People In Receipt Research Articles

Epidemiology of ischaemic heart disease in France

Background: Cardiovascular disease is the leading cause of death worldwide. Ischaemic heart disease (IHD), including acute coronary syndromes (ACS) with or without ST-segment elevation and chronic coronary syndromes, is one of the main causes.Aim: To describe the epidemiology of IHD in France in 2022.Methods: Adults hospitalized due to IHD in 2022 were identified in the French National Health Data System. The characteristics, hospital management and one-year outcomes of patients were described. The IHD prevalence among people alive on 01.01.23 was estimated by combining previous hospitalizations and people in receipt of 100% coverage for a registered long-term disease. IHD-related mortality was estimated from death certificates.Results: In 2022, 242,227 adults were hospitalized for IHD in France (452/100,000 person-years); 2.98 million prevalent cases of IHD (5.6% of the adult population) and 31,391 IHD-related deaths (4.8% of all deaths) were recorded. The average age at hospitalization for IHD was 69.3 years and 29.0% of patients were women. Exposure to cardiovascular risk factors was high. The average length of hospitalization was 4.9 days, 55.9% had undergone a percutaneous coronary intervention and 4.5% a coronary artery bypass graft. The in-hospital death rate was 3.6%. Six months after the index hospitalization, 22.0% of patients had been admitted to a rehabilitation service (42.9% for STE-ACS). In the year following the index hospitalization, 84.5% of patients had received antiplatelet drugs, 82.6% a statin, 68.8% a beta-blocker and 67.7% a renin-angiotensin-aldosterone system treatment. One year after index hospitalization, the rate of rehospitalization for IHD was 29.9% and the rate of all-cause death was 9.3%.Conclusions: The burden of IHD remains high in France. These results suggest that primary prevention of IHD should be maintained and improved, as well as secondary prevention, to improve the prognosis and quality of life of the 3 million patients with coronary disease.

Epidemiology of major heart rhythm and conduction disorders

BackgroundHeart rhythm and conduction disorders cover a variety of pathologies, ranging from the benign to the immediately life threatening. AimsTo describe the epidemiology of patients hospitalized for arrhythmias in France, and to estimate the prevalence and mortality associated with these disorders, divided into three separate groups: atrial fibrillation and flutter; conduction disorders; and ventricular tachycardia/cardiac arrest. MethodsWe looked in the National Health Data System and selected patients who had been hospitalized at least once in 2022 for these diseases and patients who died as a result of these diseases in 2021. The prevalence of these disorders among people alive on 1st January 2023 was estimated by combining previous hospitalizations and people in receipt of 100% coverage for a registered long-term disease. ResultsAt 1st January 2023, the prevalence of patients who had been hospitalized with major rhythm and conduction disorders was 2,740,141: 2,027,900 with atrial fibrillation/flutter; 999,692 with conduction disorders; and 214,989 with ventricular tachycardia/cardiac arrest. In 2022, respectively 90,502, 48,268 and 16,930 were hospitalized for these conditions, which equate to rates of 169.5, 68.3, and 31.7 per 100,000 inhabitants, respectively. Several departments in the Hauts-de-France and Grand-Est regions had rates>20% above the national rate. The rate of ventricular tachycardia/cardiac arrest was 40% higher among residents of the most deprived municipalities than among residents of the least deprived municipalities. Mortality at the end of hospitalization reached 44% for patients hospitalized for ventricular tachycardia/cardiac arrest. ConclusionsArrhythmias and conduction disorders affect a significant proportion of the population, leading to a large number of hospitalizations and procedures, particularly ablation techniques and pacemaker/defibrillator implantation. Given the extent of regional disparities and the impact of the socioeconomic status of the municipality of residence, targeted prevention and screening strategies should be implemented.

