Extending the Comfort Zone: Building Resilience in Older People With Long-Term Conditions

2017 ◽  
Vol 38 (6) ◽  
pp. 825-848 ◽  
Author(s):  
Mark Robinson ◽  
Esmée Hanna ◽  
Gary Raine ◽  
Steve Robertson
Keyword(s):  
Older People ◽  
Peer Support ◽  
Social Engagement ◽  
Well Being ◽  
Significant Drop ◽  
Long Term Conditions ◽  
Before And After ◽  
And Gender ◽  
Ongoing Support

This article examines how a 6-week mental health resilience course for people with long-term conditions (LTCs; diabetes, heart disease, and arthritis) increased perceived resilience of older participants. This article examines how peer support assisted participants to develop resilience, considers gender issues, examines the importance of course activities, and explores how resilience enhances quality of life. A mixed methods approach was used. A before-and-after questionnaire was administered 3 times, including 3-month follow-up. Interviews were held with 24 program participants, aged 45 to 80 years. Diaries were kept by participants over 3 months. Survey findings showed significant gains in perceived resilience, at the end of the course, with no significant drop-off after 3 months. Interview and diary narratives highlighted positive experiences around well-being, condition management, and social engagement. Peer support was key to effective processes. Challenges concern ongoing support in communities, and considering age and gender variables when researching what improved resilience means to older people with LTCs.

Comparative Study of Outcomes for Older People with Long Term Conditions Attending Day Care Services Delivered by Paid Staff or by Volunteers

2020 ◽  
Author(s):  
Catherine Lunt ◽  
Chris Shiels ◽  
Christopher Dowrick ◽  
Mari Lloyd-Williams
Keyword(s):  
Older People ◽  
Comparative Study ◽  
Day Care ◽  
Symptom Burden ◽  
Well Being ◽  
Long Term Conditions ◽  
North West ◽  
Age In Place ◽  
Care Services

Abstract Background Day care services can support older people living with multiple long term conditions (LTCs), to age in place, but little research on outcomes of Day Care attendance. Aims The aims of this comparative study were to determine outcomes for older people with LTCs attending day care services run entirely by paid staff or predominantly volunteers Methods Newly referred older people with LTCs to nine day care services in North West of England and North Wales were invited to participate in this longitudinal study with data being collected at baseline attendance and at 6 and 12 weeks. Demographic information was collected and the EQ-5D-3L and De Jong Loneliness 6 item questionnaire were completed at each time point.RESULTS 94 older people (64% female),age range 65 - 99 years (mean 82 years) were recruited. The mean number of LTCs was 4.3 (range 2-9) and 52% people lived alone. More than a third (36%) lived in one of the 20% most deprived local authorities in England and Wales. The outcomes in this exploratory study over 12 weeks appeared to be similar for paid, blended (paid staff and volunteers) and for volunteer led service, with those attending volunteer led services were significantly more likely to report fewer health problems in follow-up (OR=3.45, 95% CI 1.01-12.8, P=0.04). CONCLUSIONS This study suggests that Day Care Services for older people with long term conditions provide benefits in terms of self-rated physical and emotional well-being. Older people attending paid staff services were more likely to have greater number of LTCs associated with a higher symptom burden. However, at baseline there was no difference in self-reported health by service type. This study suggests that Day Care Services provided by volunteers can provide comparable outcomes. Following the Covid-19 pandemic, it is increasingly urgent to support older people with long term conditions who have lost physical and cognitive function during lockdown and to maintain and improve their function. Our study suggests that volunteers may be able to complement the care provided by paid staff freeing up resources and enabling increasing numbers of people to be supported.

scholarly journals Does a social prescribing ‘holistic’ link-worker for older people with complex, multimorbidity improve well-being and frailty and reduce health and social care use and costs? A 12-month before-and-after evaluation

2019 ◽  
Vol 20 ◽  
Author(s):  
Julian Elston ◽  
Felix Gradinger ◽  
Sheena Asthana ◽  
Caroline Lilley-Woolnough ◽  
Sue Wroe ◽  
...  
Keyword(s):  
Older People ◽  
Service Use ◽  
Social Care ◽  
Patient Activation ◽  
Well Being ◽  
Long Term Conditions ◽  
Social Prescribing ◽  
Health And Social Care ◽  
Before And After ◽  
The Impact

