Models Of Care For Older People Research Articles

공공실버주택 거주 노인 대상의 Wel-Tech 프로그램 효과성 평가: 커뮤니티케어 모델 개발을 위한 선행 연구

The purpose of this study is to evaluate effectiveness of Wel-Tech programs as a pilot study on developing a community care model for older people living in public silver housing. More specifically, Wel-Tech based community care services the current research suggests focus on improving physical functions, cognitive functions, and psychological stability for older people. To evaluate effectiveness of services, the non-equivalent control group design with pretest-posttest was used, and two experimental groups and one control group was assigned based on service contents. The differences between the experimental group 1 (n=9) and 2 (n=9) were based on whether participants receive Wel-Tech programs or not, and those between the experimental group and the control group (n=19) were based on whether participants receive community care services or not. Older people assigned to the experimental groups participated in community care service programs for three months and all participants responded to survey questions before and after the program. Findings indicated that participants in the experimental group 1 are more likely than the experimental group 2 and the control group to show improved depression level, memory, and cognitive functions. Participants in the experimental group 1 also showed better life satisfaction and maintained physical functions while the experimental group 2 and the control group deteriorated. This study is meaningful in that the application of Wel-Tech in the community care model can maximize the effectiveness of service programs and findings suggest new directions to traditional elderly welfare services taking into account the changing times.

Revisiting the Nordic long-term care model for older people—still equal?

With the extensive long-term care services for older people, the Nordic countries have been labelled ‘caring states’ as reported (Leira, Welfare state and working mothers: the Scandinavian experience, Cambridge University Press, Cambridge, 1992). The emphasis on services and not cash benefits ensures the Nordics a central place in the public service model (Anttonen and Sipilä, J Eur Soc Policy 6:87–100, 1996). The main feature of this ideal model is public social care services, such as home care and residential care services, which can cover the need for personal and medical care, as well as assistance with household chores. These services are provided within a formally and professionally based long-term care system, where the main responsibility for the organization, provision and financing of care traditionally lays with the public sector. According to the principle of universalism (in: Antonnen et al. (eds), Welfare state, universalism and diversity, Elgar, Cheltenham, 2013), access to benefits such as home care and residential care is based on citizenship and need, not contributions nor merit. Also, care services should be made available for all and generally be used by all, with no stigma associated. Vabø and Szebehely (in: Anttonen (ed), Welfare State, universalism and diversity, Edward Elgar Publishing, London, 2012)) further argue that the Nordic service universalism is more than merely issues of eligibility and accessibility, in that it also encompasses whether services are attractive, affordable and flexible in order to meet a diversity of needs and preferences. However, recent decades have seen a continuous tendency towards prioritization of care for the most frail, contributing to unmet need, informalization of care and privatization in the use of topping up with market-based services. These changes have raised questions about increasing inequalities within Nordic long-term care systems. We investigate in the article what effect changes have for equality across social class and gender, for users and informal carers. The article is based on analysis of comparable national and international statistics and a review of national research literature and policy documents.

Contemporary care model for older people: an urgent need

Resumo Proposta de um modelo assistencial resolutivo e com excelente relação custo-benefício, em linha com o que há de mais contemporâneo no cuidado integral para o grupo etário dos idosos. Apresentou-se em detalhes a teoria e os conceitos que fundamentam o modelo proposto, bem como os instrumentos de avaliação epidemiológica utilizados. O artigo contextualiza o crescimento desse contingente populacional no mundo e, em particular, no Brasil, mostrando seus impactos sociais e financeiros para a sociedade. A partir dessa análise, defende-se que o cuidado prestado à população idosa seja repensado, valorizando cada vez mais as ações de prevenção de agravos e de promoção da saúde. Propõe-se também o uso inteligente da tecnologia para consultas, monitoramento, atitudes preventivas e na coordenação dos novos cuidados. Acredita-se que a ênfase da atenção ao público idoso deve se dar nas instâncias leves de cuidado, de forma a minimizar desperdícios, usando com racionalidade os recursos disponíveis no sistema de saúde e valorizando os profissionais envolvidos.

