Health Services For Older People Research Articles

Clinical Audit of Standard for Electronic Recording of Dementia Diagnostic Assessments in Stockton Mental Health Services for Older People

Clinical Audit of Standard for Electronic Recording of Dementia Diagnostic Assessments in Stockton Mental Health Services for Older People

Clinical Audit of Rapid Tranquilisation in Mental Health Services for Older People (MHSOP)

Clinical Audit of Rapid Tranquilisation in Mental Health Services for Older People (MHSOP)

Long-term inequalities in health among older Mexican adults: An outcome-wide analysis

The relationship between socioeconomic level and health outcomes in older people has been widely studied, but less information about health inequalities associated with gender and place of residence exists. Also, there is scarce evidence of longitudinal inequalities, particularly in countries from the global south. This study aimed to describe the longitudinal patterns of health inequalities associated with wealth, gender, and residence area among older Mexican adults. We used data from two longitudinal studies in Mexico: The Study on Global AGEing and Adult Health (SAGE) and the Mexican Health and Aging Study (MHAS). Three domains to characterize health inequities were used: wealth, gender, and rurality. We conducted an outcome-wide analysis with nine health indicators assessing older adults' physical and cognitive function. The Slope Index of Inequality and the Relative Index of Inequality were used as inequality measurements. Our results indicate that the greatest inequalities are observed in relation to wealth and gender. Older adults with lower socioeconomic status demonstrated higher rates of depression, sarcopenia, falls, and limitations in both basic and instrumental activities of daily living compared to their wealthier counterparts, with increasing trends in physical functionality over time. Furthermore, women experienced higher rates of depression, sarcopenia, frailty, and physical limitations compared to men. The only significant difference related to rurality was a lower rate of frailty among rural older adults. Longitudinal trajectories revealed an increase in the gap of inequality for various health indicators, especially in terms of wealth and gender. Health inequalities in old age are one of the greatest challenges facing health systems globally. Actions like universal coverage of health services for older people and the empowerment of individuals and their communities to have control over their lives and circumstances must be guaranteed.

Pre-Therapeutic Assessment of Older People in Sub-Saharan Africa: Introduction to the Comprehensive Geriatric Assessment.

Objectives: With the ongoing epidemiological transition in sub-Saharan Africa (SSA), conditions that require invasive treatment (surgery, cancer, and anaesthesia, etc.) will become increasingly common. Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic process aimed at identifying older people at risk of negative outcomes. It is important to know whether this approach integrates care management strategies for older people in a context where health services for older people are scarce, and staff members have little training in geriatrics. The current work is a situational analysis on the use of CGA on invasive care (cancer, surgery, etc.) among older people in SSA. Methods: We searched PubMed-MEDLINE and other sources for studies reporting on CGA and conditions requiring invasive treatment in older patients in SSA. Results/Conclusions: We found no study that had comprehensively examined CGA and invasive care in SSA. There is, however, evidence that the offer of invasive care to older people has improved in SSA. Further research is needed to explore the applicability of CGA in SSA. Similarly, more investigations are needed on the role of CGA in the care trajectories of older people in SSA, in terms of outcomes and affordability.

Impact of applying the STOPPFrail criteria in patients with dementia

Excessive polypharmacy in the elderly carries a high burden of drug‐related morbidity and contributes negatively to the environmental impact of health care systems. The aim of the project was to evaluate the outcomes of implementing the STOPPFrail tool within a mental health service for older people (MHSOP) inpatient setting in a population of patients with dementia. The authors demonstrate that the STOPPFrail guidelines can be implemented to help to overcome barriers to deprescribing.

Mobile phone intervention to reduce dropout from treatment at an outpatient mental health service for older people in Nigeria.

Half of older Africans drop out of treatment after a single contact with biomedical mental health services. This study examined the effect of introducing a mobile phone reminder intervention delivered by volunteering health staff to reduce dropout from an outpatient mental health service for older people in Nigeria. 405 patients were studied using a quasi-experimental design: 169 who attended clinic pre-intervention (2016-2017) and 236 who attended during intervention (2018-2019). We estimated annual dropout rates, reasons for dropout and predictors of drop-out. We found a trend for decreasing dropout rates during intervention (p<0.001). The most common reasons for dropout were distance to the clinic (19.5%) and unavailability of a caregiver (47.6%). Current single status (O.R =2.02, 95% C. I=1.02-3.99) and treatment without adjunctive pharmacotherapy (O. R=2.14, 95% CI; 1.07-4.26) predicted dropout. Mobile phone call reminders improved treatment engagement in this population. Findings are important for policy to improve access to mental healthcare in Africa.

