Needs of patients with dementia and their caregivers in primary care: lessons learned from the Alzheimer plan of Quebec

Abstract Background Persons living with dementia have various health and social care needs and expectations, some which are not fully met by health providers, including primary care clinicians. The Quebec Alzheimer plan, implemented in 2014, aimed to cover these needs, but there is no research on the effect this plan had on the needs and expectations of persons living with dementia. The objective of this study is to identify persons living with dementia and caregivers’ met and unmet needs and to describe their experience. Methods This is a sequential mixed methods explanatory design: Phase 1: cross-sectional study to describe the met and unmet health and social care needs of community-dwelling persons living with dementia using Camberwell Assessment of Need of the Elderly and Carers’ Assessment for Dementia tools. Phase 2: qualitative descriptive study to explore and understand the experiences of persons living with dementia and caregivers with the use of social and healthcare services, using semi-structured interviews. Data from phase 1 was analyzed with descriptive statistics, and from phase 2, with inductive thematic analysis. Results from phases 1 and 2 were compared, contrasted and interpreted together. Results The mean total number of needs reported by the patients was 5.03 (4.48 and 0.55 met and unmet needs, respectively). Caregivers had 0.52 met needs (3.16 unmet needs). The main needs for both were memory, physical health, eyesight/hearing/communication, medication, looking after home, money/budgeting. Three categories were mentioned by the participants: Persons living with dementia and caregiver’s attitude towards memory decline, their perception of community health services and of the family medicine practice. Conclusions Our study confirms the findings of other studies on the most common unmet needs of the patients and caregivers that are met partially or not at all. In addition, the participants were satisfied with access to care, and medical services in primary practices, being confident in their family. Our results indicate persons living with dementia and their caregivers need a contact person, a clear explanation of their dementia diagnosis, a care plan, written information on available services, and support for the caregivers.

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Refugee-like migrants have similar health needs to refugees: a New Zealand post-settlement cohort study

BJGP Open ◽

10.3399/bjgpopen20x101013 ◽

2020 ◽

Vol 4 (1) ◽

pp. bjgpopen20X101013

Author(s):

Jonathan Donald Kennedy ◽

Serena Moran ◽

Sue Garrett ◽

James Stanley ◽

Jenny Visser ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

New Zealand ◽

Primary Care Practice ◽

Social Care ◽

Hospital Admissions ◽

Outpatient Service ◽

Care Practice ◽

Care Needs ◽

Health And Social Care

BackgroundRefugees and asylum seekers have specific health and social care needs on arrival in a resettlement country. A third group — migrants with a refugee-like background (refugee-like migrants) — are less well defined or understood.AimUsing routinely collected data, this study compared demographics, interpreter need, and healthcare utilisation for cohorts of refugee-like migrants and refugees.Design & settingA retrospective cohort study was undertaken in Wellington, New Zealand.MethodData were obtained for refugee-like migrants and refugees accepted under the national quota system (quota refugees), who enrolled in a New Zealand primary care practice between 2011 and 2015. Data from the primary care practice and nationally held hospital and outpatient service databases, were analysed. Age and sex standardisation adjusted for possible differences in cohort demographic profiles.ResultsThe cohorts were similar in age, sex, deprivation, and interpreter need. Refugee-like migrants were found to have similar, but not identical, health and social care utilisation to quota refugees. Primary care nurse utilisation was higher for refugee-like migrants. Clinical entries in the primary care patient record were similar in rate for the cohorts. Emergency department utilisation and hospital admissions were similar. Hospital outpatient utilisation was lower for refugee-like migrants.ConclusionThis research suggests that health, social care, and other resettlement services should be aligned for refugee-like migrants and quota refugees. This would mean that countries accepting quota refugees should plan for health and social care needs of subsequent refugee-like migrant family migration. Further research should investigate matched larger-scale national health and immigration datasets, and qualitatively explore factors influencing health-seeking behaviour of refugee-like migrants.

