A Scoping Review of the Implementation of Local Health and Social Services for Older Adults

Abstract Background The scale-up of evidence-based innovations is required to reduce waste and inequities in health and social services (HSS). However, it often tends to be a top-down process initiated by policy makers, and the values of the intended beneficiaries are forgotten. Involving multiple stakeholders including patients and the public in the scaling-up process is thus essential but highly complex. We propose to identify relevant strategies for meaningfully and equitably involving patients and the public in the science and practice of scaling up in HSS. Methods We will adapt our overall method from the RAND/UCLA Appropriateness Method. Following this, we will perform a two-prong study design (knowledge synthesis and Delphi study) grounded in an integrated knowledge translation approach. This approach involves extensive participation of a network of stakeholders interested in patient and public involvement (PPI) in scaling up and a multidisciplinary steering committee. We will conduct a systematic scoping review following the methodology recommended in the Joanna Briggs Institute Reviewers Manual. We will use the following eligibility criteria: (1) participants—any stakeholder involved in creating or testing a strategy for PPI; (2) intervention—any PPI strategy proposed for scaling-up initiatives; (3) comparator—no restriction; (4) outcomes: any process or outcome metrics related to PPI; and (5) setting—HSS. We will search electronic databases (e.g., Medline, Web of Science, Sociological Abstract) from inception onwards, hand search relevant websites, screen the reference lists of included records, and consult experts in the field. Two reviewers will independently select and extract eligible studies. We will summarize data quantitatively and qualitatively and report results using the PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist. We will conduct an online Delphi survey to achieve consensus on the relevant strategies for PPI in scaling-up initiatives in HSS. Participants will include stakeholders from low-, middle-, and high-income countries. We anticipate that three rounds will allow an acceptable degree of agreement on research priorities. Discussion Our findings will advance understanding of how to meaningfully and equitably involve patients and the public in scaling-up initiatives for sustainable HSS. Systematic review registration We registered this protocol with the Open Science Framework on August 19, 2020 (https://osf.io/zqpx7/).

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Aftercare: who attends section 117 meetings?

Psychiatric Bulletin ◽

10.1192/pb.19.2.106 ◽

1995 ◽

Vol 19 (2) ◽

pp. 106-107

Author(s):

Rosemary Lethem

Keyword(s):

Mental Health ◽

Nursing Home ◽

Patient Care ◽

Social Services ◽

Local Health ◽

Hospital Department ◽

Health And Social Services ◽

Mental Health Act ◽

Department Of Health ◽

Legal Duty

The purpose of aftercare is to enable patients to return to their home or accommodation other than a hospital or nursing home, and to minimse the need for future in-patient care. Under section 117 of the Mental Health Act 1983, local health and social services authorities have a legal duty to provide aftercare for certain categories of patients when they leave hospital (Department of Health and Welsh Office, 1993).

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The Prevalence of Elder Abuse and Neglect of Older Adults Who Access Health and Social Services in London, Ontario, Canada

Journal of Elder Abuse & Neglect ◽

10.1300/j084v05n04_06 ◽

1994 ◽

Vol 5 (4) ◽

pp. 77-94 ◽

Cited By ~ 12

Author(s):

Elizabeth Dow Pittaway ◽

Anne Westhues

Keyword(s):

Older Adults ◽

Social Services ◽

Elder Abuse ◽

Health And Social Services ◽

Elder Abuse And Neglect ◽

Abuse And Neglect

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A Usability and Feasibility Study: GENIE - An App Supporting Self-Management among Older Adults who are High Users of the Health Care System (Preprint)

10.2196/preprints.25285 ◽

2020 ◽

Author(s):

Ruta Valaitis ◽

Laura Cleghorn ◽

Ivaylo Vassilev ◽

Anne Rogers ◽

Jenny Ploeg ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Health Care ◽

Social Networks ◽

Social Services ◽

Health Care System ◽

Self Management ◽

Health And Social Services ◽

Primary Care Clinicians ◽

Care System

BACKGROUND Primary care providers have been tasked with fostering self-management through managing referrals and linking patients to community-based health and social services. This study evaluated a web-based tool –GENIE (Generating Engagement in Network InvolvEment)– as a component of the Health TAPESTRY program to support self-management of older adults who are high health care system users. GENIE aims to empower patients to leverage their personal social networks to access community services towards reaching their health goals. GENIE maps client’s personal networks, elicits preferences, and filters local health and social resources from a community service directory based on results of a questionnaire that explores client’s interests. In the Health TAPESTRY program, volunteers conducted home visits to gather health information on tablets and implemented the GENIE tool. A report was generated for the primary care team for follow up. OBJECTIVE This study examined the usability, feasibility, and perceived outcomes of the implementation of GENIE with older adults who were enrolled in Ontario’s Health Links Program, which coordinates care for the highest users of the health care system. METHODS This study involved two primary care clinician focus groups, one clinician interview, a volunteer focus group, client telephone interviews, field observations, and GENIE utilization statistics. RESULTS Eight patients, three volunteers, and 16 primary care clinicians participated. Patients were most interested in services that were health-related (exercise and socialization). Overall, participants perceived GENIE to be useful and easy to use, despite challenges related to email set up, disease terminology, instructions for personal network mapping, and clarity of questionnaire items. Volunteer facilitation was critical to support implementation of Genie. Tool completion averaged 39 minutes. Almost all patients identified a community program or activity of interest using GENIE. Half followed up on health and social services and added new members to their network over 6 months, while one participant lost a member. Clinicians had concerns about accuracy, suitability, and quantity of suggested programs and services generated from the tool and believed that they could better tailor choices for their patients highlighting the inherent tension between user-centred preferences focused on capabilities and bio-medical definitions of need shaping professional judgement. However, clinicians did note that GENIE strengthened their understanding of patients’ personal social networks. CONCLUSIONS This study demonstrated GENIE’s potential, facilitated by volunteers, to expand patients’ social networks and link them to relevant health and social services to support self-management. Volunteers require training to effectively implement GENIE for self-management support and can help overcome time limitations that primary care clinicians face. Refining the filtering capability of GENIE to allow for better tailoring of results to address the complex needs of those who are high system users may help to improve primary care provider’s confidence in such tools. CLINICALTRIAL Not applicable

