scholarly journals Service provision for older homeless people with memory problems: a mixed-methods study

2019 ◽  
Vol 7 (9) ◽  
pp. 1-184 ◽  
Author(s):  
Jill Manthorpe ◽  
Kritika Samsi ◽  
Louise Joly ◽  
Maureen Crane ◽  
Heather Gage ◽  
...  
Keyword(s):  
Older People ◽  
Urban Areas ◽  
Unmet Needs ◽  
Homeless People ◽  
Long Term Conditions ◽  
Memory Assessment ◽  
Health Lifestyle ◽  
Memory Problems ◽  
People With Dementia ◽  
With Memory

Background Early or timely recognition of dementia is a key policy goal of the National Dementia Strategy. However, older people who are homeless are not considered in this policy and practice imperative, despite their high risk of developing dementia. Objectives and study design This 24-month study was designed to (1) determine the prevalence of memory problems among hostel-dwelling homeless older people and the extent to which staff are aware of these problems; (2) identify help and support received, current care and support pathways; (3) explore quality of life among older homeless people with memory problems; (4) investigate service costs for older homeless people with memory problems, compared with services costs for those without; and (5) identify unmet needs or gaps in services. Participants Following two literature reviews to help study development, we recruited eight hostels – four in London and four in North England. From these, we first interviewed 62 older homeless people, exploring current health, lifestyle and memory. Memory assessment was also conducted with these participants. Of these participants, 47 were included in the case study groups – 23 had ‘memory problems’, 17 had ‘no memory problems’ and 7 were ‘borderline’. We interviewed 43 hostel staff who were participants’ key workers. We went back 3 and 6 months later to ask further about residents’ support, service costs and any unmet needs. Findings Overall, the general system of memory assessment for this group was found to be difficult to access and not patient-centred. Older people living in hostels are likely to have several long-term conditions including mental health needs, which remain largely unacknowledged. Participants frequently reported experiences of declining abilities and hostel staff were often undertaking substantial care for residents. Limitations The hostels that were accessed were mainly in urban areas, and the needs of homeless people in rural areas were not specifically captured. For many residents, we were unable to access NHS data. Many hostel staff referred to this study as ‘dementia’ focused when introducing it to residents, which may have deterred recruitment. Conclusions To the best of our knowledge, no other study and no policy acknowledges hostels as ‘dementia communities’ or questions the appropriateness of hostel accommodation for people with dementia. Given the declining number of hostels in England, the limits of NHS engagement with this sector and growing homelessness, this group of people with dementia are under-recognised and excluded from other initiatives. Future work A longitudinal study could follow hostel dwellers and outcomes. Ways of improving clinical assessment, record-keeping and treatment could be investigated. A dementia diagnosis could trigger sustained care co-ordination for this vulnerable group. Funding The National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Unmet care needs are common among community-dwelling older people with memory problems in Finland

2019 ◽  
pp. 140349481989080 ◽  
Author(s):  
Mari S. Aaltonen ◽  
Lina H. Van Aerschot
Keyword(s):  
Home Care ◽  
Older People ◽  
Home Care Services ◽  
Community Dwelling ◽  
Care Needs ◽  
Care Services ◽  
Memory Problems ◽  
More Care ◽  
Community Dwelling Older People ◽  
With Memory

Aims: Ageing in place has become a policy priority. Consequently, residential care has been reduced, and more older people with multiple care needs reside at home with the help of informal care and home care services. An increasing share of these people has memory disorders. We examined the extent to which memory problems, in addition to other individual characteristics, are associated with unmet care needs among community-dwelling older people. Methods: The study employed cross-sectional survey data from community-dwelling people aged 75+ collected in 2010 and 2015, analysed using binary logistic regression analysis. The study population consisted of people who had long-term illnesses or disabilities that limited their everyday activities ( N = 1928). Nine per cent reported substantial memory problems. Of these, 35.7% had a proxy respondent. Results: People with memory problems have more care needs than those with other types of disability or illness. They receive more care but still have more unmet needs than others. About a quarter of people with memory problems reported that they did not receive enough help. This result did not change significantly when the proxy responses were excluded. Even a combination of informal and formal home care was insufficient to meet their needs. Conclusions: Insufficient care for people with memory problems implies a serious demand for further development of home care services. The care needs of this population are often complex. Unmet needs represent a serious risk to the well-being of people with memory disorders, and may also create an extensive burden on their informal caregivers.

