Case Management For Older People Research Articles

Treatment fidelity and satisfaction with an intervention based on case management for older people with falls history: Randomized clinical trial

PurposeTo verify the treatment fidelity and satisfaction with a multifactorial intervention based on case management in community-dwelling older people with falls history and related sociodemographic and clinical factors. MethodsThis is a single-center, randomized, parallel-group controlled clinical trial. 62 community-dwelling older people with falls history were distributed into two groups. The Intervention Group (IG) underwent a case management involving multidimensional evaluation, explanation of the risk factors for falls identified, implementation of an intervention proposal based on the identified risks, elaboration of an individualized falls intervention plan, implementation, monitoring and review of the intervention plan. The Control Group (CG) was accompanied by a monthly phone call. After 16 weeks, the volunteers answered two closed questionnaires about treatment fidelity or non-fidelity to intervention (IG) and satisfaction with intervention (both groups). In addition, the frequency of intervention, adherence to each recommendation of the case management and satisfaction with general care were evaluated. ResultsThere was good treatment fidelity based on case management, as well as good adherence to recommendations. In addition, the satisfaction of both groups was positive, although the IG had a better score (p<0.05). There was a significant influence of monthly income and general health on treatment fidelity (IG). Also, age, years of schooling, general health and physical mobility significantly influenced satisfaction with the IG. There was a significant influence of number of falls on satisfaction with monitoring conducted in the CG. ConclusionsClinical and sociodemographic factors can influence treatment fidelity and satisfaction of older people with falls history to a falls prevention program.

Case managers’ experiences of their everyday practice

Introduction.– Today, there is an interest in how Case Management (CM) should be designed to best suit the complex needs of the older people with multi-morbidity. Current research on CM has mainly focused on health care costs and consumption, but the results have been inconsistent and ranging from positive outcomes to no effect. To improve CM, there is need to investigate what mechanisms are important for a successful intervention. To advance this knowledge, there is a necessity for studies investigating the experiences of those practicing CM i.e. Case Managers. There might be unknown factors or interpersonal factors that can contribute to a CM intervention's success or failure. Therefore, the aim of this study was to explore the Case Managers’ experiences of their everyday practice. Methods.– The study design was qualitative and descriptive utilizing an ethnographic approach, consisting of participant observations, a focus group interview and individual interviews with nine Case Managers conducted during 2012/2013. The interviews were recorded and transcribed verbatim and then subjected to content analysis. Results.– Three main themes described Case Managers’ experience of their everyday practice: navigating the older person, working to improve the health care system and being the older persons advocate. Conclusions.– Findings from this study sheds light on the complexity of CM for older people with multi-morbidity, from the experiences of Case Managers. These findings could help in the development of CM models designed for older people with complex health needs.

Good practice in social care for disabled adults and older people with severe and complex needs: evidence from a scoping review

This article reports findings from a scoping review of the literature on good practice in social care for disabled adults and older people with severe and complex needs. Scoping reviews differ from systematic reviews, in that they aim to rapidly map relevant literature across an area of interest. This review formed part of a larger study to identify social care service models with characteristics desired by people with severe and complex needs and scope the evidence of effectiveness. Systematic database searches were conducted for literature published between January 1997 and February 2011 on good practice in UK social care services for three exemplar groups: young adults with life-limiting conditions; adults who had suffered a brain injury or spinal injury and had severe or complex needs; and older people with dementia and complex needs. Five thousand and ninety-eight potentially relevant records were identified through electronic searching and 51 by hand. Eighty-six papers were selected for inclusion, from which 29 studies of specific services were identified. However, only four of these evaluated a service model against a comparison group and only six reported any evidence of costs. Thirty-five papers advocated person-centred support for people with complex needs, but no well-supported evaluation evidence was found in favour of any particular approach to delivering this. The strongest evaluation evidence indicated the effectiveness of a multidisciplinary specialist team for young adults; intensive case management for older people with advanced dementia; a specialist social worker with a budget for domiciliary care working with psycho-geriatric inpatients; and interprofessional training for community mental health professionals. The dearth of robust evaluation evidence identified through this review points to an urgent need for more rigorous evaluation of models of social care for disabled adults and older people with severe and complex needs.

Care in the community for older people: an English perspective on the German care system

I was recently awarded a TH Marshall Fellowship at the London School of Economics and spent four months in Berlin, supported by the Volkswagen Foundation. Hosted by the Katholische Hochschule fur Sozialwesen Berlin, a higher education institute for applied social science, I spent half of each week in the local office of a Berlin-wide project providing case management for older people (www.koordinierungsstellen-rundumsalter. de), researching case management within the context of the structures and processes of the German care system. This task led me to look for points of similarity and difference with the British system of community care that has shaped my professional life since the implementation of the NHS (National Health Service) and Community Care Act 1990. Since devolution, the community care policy in the UK differs between England and Wales, Scotland and Northern Ireland, particularly in relation to the provision of free long-term care.

Nurse-led case management for older people with long-term conditions

People in the UK are successfully living longer but demonstrating an increased incidence of long-term conditions. In response to this, there has been a growth of service models that draw on the principles of case management, particularly for those older people with multiple and complex needs. Nurses working in primary care, and district nurses in particular, have always made a significant contribution to the care of older people with long-term, chronic conditions using case management techniques. However, the recent emphasis on case management has created new and expanded roles for nurse in primary care as the providers and coordinators of care. The aim of this article is to provide an overview of service models that use a case management approach and the current evidence for their effectiveness. We will then describe current examples of nurse-led case management in the UK and discuss some key issues for nurses in primary care and their patients.

Randomised trial of impact of model of integrated care and case management for older people living in the community

Objective: To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community.Design: Randomised study with 1 year follow up.Setting: Town...