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Integrated Primary Care and Social Services for Older Adults With Multimorbidity in England: A Scoping Review

10.21203/rs.3.rs-140720/v1 ◽

2021 ◽

Author(s):

Hajira Dambha-Miller ◽

Glenn Simpson ◽

Lucy Hobson ◽

Paul Roderick ◽

Paul Little ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Integrated Care ◽

Population Health ◽

Social Services ◽

Scoping Review ◽

Integrated Primary Care ◽

Integration Of Services ◽

Multi Level ◽

Sector Integration

Abstract Background: As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the range of physical and social needs of the population. The aim of this study is to describe and summarise current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in an English context. Methods: A scoping review was conducted which included a systematic electronic search of Medline, EMBASE, The Cochrane Library, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, Science and Social Science Citation Indices and Opengrey from data inception until the 16th June 2020. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis used to summarise findings.Results: Our search yielded 7656 papers of which 84 papers were included. Three themes were identified: (1) diverse focus on individual level services rather than multi-level or multi-sector integration, with an increasing emphasis on the need to consider broader determinants of population health as critical to integrated care in multimorbidity; (2) time was needed for integration to embed to allow new structures and relationships to develop and mature; and (3) we identified inherent tension between top-down and bottom-up driven approaches to integrated care that requires a whole-systems structure while allowing for local flexibilities.Conclusions: There is limited evidence of multi-level and multi-sector integration of services for older adults with multimorbidity in an English context. The literature increasingly acknowledges wider determinants of population health that are likely to require integration beyond primary care and social services. Improving clinical care in one or two sectors may not be as effective as simultaneously improving the organisation or design across services as one single system of provision. This may take time to establish and will require local input.

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Integrated primary care and social services for older adults with multimorbidity in England: a scoping review

BMC Geriatrics ◽

10.1186/s12877-021-02618-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hajira Dambha-Miller ◽

Glenn Simpson ◽

Lucy Hobson ◽

Paul Roderick ◽

Paul Little ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Integrated Care ◽

Population Health ◽

Social Services ◽

Scoping Review ◽

Integrated Primary Care ◽

Integration Of Services ◽

Multi Level ◽

Sector Integration

Abstract Background As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the physical and psycho-social needs of this cohort. This study describes and summarises current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in England. Methods A scoping review was conducted involving systematic searches of a range of electronic academic and policy databases. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis was used to summarise findings. Articles were included if published in English and related to primary care, social care and multimorbidity in older adults in England. Conceptually, the review was framed using the Rainbow Model of Integrated Care. Results The search yielded 7656 articles of which 84 were included. Three themes were identified: (1) a focus on individual level services rather than multi-level or multi-sector integration, with an increasing emphasis on the need to consider broader determinants of population health as critical to integrated care for older adults with multimorbidity; (2) the need for policymakers to allow time for integration to embed, to enable new structures and relationships to develop and mature; and (3) the inherent tension between top-down and bottom-up driven approaches to integrated care requires a whole-systems structure, while allowing for local flexibilities. Conclusions There is limited evidence of multi-level and multi-sector integration of services for older adults with multimorbidity in England. The literature increasingly acknowledges wider determinants of population health that are likely to require integration beyond primary care and social services. Improving clinical care in one or two sectors may not be as effective as simultaneously improving the organisation or design across services as one single system of provision. This may take time to establish and will require local input.

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A Postcolonial Discourse Analysis of Community Stakeholders’ Perspectives on Supporting Urban Indigenous Older Adults to Age Well in Ottawa, Canada

International Indigenous Policy Journal ◽

10.18584/iipj.2020.11.1.9443 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Lauren A. Brooks-Cleator ◽

Audrey R. Giles

Keyword(s):

Older Adults ◽

Discourse Analysis ◽

Social Services ◽

Service Providers ◽

Indigenous Health ◽

Adult Population ◽

Structured Interviews ◽

Health And Social Services ◽

Community Stakeholders ◽

Postcolonial Discourse

The urban Indigenous older adult population in Canada continues to grow; however, there is a lack of understanding of how non-Indigenous health and social services and Indigenous-specific organizations are responding to and addressing the growth of this population. Therefore, in this research, we conducted a postcolonial discourse analysis of semi-structured interviews with six decision-makers (e.g., managers and directors of health and social services organizations) and seven service providers (e.g., program coordinators and social workers) from Indigenous and non-Indigenous health and social service organizations in Ottawa, Canada, to examine how they produce understandings of supporting urban Indigenous older adults to age well. The participants produced three main discourses: (a) non-Indigenous organizations have a responsibility to support Indigenous older adults, (b) culturally specific programs and services are important for supporting Indigenous older adults to age well, and (c) it is difficult for community stakeholders to support Indigenous older adults to age well because this population is hard to reach. The results demonstrate the complexities and tensions that community stakeholders face in supporting Indigenous older adults to age well within a sociopolitical environment informed by reconciliation and a sociodemographic trend of an aging population.

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