Access to care: a qualitative study exploring the primary care needs and experiences of older people needing assistance with daily living

Author(s):  
Marina Kunin ◽  
Jenny Advocat ◽  
Nilakshi Gunatillaka ◽  
Grant Russell
2016 ◽  
Vol 45 (suppl 2) ◽  
pp. ii13.11-ii56
Author(s):  
David O Riordan ◽  
Stephen Byrne ◽  
Aoife Fleming ◽  
Rose Galvin ◽  
Patricia M Kearney ◽  
...  

2021 ◽  
pp. BJGP.2020.1118
Author(s):  
Bethany Kate Bareham ◽  
Jemma Stewart ◽  
Eileen Kaner ◽  
Barbara Hanratty

Background: Risk of harm from drinking is heightened in later life, due to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people to make healthier decisions about alcohol. Aim: To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction. Design and Setting: Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England. Method: Thirty-five practitioners (general practitioners, practice/district nurses, pharmacists, dentists, social care practitioners, domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison. Results: Practitioners highlighted particular sensitivities amongst older people to discussing alcohol, and reservations about older people’s resistance to making changes in old age; given drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people’s contact with practitioners; but management of older people’s long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people, and training in alcohol intervention facilitated practitioners; particularly pharmacists and practice nurses. Conclusion: There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks, particularly those associated with old age; and tailored interventions for older people, feasible to implement in practice settings, would support primary care practitioners to address older people’s alcohol use.


PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249656
Author(s):  
Xiu-Fen Yang ◽  
Meng-qi Li ◽  
Lu-lu Liao ◽  
Hui Feng ◽  
Si Zhao ◽  
...  

Background The pandemic of coronavirus disease 2019 (COVID-19) has global impact, Wuhan in Hubei province is a high-risk area. And the older people in nursing homes are the most susceptible group to COVID-19. The aim of this study was to describe the practice and experience of the first-line medical team, to provide insights of coping with COVID-19 in China. Method This qualitative study used a descriptive phenomenological design to describe the experience of medical staff supported the nursing homes in Wuhan fighting against COVID-19. Unstructured interviews via online video were conducted with seven medical staffs who supported the nursing homes in Wuhan. Data were analyzed using content analysis in five main themes: for nursing homes, we interviewed the difficulties faced at the most difficult time, services for the older people, and prevention and management strategies, for the medical staff, the psychological experience were interviewed, and the implications for public health emergencies were also reported. Conclusions It is imperative that effective preventive and response measures be implemented to face the outbreak of COVID-19 and meet the care needs of older people in the context of COVID-19. Implications Findings will inform managers of some reasonable instructional strategies for implementing effective infection management. Nursing homes need to provide targeted services to help alleviating their bad psychology for residents.


2020 ◽  
Author(s):  
Maria Evamdrou ◽  
Jane Falkingham ◽  
Min Qin ◽  
Athina Vlachantoni

On 23 March 2020 the UK went into lockdown in an unprecedented step to attempt to limitthe spread of coronavirus. Government advice at that time was that all older people aged 70and over should stay at home and avoid any contact with non-household members. This studyuses new data from the Understanding Society COVID 19 survey collected in April 2020,linked to Understanding Society Wave 9 data collected in 2018/19, in order to examine theextent of support received by individuals aged 70 and over in the first four weeks oflockdown from family, neighbours or friends not living in the same household, and how thatsupport had changed prior to the outbreak of the coronavirus pandemic. The researchdistinguishes between different types of households as, given with guidance not to leavehome and not to let others into the household, those older people living alone or living onlywith a partner also aged 70 and above are more likely to be particularly vulnerable. Theresults highlight both positive news alongside causes for concern. The receipt of assistancewith Instrumental Activities of Daily Living (IADLs), especially shopping, has increasedparticularly among those living alone or with an older partner, reflecting the rise ofvolunteering and community action during this period. However, not all older people reporteda rise, and the majority reported ‘no change’, in the support received. Moreover, amongstthose older people reporting that they required support with at least one Activity of DailyLiving (ADL) task prior to the pandemic, around one-quarter reported receiving no care fromoutside the household and one-in-ten of those with two or more ADL care needs reportedreceiving less help than previously. Although formal home care visits have continued duringthe pandemic to those who have been assessed by the local government to be in need, it isimportant to acknowledge that some older people risk not having the support they need.


