Community Care For Older People Research Articles

Can Socially Assistive Robots Be Accepted by Older People Living Alone in the Community?: Empirical Findings from a Social Work Project in China

ABSTRACT A pilot study was undertaken between March 2019 and September 2021, loaning socially assistive robots (SARs) for a 7-day trial to older people living alone in China. Quantitative assessments of participants’ acceptance of technology and loneliness were conducted before and after the intervention, supplemented with qualitative interviews. Unexpectedly, participants’ intention to use SARs decreased significantly, largely due to emotional anxiety. Meanwhile, participants’ level of loneliness remained unchanged. Follow-up interviews revealed anxious emotion, hesitant attitudes, unreal social presence, usability difficulties as contributing factors. The study provides social workers with valuable insights into introducing SARs into community care of older people.

Factors associated with willingness to receive a novel community care service for older people in Foshan, China: a cross-sectional study

BackgroundIn China, the majority of community care for older people is planned and offered in a few large cities. The provision of community care to the rural population is a new concept. This study aimed to assess the prevalence of willingness to receive a novel community care service that incorporates community rehabilitation among older people, and identify the possible factors influencing utilization willingness in Foshan, China.MethodsA cross-sectional study was conducted involving 413 older people in Lishui county, China from January to March 2021. Trained staff interviewed older people using structured questionnaires. Multivariate logistic regression analysis was used to determine factors that were significantly associated with the willingness to receive this novel community care.ResultsThe prevalence of willingness to receive community care for older people was 61.9% (n = 245) in Foshan, China. Older people who were living alone or living with spouses were about two times significantly more likely to receive community care compared to those living with children/others (OR = 2.19, 95%CI:2.44 ~ 3.19, OR = 2.015, 95%CI: 1.39 ~ 2.23, respectively). Older people who lived closer to the community care center were about two times significantly more likely to receive community care compared to those who lived far away (OR = 2.10, 95%CI: 1.61 ~ 2.41). Older people with activity of daily living disability were about three times significantly more likely to receive community care compared to those without a disability (OR = 3.13, 95%CI: 2.38 ~ 3.29).ConclusionsA majority of rural older people were willing to receive this novel community care service that includes community rehabilitation. The findings suggest the need for policies and programs to not only improve the provision of this novel community care service but also promote its uptake among older people in the study setting.

Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: A randomised controlled single-blind mixed method trial

BackgroundGlobally, a rising number of people live into advanced age and die with multimorbidity and frailty. Palliative care is advocated as a person-centred approach to reduce health-related suffering and promote quality of life. However, no evidence-based interventions exist to deliver community-based palliative care for this population. AimTo evaluate the impact of the short-term integrated palliative and supportive care intervention for older people living with chronic noncancer conditions and frailty on clinical and economic outcomes and perceptions of care. DesignSingle-blind trial with random block assignment to usual care or the intervention and usual care. The intervention comprised integrated person-centred palliative care delivered by multidisciplinary palliative care teams working with general practitioners and community nurses. Main outcome was change in five key palliative care symptoms from baseline to 12-weeks. Data analysis used intention to treat and complete cases to examine the mean difference in change scores and effect size between the trial arms. Economic evaluation used cost-effectiveness planes and qualitative interviews explored perceptions of the intervention. Setting/participantsFour National Health Service general practices in England with recruitment of patients aged ≥75 years, with moderate to severe frailty, chronic noncancer condition(s) and ≥2 symptoms or concerns, and family caregivers when available. Results50 patients were randomly assigned to receive usual care (n = 26, mean age 86.0 years) or the intervention and usual care (n = 24, mean age 85.3 years), and 26 caregivers (control n = 16, mean age 77.0 years; intervention n = 10, mean age 77.3 years). Participants lived at home (n = 48) or care home (n = 2). Complete case analysis (n = 48) on the main outcome showed reduced symptom distress between the intervention compared with usual care (mean difference -1.20, 95% confidence interval -2.37 to -0.027) and medium effect size (omega squared = 0.071). Symptom distress reduced with decreased costs from the intervention compared with usual care, demonstrating cost-effectiveness. Patient (n = 19) and caregiver (n = 9) interviews generated themes about the intervention of ‘Little things make a big difference’ with optimal management of symptoms and ‘Care beyond medicines’ of psychosocial support to accommodate decline and maintain independence. ConclusionsThis palliative and supportive care intervention is an effective and cost-effective approach to reduce symptom distress for older people severely affected by chronic noncancer conditions. It is a clinically effective way to integrate specialist palliative care with primary and community care for older people with chronic conditions. Further research is indicated to examine its implementation more widely for people at home and in care homes.Trial registration: Controlled-Trials.com ISRCTN 45837097Tweetable abstract: Specialist palliative care integrated with district nurses and GPs is cost-effective to reduce symptom distress for older people severely affected by chronic conditions.