A qualitative exploration of the experiences of transdermal alcohol sensor devices amongst people in receipt of treatment for alcohol use disorder

IntroductionTransdermal alcohol sensors (TAS) have the potential to be used as a clinical tool in alcohol treatment, but there is limited research with individuals with alcohol dependence using TAS. Our study is a qualitative evaluation of the views of people attending alcohol treatment and their experiences of wearing the BACtrack Skyn, within alcohol services in South London. MethodsParticipants with alcohol dependence wore a BACtrack Skyn TAS for one week and met with the researcher every two days, for a total of four meetings (for example: Monday, Wednesday, Friday, and Monday). In the final meeting, a post-wear survey (on their physical, social and comfort experience of the TAS) and semi-structured interview were completed. The Technology Acceptance Model (TAM) informed the topic guide and data analysis. ResultsAdults (N = 16) receiving alcohol treatment were recruited. Three core topics guided analysis: perceived usefulness, perceived ease of use and attitudes towards use. Participants found the TAS easy to wear and felt positive about its appearance and comfort. The only challenges reported were side effects, mostly skin irritation. The main two perceived uses were 1) TAS working as a drinking deterrent and 2) reducing daily breathalyser visits during detox. ConclusionFindings support the use of TAS amongst alcohol service users. Wearing the TAS for one week was acceptable and feasible for objective alcohol concentration measurement. Participants reported high perceived ease of use and usefulness of the Skyn in the context of alcohol treatment. These results are encouraging for the use of TAS in clinical settings.

The association between frailty, care receipt and unmet need for care with the risk of hospital admissions.

Frailty is characterised by a decline in physical, cognitive, energy, and health reserves and is linked to greater functional dependency and higher social care utilisation. However, the relationship between receiving care, or receiving insufficient care among older people with different frailty status and the risk of unplanned admission to hospital for any cause, or the risk of falls and fractures remains unclear. This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA) waves 6-8. Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalisation due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. Care receipt increases the risk of hospitalisation substantially, suggesting this is a group worthy of prevention intervention focus.

"Taking from Peter to pay Paul": The experience of people in receipt of fuel and food vouchers from a UK foodbank.

For people on very low incomes, household fuel and food environments are increasingly uncertain. Many live in precarious situations with little control over their lives. In addition to food parcels, many foodbanks also supply emergency fuel payments. There has been a surge in demand due to the cost of living crisis in the United Kingdom. This qualitative study, using semi-structured interviews, explored the lived experience of people who received a fuel voucher via a foodbank to gain insights into food preparation, eating practices and heating and appliance use in their homes. All participants (n = 6) described a change in life circumstances leaving them at crisis point with overwhelming uncertainty. Using Thematic Analysis, we identified four themes: (1) Bewilderment in using foodbank services; (2) The need to make trade-offs between food and fuel; (3) Feeling shame at using the services and (4) Missing out on pleasurable eating practices. Three case studies give fuller insights and context. All interviewees had acute and complex needs and described being 'at rock bottom', with fuel vouchers viewed as a 'lifeline' to address essential cooking, heating and electrical appliance needs. We, therefore, suggest the need for extra support and follow-up for first-time users who are in a state of denial and shock when seeking help. Further research is needed on how to best help organisations develop strategies to address and ameliorate a sense of powerlessness and shame felt by their clients which likely limits them from seeking help, despite being in acute, complex and dire need.

Communication skills training for improving the communicative abilities of student social workers.

