scholarly journals How are people with dementia involved in care-planning and decision-making? An Irish social work perspective

Dementia ◽  
2018 ◽  
Vol 18 (7-8) ◽  
pp. 2985-3003 ◽  
Author(s):  
Sarah Donnelly ◽  
Emer Begley ◽  
Marita O’Brien
Keyword(s):  
Decision Making ◽  
Social Work ◽  
Older People ◽  
Social Workers ◽  
Social Care ◽  
Practice Research ◽  
Care Planning ◽  
Client Group ◽  
People With Dementia ◽  
Health And Social Care

In recent years, there have been national and international policy advances around capacity and decision-making and an apparent burgeoning rights-based approach to the issue, all of which have the potential to impact on the experience for people with dementia in Ireland. There is little evidence however on whether these policies and principles are being translated into practice and whether traditional paternalistic approaches to decision-making are being challenged. To gain insight into current practice, research was undertaken with social workers working with older people in Ireland; reporting on the involvement of people living with dementia in care-planning processes. Data collection included a mixed method approach; an on-line survey of social workers from across the country who reported on their open caseload during the month of June 2015 (N = 38 social workers reporting on the experiences of 788 older people, of which 39% of older people had a formal diagnosis of dementia). In addition, semi-structured telephone interviews were conducted with social workers working in the nine Community Health Organisation areas (N = 21). Findings show that people with dementia were high users of social work services, accounting for 44.5% of the client group. Social workers reported that there were no standardised approaches to how Health and Social Care Professionals involved people with dementia in care planning and decision-making. Overall, people with dementia were more likely to be excluded from decision-making processes due to (i) assumptions that they lacked capacity, (ii) family members preferences that the person was not involved, (iii) communication difficulties, (iv) time constraints, (v) little or no opportunity given or (vi) the person delegated decision-making to others. Good practices were identified through multidisciplinary team approaches and formal care planning meetings. This research highlights variability in how people with dementia participate in decision-making around their care. It sheds light on existing barriers which challenge the full implementation of the Irish Assisted Decision-Making legislation; highlighting the need for appropriate guidance and education for Health and Social Care Professionals. The findings also show that family dynamics and existing relationships can play a role in how people with dementia participate and are involved. To ensure consistent opportunities for participation, effective practices and approaches to supporting the participation of people living with dementia in care planning needs to be developed and rolled out in all care settings through increased training and adoption of standardised approaches.

scholarly journals 323 - I’d prefer to stay at home but I don’t have a choice’: Irish social workers’ experiences of decision-making in care planning with older people with dementia

2020 ◽  
Vol 32 (S1) ◽  
pp. 81-81
Author(s):  
John P. Brennan
Keyword(s):  
Decision Making ◽  
Social Justice ◽  
Older People ◽  
Social Workers ◽  
Family Relationships ◽  
Reduction Process ◽  
Decision Making Process ◽  
People With Dementia ◽  
Health And Social Care ◽  
At Home

This paper is based on a collaborative research study undertaken by the Irish Association of Social Workers, Age Action Ireland, The Alzheimer Society of Ireland and the School of Social policy, Social Work and Social Justice, University College Dublin. The study explored the experiences and views of social workers working with older people, including people with dementia. The purpose of the study was to investigate how the health and social care system in Ireland was responding to the care needs, required supports and preferences of older people. This paper will mainly focus on reported experiences related to older people with dementia in decision-making about their care.Data collection included a mixed method approach, that is, (i) an on-line survey of social workers across Ireland reporting on their open caseload over a period of one month (N = 38)) and (ii) semi-structured telephone interviews with social workers (N = 21).The Quantitative data was analysed using SPSS statistical software to produce descriptive and bivariate results. For the qualitative data an iterative data reduction process was used.Findings echoed that of other Irish research demonstrating (i) that the preference of older people is to remain living at home and receiving care in this setting as needed, and (ii) that this preference is not being realized. The study further highlighted variations in participation levels of people with dementia in the decision-making process, the barriers to participation and the place of family relationships in the decision-making process. The study made recommendations as to how to address these issues. The findings will also be considered within the context of social justice for older people.