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.

Direct referrals from social services to community teams for older people with mental illness

2008 ◽  
Vol 32 (5) ◽  
pp. 164-165 ◽  
Author(s):  
Sujata Das ◽  
Walter P. Bouman
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Older People ◽  
Social Services ◽  
Mental Health Problems ◽  
Referral System ◽  
Memory Problems ◽  
People With Mental Illness ◽  
Referral Criteria ◽  
With Memory

Aims and MethodThe aim of the study was to evaluate the open referral system from social services to a community mental health team (CMHT) for older people. Referral letters from social services to the specialist team were reviewed, as were the case notes.ResultsOf the 40 referrals, 95% (n=38) were accepted by the CMHT. Only 15% (n=6) fulfilled the team's existing referral criteria. The majority of referrals (n=36, 90%) had details of the patient's mental health problems. None of the referrals with memory problems had a cognitive assessment. Of the 38 referrals accepted by the CMHT, 36 were found to be suffering from a mental illness. The open referral system from social services did not increase the total number of annual referrals.Clinical ImplicationsSocial services play an important role in identifying and referring older people with mental illness and ensure a potentially rapid referral route bypassing primary care. The practice of accepting direct referrals from social services should be encouraged and made an integral part of the referral system.

scholarly journals Managing diabetes in people with dementia: a realist review

2017 ◽  
Vol 21 (75) ◽  
pp. 1-140 ◽  
Author(s):  
Frances Bunn ◽  
Claire Goodman ◽  
Peter Reece Jones ◽  
Bridget Russell ◽  
Daksha Trivedi ◽  
...  
Keyword(s):  
Older People ◽  
Intervention Strategy ◽  
Realist Review ◽  
Cochrane Library ◽  
Future Research ◽  
Care Providers ◽  
Long Term Conditions ◽  
People With Dementia ◽  
Increased Risk

BackgroundDementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes.ObjectivesTo identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research.DesignRealist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders.ParticipantsTwenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference.Data sourcesThe following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing – UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA).ResultsWe included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context–mechanism–outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia.LimitationsThere is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven.ConclusionsThis review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes.Study registrationThis study is registered as PROSPERO CRD42015020625.FundingThe NIHR HTA programme.

Advance care planning for an ageing population

2018 ◽  
Author(s):  
Martin J. Vernon
Keyword(s):  
Older People ◽  
Advance Care Planning ◽  
Later Life ◽  
Ageing Population ◽  
Care Planning ◽  
Long Term Conditions ◽  
Health Decline ◽  
People With Dementia ◽  
Increased Risk ◽  
Advance Care

Population ageing is driven by declining fertility and improved life expectancy. As people survive to later life with multiple long-term conditions, advance care planning ACP) is of increasing importance to those wishing to retain control over their end-of-life care. Understanding disability trajectories for people can assist with advance care planning, mindful that older people living with frailty have increased risk of acute and unexpected health decline. Routine frailty identification by severity in older people can prompt care planning in anticipation of health decline and imminent lost capacity to make important decisions. Recognizing potential professional and organizational barriers to advance carer planning for older people could also improve its uptake. Guided serious illness conversations could assist this process over time for older people and those important to them. In care homes and among people with dementia ACP is also likely to be beneficial.

scholarly journals Predictors of unmet needs in Chilean older people with dementia: a cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Thamara Tapia Muñoz ◽  
Andrea Slachevsky ◽  
María O. León-Campos ◽  
Michel Madrid ◽  
Alejandra Caqueo-Urízar ◽  
...  
Keyword(s):  
Older People ◽  
Unmet Needs ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
People With Dementia

scholarly journals The CAREGIVERSPRO-MMD Platform as an Online Informational and Social Support Tool for People Living With Memory Problems and Their Carers: An Evaluation of User Engagement, Usability and Usefulness