Good communication is central to effective social work practice, helping to develop constructive working relationships and improve the outcomes of people in receipt of social work services. There is strong consensus that the teaching and learning of communication skills for social work students is an essential component of social work qualifying courses. However, the variation in communication skills training and its components is significant. There is a sizeable body of evidence relating to communication skills training therefore a review of the findings helps to clarify what we know about this important topic in social work education. We conducted this systematic review to determine whether communication skills training for social work students works and which types of communication skills training, if any, were more effective and lead to the most positive outcomes. This systematic review aimed to critically evaluate all studies which have investigated the effectiveness of communication skills training programmes for social work students. The research question which the review posed is: 'What is the effectiveness of communication skills training for improving the communicative abilities of social work students?' It was intended that the review would provide a robust evaluation of communication skills training for social work students and help explain variations in practice to support educators and policy-makers to make evidence-based decisions in social work education, practice and policy. We conducted a search for published and unpublished studies using a comprehensive search strategy that included multiple electronic databases, research registers, grey literature sources, and reference lists of prior reviews and relevant studies. Study selection was based on the following characteristics: Participants were social work students on generic (as opposed to client specific) qualifying courses; Interventions included any form of communication skills training; eligible studies were required to have an appropriate comparator such as no intervention or an alternative intervention; and outcomes included changes in knowledge, attitudes, skills and behaviours. Study selection was not restricted by geography, language, publication date or publication type. The search strategy was developed using the terms featuring in existing knowledge and practice reviews and in consultation with social work researchers, academics and the review advisory panel, to ensure that a broad range of terminology was included. One reviewer conducted the database searches, removing duplicates and irrelevant records, after which each record was screened by title and abstract by both reviewers to ensure robustness. Any studies deemed to be potentially eligible were retrieved in full text and screened by both reviewers. Fifteen studies met the inclusion criteria. Overall, findings indicate that communication skills training including empathy can be learnt, and that the systematic training of social work students results in some identifiable improvements in their communication skills. However, the evidence is dated, methodological rigour is weak, risk of bias is moderate to high/serious or incomplete, and extreme heterogeneity exists between the primary studies and the interventions they evaluated. As a result, data from the included studies were incomplete, inconsistent, and lacked validity, limiting the findings of this review, whilst identifying that further research is required. This review aimed to examine effects of communication skills training on a range of outcomes in social work education. With the exception of skill acquisition, there was insufficient evidence available to offer firm conclusions on other outcomes. For social work educators, our understanding of how communication skills and empathy are taught and learnt remain limited, due to a lack of empirical research and comprehensive discussion. Despite the limitations and variations in educational culture, the findings are still useful, and suggest that communication skills training is likely to be beneficial. One important implication for practice appears to be that the teaching and learning of communication skills in social work education should provide opportunities for students to practice skills in a simulated (or real) environment. For researchers, it is clear that further rigorous research is required. This should include using validated research measures, using research designs which include appropriate counterfactuals, alongside more careful and consistent reporting. The development of the theoretical underpinnings of the interventions used for the teaching and learning of communication skills in social work education is another area that researchers should address.

The experience of people in receipt of fuel and food vouchers from a UK Foodbank: A qualitative study

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The teaching and learning of communication skills for social work students: a realist synthesis protocol

BackgroundGood interpersonal communication is the cornerstone of social work practice, enhancing the outcomes of people in receipt of its services. Social workers’ communication skills are often identified as an area of concern. Communication skills can be developed and refined through training or education. The teaching and learning of communication skills is firmly embedded in many social work qualifying courses; however, considerable heterogeneity exists regarding such complex interventions and the theoretical underpinnings of which have not been made explicit. Realist synthesis can help explain how, why, for whom and in what circumstances an intervention might work, which is an important first step for helping educators to tailor courses to meet the needs of different learner groups and, where applicable, the employing agencies and government departments who fund them.MethodsRealist synthesis is an interpretive, theory-driven and explanatory approach that aims to explain the interplay between the context, mechanisms and outcomes of interventions. This realist synthesis seeks to understand and explain to what extent, how, why, for whom and in what circumstances complex educational interventions aimed at teaching communication skills to social work students produces its effects. A five-step process will be followed iteratively. In step 1, the initial programme theory will be developed. Step 2 will involve searching for evidence. In step 3, selection and appraisal will take place. Step 4 requires data to be extracted and organised, and in step 5, data will be analysed and synthesised.DiscussionThe teaching and learning of communication skills in social work education is under theorised. The findings from this realist synthesis aim to help policymakers and educators make informed decisions about the design and delivery of complex educational interventions aimed at improving the communication skills of social work students. The realist synthesis will be conducted and reported in accordance with the RAMESES guidelines and standards.Systematic review registrationThe review is registered with the Open Science Framework. https://doi.org/10.17605/OSF.IO/BYHC7