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Comprehensive assessment of older people with complex care needs: the multi-disciplinarity of the Single Assessment Process in England

Ageing and Society ◽

10.1017/s0144686x10000395 ◽

2010 ◽

Vol 30 (7) ◽

pp. 1115-1134 ◽

Cited By ~ 13

Author(s):

DAVID CHALLIS ◽

MICHELE ABENDSTERN ◽

PAUL CLARKSON ◽

JANE HUGHES ◽

CAROLINE SUTCLIFFE

Keyword(s):

Older People ◽

Social Care ◽

Local Authority ◽

Care Home ◽

Comprehensive Assessment ◽

Assessment Process ◽

Care Plan ◽

Assessment Practice ◽

Care Needs ◽

Health And Social Care

ABSTRACTThe quality of assessment of older people with health and social care needs has for some time been a concern of policy makers, practitioners, older people and carers in the United Kingdom and internationally. This article seeks to address a key aspect of these concerns, namely whether sufficient expertise is deployed when, as a basis for a care plan and service allocation, an older person's eligibility for local authority adult social-care services requires a comprehensive needs assessment of their usually complex and multiple problems. Is an adequate range of professionals engaged, and is a multi-disciplinary approach applied? The Single Assessment Process (SAP) was introduced in England in 2004 to promote a multi-disciplinary model of service delivery. After its introduction, a survey in 2005–06 was conducted to establish the prevalence and patterns of comprehensive assessment practice across England. The reported arrangements for multi-disciplinary working among local authority areas in England were categorised and reviewed. The findings suggest, first, that the provision of comprehensive assessments of older people that require the expertise of multiple professionals is limited, except where the possibility arose of placement in a care-home-with-nursing, and second that by and large a systematic multi-disciplinary approach was absent. Policy initiatives to address the difficulties in assessment need to be more prescriptive if they are to produce the intended outcomes.

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A Cross-Sectional Examination of the Mental Wellbeing, Coping and Quality of Working Life in Health and Social Care Workers in the UK at Two Time Points of the COVID-19 Pandemic

Epidemiologia ◽

10.3390/epidemiologia2030017 ◽

2021 ◽

Vol 2 (3) ◽

pp. 227-242

Author(s):

Paula McFadden ◽

Ruth D. Neill ◽

John Moriarty ◽

Patricia Gillen ◽

John Mallett ◽

...

Keyword(s):

Social Care ◽

Phase 1 ◽

Working Life ◽

Phase 2 ◽

Cross Sectional ◽

Quality Of Working Life ◽

Care Workers ◽

Health And Social Care ◽

The Uk

As the COVID-19 pandemic continues to evolve around the world, it is important to examine its effect on societies and individuals, including health and social care (HSC) professionals. The aim of this study was to compare cross-sectional data collected from HSC staff in the UK at two time points during the COVID-19 pandemic: Phase 1 (May–July 2020) and Phase 2 (November 2020–January 2021). The HSC staff surveyed consisted of nurses, midwives, allied health professionals, social care workers and social workers from across the UK (England, Wales, Scotland, Northern Ireland). Multiple regressions were used to examine the effects of different coping strategies and demographic and work-related variables on participants’ wellbeing and quality of working life to see how and if the predictors changed over time. An additional multiple regression was used to directly examine the effects of time (Phase 1 vs. Phase 2) on the outcome variables. Findings suggested that both wellbeing and quality of working life deteriorated from Phase 1 to Phase 2. The results have the potential to inform interventions for HSC staff during future waves of the COVID-19 pandemic, other infectious outbreaks or even other circumstances putting long-term pressures on HSC systems.

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Reducing unplanned hospital admissions in Older people with high needs: a review of local practice in a small sample of primary care patients in an inner London borough.

The International Journal of Person Centered Medicine ◽

10.5750/ijpcm.v6i2.561 ◽

2016 ◽

Vol 6 (2) ◽

pp. 108-118

Author(s):

Harriet Selina Anne Sinclair ◽

Alison Furey

Keyword(s):

Primary Care ◽

High Risk ◽

Older People ◽

Social Care ◽

Hospital Admissions ◽

Health Check ◽

Care Needs ◽

Health And Social Care ◽

Risk Patients ◽

Unplanned Hospital Admissions

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.

