Care For Frail Elderly People Research Articles

Integrated Health Care for frail elderly people with complex needs.

Background: Demographic changes will lead to an increase in older, frail and complex patients. This place a high demand on health care systems and requires the care system to work more preventively, user-driven and coherent. For the most efficient use of resources, it becomes important to identify patients with the greatest potential to benefit. Digital aids may help to identify such patients.
 Design, implementation and monitoring of the initiative: In this pilot project the patient group is frail elderly people with complex long-term needs who face multiple care providers. These patients are especially vulnerable to care fragmentation. This group also dominates the 5-10% top spenders who account for 2/3 of high-level health care spending both in Norway and internationally.
 Intervention: Akershus University Hospital (Ahus), a 1098 beds hospital has with 6 associated municipalities developed a model for closer interdisciplinary collaboration around the frail elderly with complex needs and high consumption of health care services. This model is called Integrated Health Care (IHT).
 We designed a computer application that uses deidentified health care data to identify risk patients based on age (>65) and number of emergency admissions the last six months (>3) spread over two or more different specialist departments. When a patient is included in IHT a multidisciplinary team (IHT-team) across primary and secondary care visit the patient at home. The IHT-team consists of a nurse and geriatrician from the hospital and a nurse and general practitioner from the municipality. In the conversation during the home visit, emphasis is placed on what is important to the patient. The team map risk areas and need for assistance. An individual treatment plan is created based on this conversation. The patient gets a contact person in the hospital and one in the municipality. If the patient is admitted to hospital, the IHT-team will receive an automatic notification and thus follow the patient during the hospital stay. Every 6 months there will be a follow-up conversation and opportunity to adjust the treatment plan. 
 Results: The first patient was included in 2020 and so far 63 patients have been included (40 of these have been followed for longer than 12 months) and the feedback is good. The patients and relatives highlight the importance of a patient-centered approach. They feel that the IHT-project provides increased security and predictability. We have seen a dramatic decrease in acute hospital admission for those patients included in the program; from on average 3 acute admissions the 6 months prior to inclusion, and 1,25 acute admission the 6 months following inclusion in IHT. There has also been a decrease in use of short-term stays in the municipalities.
 Conlusion: Our IHT method is effective in identifying patients at risk of frequent hospital admissions. Offering targeted and multidisciplinary services to frail patients seems to be effective in reducing acute admissions and use of health care services in the muncipalities.
 Next steps: We are now about to expand our project to more municipalities, and aim to calculate health care costs.
 
 
 

General practitioners’ views on the influence of long-term care reforms on integrated elderly care in the Netherlands: a qualitative interview study

This study explores the long-term care (LTC) reform in the Netherlands and its relation to the day-to-day integrated care for frail elderly people, from the perspective of general practitioners (GPs). We assessed GP perspectives regarding which elements of the LTC reform have promoted and hindered the provision of person-centred, integrated care for elderly people in the Netherlands. We performed case studies conducted by semi-structured interviews, using the Healthy Alliances (HALL) framework as a framework for thematic analysis. GPs reported that the ideals of the LTC reform (self-reliance) were largely achievable and listed a number of positive effects, including increased healthcare professional engagement and the improved integration of the medical and social domains through the close involvement of social support teams. The reported negative implications were a lack of co-ordination in the implementation of the reforms by the municipality, insufficient funding for multidisciplinary team meetings and the reinforced fragmentation of home care. In particular, the implementation of the system reforms took place with little regard for the local context. We suggest that the implementation of national care reforms should be aligned with factors operating at the micro level and make the following recommendations: use one central location for primary health and social services, integrate regional ICT structures to improve the exchange of patient information, and reduce fragmentation in home care.

Care needs of the elderly who live alone: an intersectoral perception

Objective: to understand the perception of health and law professionals regarding care for frail elderly people who live alone. Methods: qualitative research, carried out through interviews with health and law professionals, using a vignette as a trigger, presenting the description of the story of a frail elderly woman who lived alone. Data were submitted to the thematic analysis technique. Results: the 23 professionals pointed out that the family members should be the responsible ones for the elderly; that institutionalization should take place as the last option; stressed the importance of multi-professional and intersectoral work; and recognized the limitations of the state. The professionals reported the appropriate interventions for the case. Conclusion: in care for the elderly who live alone, there are limitations for families, social care, and health services for the elderly, as well as the State, with the need to strengthen legally guaranteed resources.