Assessing Sarcopenia, Frailty, and Malnutrition in Community-Dwelling Dependant Older Adults—An Exploratory Home-Based Study of an Underserved Group in Research

Adults of advanced age, with functional dependency, socioeconomic disadvantage, or a need for home care, are expected to be at high risk of sarcopenia, frailty and malnutrition, yet are likely to be underrepresented in research. We aimed to explore the assessment of sarcopenia, frailty, and malnutrition in-home, and to describe the practicality of performing these assessments. Home-based health assessments and post-study feedback surveys were conducted among community-dwelling older adults ≥65 years in receipt of state-funded home care (n = 31). Assessments included probable sarcopenia [hand-grip strength (HGS), chair rise-test, and SARC-F case-finding tool], the Mini Nutritional Assessment (MNA), and the Clinical Frailty Scale (CFS). The study group was of mean age 83.2 ± 8.2 years, 74% were female and 23% lived in socioeconomically disadvantaged areas. Almost all met the criteria for probable sarcopenia (94%, n = 29/31), were frail or vulnerable by the CFS (97%, n = 30/31), and over a quarter were at risk of malnutrition (26%, n = 8). Participants had low physical activity (71.0%, n = 22/31), with a mean daytime average of 11.4 ± 1.6 h spent sitting. It was possible to assess probable sarcopenia (by HGS and SARC-F, but not the chair rise test), malnutrition (MNA), and frailty (CFS). Home-based research was a complex environment, and unearthed significant unmet need, prompting referrals to health services (36%, n = 11), in addition to technology assistance. The majority of participants (93%) reported a willingness to partake in future research. Most community-dwelling older people in receipt of home support, assessed in this exploratory study, were at risk of probable sarcopenia, frailty, and low physical activity, with over a quarter were at risk of malnutrition. Our initial findings provide practical data for large scale studies and may inform the development of intervention studies aiming to support ageing in place.

NUJ Reporting Poverty campaign: Introducing a trade union challenge to journalistic representations of the unemployed and the working poor

The National Union of Journalists (NUJ) has reporting poverty guidelines for its 25k+ members to use alongside its code of conduct. These were introduced following a campaign from trade union activists and are now available to media workers in the industry including, among others, staff at the BBC, the tabloid and broadsheet press. These guidelines were created to challenge the demonizing and stereotyping of the working poor and people in receipt of benefits found in British journalism. In this article these guidelines are contextualized, within the ideology of austerity, a British media dominated by the middle and upper class and the resulting demonizing of the poor during economic crises. This article posits that the campaigning work can provide a theoretical and practical challenge to encourage and enable workers to join forces in rejecting the scapegoating of low-paid, unemployed and under-employed workers as seen in the media. In so doing, it considers that, while the guidelines may have limited influence in some sections of the media, they are nonetheless a significant tool, and position of solidarity, in challenging the depoliticizing individualizing apparent in reporting poverty, the ‘skivers versus strivers’ discourse, and in providing a critique of the journalistic use of sources. This article, written by a contributor to those guidelines and leader of the NUJ campaign, serves as an introduction to this unique British trade union approach informed and led by collaboration with people who have experienced of poverty.

From care packages to Zoom cookery classes: youth work during the COVID-19 “lockdown”

PurposeThis paper aims to explore the experience of one large Irish youth work organisation, Foróige, to measures introduced during the initial phase of COVID-19 in 2020. In the face of the unprecedented crisis including the closure of schools and curtailment of many youth services, this paper examines how the organisation responded and adapted its service offering.Design/methodology/approachQualitative semi-structured interviews were conducted with 12 senior managers and youth officers in Foróige to explore their perspectives on the organisation’s response. Participants were purposively sampled from across the operational management functions and also from regional levels and youth workers engaging in work “on the ground”.FindingsShifting from a face-to -face, relationship-based to a distanced mode of engagement with young people, colleagues and volunteers required significant adaptation of Foróige’s service model. Innovation took place both in the delivery platform and fundamentally, in its service orientation. The accelerated move to online youth work brought about by the pandemic enabled the organisation to embrace and learn from the challenges and opportunities posed by digital technology. Responding to the immediate and tangible needs of young people in receipt of services, staff found themselves working with families at the more basic levels of intervention.Originality/valueThis paper provides new insights into the nature of non-profit service innovation during a time of unprecedented crisis management. It highlights characteristics of organisational agility that can assist organisations in managing crises, while also pointing the way towards a more flexible operating model for youth work service delivery.

