Review: `Introducing yourself to strangers' Nurses' views on assessing older people with complex care needs

Background:Little is known regarding the complex care needs, level of frailty or quality of life ofmulti-morbid older patients. Objectives:The objective of this study was to determine the relationship betweenfrailty, complexity of care and quality of life in multi-morbid older people. Design:Cross-sectional study.Setting: Thirteen primary care practices in the Netherlands. Participants:1,150 multi-morbid older people livingin the community. Measurements:The level of frailty was assessed with the Groningen Frailty Indicator.Complexity of care needs was measured with the Intermed for the Elderly Self-Assessment. Quality of life (QoL)was measured with two items of the RAND-36. Results:In total, 758 out of 1,150 (65.9%) patients were frail,8.3% had complex care needs, and the mean QoL score was 7.1 (standard deviation 1.2). Correlations betweenfrailty and complexity, frailty and QoL, and complexity of care and QoL were 0.67, -0.51 and -0.52 (all p<0.001)respectively. All patients with complex care needs were frail, but, only 12.5% of the frail patients had complexcare needs. Problems at climbing up stairs was associated with higher levels of frailty and complexity of care butwith a lower QoL. Conclusions:Higher levels of frailty and complexity of care are associated with a lower QoLin multi-morbid older people. The results of this study contribute to a better understanding these concepts and arevaluable for the development of tailored interventions for older persons in the future.

Download Full-text

Complex care needs and devolution in Greater Manchester: a pilot study to explore social care innovation in newly integrated service arrangements for older people

Australian Health Review ◽

10.1071/ah19168 ◽

2020 ◽

Vol 44 (6) ◽

pp. 838

Author(s):

Baber Malik ◽

Jude Wells ◽

Jane Hughes ◽

Paul Clarkson ◽

John Keady ◽

...

Keyword(s):

Older People ◽

Integrated Care ◽

Social Care ◽

Complex Care ◽

Care Providers ◽

Care Needs ◽

Health And Social Care ◽

Complex Care Needs ◽

Home Care Providers

ObjectiveThe aim of this study was to describe emergent approaches to integrated care for older people with complex care needs and investigate the viability of measuring integrated care. MethodsA case study approach was used. Sites were recruited following discussion with senior staff in health and social care agencies. Service arrangements were categorised using a framework developed by the researchers. To investigate joint working within the sites, the development model for integrated care was adapted and administered to the manager of each service. Data were collected in 2018. ResultsSix case study sites were recruited illustrating adult social care services partnerships in services for older people with home care providers, mental health and community nursing services. Most were established in 2018. Service arrangements were characterised by joint assessment and informal face-to-face discussions between staff. The development of an infrastructure to promote partnership working was evident between adult social care and each of the other services and most developed with home care providers. There was little evidence of a sequential approach to the development of integrated working practices. ConclusionComponents of partnerships promoting integrated care have been highlighted and understanding of the complexity of measuring integrated care enhanced. Means of information sharing and work force development require further consideration. What is known about the topic?The devolution of health and social care arrangements in Greater Manchester has aroused considerable interest in much wider arenas. Necessarily much of the focus in available material has been upon strategic development, analysis of broader trends and mechanisms and a concern with changes in the healthcare system. What does this paper add?The findings from this study will enable emerging approaches to be described and codified, and permit the specific social care contribution to the new arrangements to be discerned. The findings are relevant beyond the immediate context of Greater Manchester to wider integrated care. The evidence can be used by commissioners and services, providing a sound basis for further work as service systems develop. What are the implications for practitioners?This research is important because it is one of the first pieces of work to examine the new integrated care arrangements in Greater Manchester. By providing guidance to promote evidence-based practice, this study contributes to service development in Greater Manchester and the achievement of the broad national service objectives of improving user and carer experiences and ensuring value for money.

Download Full-text

Comparison of two tools developed to assess the needs of older people with complex care needs

Journal of Research in Nursing ◽

10.1177/1744987108096972 ◽

2009 ◽

Vol 14 (5) ◽

pp. 421-436 ◽

Cited By ~ 3

Author(s):

Susan Lambert ◽

Wai-Yee Cheung ◽

Shan Davies ◽

Lyn Gardner ◽

Valerie Thomas

Keyword(s):

Older People ◽

Complex Care ◽

Care Needs ◽

Complex Care Needs

Download Full-text

Improving care coordination for community-dwelling older Australians: a longitudinal qualitative study

Australian Health Review ◽

10.1071/ah16054 ◽

2017 ◽

Vol 41 (2) ◽

pp. 144 ◽

Cited By ~ 8

Author(s):

Desley Harvey ◽

Michele Foster ◽

Edward Strivens ◽

Rachel Quigley

Keyword(s):

Older People ◽

Care Transitions ◽

Care Transition ◽

Complex Care ◽

Coordinated Care ◽

Model Of Care ◽

Care Needs ◽

Levels Of Care ◽

Transition Experiences ◽

Complex Care Needs

Objective The aim of the present study was to describe the care transition experiences of older people who transfer between subacute and primary care, and to identify factors that influence these experiences. A further aim of the study was to identify ways to enhance the Geriatric Evaluation and Management (GEM) model of care and improve local coordination of services for older people. Methods The present study was an exploratory, longitudinal case study involving repeat interviews with 19 patients and carers, patient chart audits and three focus groups with service providers. Interview transcripts were coded and synthesised to identify recurring themes. Results Patients and carers experienced care transitions as dislocating and unpredictable within a complex and turbulent service context. The experience was characterised by precarious self-management in the community, floundering with unmet needs and holistic care within the GEM service. Patient and carer attitudes to seeking help, quality and timeliness of communication and information exchange, and system pressure affected care transition experiences. Conclusion Further policy and practice attention, including embedding early intervention and prevention, strengthening links between levels of care by building on existing programs and educative and self-help initiatives for patients and carers is recommended to improve care transition experiences and optimise the impact of the GEM model of care. What is known about the topic? Older people with complex care needs experience frequent care transitions because of fluctuating health and fragmentation of aged care services in Australia. The GEM model of care promotes multidisciplinary, coordinated care to improve care transitions and outcomes for older people with complex care needs. What does this paper add? The present study highlights the crucial role of the GEM service, but found there is a lack of systemised linkages within and across levels of care that disrupts coordinated care and affects care transition experiences. There are underutilised opportunities for early intervention and prevention across the system, including the emergency department and general practice. What are the implications for practitioners? Comprehensive screening, assessment and intervention in primary and acute care, formalised transition processes and enhanced support for patients and carers to access timely, appropriate care is required to achieve quality, coordinated care transitions for older people.

Download Full-text