Abstract Aim: To evaluate the impact of ‘holistic’ link-workers on service users’ well-being, activation and frailty, and their use of health and social care services and the associated costs. Background: UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the evidence to support this policy is generally weak and poorly conceptualised, particularly in relation to frail, older people and patient activation. Torbay and South Devon NHS Foundation Trust, an integrated care organisation, commissioned a Well-being Co-ordinator service to support older adults (≥50 years) with complex health needs (≥2 long-term conditions), as part of its service redesign. Methods: A before-and-after study measuring health and social well-being, activation and frailty at 12 weeks and primary, community and secondary care service use and cost at 12 months prior and after intervention. Findings: Most of the 86 participants achieved their goals (85%). On average health and well-being, patient activation and frailty showed a statistically significant improvement in mean score. Mean activity increased for all services (some changes were statistically significant). Forty-four per cent of participants saw a decrease in service use or no change. Thirteen high-cost users (>£5000 change in costs) accounted for 59% of the overall cost increase. This was largely due to significant, rapid escalation in morbidity and frailty. Co-ordinators played a valuable key-worker role, improving the continuity of care, reducing isolation and supporting carers. No entry-level participant characteristic was associated with change in well-being or service use. Larger, better conceptualised, controlled studies are needed to strengthen claims of causality and develop national policy in this area.

scholarly journals What matters to people with multiple long-term conditions and their carers?

2021 ◽  
pp. postgradmedj-2021-140825
Author(s):  
Gemma Spiers ◽  
Elisabeth Boulton ◽  
Lynne Corner ◽  
Dawn Craig ◽  
Stuart Parker ◽  
...  
Keyword(s):  
Older People ◽  
Public Involvement ◽  
Research Priorities ◽  
Well Being ◽  
Future Research ◽  
Long Term Conditions ◽  
Ongoing Research ◽  
Published Research ◽  
What Matters

BackgroundThe number of people living with multiple long-term conditions is increasing worldwide. This presents challenges for health and care systems, which must adapt to meet the needs of this population. This study drew on existing data to understand what matters to people living with multiple long-term conditions and identify priorities for future research.MethodsTwo studies were conducted. (1) A secondary thematic analysis of interview, survey and workshop data collected from the 2017 James Lind Alliance Priority Setting Partnership for Older People with Multiple Conditions, and patient and public involvement workshops; (2) a review of ongoing research and published research priorities, relating to older people (80+) living with multiple long-term conditions.FindingsOlder people with multiple long-term conditions identified a number of key concerns: access to care, support for both the patient and their carer, physical and mental health and well-being and identifying opportunities for early prevention. The review identified no published research priorities or ongoing research focusing specifically on populations aged over 80 years with multiple long-term conditions.ConclusionOlder people living with multiple long-term conditions experience care that is inadequate for their needs. A holistic approach to care that extends beyond treating single conditions will ensure wide-ranging needs are met. As multimorbidity rises worldwide, this is a critical message for practitioners across health and care settings. We also recommend key areas that should be given greater focus in future research and policy to inform effective and meaningful forms of support for people living with multiple long-term conditions.

scholarly journals The Impact of Intersectional Identities on Older People With HIV

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 723-723
Author(s):  
Mark Brennan-Ing ◽  
Charles Emlet
Keyword(s):  
Older People ◽  
African American Women ◽  
Well Being ◽  
Hiv Stigma ◽  
Neurocognitive Functioning ◽  
Bisexual Men ◽  
And Bisexual ◽  
And Gender ◽  
The Impact ◽  
Racial Ethnic

Abstract Kimberlé Crenshaw introduced the term “intersectionality” in the late 1980s to highlight the experience discrimination and marginalization of Black and African-American women originating from the confluence of their racial/ethnic and gender identities. Since that time the focus on intersectionality has broadened to consider other communities and individuals who may have multiple stigmatized and discredited identities, including older people with HIV (PWH). For example, Porter and Brennan-Ing described the “Five Corners” model as the intersection of ageism, racism, classism, sexism, and HIV stigma for older transgender and gender non-conforming PWH. HIV disproportionately affects marginalized communities (e.g., racial/ethnic and sexual minorities). Thus, for older PWH it is important to consider how HIV stigma may intersect with other marginalized identities and impact physical and psychological well-being. The first paper in this session examines how the intersection of HIV serostatus, gay identity, and age complicates identity disclosure, leading to social isolation and interference with care planning. The second paper describes how intersectional identities among older PWH interfere with access to mental health services in a population that is disproportionately affected by depression and PTSD. Our third paper examines the role of race, education, and behavioral health in neurocognitive functioning among a diverse sample of older HIV+ gay and bisexual men. Our last paper examines neurocognitive functioning among older Latinx PWH, finding that sexual and gender minorities were at greater risk for impairment. Implications of these findings for research and programming that accounts for the effects of intersectionality among older PWH will be discussed.