Variations in COVID-19 vaccination uptake among people in receipt of psychotropic drugs: cross-sectional analysis of a national population-based prospective cohort.

Coronavirus disease 2019 (COVID-19) has disproportionately affected people with mental health conditions. We investigated the association between receiving psychotropic drugs, as an indicator of mental health conditions, and COVID-19 vaccine uptake. We conducted a cross-sectional analysis of a prospective cohort of the Northern Ireland adult population using national linked primary care registration, vaccination, secondary care and pharmacy dispensing data. Univariable and multivariable logistic regression analyses investigated the association between anxiolytic, antidepressant, antipsychotic, and hypnotic use and COVID-19 vaccination status, accounting for age, gender, deprivation and comorbidities. Receiving any COVID-19 vaccine was the primary outcome. There were 1 433 814 individuals, of whom 1 166 917 received a COVID-19 vaccination. Psychotropic medications were dispensed to 267 049 people. In univariable analysis, people who received any psychotropic medication had greater odds of receiving COVID-19 vaccination: odds ratio (OR) = 1.42 (95% CI 1.41-1.44). However, after adjustment, psychotropic medication use was associated with reduced odds of vaccination (ORadj = 0.90, 95% CI 0.89-0.91). People who received anxiolytics (ORadj = 0.63, 95% CI 0.61-0.65), antipsychotics (ORadj = 0.75, 95% CI 0.73-0.78) and hypnotics (ORadj = 0.90, 95% CI 0.87-0.93) had reduced odds of being vaccinated. Antidepressant use was not associated with vaccination (ORadj = 1.02, 95% CI 1.00-1.03). We found significantly lower odds of vaccination in people who were receiving treatment with anxiolytic and antipsychotic medications. There is an urgent need for evidence-based, tailored vaccine support for people with mental health conditions.

News media representations of people receiving income support and the production of stigma power: An empirical analysis of reporting on two Australian welfare payments

People receiving working-age income support payments are often stigmatised as morally and/or behaviourally deficient. We consider the role of the media, as a potential source of structural stigma, in perpetuating negative characterisations of people in receipt of either the Disability Support Pension (DSP) or unemployment benefits (Newstart) during a major period of welfare reform in Australia. Newspaper articles (N = 8290) that appeared in Australia’s five largest newspapers between 2001 and 2016, and referenced either payment were analysed. We found an increased use of fraud language associated with the DSP, which coincides with increased political and policy focus on this payment. We conclude that in a period of increasing political concern with welfare reform, media coverage of welfare recipients is a form of stigma power, acting discursively as symbolic violence.

Administrative burden and the Cashless Debit Card: Stripping time, autonomy, and dignity from social security recipients

AbstractAlthough Western nations have long placed conditions on access to social security payments, many of the more recent conditions utilising technological tools have intensified surveillance and control of the poor and imposed weighty administrative burdens on social security recipients as they attempt to navigate these systems. The Cashless Debit Card (CDC) imposes additional administrative burdens – learning costs, compliance costs, and psychological costs – on people in receipt of social security as part of an overall welfare conditionality project that structures in disincentives to claim government income support. Cardholders experience heavy administrative burdens in securing essentials and managing their social security income via the CDC, seeking a reduction of their restricted payment portion, and seeking a well‐being exemption or a financial responsibility exit to regain their budgetary autonomy. Evidence suggests that numerous people in need of social security who have been forced on to the CDC could do with a reduction in burdensome processes – which would be facilitated by designing systems that are autonomy enhancing, respectful of the human dignity of claimants, and fairly easy to navigate.