AgeWell: A Unique Care Model for Older People in Ireland combining peer-based social engagement and mobile technology to improve health outcomes and well-being among older people.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

The regional effect of the consumer directed care model for older people in Australia

Evaluation of Consumer Directed Care (CDC), an internationally recognized means to promote autonomy and choices in the delivery of health in community aged care, is growing, but little is known about the spatial implications of such policy. With differences in the utilisation of home care services across locations, the introduction of a national CDC program may affect different regions to different extents. This paper explores the regional effect of the CDC introduction on older Australians' mental health. We analyse data on 1780 individuals aged 65 years and over, from 11 waves (2007–2017) of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. We find that older adults’ mental health is worse after the introduction of the CDC in 2013. Moreover, older adults, who lived in the areas with higher utilisation of Home Care Packages, experienced worse mental stress than the same individuals who lived in the areas with lower utilisation of home care services. This pattern may reflect regional differences in Government funding, community aged care waiting time and provider service fees. Therefore, it is important for health policies that aim to promote choices to older consumers, such as CDC, to consider regional differences in its implementation, to minimise unwarranted variations in the population health and well-being.

"All for One" experiences of interprofessional team members caring for older adults: A metasynthesis.

There is some evidence that healthcare professionals prefer an interprofessional approach to care and this approach is of particular importance to older people due to their complex needs and multitude of chronic conditions. This metasynthesis aimed to synthesise and unearth new understandings of the experiences of interprofessional team members that are caring for older people from a variety of qualitative studies. This review is designed as a metasynthesis based on the method put forth by Noblit and Hare for synthesising qualitative research. A search for qualitative and mixed methods articles that included healthcare professionals' experiences of caring for older people as a member of an interprofessional team was conducted via an electronic database search of CINAHL, PubMed, SCOPUS and PsycINFO. The inclusion criteria were as follows: (a) the method of the study was qualitative or included a qualitative component, (b) an interprofessional team cared for an older person, (c) data regarding interprofessional team members' experiences were gathered, (d) published in English and (e) between the period of 2000 and 2019. Key metaphors were extracted from the data and juxtaposed until themes emerged. A total of 1807 full-text articles were retrieved and screened via their titles and abstracts. Nine studies were included in this metasynthesis based upon full-text relevance and meeting the inclusion criteria. Six themes emerged describing the experience of interprofessional team members caring for older people: All for One: Unifying the Team for a Meaningful Purpose; The Cast; A Shared Vocabulary; Collaboration and Integration; A Functional-Dysfunctional Family and Appreciate the Lifeworld. Team members appreciated this model of care. The emergent themes suggest potential buy-in from interprofessional team members to this care model for older people. Nursing can assert their unique knowledge and practice into the role as the team leader to mitigate potential barriers and team conflicts. Interprofessional team members caring for older people can improve their experience. Improved experiences for interprofessional team members can lead to better care for older people. Professionals need specialized training prior to practicing interprofessionally.

Exploring an integrated palliative care model for older people: an integrative review

PurposeDue to an international ageing population, global health organisations have recognised the challenges arising from fragmented interaction between health and social sectors in the end of life care. The purpose of this paper is to explore the existing literature on integrative palliative care services for older people.Design/methodology/approachAn integrative review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Papers included in the review focused upon integrated care within palliative care systems (January 2007–2017). A certain number of papers were excluded when the review focused on individuals younger than 65, not written in English and not being focused on integrated palliative care.FindingsNine studies fitted the inclusion criteria and three themes were identified: person-centred care, co-ordination of care, and education and training. The review identifies that integrated palliative care requires co-ordinated techniques that focus upon the quality of life, individual needs and awareness of vulnerability rather than fixation on inevitable mortality.Research limitations/implicationsThe emerging presence of the need for integrated palliative care requires further research in order to develop coherent models of integrated palliative care which can be incorporated into practice.Originality/valueThis review identified themes relevant to the emerging issues in the global health sector of end of life care. The literature suggests that the optimised use of an integrated care approach to a palliative model of care is required and in need of further investigation.

Significance of scientific evidence in organizing care processes.