Implementation of an interprofessional collaboration in practice program: a feasibility study using social network analysis

BackgroundDue to multimorbidity and geriatric problems, older people often require both psychosocial and medical care. Collaboration between medical and social professionals is a prerequisite to deliver high-quality care for community-living older people. Effective, safe, and person-centered care relies on skilled interprofessional collaboration and practice. Little is known about interprofessional education to increase interprofessional collaboration in practice (IPCP) in the context of community care for older people. This study examines the feasibility of the implementation of an IPCP program in three community districts and determines its potential to increase interprofessional collaboration between primary healthcare professionals caring for older people.MethodA feasibility study was conducted to determine the acceptability and feasibility of data collection and analysis regarding interprofessional collaboration in network development. A questionnaire was used to measure the learning experience and the acquisition of knowledge and skills regarding the program. Network development was assessed by distributing a social network survey among professionals attending the program as well as professionals not attending the program at baseline and 5.5 months after. Network development was determined by calculating the number, reciprocity, value, and diversity of contacts between professionals using social network analysis.ResultsThe IPCP program was found to be instructive and the knowledge and skills gained were applicable in practice. Social network analysis was feasible to conduct and revealed a spill-over effect regarding network development. Program participants, as well as non-program participants, had larger, more reciprocal, and more diverse interprofessional networks than they did before the program.ConclusionsThis study showed the feasibility of implementing an IPCP program in terms of acceptability, feasibility of data collection, and social network analysis to measure network development, and indicated potential to increase interprofessional collaboration between primary healthcare professionals. Both program participants and non-program participants developed a larger, more collaborative, and diverse interprofessional network.

Implementing nutrition screening in the community – results from phase two of a prospective process evaluation of a new procedure for screening and treatment of malnutrition in community care for older people (INSCCOPe - phase two)

Implementing nutrition screening in the community – results from phase two of a prospective process evaluation of a new procedure for screening and treatment of malnutrition in community care for older people (INSCCOPe - phase two)

Home and community care for older people in urban China: Receipt of services and sources of payment.

This study investigates the characteristics of Chinese older people receiving home and community care and the factors associated with the sources of payment for care services. The data come from the Social Survey of Older People in Urban China, which collected information from a random sample of 3,247 older people aged 60 and over in 10 large cities in different regions of China in 2017. Anderson's behavioural model of care utilisation is used to guide the analyses. The study identifies four striking features of the Chinese social care system. First, although disabilities are a significant predictor of receiving home and community care, a large proportion of care recipients do not have disabilities. Second, perceived proximity of care is the most important predictor, which implies high elasticity of demand for care services with regard to perceived distance and the great geographical inequality of care resources in the cities. Third, the government policies support the use of the internet to facilitate care access, but the enabling effect of the internet among older people is limited. Finally, sources of payment for care differ significantly according to people's age, living arrangements, disability and level of education. We argue that the government should consider shifting the focus of financial support from service providers to care recipients in the future.

Implementing professional behaviour change in teams under pressure: results from phase one of a prospective process evaluation (the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) project)

ObjectivesTo evaluate the implementation of a new procedure for screening and treatment of malnutrition for older people in community settings and to identify factors promoting or inhibiting its implementation as...

What factors promote or inhibit implementation of a new procedure for screening and treatment of malnutrition in community settings? A prospective process evaluation of the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) project (UK)

IntroductionMalnutrition remains underdetected, undertreated and often overlooked by those working with older people in primary care in the UK. A new procedure for screening and treatment of malnutrition is currently...

Implementing nutrition screening in the community – Results from phase one of a prospective process evaluation of a new procedure for screening and treatment of malnutrition in community care for older people (INSCCOPe - phase one).

Implementing nutrition screening in the community – Results from phase one of a prospective process evaluation of a new procedure for screening and treatment of malnutrition in community care for older people (INSCCOPe - phase one).

Exploring community healthcare staff experiences of current screening and treatment practices for malnutrition – Baseline survey results from the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) process evaluation project

Exploring community healthcare staff experiences of current screening and treatment practices for malnutrition – Baseline survey results from the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) process evaluation project

Quality indicators for community care for older people: A systematic review.