A third sector outreach project to increase knowledge of psychological wellbeing, psychological therapies and how to access mental health services for older people in a Scottish health board

Despite psychological therapies being as, if not more, effective for older adults as compared to working age adults, older adults face additional barriers in accessing psychological therapies, and are more likely than working aged adults to be offered pharmacological intervention in the first instance. This paper describes an outreach program carried out by the Older Adult Psychology Specialty in NHS Ayrshire and Arran, which aimed to increase knowledge and understanding of psychological therapies for older people living in the health board area, and to provide information about healthy ageing from a psychological perspective to a population who may otherwise not have had access to this information. This paper summarises this work and gives suggestions for future developments. Whilst this project was set in a semi-rural Scottish context, there are elements that could be replicated in other UK board areas that have a similar service aim and that have similar third sector agencies operating in their area.

27 An evaluation of suicidality of those over 65 years referred to liaison psychiatry in the acute hospital setting

Abstract Background The Mental Health Service for Older People (MHSOP) Liaison Service in North Dublin noted an exponential increase in suicide attempts in those over 65 over a period of 3 years (2020–2022). Annually in Ireland, more than 400 people die by suicide and a further 12,500 present to hospital following self-harm, of which approximately 15% are older adults (aged &amp;gt;60). Worldwide, the age group that is most likely to die by suicide is represented by older adults, in particular men. Methods Analysis of referrals to the service from an established clinical database was performed to include those referred post suicide attempt or those referred for suicidal ideation or expressing a Passive Death Wish (PDW). Data was anonymized and recorded using Microsoft excel. Results There was a highly significant difference between the number of males who were referred post suicide attempt between 2021 (n = 1) and 2022 (n = 13), with z = +3.21 p &amp;lt; 0.001. Referrals post suicide attempt in 2021 consisted of 2% (n = 6) of all referrals to the service, and 6% (n = 20) in 2022. In 2021 the mean age of those referred was 75.16, and in 2022 was slightly lower at 72.65, with 60% of those in the 65–72 year age range. Alcohol was involved in 45% of all suicide attempts in 2022. The overall referrals to the service for suicidality (post suicide attempt and PDW) increased from 5% to 16% from 2021 to 2022 of all those referred. Conclusion A Suicide prevention working group was established to include members of: MHSOP, Older Persons Services, Public Health and the National Office for Suicide Prevention (NOSP) to explore evidence based suicide and self-harm prevention strategies and guidelines in order to address the multiple precipitative factors for suicidality in older persons by developing improved care pathways and integration of services.

Strengthening community empowerment for elderly health service in new normal by Pol-Sadar (Integrated Health Service Post for Elderly)

Before the pandemic, older people actively participated in an integrated health service post named POSYANDU. This high participation is due to community health workers who understand their role in realizing basic health services. During the pandemic, POSYANDU must be held with attention to developments in the COVID-19 case. We implemented the online-based service of integrated health posts to provide online health services for older people. This paper explains the participation of elders, family, and community health workers in the revitalization strategies of integrated health service activities for older people during the pandemic. The activities included health assessments via telemedicine (video call), drive-thru services for vital signs assessment and simple lab checks, home visits, and education via WhatsApp as needed. The implementation began in June 2020 and in May 2021 with 184 older people in some places in Central Java, including Semarang City, District of Semarang, and District of Batang. We also worked with teaching volunteers consisting of five community health workers and 19 nursing students in the community. The results of these activities were the findings of health problems experienced by the elderly during the pandemic (depression, hypertension, and joint stiffness), increased knowledge, and physical activity in the elderly group. The 100 older people participated in online exercise activities accompanied by their families and felt a decrease in complaints of joint stiffness, and 84 elders people participated in health education and exercise activities in open areas by implementing strict health protocols. Most participants said they were satisfied with Pol-Sadar activities as a health service strategy for older people during the pandemic. In conclusion, the online program was effective as a strategy of health services for elderly people, especially during the new normal era, and increased the participation of family and community health workers, but it needs adequate devices to participate.

Factors related to the utilization of integrated health services among older people in Kendari City, Southeast Sulawesi Province, Indonesia

Background: Integrated health service, called Posyandu, is one of the efforts by the Indonesian Government to improve the health quality of older people. However, its utilization is not optimal. Thus, factors related to it warrant investigation. Objective: This study aimed to identify factors related to the utilization of integrated health services for older people. Methods: This study employed a cross-sectional design among 173 older people aged ≥ 60 registered as members of integrated health services in two areas in Kendari City, Southeast Sulawesi, Indonesia. Convenience sampling was applied, and data were collected from January to March 2022. Result: There was a significant relationship between the older people’s perception (AOR = 2.40; CI = 1.14-5.03; p = 0.018), family support (AOR = 2.73; CI = 1.23-6.02; p = 0.028), and cadres’ role (AOR = 3.62; CI = 1.59-8.21; p = 0.011) with the use of integrated health services. Otherwise, treatment-seeking showed no relation with the utilization of integrated health services (AOR = 1.68; CI = 0.74-3.82; p = 0.094). Conclusion: The significant factors revealed in this study can be used to improve the utilization of integrated health services for older people in the community. Education to change the perception of older people is needed, and family support and cadres’ roles should be advanced to improve healthcare visits in order to increase health quality.

