the requirement for social care would have a major impact on reducing the societal and economic burden of AD on patients and society.

BackgroundBesides confronting the challenges of a growing older population, developing countries are dealing with limited resources and infrastructure, to ensure good health and social care services. One of these developing countries facing these challenges is Ghana. The healthcare system in Ghana currently does not have specialized geriatric services and is funded through the National Health Insurance Scheme (NHIS), private insurance companies and an out-of-pocket expenditure system. Social care services are important in improving Quality of Life (QoL) as it helps in building and strengthening relationships while also keeping slum-dwelling older adults active. There are various challenges with the health and social care of older adults in slums and practical ways to improve these have not been explored among the providers of this care.AimsThis study, therefore, aimed to explore (1) the views of health professionals on older slum-dwelling adults' health and social care needs, access, and use, and (2) recommendations for improving access to health and social care services among slum-dwelling older adults.MethodA qualitative exploratory descriptive approach was used among health professionals by conducting a focus group discussion (FGD) and interviews. A semi-structured interview guide was used to collect data from each participant.ResultsA total of 27 participants took part in the study. In the analysis of transcripts, 3 themes and 14 subthemes were conceptualized. Financial difficulties, queueing issues, distance to health facilities, health illiteracy and negative attitude of health professionals were identified as some barriers to the utilization of formal healthcare services. Social care services were described as non-existent, not structured, and having limited resources to cater for attendants. The health professionals also provided recommendations for improvement.ConclusionHealth professionals in this study discussed barriers to access and use of health and social care services. Addressing these barriers is essential to improve the use of formal health and social care services and diminish health inequity among older adults.

PurposeThis paper aims to present data about access to and use of health and social care services by adults with learning disabilities during the COVID-19 pandemic in England, Northern Ireland, Scotland and Wales.Design/methodology/approachData were collected in three waves between December 2020 and September 2021 and concerned the use of health and social care services during the COVID-19 pandemic. Data were collected at one or more time-points directly from 694 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 447 adults with learning disabilities.FindingsMany people with learning disabilities who reported regularly accessing services/supports pre-pandemic were not receiving them during the timeframe of this study. There were indications of increasing access to some services and supports between Wave 2 and 3, but this was not universal.Practical implicationsPeople in Cohort 2, who were likely to have severe/profound learning disabilities, were less frequently reported to access online community activities than people in Cohort 1, which is likely to exacerbate existing social isolation for this cohort and their family carers. Service providers should seek to ensure equitable access to services and activities for all people with learning disabilities in the event of future lockdowns or pandemics.Originality/valueThis is the largest longitudinal study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. We primarily collected data directly from adults with learning disabilities and worked with partner organisations of people with learning disabilities and family members throughout the study.

This study investigates the association between insufficient home care and the use of health and social care services among older adults. Data was collected from the Resident Assessment Instrument (RAI) home care register linked to registers for health care and primary health care (N = 33,493). The results show that one in six respondents felt that they would be better off living elsewhere than at home with home care, and these respondents used more hospital, emergency, and home care services than those who preferred living at home. The findings suggest that when older adults perceive their home care to be insufficient, they are more likely to utilize a range of health and social care services. Improved service integration could potentially mitigate the increased use of health and social care services by older adults who perceive their home care as inadequate. Furthermore, the ongoing healthcare reform in Finland aims to promote the integration of health and social services, which could lead to improved care outcomes for older adults. The study's findings can inform policymakers and healthcare providers on the importance of identifying and addressing the needs of older home care clients, particularly in the context of the ongoing healthcare reform in Finland.