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The older prisoner health and social care assessment and plan (OHSCAP) versus treatment as usual: a randomised controlled trial

BMC Public Health ◽

10.1186/s12889-021-11965-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Katrina Forsyth ◽

Roger T. Webb ◽

Laura Archer Power ◽

Richard Emsley ◽

Jane Senior ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Unmet Needs ◽

Social Care ◽

Controlled Trial ◽

Care Needs ◽

Treatment As Usual ◽

Prisoner Health ◽

Care Assessment ◽

Health And Social Care ◽

Randomised Controlled

Abstract Background Older people are the fastest-growing demographic group among prisoners in England and Wales and they have complex health and social care needs. Their care is frequently ad hoc and uncoordinated. No previous research has explored how to identify and appropriately address the needs of older adults in prison. We hypothesised that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) would significantly increase the proportion of met health and social care needs 3 months after prison entry, compared to treatment as usual (TAU). Methods The study was a parallel randomised controlled trial (RCT) recruiting male prisoners aged 50 and over from 10 prisons in northern England. Participants received the OHSCAP or TAU. A clinical trials unit used minimisation with a random element as the allocation procedure. Data analysis was conducted blind to allocation status. The intervention group had their needs assessed using the OHSCAP tool and care plans were devised; processes that lasted approximately 30 min in total per prisoner. TAU included the standard prison health assessment and care. The intention to treat principle was followed. The trial was registered with the UK Clinical Research Network Portfolio (ISRCTN ID: 11841493) and was closed on 30 November 2016. Results Data were collected between 28 January 2014 and 06 April 2016. Two hundred and forty nine older prisoners were assigned TAU of which 32 transferred prison; 12 were released; 2 withdrew and 1 was deemed unsafe to interview. Two hundred and fifty three 3 prisoners were assigned the OHSCAP of which 33 transferred prison; 11 were released; 6 withdrew and 1 was deemed unsafe to interview. Consequently, data from 202 participants were analysed in each of the two groups. There were no significant differences in the number of unmet needs as measured by the Camberwell Assessment of Needs – Forensic Short Version (CANFOR-S). The mean number of unmet needs for the OHSCAP group at follow-up was 2.03 (SD = 2.07) and 2.06 (SD = 2.11) for the TAU group (mean difference = 0.088; 95% CI − 0.276 to 0.449, p = 0.621). No adverse events were reported. Conclusion The OHSCAP was fundamentally not implemented as planned, partly due to the national prison staffing crisis that ensued during the study period. Therefore, those receiving the OHSCAP did not experience improved outcomes compared to those who received TAU. Trial registration Current Controlled Trials: ISRCTN11841493, 25/10/2012.

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Unmet health and social care needs and associated factors among elderly people aged ≥ 80 years in Balçova, Izmir, Turkey

Eastern Mediterranean Health Journal ◽

10.26719/emhj.21.009 ◽

2021 ◽

Author(s):

Hatice Simsek ◽

Erdem Erkoyun ◽

Ali Akoz ◽

Alp Ergor ◽

Reyhan Ucku

Keyword(s):