Establishing an Old Age Liaison Psychiatry Network

AimsOur aim is to establish a network for clinicians working in or with an interest in the growing specialty of old age liaison psychiatry to provide peer support (inclusive of disciplines and geography) and access to CPD opportunities, to raise the profile of this subspecialty and enable it to continue to develop, to facilitate collaboration and integration with related disciplines and pathways and to strengthen the voice of clinicians in lobbying for improvements in mental health services for older people in the general hospital.MethodsOld Age Liaison Psychiatry is a growing subspecialty in the UK and nationally, following widespread investment in development of liaison services in line with Department of Health strategy. With this expansion comes an increasing need for continuous professional development, networking and collaboration opportunities in order to nurture the specialty and those working in it.ResultsOver 100 people registered for the initial webinar, and many more have watched the recording. Since the webinar the network has grown to 350 members. The webinars were received very positively, with many suggestions made for topics to be covered at future events.ConclusionThe network has been established successfully and founders are now planning future events with the support of the Royal College of Psychiatrists, including a half day learning event in late 2022.

Improving clinical practice guidelines for older people: considerations and recommendations for more inclusive and ageing-relevant guidelines

The global population is rapidly ageing and the UN has marked this decade (2021–30) as the Decade of Healthy Ageing, with an action plan to improve the lives of older people around the world.1 A key aspect outlined in the global action plan is the need for access to high-quality health services. An important component of access to high quality health services for older people are clinical practice guidelines, which summarise best evidence regarding treatment options to provide a framework for clinicians in treating older people.

Exploring the temporal variations in accessibility to health services for older adults: A case study in Greater London

IntroductionIncreasing attention has been paid to accessibility and equity during the last two decades. Yet, despite the proliferation of studies investigating accessibility and equity from the perspective of the younger generation, only modest progress has been made in embedding a temporal perspective and targeting health services for older adults. Currently, the number of people over 60s in London is growing rapidly and is projected to increase to approximately two million by 2035. AimsThis research aims to examine walking accessibility to General Practitioners (GPs) for older people in Greater London, with a particular focus from a temporal perspective. MethodsThree different datasets were used for this study, namely: GP services data and data on GP Opening Times data from NHS Choices; the London Lower Super Output Area (LSOA) atlas; and the road network derived from OpenStreetMap (OSM). This study uses on the cumulative method to calculate accessibility to GPs – and applies the vertical equity index to measure temporal equity. ResultsOur results show that opening times have a significant impact on accessibility to health services for older people in London. Overall accessibility peaked at midday when 15.88% of areas have a low degree of accessibility. Additionally, our study classifies local authorities into five groups based on their performance on accessibility and vertical equity measurements. We found several districts with inadequate and unequal accessibility that can be identified as vulnerable areas. ConclusionsGaining insights into the temporal variations in accessibility to GPs represents a key step towards providing optimal services. Our findings can be used to provide an evidence-based reference for transport planners and policymakers to promote age-friendly development and planning.

Issues in the Development of Community Mental Health Services for Older People in Australia, 1950–2020

Issues in the Development of Community Mental Health Services for Older People in Australia, 1950–2020

Vulnerabilities of older adults and mitigation measures to address COVID-19 outbreak in Bangladesh: A review.

The infection with coronavirus disease (COVID-19) had an extremely negative influence on public health and the global economy. Covid-19 infection is more likely to affect the elderly than younger people, and pre-existing medical conditions, such as cardiovascular disease, diabetes, high blood pressure, and respiratory diseases, might lead to death due to COVID-19 infection. In low-income, developing, and highly dense countries like Bangladesh, the aging population is particularly vulnerable to the pandemic due to inadequate health services, socio-economic circumstances, environmental settings, religious and cultural beliefs, personal cleanliness habits, and a contemplative approach to infectious disease. Besides, recent cyclones and floods have combined effects on older people's increasing vulnerabilities. In this study, we reviewed and examined the vulnerabilities of older adults to the COVID-19 outbreak in Bangladesh. Different mitigation measures are discussed to protect the elderly from the adverse effect of the pandemic. This study proposes several steps to reinforce the commitment to social care and health care services to guarantee well-being, encourage preventive measures, and increase access to older people's health services in Bangladesh. The core findings will provide a valuable guideline for older adults, scientists, and policymakers to take effective long-term measures to mitigate the pandemic's risk.