Abuse of people with dementia

2009 ◽  
Vol 19 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Amber Selwood ◽  
Claudia Cooper
Keyword(s):  
Older Adults ◽  
General Population ◽  
Older People ◽  
Memory Impairment ◽  
Social Care ◽  
Care Recipient ◽  
People With Dementia ◽  
Health And Social Care ◽  
Vulnerable People ◽  
With Memory

SummaryPeople with dementia are particularly vulnerable to abuse. It is inherently difficult to study as it is a hidden offence, perpetrated against vulnerable people with memory impairment, by those on whom they depend. In the general population, 6% of older people have experienced abuse in the last month and this rises to approximately 25% in vulnerable populations such as people with dementia. We know that various factors in the carer and the care recipient can predispose to a higher rate of abuse and this knowledge can be harnessed to try and improve prevention. There are also valid and reliable scales available to help detect abuse in vulnerable older adults. All health and social care professionals have a responsibility to act on any suspicion or evidence of significant abuse or neglect in order to ensure that appropriate management is taken.

scholarly journals Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Frances Bunn ◽  
Claire Goodman ◽  
Bridget Russell ◽  
Patricia Wilson ◽  
Jill Manthorpe ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Shared Decision Making ◽  
Social Care ◽  
Realist Synthesis ◽  
Shared Decision ◽  
Care Needs ◽  
Health And Social Care ◽  
Multiple Health

Decision-making in older people with dementia

2013 ◽  
Vol 23 (4) ◽  
pp. 307-316 ◽  
Author(s):  
M. Aurora Viloria Jiménez ◽  
Mónica Chung Jaén ◽  
Marta Vigara García ◽  
Helena Barahona‐Alvarez
Keyword(s):  
Decision Making ◽  
End Of Life Care ◽  
Laboratory Tests ◽  
Social Care ◽  
Life Care ◽  
Economic Costs ◽  
People With Dementia ◽  
Testamentary Capacity ◽  
Key Points ◽  
Health And Social Care

SummaryDementia is a syndrome characterized by a progressive impairment in cognition, function and behaviour, with a considerable burden in terms of health and social care, and economic costs. As Alzheimer's disease and other dementias advance, the patient's capacity, competence and possibility of participation in decision-making decrease. Key points in managing people with dementia include screening of cognitive impairment, neuropsychological assessment, laboratory tests and neuroimaging, genetic tests, informed consent, inclusion in clinical trials and discussion of advance directives, driving, managing finances and testamentary capacity, pharmolocogical and non-pharmacological treatment and also palliative and end-of-life care. In this article we review these crucial points in decision-making for people with dementia and their families and caregivers.

scholarly journals Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice

2020 ◽  
Author(s):  
Pritti Aggarwal ◽  
Stephen Woolford ◽  
Harnish Patel
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Older People ◽  
Social Care ◽  
Population Ageing ◽  
Care Plans ◽  
Health And Social Care ◽  
Challenges And Opportunities ◽  
Care Systems ◽  
Global Population

Multi-morbidity and polypharmacy are common in older people and pose a challenge for health and social care systems especially in context of global population ageing. They are complex and interrelated concepts in the care of older people that require early detection and patient centred decision making that are underpinned by the principles of multidisciplinary led comprehensive geriatric assessment (CGA). Personalised care plans need to remain responsive and adaptable to the needs of a patient, enabling an individual to maintain their independence.

scholarly journals Measuring the effectiveness of embedding social workers in integrated primary health care teams working with older adults with complex needs

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X702821
Author(s):  
Di Bailey ◽  
Gabriella Mutale
Keyword(s):  
Older Adults ◽  
Social Work ◽  
Social Workers ◽  
Social Care ◽  
Cost Effective ◽  
Care Quality ◽  
Quality Data ◽  
Complex Needs ◽  
Primary Health ◽  
Health And Social Care