Purpose - The purpose of this paper is to analyze how staff and managers in health and social care organizations use scientific evidence when making decisions about the organization of care practices. Design/methodology/approach - Document analysis and repeated interviews (2008-2010) with staff (n=39) and managers (n=26) in health and social care organizations. The respondents were involved in a randomized controlled study about testing a continuum of care model for older people. Findings - Scientific evidence had no practical function in the social care organization, while it was a prioritized source of information in the health care organization. This meant that the decision making regarding care practices was different in these organizations. Social care tended to rely on ad hoc practice-based information and political decisions when organizing care, while health care to some extent also relied in an unreflected manner on the scientific knowledge. Originality/value - The study illustrates several difficulties that might occur when managers and staff try to consider scientific evidence when making complicated decisions about care practices.

Implementing a continuum of care model for older people - results from a Swedish case study

There is a need for integrated care and smooth collaboration between care-providing organisations and professions to create a continuum of care for frail older people. However, collaboration between organisations and professions is often problematic. The aim of this study was to examine the process of implementing a new continuum of care model in a complex organisational context, and illuminate some of the challenges involved. The introduced model strived to connect three organisations responsible for delivering health and social care to older people: the regional hospital, primary health care and municipal eldercare. The actions of the actors involved in the process of implementing the model were understood to be shaped by the actors' understanding, commitment and ability. This article is based on 44 qualitative interviews performed on four occasions with 26 key actors at three organisational levels within these three organisations. The results point to the importance of paying regard to the different cultures of the organisations when implementing a new model. The role of upper management emerged as very important. Furthermore, to be accepted, the model has to be experienced as effectively dealing with real problems in the everyday practice of the actors in the organisations, from the bottom to the top.

Coproduction in Practice: Participatory Action Research to Develop a Model of Community Aged Care

Coproduction has become synonymous with innovative approaches to public service delivery in European Union countries as well as in Australia. Coproduction has the potential to bring together individuals, communities, and organisations in a process to collaboratively develop new models and services which improve public services. Yet, Australian policy makers and practitioners who would like to deploy coproduction within the context of older adult social care can only draw on a handful of papers and reports that could guide implementation. This paper fills this gap by reporting on the implementation of a multi-stakeholder coproduction approach to the development of a consumer directed care model for older people with complex health issues. The paper describes and critically highlights methodological challenges encountered during the 12 month-long participatory action research phase of a larger project involving older people with complex care needs, their carers, and government and non-government stakeholders. The paper outlines key considerations regarding (1) the involvement of older people with complex needs, (2) collaboration with industry partners, (3) engagement of government representatives, and (4) reflects on implementing participatory research projects within a context of outsourcing and interlinked supply chains. While not all challenges encountered could be resolved, the coproduction approach was successful in bringing together a wide range of stakeholders with competing agendas in an iterative process geared to resolve a plethora of concerns raised by older people, carers and services providers. This paper provides an example for others seeking to use coproduction and participatory methods to provide person-centred care services for older people.

Integrated care facilitation for older patients with complex health care needs reduces hospital demand

The evaluation of a new model of care for older people with complex health care needs that aimed to reduce their use of acute hospital services. Older people (over 55 years) with complex health care needs, who had made three or more presentations to a hospital emergency department (ED) in the previous 12 months, or who were identified by community health care agencies as being at risk of making frequent ED presentations, were recruited to the project. The participants were allocated a "care facilitator" who provided assistance in identifying and accessing required health care services, as well as education in aspects of self management. Data for the patients who had been participants on the project for a minimum of 90 days (n=231) were analysed for their use of acute hospital services (ED presentations, admissions and hospital bed-days) for the period 12-months pre-recruitment and post-recruitment. A similar analysis on the use of hospital services was conducted on the data of patients who were eligible and who had been offered participation, but who had declined (comparator group; n=85). Post recruitment, the recruited patients displayed a 20.8% reduction in ED presentations, a 27.9% reduction in hospital admissions, and a 19.2% reduction in bed-days. By comparison, the patients who declined recruitment displayed a 5.2% increase in ED presentations, a 4.4% reduction in hospital admissions, and a 15.3% increase in inpatient bed-days over a similar timeframe. A model of care that facilitates access to community health services and provides coordination between existing services reduces hospital demand.

Intermediate care for older people - an implementation

Intermediate care services are being developed in England and elsewhere to provide an integrated health and social care model for older people with sub-acute illness and/or needing rehabilitation. A more rapid implementation of these services might be achieved if the practical service development issues were better understood.