Societal costs of informal care of community-dwelling frail elderly people.

Aims: The aims of this study are to describe informal care activities and to estimate the societal cost of informal care of community-dwelling frail elderly people in Sweden. Methods: This study was performed within the frame of the TREEE project that included 408 frail elderly patients. At index hospitalisation (baseline), primary informal caregivers of the patients were provided with a questionnaire on informal care during a period of three months. Questions concerning other (secondary) informal caregivers were also included. A rough estimate of the total cost of informal care of frail elderly people in Sweden was obtained by combining data from this study with published data and official statistics. Results: In total, 176 informal caregivers responded, and 89% had provided informal care. The informal caregivers (primary and secondary) provided care for an average of 245 hours over three months. Taking care of the home was the dominating activity. In total, the mean cost of informal care was estimated to approximately 18,000 SEK (€1878) over three months, corresponding to an annual cost of approximately 72,000 SEK (€7477) per frail elderly person. The total annual societal costs of informal care of community dwelling frail elderly people aged 75 years and older in Sweden was estimated to be approximately 11,000 million SEK (€1150 million). Conclusions: The care of frail elderly people provided by informal caregivers is extensive and represents a great economic value. Although our calculations are associated with uncertainty, the size indicates that supporting informal caregivers should be a priority for society.

Questionnaire development and validation for designing a health telemonitoring system for frail elderly people.

BackgroundAdvancements in information technology have been instrumental in successful recent developments in telemonitoring systems. In this regard, there is a lack of development of valid and reliable tools to determine the requirements and applications of telemonitoring systems used to provide health care for frail elderly people living at home, specifically in a national setting.MethodA cross-sectional study was carried out in 2018. The statistical population was 15 geriatric and gerontology professionals and 15 health information management experts. Then, content validity ratio (CVR), Cronbach's alpha, and correlation coefficient were calculated for measuring content validity, internal consistency and external reliability (through the test–retest method) respectively. SPSS software was used to analyze the collected data.ResultsBased on the identified items, a draft questionnaire was developed. Using the validity analysis in two stages, 37 items were removed, and 60 items were approved as the essential system requirements. The final questionnaire was organized into five sections with content validity index 99% and internal reliability (Cronbach's alpha coefficient 0.9). Furthermore, the external reliability results of the questionnaire showed that this instrument has a desirable correlation coefficient (r = 0.85, p-value<0.05).ConclusionConsidering the desirable validity and reliability of the questionnaire developed, it is recommended to telemonitoring system designers to determine the usages and requirements of health monitoring systems for frail elderly people living at home. The verified instrument is suitable for use in countries with the same living conditions and level of development as Iran.

Outcomes of Integrated Community Care Interventions for Frail Elderly People: A Literature Review

This study aimed to summarize the outcome measures and the significant outcome of effective integrated community care for frail elderly people through a literature review. A literature search was conducted using the Cochrane Library and PubMed for articles published up to November 2016 with the following search terms: Integrated community care, primary care, community, frail elderly, and effectiveness. A total of 106 articles were identified, of which eight with an interventional research design the inclusion criteria. All outcome measures were classified into the three categories: Functional abilities, quality of life, and health. As the significant effect, the physical function was perceived in four references, the quality of life in one reference, and the mental health in one reference. The evidence of the effectiveness of integrated community care seemed to be lacking. More studies will need to be conducted.