Has consumer-directed care improved the quality of life of older Australians? An exploratory empirical assessment.

To assess the impact of a Consumer Directed Care (CDC) model of service delivery on the quality of life of older people receiving home care packages. Quality of life was assessed using validated instruments. The relationship between quality of life and length of time exposed to CDC was examined using descriptive statistical and multivariate regression analyses. Consenting older adults (n=150) in receipt of home care packages participated. Quality of life and capability scores were higher for older people in receipt of a CDC model of service delivery for <12months compared to those receiving the model of care for longer, although this difference was not statistically significant. However, older people with more recent exposure to CDC indicated a stronger capability to do things that made them feel valued. Extended longitudinal follow-up is needed to facilitate a detailed examination of the relationship between the evolution of CDC and its longer-term influences on quality of life.

Developing dimensions for a new preference-based quality of life instrument for older people receiving aged care services in the community

PurposeTo identify the salient quality of life characteristics relevant to older people in receipt of community aged care services in order to develop dimensions for a draft descriptive system for a new preference-based quality of life instrument.MethodsForty-one in-depth semi-structured interviews were undertaken with older people (65 years and over) receiving community aged care services across three Australian states to explore quality of life characteristics of importance to them. The data were analysed using framework analysis to extract broader themes which were organised into a conceptual framework. The data were then summarised into a thematic chart to develop a framework matrix which was used to interpret and synthesise the data. Care was taken throughout to retain the language that older people had adopted during the interviews to ensure that appropriate language was used when identifying and developing the quality of life dimensions.ResultsThe analysis resulted in the identification of five salient quality of life dimensions: independence, social connections, emotional well-being, mobility, and activities.ConclusionThis research finds that quality of life for older people accessing aged care services goes beyond health-related quality of life and incorporates broader aspects that transcend health. The findings represent the first stage in a multiphase project working in partnership with older people to develop a new preference-based instrument of quality of life for informing quality assessment and economic evaluation in community aged care. In future work, draft items will be developed from these dimensions and tested in face validity interviews before progressing to further psychometric testing.

Qualitative accounts of PrEP discontinuation from the general population in Eswatini

People in receipt of pre-exposure prophylaxis (PrEP) for the prevention of HIV in Sub-Saharan Africa often discontinue taking the medication. We conducted 27 semi-structured interviews with men and women who had started PrEP but did not return to the clinic for a refill after a 1, 2 or 3-month period. These ‘discontinuation’ clients were enrolled in a PrEP demonstration project for the general population in nurse-led, public-sector, primary-care clinics in Eswatini. Reasons for discontinuation included changes to self-perceived HIV risk such as the end of pregnancy and absent partners. Others described PrEP as inaccessible when working away from home and many described difficulties relating to a daily pill regimen and managing side effects. Female clients described being prohibited from using PrEP by their partners and co-wives. From these results, we recommend that client-centred counselling stresses the prevention-effective adherence paradigm, which promotes PrEP use in risk periods that are identifiable and PrEP discontinuation when the risk period has finished. A national scale up of PrEP may mitigate problems accessing PrEP. Extended counselling and support could assist with adherence and the management of side effects. Education and support for partners and families of PrEP clients may also contribute to better PrEP continuation.

Education, health and care plans and tribunals in England: A statistical tale from 2019

Education, health and care (EHC) plans were introduced in England in 2014, as a replacement for statements of special educational needs. Unexpectedly, the number of children and young people in receipt of an EHC plan rose by 49% during the 5 years up to 2019. Whilst most of the increase has been due to the extension of the age range up to age 25, there has still been a notable rise of 20% in the 0–15‐year range. This study explores the trends and variations in EHC plans and tribunals within English local authorities (LAs) for children and young people with special educational needs and disability (SEND) by interrogating the latest full set of data from 2013 to 2018. Two quintile groups (n = 30) are used for comparing LAs with high and low levels of EHC plans and LA case studies are also presented for further inspection of the data. Wide variations across LAs still exist for EHC plans (5.2% to 1.0%) and tribunal appeals (43 to 0 per 10,000). LAs with low EHC plans have more appealable decisions at tribunals and are financed at significantly lower levels than LAs with high EHC plans, largely due to an historic spend factor of 50% in the national funding formula. There are also clear differences between the English regions for both EHC plans and tribunals, with high increases for both in the South East. The implications of the findings are discussed within the framework of LA critical self‐reviews, benchmarking, fiscal constraints and inclusion.