BackgroundHealth care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality.MethodsRelevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality.ResultsSearches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain ‘Additional evidence, formulation and usage’ (51%), followed by ‘Scientific evidence’ (39%) and ‘Stakeholder involvement’ (28%).ConclusionA substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes.PROSPERO Registration: 2014:CRD42014007199

PHR in health and social care for older people – regional development through learning within and across organisations

The study draws on findings from a series of seven participatory action research projects in community care for older people carried out over a period of eight years in 20 municipalities in southern Sweden. The analysis here looks at social impact across administrative levels and geographical scales. Different professional groups and care workers in community care participated, crossing divides between social work and health care. The participatory methods all involved a phase of individual reflection, a phase of reflection in practice with colleagues and mixed groups at the regional level, including unit managers and directors in some stages. Impacts concerned interprofessional learning and improved conditions for collaboration in care for older people across institutional boundaries as well as organisational learning across the municipalities. The action research approach was characterised by intensive work with values, empowering low-status professional groups. Social impacts were achieved beyond each project by benefitting from the multi-stakeholder design, using the structure of the organisations and the regional R&D department of the Association of Local Authorities. Over time, the different projects thus contributed to regional development ‘from below’. Nevertheless, employer perspectives tended to determine which conclusions from the projects were eventually implemented and prioritised. Continued reflective dialogue meetings between professional groups are therefore, needed as part of regular work processes. Local and regional structures need forms of autonomy that allow them to implement recommendations from participatory projects. Finally, employee perspectives need to be reflected in decision-making at all levels, particularly including low-status groups of care staff.

Person‐centredness in the community care of older people: A literature‐based concept synthesis

‘Person‐centredness’ is a ubiquitous term, employed in modern care services to signify policies and practices that attend to the uniqueness of each individual user. Despite being highly regarded in older adult community care services, there is much ambiguity over its precise meaning. Existing reviews of person‐centredness and its attributes have tended to focus on the medico‐nursing literature, neglecting other interpretations, such as those relevant to community social care. A new literature‐based concept synthesis reported here identified 12 common attributes within the broad themes of ‘understanding the person’, ‘engagement in decision‐making’ and ‘promoting the care relationship’. The review also contrasts how these attributes are applied across different interpretations of person‐centredness. The article argues that not all attributes necessarily pull in the same direction, and that older adults may require them to be delivered in different ways than they are to younger people. Thus, a ‘one‐size‐fits‐all’ approach should be discouraged in community care.Key Practitioner Message: • ‘Person‐centredness’ is open to multiple interpretations, causing difficulties for services trying to gauge performance and quality; • Three themes are central to person‐centred services: ‘understanding the person’, ‘engagement in decision‐making’ and ‘promoting the care relationship’; • A ‘one‐size‐fits‐all’ approach to applying person‐centredness is to be discouraged.

Substantial between-country differences in organising community care for older people in Europe-a review.

The European population is aging. The main drivers of public spending on health care for people of 65 years and older are hospital admission and admission to long-term care facilities. High quality community care can be a cost-effective and quality solution to respond to the impact of ageing populations on health-care systems. It is unclear how well countries are equipped to provide affordable and quality community care. The aim of this article is to describe and compare community care delivery with care-dependent older people in Europe. This study is conducted within the European Union-financed IBenC project [Identifying best practices for care-dependent elderly byBenchmarkingCosts and outcomes of community care (FP7)] in which six European countries are involved. To compare the community care delivery with care-dependent older people in these countries, we performed a systematic comparison of macro indicators using metadata complemented with data from multinational surveys. Data on the following dimensions are described and compared: population of the country, governmental expenditures on health, sources of community health services funding, governmental vision and regulation on community care, community care organisations and care professionals, eligibility criteria for and equity in receiving care and the involvement of informal care. : Because of the variations in the European community care contexts, the growing demand for community care as a cost-effective and quality solution to the care burden of aging populations will have country-specific impacts. When learning from other countries' best practices, in addition to researchers, policy makers should take full account of local and national care contexts.

Improving the mix of institutional and community care for older people with dementia: an application of the balance of care approach in eight European countries

Objectives: To examine whether the mix of community and institutional long-term care (ILTC) for people with dementia (PwD) in Europe could be improved; assess the economic consequences of providing alternative services for particular groups of ILTC entrants and explore the transnational application of the ‘Balance of Care’ (BoC) approach.Method: A BoC study was undertaken in Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the UK as part of the RightTimePlaceCare project. Drawing on information about 2014 PwD on the margins of ILTC admission, this strategic planning framework identified people whose needs could be met in more than one setting, and compared the relative costs of the possible alternatives.Results: The findings suggest a noteworthy minority of ILTC entrants could be more appropriately supported in the community if enhanced services were available. This would not necessarily require innovative services, but more standard care (including personal and day care), assuming quality was ensured. Potential cost savings were identified in all countries, but community care was not always cheaper than ILTC and the ability to release resources varied between nations.Conclusions: This is believed to be the first transnational application of the BoC approach, and demonstrates its potential to provide a consistent approach to planning across different health and social care systems. Better comparative information is needed on the number of ILTC entrants with dementia, unit costs and outcomes. Nevertheless, the findings offer important evidence on the appropriateness of current provision, and the opportunity to learn from different countries' experience.