Health Care Use in the Randomized Controlled Trial “Continuum of Care for Frail Elderly People”

Dependence in the Activities of Daily Living (ADL) is associated with increased health care consumption. This study aimed to determine if an intervention involving a continuum of care for frail elderly people reduced the use of in-hospital and outpatient care; and if healthcare use differed by subgroups based on ADL dependence. This was a non-blinded randomized controlled trial. Participants (n=161) were aged 65-79 years with at least one chronic disease, and dependent in at least one activity of daily living (ADL); or aged 80+ years; and sought care at the emergency department. Exclusion criteria were immediate need of assessment and treatment by a physician, severe cognitive impairment, and palliative care. The intervention involved collaboration between a nurse with geriatric competence based in the emergency department, hospital wards, and a municipality-based multi- professional team with a case manager that provided care for the elderly people, care planning in the home, and active follow-up. Participants were divided into subgroups based on ADL dependence during the analysis. In the intervention group, participants classified as independent in ADL had fewer visits to a physician compared with the control group. The intervention group received more home visits by occupational therapists/physiotherapists, probably attributed to the rehabilitation inherent to the intervention. Time to first readmission was almost twice as long for independent participants in the intervention group compared with the control group (not statistically significant). Further research with a larger sample size and longer follow-up is needed to confirm if the intervention also reduces in-hospital care.

Longitudinal effects on self-determination in the RCT “Continuum of care for frail elderly people”

Purpose – An intervention “Continuum of care for frail elderly people” was designed to create an integrated care from the hospital emergency department (ED) to home. The purpose of this paper is to evaluate longitudinal effects in terms of self-determination in daily life for community-living frail older persons. Design/methodology/approach – A non-blinded, controlled trial with participants randomised to the intervention group or a control group with follow-ups at three, six and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the ED, the hospital wards and a multi-professional team in the community with a case manager as the hub. The intervention’s person-centred approach involved the older persons in all decisions. Inclusion criteria: 80 years and older or 65-79 years with at least one chronic disease and dependent in at least one daily activity. Analyses were made on the basis of the intention-to-treat principle and outcome measure experienced self-determination in daily life measured by Impact on Participation and Autonomy for Older persons (IPA-O). The analysis was made using Svenssons’ statistical method. Findings – There were significant differences in favour of the intervention at three months in self-determination concerning activities at home and at three and six months concerning social relationships. Originality/value – Self-determination seems to deteriorate over time in both groups, and the intervention “Continuum of care for frail elderly people” seemed to slow the rate of decline in two dimensions; activities in and around the house at three-month follow-up, and at three and six months concerning social relationship. Thus, the intervention has the means to support them in exercising self-determination and aging in place, a valuable benefit both for the individual and for society.

Reliable and Sustainable Comprehensive Care for Frail Elderly People

Reliable and Sustainable Comprehensive Care for Frail Elderly People

Home care in Italy: a system on the move, in the opposite direction to what we expect

For a long time, the international literature has described the Italian public system of home care for frail elderly people as underfunded and mostly cash-oriented; a system, thus, relying almost entirely on informal care provided by the family and, more recently, by migrant workers. Abroad and in Italy, most experts have long shared the expectation that, if and when, public expenditure devoted to home care was to increase, the outcome would be an expansion in the provision of services in kind. This study analyses how the provision of home care actually has changed in the last decade. The analysis reveals that indeed public expenditure has risen. However, while the system of home-care provision also has changed, it has done so in the opposite direction to that expected. In fact, most of the additional resources have funded an increase in the number of users of the companion payment [Indennità di Accompagnamento (IA)], a cash benefit of €487 per month. In this respect, the Italian welfare system is more cash-oriented than it was 10 years ago. This article discusses the reasons behind the increased uptake of the IA, namely: an increase in the needs and demands of older people; the traits of the Italian welfare system; and the peculiar features of the companion payment itself. The article then looks at why services in kind rose to a lesser degree, pinpoints the main reason as being based on the politics of social care at national level, and finally focuses on the challenges that the Italian home-care system has to face within the changed policy environment with respect to quality of care, carers' conditions and support for users with high-level needs.