2016 ◽  
Vol 6 (2) ◽  
pp. 108-118
Author(s):  
Harriet Selina Anne Sinclair ◽  
Alison Furey

Background: Older people with complex health and social care needs are a growing group of people with high use of NHS and social services. In particular, this group account for a large number of unplanned hospital admissions a year.Aims: To evaluate the evidence base for preventing unplanned hospital admissions in this group, to identify their characteristics and to undertake a focussed local review of their primary care management.Methods: A literature review, a review of the Southwark CCG data risk stratification tool and a review of high risk patients and their management at a Southwark GP practice.Results: High risk patients have multiple comorbidities and are frequent users of healthcare services. Although there was in general good involvement with social care services, there were certain areas that could be improved upon. For instance, the referral of frequent fallers to falls services and provision of an older person’s annual health check both offer opportunities for primary prevention.Conclusions: An older person’s annual health check would ensure holistic assessment of their health and social care needs and could then be acted upon to ensure that there is the required level of support in place, including a personalised anticipatory care plan and attention to key preventative measures such as falls prevention, exercise, smoking cessation, medicines optimisation and sensory impairment.


2017 ◽  
Vol 83 (7) ◽  
pp. 1521-1531 ◽  
Author(s):  
David O. Riordan ◽  
Stephen Byrne ◽  
Aoife Fleming ◽  
Patricia M. Kearney ◽  
Rose Galvin ◽  
...  

2021 ◽  
Vol 10 (10) ◽  
pp. 2106
Author(s):  
Juan-José Zamora-Sánchez ◽  
Edurne Zabaleta-del-Olmo ◽  
Sergio Fernández-Bertolín ◽  
Vicente Gea-Caballero ◽  
Iván Julián-Rochina ◽  
...  

Background: The multidimensional assessment of frailty allows stratifying it into degrees; however, there is still heterogeneity in the characteristics of people in each stratum. The aim of this study was to identify frailty profiles of older people users of a home-based primary care service. Methods: We carried out an observational study from January 2018 to January 2021. Participants were all people cared for a home-based primary care service. We performed a cluster analysis by applying a k-means clustering technique. Cluster labeling was determined with the 22 variables of the Frail-VIG index, age, and sex. We computed multiple indexes to assess the optimal number of clusters, and this was selected based on a clinical assessment of the best options. Results: Four hundred and twelve participants were clustered into six profiles. Three of these profiles corresponded to a moderate frailty degree, two to a severe frailty degree and one to a mild frailty degree. In addition, almost 75% of the participants were clustered into three profiles which corresponded to mild and moderate degree of frailty. Conclusions: Different profiles were found within the same degree of frailty. Knowledge of these profiles can be useful in developing strategies tailored to these differentiated care needs.


2015 ◽  
Vol 16 (2) ◽  
pp. 94-105 ◽  
Author(s):  
Alice K. Stevens ◽  
Helen Raphael ◽  
Sue M. Green

Purpose – Residential care for older people in the UK includes care homes with and without 24-hour Registered Nurse (RN) care. Reduced autonomy and personal wealth can result when people assessed as having minimal care needs, enter and reside in care homes with RN care. The purpose of this paper is to explore the experiences of older people with minimal care needs admission to care homes with RN care. Design/methodology/approach – A qualitative study using a grounded theory method was undertaken. In total, 12 care home with RN care residents assessed as not requiring nursing care were interviewed. Initial sampling was purposive and progressed to theoretical. Interviews were analysed using the grounded theory analysis method of constant comparison and theory development. Findings – Two main categories emerged: “choosing the path”, which concerned the decision to enter the home, and “settling in”, which related to adaptation to the environment. Findings suggested participants who perceived they had greater control over the decision-making process found it easier to settle in the care home. The two categories linked to form an emerging framework of “crossing the bridge” from independent living to care home resident. Research limitations/implications – The findings contribute to the understanding of factors influencing admission of older people with minimal care needs to care homes with RN care and highlight the importance of informed decision making. Practical implications – Health and social care professionals must give informed support and advice to older people seeking care options to ensure their needs are best met. Originality/value – This study enabled older people with minimal care needs admission to care homes with RN care to voice their experiences.


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