Risk Factor ◽

Low Income ◽

Associated Factors ◽

Social Care ◽

Community Dwelling ◽

Care Needs ◽

Income Status ◽

Healthcare Needs ◽

Unmet Healthcare Needs ◽

Health And Social Care

Background: The health and social care needs of people aged ≥ 80 years are a neglected topic. Aims: To determine the prevalence of unmet health and social care needs and associated factors in community-dwelling individuals aged ≥ 80 years in Izmir District of Balçova, Turkey. Methods: There were 1075 participants aged ≥ 80 years. The dependent variables were unmet health and social care needs. Independent variables were sociodemographic, socioeconomic and lifestyle characteristics. The data were collected in face-to-face interviews conducted at the homes and analysed by multiple logistic regression model. Ethical approval was obtained from the Non-Invasive Research Ethics Board of Dokuz Eylul University Medical Faculty (2017/26-24). Results: The mean age was 84.1 (3.7) years and 61.0% were female. Healthcare needs were expressed by 88.2% of the participants and 78.9% claimed that they had social care needs. Prevalence of unmet health and social care needs was 32.5% and 46.6%, respectively. Approximately 90.0% of their needs were covered by families. Perceived low-income status was a risk factor for unmet healthcare needs, and lack of social support was a risk factor for unmet social care needs. Additionally, not receiving formal education was a protective factor in unmet social care needs. Conclusion: Public health policy should be developed to enable better access to care, especially for the oldest people, considering that nearly one third of the participants in this study had unmet healthcare needs and almost half had unmet social care needs.

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The Older Prisoner Health and Social Care Assessment and Plan (OHSCAP) versus Treatment as Usual: A Randomised Controlled Trial

10.21203/rs.3.rs-75588/v1 ◽

2020 ◽

Author(s):

Katrina Forsyth ◽

Roger T Webb ◽

Laura Archer Power ◽

Richard Emsley ◽

Jane Senior ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Unmet Needs ◽

Social Care ◽

Controlled Trial ◽

Care Needs ◽

Treatment As Usual ◽

Prisoner Health ◽

Care Assessment ◽

Health And Social Care ◽

Randomised Controlled

Abstract Background Older adults are the fastest-growing subgroup among prisoners in England and Wales and have more health and social care needs than their younger counterparts and those the same age living in the community . We hypothesised that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) would significantly increase the proportion of met health and social care needs three months after prison entry, compared to treatment as usual (TAU).MethodsA parallel randomised controlled trial (RCT) was conducted at ten prisons in the North of England. Males aged 50 and over received the OHSCAP or TAU. The allocation procedure was minimisation with a random element. The OHSCAP process involved individuals having their needs assessed, care plans being created and reviewed. TAU encompassed the standard prison health assessment. The trial was registered with the UK Clinical Research Network Portfolio (ISRCTN ID: 11841493) and was closed on 30th November 2016.ResultsData were collected between 28th January 2014 and 06th April 2016. 249 older prisoners were assigned TAU of which 32 transferred prison; 12 were released; 2 withdrew and 1 was deemed unsafe to interview. 253 prisoners were assigned the OHSCAP of which 33 transferred prison; 11 were released; 6 withdrew and 1 was deemed unsafe to interview. Consequently, data from 202 participants were analysed in each of the two groups. There were no significant differences in the number of unmet needs as measured by the Camberwell Assessment of Needs – Forensic Short Version (CANFOR-S). The mean number of unmet needs for the OHSCAP group at follow-up was 2.03 (SD=2.07) and 2.06 (SD= 2.11) for the TAU group (RR = 0.088; 95% CI -0.276 to 0.449, p = 0.621). No adverse events were reported. Conclusion Those received the OHSCAP did not experience an improvement to the meeting of the needs in comparison to the TAU g. This was largely due to the OHSCAP not being implemented as planed due to a national prison crisis.The OHSCAP was fundamentally not implemented as planned, partly due to the national prison staffing crisis that ensued during the study period. Therefore, those receiving OHSCAP did not experience improved outcomes compared to those who received TAU. Trial RegistrationISRCTN11841493 25/10/2013Protocol available at: http://www.isrctn.com/ISRCTN11841493

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Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020001122 ◽

2021 ◽

Vol 30 ◽

Author(s):

Shiyu Lu ◽

Tianyin Liu ◽

Gloria H. Y. Wong ◽

Dara K. Y. Leung ◽

Lesley C. Y. Sze ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Symptom Severity ◽

Social Care ◽

Late Life ◽

Community Dwelling ◽

Service Utilisation ◽

Late Life Depression ◽

Social Care Service ◽

Health And Social Care

Abstract Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

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