Mental distress and “self-stigma” in the context of support provision: exploring attributions of self-stigma as sanism

Purpose The purpose of this paper is to discuss the findings from a detailed qualitative PhD study exploring experiences of stigma and discrimination in the lives of people in receipt of “mental health support” at two voluntary sector organisations in the North East of England. Design/methodology/approach Empirical material was collected during two periods of three-month long ethnographic periods of fieldwork from July to December of 2013 at two organisations providing support to their members who experience or have experienced mental distress. Along with field notes taken during and after periods of participant observation, the empirical material also included 30 interviews with staff (n=10) and members (n=20) across both organisations, along with a series of three focus groups at each organisation. Findings Staff at the organisations did not demonstrate obvious stigmatising or discriminatory attitudes or behaviours. However, they did attribute “self-stigma” to particular attitudes and behaviours of some of the members they support, referring to how they “made excuses”, “did not try” and/or “avoided situations”. Originality/value This paper argues that these attributions resulted from the misrecognition of members’ reactions to experiences of discrimination. The empirical material also suggests that these attributions of self-stigma may be indicative of the material limitations of the support environment, the consequent frustrations of well-intentioned staff, and, overall, as symptoms of neoliberalism. Drawing upon a Mad Studies approach and focussing on self-stigma and its attribution in contemporary mental health support, this paper provides a new perspective, which considers how stigma is linked to discrimination by rethinking what is thought of as “self-stigma”.

236 Socioeconomic and Social Factors among Community-Dwelling Dependent Older People with Cognitive Impairment in Ireland

Abstract Background Dementia, and related cognitive impairment, is prevalent in dependent older adults in receipt of formal home care; importantly, this is a determinant of transition into long-term care (Aspell., 2019). Our study aimed to explore social and socioeconomic factors in community dwelling older people in receipt of formal home care. To our knowledge social deprivation has not been previously investigated in this population in Ireland. Methods This study comprised a large cohort (n=1597) of community-dwelling adults aged 65 years or older who were in receipt of formal home care. Demographic, living setting, dependency (Barthel Index) were recorded; cognitive dysfunction (CD) included dementia and related cognitive impairment (Aspell., 2019). Social deprivation was captured by the Pobal HP Deprivation index which categorises affluence or disadvantage by residential area in Ireland. Results The study population (n=1597) was of mean age 83.3 ± 7.2, supported by 11.1 ± 7.2 hours of home care per week and 10.8% and 31.7% were categorised as of disadvantaged and affluent deprivation status, respectively. Those who received home support in areas of disadvantage were significantly younger than in affluent areas (79.1 ± 7.3 v 85.6 ± 6.87 years, p&lt; 0.001). Prevalence of CD was 43.3%. CD vs non-documented CD were characterised by a significantly higher proportion of females (66.5% v 61.4%, p &lt;0.05), widowed (47.4% v 41.8%, p &lt;0.05) and very disadvantaged (7.4% vs 5.0%, p &lt;0.05). Furthermore, the CD group had a significantly higher falls risk but lower physical dependency (Barthel), lower requirement for mobility support and higher need for meal assistance. Home care hours were higher (11.6 ± 7.2 v 10.8 ± 7.2 p &lt;0.001) for the CD group, and comprised generic, rather than dementia-specific support. Conclusion The findings have implications for developing personalised dementia-specific home support and interventions. Further research is needed into disadvantaged deprivation and the need for home support at a younger age.