Integrated care for frail older people: does it work?

Emiel Hoogendijk is postdoctoral researcher at the VU University Medical Center in Amsterdam, the Netherlands, where he works for the Longitudinal Aging Study Amsterdam. He discusses his Age & Ageing paper ‘How effective is integrated care for community-dwelling frail older people? The case of the Netherlands’

How can we optimise quality of care for frail older people in the community? That is an important question, which is not easy to answer. Integrated care programs are often seen as the solution. These programs are characterised by a multidisciplinary approach, with personalised care based on comprehensive geriatric assessments. In many countries, these programs are implemented in primary care. However, the beneficial effects of these programs are not so clear. It is important to report on both successful and less successful initiatives in the field. By comparing effective and non-effective interventions we may identify elements which can make a difference for frail older people.

‘Help yourself’; Supporting older people towards independence

Rudi GJ Westendorp, is Professor of Medicine at Old Age at the Department of Public Health and Centre for Healthy Ageing, University of Copenhagen. In this blog he discusses his recent Age and Ageing paper New horizons: Reablement – supporting older people towards independence.

The majority of older people wish to remain independent and live in their own homes for as long as possible. Instead maintaining a cruising altitude however, the process of ageing forces many to descend towards dependency and long-term care.

It’s never too late to learn new ways for coping by yourself and to make preparations for independent living in older age. But it is a shame that too often these good intentions are superseded by doubts and avoidance.

The National Audit of Intermediate Care 2014

Prof John Young is the National Clinical Director for Integration and Frail Elderly for NHS England. He is an Honorary Consultant Geriatrician, Bradford Teaching Hospitals and Head of the Academic Unit of Elderly Care and Rehabilitation at the University of Leeds. Here he updates his recent commentary published in Age and Ageing journal.

Some solutions can be hidden in plain sight. Those of us closely connected with intermediate care will certainly see these services as an important part of the solution for our overheated health and social care system. Perhaps it requires a time of austerity and an ageing population for the potential of intermediate care to be drawn into focus. The National Audit of Intermediate Care 2014 provides this focus. It allows us to take stock; to pose and receive answers to two fundamental questions: can intermediate care deliver good outcomes at an affordable cost; and, is it making a difference?

The key to happy retirement… independence

Sarah Wallace, Head of Services at the Charity Crossroads Care CNL, talks about their Homeshare programme and how it is a scheme that helps older people keep their independence and remain in the home they love. 

I like to think that as I get older, I will be able to keep my independence.  But will increasing care costs mean that I’ll just struggle alone at home?  Recently, I met Felicity who has recently struggled with ill health, meaning that she has had to consider alternative ways to maintain her independence.  In this search, Felicity came across the new Homeshare programme which we run here at the charity Crossroads Care CNL.

Perfect match

The Homeshare scheme uses a ‘matching’ service which helped Felicity find someone to share her house with because her disabilities make it tough for her to live alone.  The Homeshare scheme has changed her life and that of her sharer.

BBC documentary series ‘Protecting our Parents’

Dr Peter Wallis, formerly consultant geriatrician – Birmingham Heartlands Hospital, was involved with the filming of a new BBC 2 Documentary Series

The department of elderly medicine at Birmingham Heartlands Hospital became aware of the BBC‘s interest in a documentary series about the care of older people following an advertisement in the British Geriatrics Society Newsletter (2012) placed by the BBC Bristol Documentary team.   The intention was to produce a 3 part documentary series reflecting current issues in the health and social care of older people. Following successful discussions and with the agreement of partner organisations including social services as well as primary, community, mental health and ambulance service teams, filming took place during 2012/13. Filming was centred around the elderly care and general wards as well as the A&E department at Birmingham Heartlands Hospital and the patients with their stories were followed into community settings.

PANICOA – the Prevention of Abuse and Neglect in the Institutional Care of Older Adults

Laura Izzard is an Specialty Trainee in Geriatric Medicine at Kings College Hospital, London

PANICOA – the Prevention of Abuse and Neglect in the Institutional Care of Older Adults – is a joint research initiative between Comic Relief and the Department of Health.

Published in December 2013, the PANICOA report ‘Respect and Protect’ draws together the findings of eleven individual research studies commissioned to examine the complex issue of mistreatment of older people in hospitals and care homes. It outlines three vantage points i.e. “narratives” reflecting the perspectives of residents and patients, care staff and care organisations. Themes emerging from the PANICOA Narratives were used by the authors to produce a number of recommendations intended to reinforce and/or improve current practice.

Who will care for the carers?

Sharon Xiaorong Wang is a  nurse researcher at the Center of Research on Aging, Jinan, Shandong, China and is the lead investigator for the Chronic Disease Self-Management Program at the Department of Gerontology, Jinan Central Hospital.

The association between chronic disease and carers of patients with dementia has been well described in the literature. Caring for patients with memory impairment can put a strain on the health [both physical and mental] of the care-giver. Up till now, the demographics and scale of chronic disease afflicting care providers have not been well explored. We have conducted a study to examine the prevalence of chronic disease in carers of patients with dementia.

Our results indicate that more than four-fifths of care-givers reported having at least one chronic disease, and nearly two-thirds reported multiple.

EASYCare Project: A new world for older people

 

Judith Long is a Project Officer in Research and Development at Hull and East Yorkshire Hospitals NHS Trust. Here she introduces a new collaborative project to promote independence  in older age.

EASYCare is a collaborative project involving a large network of researchers, service providers, practitioners, volunteers and age advocacy partners throughout the world. Our mission is to extend healthy active life and maximise independence in old age using the EASYCare targeted approach to early identification of needs, and by providing a response according to the priorities of the older person.

Getting out of our box – subspecialty training in Community Geriatrics

Jenny Thain is a Specialty Trainee and Wei Mei Chua is a recently appointed consultant in Geriatric Medicine.  Jenny is based in Nottingham and Wei in Derby, UK.  Both took part in a newly designed Specialty Training Rotation in Geriatric Medicine at Nottingham University Hospitals in 2012-2013. Here they share their experience

In August 2012 we were privileged to take up the first dedicated specialty training post in Community Geriatrics in the UK. We were, at that time, two less-than-full-time trainees in the East Midlands region, and both of us were in the latter stages of our training. Over the years we had participated in the odd community session, such as domiciliary visits and community hospital ward rounds. But it was only when we took up this post – which lasted a year – that we discovered the extensive nature of the sub-specialty and what it had to offer.

Strategic planning in Intermediate Care is needed to “unstick” the NHS

Prof John Young is a Consultant Geriatrician in Bradford, UK and National Clinical Director for Integration and Frail Elderly at NHS England. Here he reflects on the 2013 National Audit of Intermediate Care. The full audit report can be found here.

I have been closely involved with the National Audit of Intermediate Care since its inception in 2008. The journey has been challenging but highly rewarding. The audit now covers about half the NHS – remarkable when you consider the commitment required by local staff to collect and submit the data.

The audit is important because it describes services that are otherwise relatively hidden from view in our conventional perception of health and social care. Yet intermediate care, or “care closer to home,” has been quietly developing during the last ten years or so. The focus has always been that of older people with co-morbidities/frailty – just the group that is now so much in the forefront of health and social care thinking. And intermediate care services have always been a platform to develop new ways of working – particularly multi-agency working – and so it is highly relevant to our current interest in service integration.