Developing health and social care planning in collaboration

Collaboration between different professions in community care for older people is often both difficult and complex. In this project, a participatory action research (PAR) was conducted in order to support the professions involved in the care for older people to develop individualized health and social care plans. Cases from daily work were discussed in different professional groups over a period of one year. A key finding was that lack of knowledge regarding the other professions' field of expertise and their underlying professional culture and values was a barrier in their collaboration. However, as the continuous reflective dialogue process progressed, the participants began to reflect more about the importance of collaboration as a prerequisite to achieve the best possible care for the recipient. This process of reflection led to the often complex needs of the care recipients being given a more central position and thus care plans being better tailored to each person's needs.

Working towards integrated community care for older people: Empowering organisational features from a professional perspective

Although multi-disciplinary cooperation between professionals is a prerequisite to provide integrated care in the community, this seems hard to realise in practice. Yet, little is known about the experiences of professionals who implement it nor about the organisational features professionals identify as empowering during this cooperation process. Therefore, a case study of a multi-disciplinary geriatric team was performed. The data-collection included observations of meetings, in-depth interviews and focus groups with professionals (N=12). Data were analysed inductively and related to the three organisational levels within the model of organisational empowerment of Peterson and Zimmerman. Signs of empowering organisational features on the intraorganisational level were mutual trust and clear working routines. On the interorganisational level important features included improved linkages between participating organisations and increased insight into each other's tasks. Tensions occurred relating to the inter- and the extraorganisational level. Professionals felt that the commitment of the management of involved organisations should be improved just as the capacity of the team to influence (local) policy. It is recommended that policymakers should not determine the nature of professional cooperation in advance, but to leave that to the local context as well as to the judgement of involved professionals.

Doing Care with Integrity and Emotional Sensibility—Reciprocal Encounters in Psychiatric Community Care of Older People with Mental Health Problems

The article focuses on the experiences of community care workers in the encounter with older persons suffering from mental health problems, such as mental illness and disability. The purpose is to describe and discuss opportunities for and challenges to reciprocal encounters with these older people in community care, based on statements from professionals interviewed. Structured conversations with five focus groups were organised, consisting of 26 participants, including nurses’ assistants, assistant nurses, nurses, social workers and occupational therapists. The participants in the focus groups highlight the essence of being involved and create space for a reflective attitude. Clinical implications will be presented as well.

Voice and choice for users and carers? Developments in patterns of care for older people in Australia, England and Finland

This article identifies key trends over the last 20 years in residential and community care for older people in England, Finland and Australia, investigating the extent of ‘de-institutionalisation’, ‘privatisation’ and ‘individualisation’. The concepts of collective and individual ‘voice’ and ‘choice’ are used to interrogate the roles of collective and individual actors, older people and carers, in influencing policy formulation. While these three processes have been pursued by policy-makers in each country, their implementation is illuminated by understanding how ‘voice’ and ‘choice’ have been operationalised – individually and collectively – in each context. In the reshaping of eldercare in the three states, the analysis identifies the greater influence of claims-making by family carers, who provide the informal bastion of formal care services in the push to de-institutionalisation, in comparison with the collective and individual voices of older people as ‘service users’.

Registered nurses' health in community elderly care in Sweden

To describe registered nurses' (RNs) ratings of their work-related health problems, sickness presence and sickness absence in community care of older people. To describe RNs' perceptions of time, competence and emotional pressure at work. To describe associations between time, knowledge and emotional pressure with RNs' perceptions of work-related health problems, sickness presence and sickness absence. There is a global nursing shortage. It is a challenge to provide working conditions that enable RNs to deliver quality nursing care. A descriptive design and a structured questionnaire were used. 213 RNs in 60 care homes for older people participated, with a response rate of 62%. RNs' reported work-related health problems, such as neck/back disorders, dry skin/dry mucous membranes, muscles/joints disorders, sleep disorders and headache. They had periods of fatigue/unhappiness/sadness because of their work (37%). Most of the RNs felt at times psychologically exhausted after work, with difficulties leaving their thoughts of work behind. RNs stated high sickness presence (68%) and high sickness absence (63%). They perceived high time pressure, adequate competence and emotional pressure at work. There was a weak to moderate correlation between RNs' health problems and time pressure. We cannot afford a greater shortage of RNs in community care of older people. Politicians and employers need to develop a coordinated package of policies that provide a long-term and sustainable solution with healthy workplaces. It is important to prevent RNs' work-related health problems and time pressure at work.