BackgroundDespite the policy agenda for health and social care collaboration currently focused on integrated care systems, there is limited evidence that examines whether embedding social workers in integrated primary health and social care teams working with older adults is effective.AimThe study aimed to establish whether embedding social workers in integrated primary care teams (IPCTs) for older adults in Nottinghamshire was cost-effective.MethodA mixed methods approach collected quantitative and qualitative data that was triangulated using a TRI-Q model. Cost and care quality data were collected from patients in receipt of social worker involvement in three different IPCTs. Patients with similarly complex needs, who were receiving involvement from social work only district teams in the same localities acted as a comparator group. Interviews were conducted with patients and carers and with social workers and GPs working in the IPCTs. Seven focus groups were conducted with IPCT members representing social work and health disciplines.ResultsThe cost data were analysed using ANCOVA to identify any significant differences in costs across the teams. The result showed costs in two of the IPCTs were significantly lower than controls. Care quality indicators were also greater in these IPCTs. Thematic analysis highlighted the important of knowledge exchange that arose from social work embeddedness as indicative of the optimal conditions for effective integrated working and care delivery to be achieved.ConclusionThe findings suggested that embedding social workers in IPCTs offers both higher quality and more cost-effective care for older people if the optimum conditions for integration are met.

The development of safer walking technology: a review

2015 ◽  
Vol 9 (2) ◽  
pp. 100-115 ◽  
Author(s):  
Esmé Wood ◽  
Gillian Ward ◽  
John Woolham
Keyword(s):  
Decision Making ◽  
Social Care ◽  
Evidence Base ◽  
Current Evidence ◽  
Content Type ◽  
People With Dementia ◽  
Published Evidence ◽  
Health And Social Care ◽  
Current Evidence Base ◽  
The Right

Purpose – The purpose of this paper is to gain a greater understanding of the development of safer walking technology for people with dementia through contemporary literature. Design/methodology/approach – A two stage systematic approach to searching the literature was adopted. Initially this involved searching the literature to gain a broad overview of the development of safer walking technology and the context in which it has been developed. Then, this literature was examined in detail to look at published evidence surrounding the use of safer walking technology by people with dementia. These articles were quality appraised and a meta ethnographic approach taken to synthesis of the findings. Findings – There is a small but growing body of literature within this field. Whilst there is only limited evidence to support the use of safer walking technologies for people with dementia, the evidence to date indicates great potential for its use. If provided with the right support and guidance, safer walking technology has the potential to increase freedoms and independence for people with dementia; gaining them improved access to outdoor spaces and environments to support their health and wellbeing. However, if the safer walking technology continues to be associated with only risk management it will not achieve this potential. Research limitations/implications – The published literature within this field is small and has limited generalisability as much of it was generated in recent years has been by the same small research teams, often reusing data sets. There is also very little research that examines the experience of actually using safer walking technology and even less which explores the views of people with dementia. It is evident that a greater breadth and depth of knowledge is needed within this field to develop a clearer understanding of how this technology is used and perceived by all stakeholders concerned. In particular the literature would benefit from greater consideration of the views and experiences of people with dementia themselves. Practical implications – For many people with dementia, health and social care professionals can play an important role in ensuring appropriate assessment and support in the decision-making process when using safer walking technology. However, greater support is needed in decision making for all people with dementia, especially those people not currently engaged with specialist services. Therefore greater awareness of the benefits and limitations of this technology is needed by all health and social care professionals as well as the general public. Originality/value – At the time of conducting this review the author is unaware of any other systematic search of literature or overview of research on the use of safer walking technology and its use by people with dementia. Despite this safer walking technology is growing in popularity, commonly recommended by health and social care practitioners and often marketed and purchased directly by people with dementia and their families. This review offers an insight into the development of the technology and the current evidence base for its use.

scholarly journals Partnership between Primary Health and Social Care Services in the Long-Term Care of Older People with Dementia: A Vignette Study

2020 ◽  
Author(s):  
Ausrine Kontrimiene ◽  
Aurelija Blazeviciene ◽  
Ida Liseckiene ◽  
Gediminas Raila ◽  
Leonas Valius ◽  
...  
Keyword(s):  
Older People ◽  
Social Care ◽  
Informal Caregiver ◽  
Three Dimensional ◽  
Term Care ◽  
Primary Health ◽  
People With Dementia ◽  
Health And Social Care ◽  
Relationship Perception