The national health and social care systems in Europe remain poorly integrated with regard to the care needs of older persons. The present study examined the range of health and social care services used by older people and their unmet care needs, across six European countries. Family carers of older people were recruited in six countries via a standard protocol. Those providing care for disabled older people (n = 2629) provided data on the older person's service use over a 6-month period, and their current unmet care needs. An inventory of 21 services common to all six countries was developed. Analyses considered the relationship between older people's service use and unmet care needs across countries. Older people in Greece, Italy and Poland used mostly health-oriented services, used fewer services overall and also demonstrated a higher level of unmet care needs when compared with the other countries. Older people in the United Kingdom, Germany and Sweden used a more balanced profile of socio-medical services. A negative relationship was found between the number of different services used and the number of different areas of unmet care needs across countries. Unmet care needs in older people are particularly high in European countries where social service use is low, and where there is a lack of balance in the use of health and social care services. An expansion of social care services in these countries might be the most effective strategy for reducing unmet needs in disabled older people.

BackgroundBecause vocational rehabilitation is a separate service from other health services, there may be interruptions at their interface. We examined whether the use of health services changes before and after rehabilitation.MethodsLongitudinal individual-level register-based data was utilized on all individuals aged 15-60 living in the city of Oulu, Finland and starting vocational rehabilitation in 2014-2015 (N = 792). We compared their use of outpatient health care services in 3-month periods from 1.5 years before to 1.5 after the rehabilitation period to the total population of the same age and to the propensity score matched controls. Several socio-demographic factors and sickness and employment histories were used for matching.ResultsAccording to the preliminary results, rehabilitees had on average 1.5 visits to outpatient health care services in the 6th quarter before the start of rehabilitation, twice that of the total population. In the 4th quarter before the start of rehabilitation, the number increased to 1.8. After the rehabilitation period, the quarterly number of visits were at the same level as in the beginning of the follow-up. The biggest changes took place in the use of occupational health services. Changes were modest in public health care services. In other services changes were minimal. Compared to the propensity score matched controls, vocational rehabilitation did not appear to have an effect on the use of health care services.ConclusionsThe use of health care services is more common before vocational rehabilitation than after it. The effect of rehabilitation on the use of health care needs further analysis.Key messages• The pattern of the use of health care services changes in the course of vocational rehabilitation. The changes are mainly due to visits in occupational health care services.• The use of health care services is most common before rehabilitation. However, vocational rehabilitation does not appear to have an effect on the use of outpatient and inpatient health care services.

BackgroundOral health inequalities are profound worldwide. Despite major improvements in oral health, inequalities exist for many racial and ethnic groups, by socioeconomic status, gender, age, and geographic location. Therefore, the purpose of this study was to investigate trends of socio-economic inequalities in access to oral health services in Peru before and after the implementation of Universal Health Assurance (AUS).MethodsAnalytical cross-sectional study based on the National Household Survey on Living Conditions and Poverty (ENAHO) 2004, 2008, 2010 and 2017. Two periods were defined before and after the AUS Law (2009). Use of oral health services was the dependent variable, for the general population and according to ages, the area of residence, and natural region. Measurements of inequality in the use of health services were made based on the concentration curves (CC), dominance test and concentration index (CI).ResultsWe included a number of 85,436 (2004), 88,673 (2008), 87,074 (2010) and 124,142 (2017) participants. The proportion of people who used oral health services was 8.4% (2014), 10.1% (2008), 10.6% (2010) and 10.4% (2017). Use of oral health services showed an increase in different age groups, urban and rural areas, and natural regions of residence during the study period. The CC were distributed below the line of equality, indicating an inequality of use of oral health services, in favor of the richest groups and dominance of the CC in 2017 over the previous years. Changes in the CI were statistically significant for < 5 years and in the rural area, and for the period 2010-2017 they were also significant in the general population, children aged 5-17 years, urban area, and Andean and Jungle regions, which indicates a reduction in the concentration of use of these services in these groups.ConclusionsThe use of oral health services in Peru increased and inequality decreased in the period 2004-2017, coinciding with the implementation of the AUS. However, the use of these services continue having a distribution in favor of the richest populations. It requires the introduction of new strategies and oral health programs in the Peruvian population, with the aim of closing the gap currently mediated by the economic possibilities.