Development, implementation and evaluation of nurse-led integrated, person-centred care with long-term conditions

2017 ◽  
Vol 25 (3) ◽  
pp. 186-195 ◽  
Author(s):  
Clare Lynette Harvey ◽  
Jonathan Sibley ◽  
Janine Palmer ◽  
Andrew Phillips ◽  
Eileen Willis ◽  
...  
Keyword(s):  
Health Services ◽  
Chronic Conditions ◽  
Well Being ◽  
Multiple Chronic Conditions ◽  
Long Term Conditions ◽  
Content Type ◽  
Care Services ◽  
Health Strategy ◽  
Global Increase

Purpose The purpose of this paper is to outline a conceptual plan for innovative, integrated care designed for people living with long-term conditions (LTCs). Design/methodology/approach The conceptual plan delivers a partnership between the health system, the person with LTCs (chronic), their family, and the community. The partnership aims to support people at home with access to effective treatment, consistent with the New Zealand Government Health Strategy. This concept of people-owned care is provided by nurses with advanced practice skills, who coordinate care across services, locations and multiple LTCs. Findings With the global increase in numbers of people with multiple chronic conditions, health services are challenged to deliver good outcomes and experience. This model aims to demonstrate the effective use of healthcare resources by supporting people living with a chronic condition, to increase their self-efficacy and resilience in accordance with personal, cultural and social circumstance. The aim is to have a model of care that is replicable and transferable across a range of health services. Social implications People living with chronic conditions can be empowered to manage their health and well-being, whilst having access to nurse-led care appropriate to individual needs. Originality/value Although there are examples of case management and nurse-led coordination, this model is novel in that it combines a liaison nursing role that works in partnership with patients, whilst ensuring that care across a number of primary and secondary care services is truly integrated and not simply interfaced.

scholarly journals THE IMPACT OF A PARO INTERVENTION ON DEPRESSION AND WELL-BEING IN OLDER ADULTS WITH DEPRESSION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S341-S341
Author(s):  
Shu-Chuan Chen ◽  
Wendy Moyle ◽  
Cindy Jones
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Older People ◽  
Long Term Care ◽  
Well Being ◽  
World Health ◽  
Term Care ◽  
Care Facilities

Abstract Aim: This study aimed to explore the effect of a social robot Paro intervention on depression and well-being in older adults with depression living in long-term care facilities in Taiwan. Methods: This study was adopted a single group and quasi-experimental with repeated measures design. Each participant participated in two stages: observation and Paro intervention stages. Stage 1 was an 8-week observation stage in long-term care facilities where the purpose was to observe the normal mood, behaviour and activities of older adults with depression. In stage 2, each participant was given a Paro by the researcher to keep for 24 hours for 7 days in for 8 weeks. Outcome measurements were obtained 4 times: a week before the intervention (T1), immediately the end of 8-week observation (T2), mid-point of Paro intervention (T3), and immediately the end of 8-week Paro intervention (T4). Instruments included the Geriatric Depression Scale, the UCLA Loneliness Scale version 3, and the World Health Organization Quality of Life Questionnaire-OLD. Results: There were 20 participants completed the study. The mean age of participants was 81.1years (SD = 8.2). After 8-week Paro intervention, statistically significant differences in changes were found on depression, loneliness, and quality of life from pre-intervention to post-intervention. Conclusion: This study was found that Paro intervention has beneficial effects on depression and mental well-being for older people with depression in long-term care facilities. Paro Intervention might be a suitable psychosocial intervention for older people with depression and should be considered as a useful tool in clinical practice.

scholarly journals Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033186 ◽  
Author(s):  
Luke Aaron Munford ◽  
Anna Wilding ◽  
Peter Bower ◽  
Matt Sutton
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Secondary Outcome ◽  
Long Term Conditions ◽  
Community Assets ◽  
Costs Of Care ◽  
Life Years ◽  
Double Robust

ObjectivesImproving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. We use longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care.DesignProspective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation.SettingParticipation in community asset facilities. Costs of primary and secondary care.Participants4377 older people with long-term conditions.InterventionParticipation in community assets.Primary and secondary outcome measuresQuality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits.ResultsStarting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £−96 (95% CI £−512 to £321) at 6 months; £−283 (95% CI £−926 to £359) at 12 months; and £−453 (95% CI £−1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of −0.102 (95% CI −0.173 to −0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months.ConclusionsParticipation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.

Working with older people with multiple long-term conditions: a qualitative exploration of nurses' experiences

2014 ◽  
Vol 71 (1) ◽  
pp. 90-99 ◽  
Author(s):  
Susan Waterworth ◽  
Merryn Gott ◽  
Deborah Raphael ◽  
John Parsons ◽  
Bruce Arroll
Keyword(s):  
Older People ◽  
Long Term Conditions ◽  
Qualitative Exploration
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