Abstract Background. Dementia is considered to be a significant cause of disability and dependency for older people worldwide and it raises difficulties in providing adequate formal and informal assistance. Research on the experience of long-term care (LTC) services for older people with dementia is scarce in Eastern European countries. This study aimed to understand the system of care for older people with dementia from the perspective of health and social care workers providing LTC services in Lithuania. Methods. A total of 72 primary health care and social care professionals from public and private institutions in Kaunas city participated in this study. One-to-one interviews were conducted with family physicians, community nurses, psychiatrists, psychiatric nurses, and social workers. A vignette situation of two fictitious patients with dementia and their informal caregiver was discussed during the interviews. Data were analyzed using thematic analysis by induction approach.Results. Thematic analysis of the data revealed two main themes: LTC provision trajectory, and three-dimensional relationship perception in realization of LTC activities. LTC provision trajectory reflected activities performed as a response to the described situation embracing formal procedures for the endorsement of LTC needs as well as the range of LTC services. Three-dimensional relationship perception in realization of LTC activities mirrored the participants’ relationships with themselves, with each other, and with the informal caregiver.Conclusions. Our study revealed the potential of complex measures that could be instrumental for the refinement of the caregiving process. First, a change in the special needs’ endorsement logic is needed, shifting focus from medical diagnosis to functional abilities assessment. Second, establishing clear procedures for formal cooperation between the health and social care sectors in the trajectory of LTC service provision. Finally, finding an adequate balance between LTC and institutional care by creating a wider range of LTC services. A more consistent and coordinated delivery of services by both health and social care sectors seems to be an untapped resource for the improvement of the LTC potential.

scholarly journals Partnership between primary health and social care services in the long-term care of older people with dementia: a vignette study

2020 ◽  
Author(s):  
Ausrine Kontrimiene ◽  
Aurelija Blazeviciene ◽  
Ida Liseckiene ◽  
Gediminas Raila ◽  
Leonas Valius ◽  
...  
Keyword(s):  
Older People ◽  
Social Care ◽  
Informal Caregiver ◽  
Three Dimensional ◽  
Term Care ◽  
Primary Health ◽  
People With Dementia ◽  
Health And Social Care ◽  
Relationship Perception

Abstract Background Dementia is considered to be a significant cause of disability and dependency for older people worldwide and it raises difficulties in providing adequate formal and informal assistance. Research on the experience of long-term care (LTC) services for older people with dementia is scarce in Eastern European countries. This study aimed to understand the system of care for older people with dementia from the perspective of health and social care workers providing LTC services in Lithuania. Methods A total of 72 primary health care and social care professionals from public and private institutions in Kaunas city participated in this study. One-to-one interviews were conducted with family physicians, community nurses, psychiatrists, psychiatric nurses, and social workers. A vignette situation of two fictitious patients with dementia and their informal caregiver was discussed during the interviews. Data were analyzed using thematic analysis by induction approach. Results Thematic analysis of the data revealed two main themes: LTC provision trajectory, and three-dimensional relationship perception in realization of LTC activities. LTC provision trajectory reflected activities performed as a response to the described situation embracing formal procedures for the endorsement of LTC needs as well as the range of LTC services. Three-dimensional relationship perception in realization of LTC activities mirrored the participants’ relationships with themselves, with each other, and with the informal caregiver. Conclusions Our study revealed the potential of complex measures that could be instrumental for the refinement of the caregiving process. First, a change in the special needs’ endorsement logic is needed, shifting focus from medical diagnosis to functional abilities assessment. Second, establishing clear procedures for formal cooperation between the health and social care sectors in the trajectory of LTC service provision. Finally, finding an adequate balance between LTC and institutional care by creating a wider range of LTC services. A more consistent and coordinated delivery of services by both health and social care sectors seems to be an untapped resource for the improvement of the LTC potential.

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