Audit of documentation of observations on mental health services for older people (MHSOP) wards following implementation of nervecentre

AimsNervecentre is an application that can be used on mobile devices and desktop computers to record and view physical observations amongst other tools. An audit had been done previously assessing the practice of recording observations using paper documentation. That audit had recommended the use of Nervecentre to improve the recording of observations. This audit was undertaken following the introduction of Nervecentre for documentation of physical observations. The aims were to evaluate if the transition to electronic documentation of NEWS (National Early Warning Score) observations on Nervecentre has improved practice in comparison to paper documentation and to evaluate if our practice could be improved by implementing electronic observations for psychiatric observations in addition.MethodData were collected over a 10-day period looking at all the documented observations from all inpatients on the MHSOP wards that met the inclusion criteria. Data were collected on the recording of psychiatric observations (recorded on paper charts) and physical observations (recorded on Nervecentre). The data were collated and analysed. The new data were compared to the original data from prior to the introduction of NerveCentre and the findings were presented at a local meeting.ResultThis audit has highlighted that the documentation of physical observations on MHSOP wards has greatly improved since Nervecentre was introduced. There was an improvement in recording of physical observations in almost all domains measured. NEWS scores were correctly documented 100% of the time compared to 87% previously. Raised NEWS scores were correctly escalated to a senior and reviewed 80% of the time compared to 0% previously. It has also highlighted that the quality of documentation regarding psychiatric observations could be improved as we are not currently meeting local or national guidance.ConclusionThe most likely cause for the improvement in the recording of the physical observations is the implementation of Nervecentre. Nervecentre prompts users when observations are due, removes the risk of calculation errors and allows for observations to be directly escalated. Implementing Nervecentre for psychiatric observations may similarly improve the quality of these observations therefore improving patient safety.

Staff experiences of formulation in a mental health service for older people

Staff experiences of formulation in a mental health service for older people

Access and Discontinuity of Care at an Outpatient Mental Health Service for Older People in South Western Nigeria.

We examined frequency and reasons for dropout from follow-up care at an outpatient mental health service for older people in South-Western Nigeria. This was a cross-sectional study. Administrative reviews of 201 case records of clinic attendees who received a psychiatric diagnosis that required follow-up consultations were conducted. Records were those of patients seen between January 2015 and December 2017. Chart extraction was followed by Key Informant Interview (KII) to explore the reasons for drop out and partial non-attendance. We identified 37(18.4%) regular clinic attendees, as well as 147(73.1%) and 17(8.5%) dropout and partially attending patients, respectively. Approximately 45.6% of the dropouts occurred after the first consultation. In KII, distance from the hospital, long waiting times and financial constraints were the common reasons for dropout. The findings of this study should inform the development of strategies to improve access to mental health services in Nigeria and other low- and middle-income countries.

Effectiveness–implementation hybrid type 2 study evaluating an intervention to support ‘information work’ in dementia care: an implementation study protocol

IntroductionPatients with long-term conditions consistently report a lack of information around services and support available to them. This unmet need for information is significant among people with dementia and family...

Patterns of use of secondary mental health services before and during COVID-19 lockdown: observational study.

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on both the physical and mental well-being of the global population. Relatively few studies have measured the impact of lockdown on utilisation of secondary mental health services in England. To describe secondary mental health service utilisation pre-lockdown and during lockdown within Leicestershire, UK, and the numbers of serious incidents during this time frame. Data pertaining to mental health referral and hospital admissions to adult mental health, child and adolescent mental health, intellectual disability and mental health services for older people were collated retrospectively from electronic records for both 8 weeks pre-lockdown and the first 8 weeks of lockdown in England. Serious incidents during this time frame were also analysed. Significantly (P < 0.05) reduced referrals to a diverse range of mental health services were observed during lockdown, including child and adolescent, adult, older people and intellectual disability services. Although admissions remained relatively stable before and during lockdown for several services, admissions to both acute adult and mental health services for older people were significantly (P < 0.05) reduced during lockdown. Numbers of serious incidents in the pre-lockdown and lockdown periods were similar, with 23 incidents pre-lockdown, compared with 20 incidents in lockdown. To the best of our knowledge, this is the first UK-based study reporting patterns of use of mental health services immediately prior to and during COVID-19 lockdown. Overall numbers of referrals and admissions reduced following commencement of COVID-19 lockdown. Potential reasons for these observations are discussed.