Development and validation of the Caregiver Guilt Questionnaire

Family care of frail elderly people has been linked to significant negative consequences for caregivers' mental health. Although outcome variables such as burden and depression have been widely analyzed in this population, guilt, an emotion frequently observed in caregivers, has not received sufficient attention in the research literature. Face-to-face interviews were carried out with 288 dementia caregivers. Guilt was measured using the Caregiver Guilt Questionnaire (CGQ). Using principal components analysis, 22 items were retained and five factors were obtained which explained 59.25% of the variance. These factors were labeled: guilt about doing wrong by the care recipient, guilt about not rising to the occasion as caregivers, guilt about self-care, guilt about neglecting other relatives, and guilt about having negative feelings towards other people. Acceptable reliability indexes were found, and significant associations between the CGQ and its factors and the Zarit Burden Interview guilt factor were also found. Caregivers with higher scores on the CGQ also scored higher in depression, anxiety, frequency and appraisal of behavioral problems. Negative associations between the CGQ and its factors and frequency of/and satisfaction with leisure and social support were also found. Being female and caring for a parent were associated with higher scores on the CGQ. Feelings of guilt are significantly related to caregiver distress. The CGQ may be a useful measure for acknowledging feelings of guilt in caregivers; moreover, it can be used as an outcome variable for psychoeducational interventions aimed at reducing caregiver distress.

Evidence summary: why is access to dental care for frail elderly people worse than for other groups?

In August 2009, members of the newly redeveloped Primary Care Dentistry Research Forum (http://www.dentistryresearch.org) took part in an online vote to identify questions in day-to-day practice that they felt most needed to be answered with conclusive research. The question which received the most votes formed the subject of a critical appraisal of the relevant literature. Each month a new round of voting will take place to decide which further questions will be reviewed. Dental practitioners and dental care professionals are encouraged to take part in the voting and submit their own questions to be included in the vote by joining the website.This paper details a summary of the findings of the first critical appraisal. In conclusion, the critical appraisal has identified that primary research is needed to look at the subject of access to dental care for frail elderly people. Similar barriers to accessing care for this group of people are still being reported today as they were 20 years ago.

Prevalence of frailty on clinical wards: Description and implications

This paper describes the prevalence and frailty level of patients aged > or = 75 years upon admission to various clinical wards. The data collection took place on five clinical wards of different clinical specialisms: Geriatric Centre, traumatology, pulmonology/rheumatology, internal medicine and surgical medicine. The Groningen Frailty Indicator was used to assess the frailty of newly admitted patients. The presence of number and kind of the various frailty indicators was different for the clinical wards, because of clinical diagnose, age and gender. On the Geriatric Centre, almost all patients were indicated as frail. On the other wards, 50-80% of the patients were indicated as frail with most frailty indicators on the scale 'psychosocial'. The study show a high prevalence of frail elderly on some wards and gives an indication of the various needs for other disciplines within the framework of the care for frail elderly people.

Effects of a Geriatrician‐Led Hip Fracture Program: Improvements in Clinical and Economic Outcomes

The hip fracture service (HFS) is an interdisciplinary, geriatrician-led program instituted to improve the care of frail elderly people who present to the hospital with acute hip fracture. The HFS pilot project used existing hospital personnel and facilities and initiated new practices, including set protocols, preprinted orders, and standardized assessments, to achieve and evaluate patient triage and care and hospital cost savings. Outcome measures for 91 patients with acute hip fracture consecutively admitted to the HFS were compared with those of 72 historical controls managed under standard care in the prior year. Analysis demonstrated better outcomes in terms of length of stay (6.1+/-2.4 days for standard care, 4.6+/-1.1 days for the HFS; P<.001) and time to surgery (<24 hours after admission in 22.2% of standard care patients vs 50.5% of HFS patients; P<.001). Furthermore, the HFS model showed a reduction in total costs, resulting in a gain in net income, from a deficit of $908+/-4,977 (95% confidence interval (CI)=-$2,078-261) per patient in the standard group to a gain of $1,047+/-2,718 (95% CI=$481-1,613) per patient in the HFS group (P<.002). The findings suggest that care with set protocols overseen by a trained lead physician may improve the quality and cost effectiveness of managing elderly patients with hip fracture. Although the results must be interpreted with caution because of the pre-post design, this pilot study provides a model of care for further hypothesis generation and more rigorous testing into the quality and financial benefits of a geriatrics-led care process.

Contested Professionalism Payments for Care and the Quality of Home Care

In the recent past, policy makers have emphasized the benefits and positive aspects of direct payments for care of frail elderly people. In this article, the authors present the theoretical framework of “struggling logics of home care,” by means of which they explore the underlying logics of the introduction of payments for care: market, family, and state. More specifically, the authors show the strengths and weaknesses of a fourth logic—professionalism—and expound how this logic is submitted to marketized and familialized payments for care. The authors conclude that there are indeed some positive aspects of the trend toward payments for care. However, (female) professional home care workers benefit hardly at all. On the long term, this could also erode the quality of care provided to recipients.

Oral health care for frail elderly people: actual state and opinions of dentists towards a well‐organised community approach

This study was undertaken to provide an analysis of the actual oral heath care for frail elderly people living in different settings and to explore opinions of dentists towards new concepts in developing a community approach. Data were collected from a sample of 101 dentists (15%) in the county of Antwerp using a self-administered 30-item questionnaire including questions about age, gender, education, organisational aspects of dental surgery, questions concerning dentists' own contribution to oral healthcare services for frail elderly people and statements concerning opinions and attitude toward the organisation of oral health care for frail elderly people. At the same time, qualitative data were collected from focus group sessions with all participating dentists. Non-parametric analysis was used to explore possible relationships between opinion and possible explanatory variables. Half of the dentists offered dental services to residential or nursing homes (mean number of treatments a year: 5.4) and at home (mean number of treatments a year: 2.4). Prosthetic treatments such as relieving denture pressure points, repairing, rebasing and making new dentures were carried out in 77.4% and 76.7% of the cases in residential or nursing homes and at home respectively. Extractions were carried out in 16% and 18.6% of the cases in both living situations respectively. The main reasons for dentists refusing domiciliary oral health care were the absence of dental equipment (63%), lack of time (19%), with 11% convincing the patients to be treated in their dental surgery. Analysis showed different opinions of dentists depending on age, gender and university of education; however, statistically significant differences were only found by age. The older the dentist, the greater the tendency to refuse domiciliary oral healthcare services. The younger dentists were reluctant to cooperate in the provision of oral health care in a structured community approach.

Network for improving the dementia care system

Network for improving the dementia care system

Do they look after their own? Informal support for South Asian carers.

Policy on care in the community was founded on the premise that the care of frail elderly people with disabilities would be a joint responsibility for health and social care professionals, and family carers, supported by people within their social networks. The policy assumes that such social networks are common features of all communities in contemporary Britain, containing a reserve of people who can be called upon to provide support to carers. The present paper draws on material gathered for a qualitative study of the experiences carers in South Asian communities to examine the quality and quantity of informal support that was available in different types of households. Male and female carers were selected from the Punjabi Sikh, Gujarati Hindu, and Bangladeshi and Pakistani communities. A total of 105 carers participated in the project. Participants were caring for people in all age groups with physical and/or mental distress, and in some cases, with multiple and complex impairments. The analysis of carers' accounts suggested that, for a variety of reasons, the main carer, irrespective of gender, had limited support both in nuclear and extended households. In addition, societal attitudes towards disability and the fear of obligation prevented the seeking and accepting of help from wider social networks. The paper concludes that the evidence does not support the assumption about extended families, and their willingness and ability to support carers. Many issues highlighted in this paper have far-reaching implications for policy makers in many countries in the West where South Asian people have made their homes.

Long-term care for frail elderly people--the On Lok model.

In January 1999, President Bill Clinton placed the issue of long-term care on the nation's health care agenda. He proposed that families be given a $1,000 annual tax credit to help pay for home health care visits, adult day care, and other needed long-term care. Long-term care ranks high on the list of our health care system's failings.1 Many elderly people spend their life savings to pay for assistance in the home or for nursing home care. Family members (usually women) make personal and financial sacrifices to care for a disabled spouse or parent.2 Over a million people live in . . .

Contracts and purchaser-provider relationships in community care

This paper considers the incentives embodied in contracts between purchasers and providers of residential care for frail elderly people. The paper begins with an assessment of current contractual arrangements. A theoretical inquiry generates propositions that some contracts create incentives for providers to misrepresent users' characteristics. These propositions are found to be supported by sample data. The paper then turns to a theoretical consideration of optimal governance structures and, in particular, the use of incentive contracts. These contracts, it is claimed, may go some way to curbing cost-exaggerating behaviour without providing strong incentives to cream-skim or shirk on quality.