2019 ◽  
Vol 39 (12) ◽  
pp. 1303-1312
Author(s):  
David Howe ◽  
Jonathan Thorpe ◽  
Rosie Dunn ◽  
Caroline White ◽  
Kate Cunnah ◽  
...  
Keyword(s):  
Social Support ◽  
Unmet Needs ◽  
User Engagement ◽  
Daily Lives ◽  
Web Based ◽  
Support Tool ◽  
Memory Problems ◽  
Peer Social Support ◽  
User Groups ◽  
With Memory

People living with dementia or cognitive impairment (PwD) and their carers often have unmet needs for informational and social support postdiagnosis. Web-based platforms have the potential to address these needs, although few have been developed for use by both PwD and carers. The CAREGIVERSPRO-MMD platform was developed to provide both user groups with informational and peer-to-peer social support. Platform logging data were analyzed to assess the extent to which PwD ( n = 37) and carers ( n = 37) engaged with the platform and its social/informational features in their daily lives. Participants also provided feedback on the usefulness and usability of the platform. The majority of PwD and carers found the platform and its social/informational features useful and usable, and significant subsets of both groups utilized the platform regularly. However, carers engaged with the informational and social features to a greater extent than PwD, and users highlighted that PwD typically required regular support to use the platform.

scholarly journals To Lie or Not to Lie: The Views of People With Dementia and Their Carers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 758-758
Author(s):  
Dympna Casey ◽  
Una Lynch ◽  
Adeline Cooney ◽  
Catherine Houghton ◽  
Siobhan Smyth ◽  
...  
Keyword(s):  
Focus Groups ◽  
Qualitative Methodology ◽  
Cognitive Symptoms ◽  
Know How ◽  
Memory Problems ◽  
People With Dementia ◽  
Informal Carers ◽  
Person With Dementia ◽  
With Memory ◽  
Purposive Sample

Abstract In Ireland over 36,000 people with dementia live at home cared for by informal carers. Yet often these carers do not know how to deal with cognitive symptoms, including repeated questions wherein ‘truthful’responses cause distress. Carers face a dilemma, do they avoid, distract or ‘correct’ the person and tell the ‘truth’, or lie? This paper explores the concept of lying from the perspective of the carer and person with dementia. A descriptive qualitative methodology was used. Focus groups with a purposive sample of people with memory problems (n = 14) and carers (n = 18) were conducted. The results found that deliberate lying with the intention to deceive was deemed unacceptable by all. However, in certain circumstances telling a ‘good lie’ or ‘white lie’ was considered acceptable when the carer knew the person and the intention behind the ‘lie’ was to mitigate the distress of the person with dementia.

Older people, dementia and neuro-dramatic-play: A personal and theoretical drama therapy perspective

2021 ◽  
Vol 7 (1) ◽  
pp. 61-75
Author(s):  
Clive Holmwood
Keyword(s):  
Older People ◽  
Memory Loss ◽  
Theoretical Framework ◽  
Drama Therapy ◽  
Dramatic Play ◽  
People With Dementia ◽  
History Of ◽  
With Memory

This conceptual article will consider Sue Jennings’ neuro-dramatic-play (NDP) as an overall theoretical framework for working with older people with dementia. NDP was developed over a number of years by pioneering UK drama therapist Sue Jennings. It is a culmination of attachment-based play, drama, movement and storytelling, and arts-based approaches that are used within drama therapy and other play and creative-based work with children. The author will consider from a personal and reflective perspective how NDP approaches can be adapted by drama therapists to work with older people with memory loss based on almost 30-years history of being involved in the field of drama therapy as a student and practioner, and his work with older people, at both the beginning of his career and his current reflections many years later.

scholarly journals Determinants of Unmet Needs Among Slovenian Old Population

2016 ◽  
Vol 55 (1) ◽  
pp. 78-85 ◽  
Author(s):  
Valentina Hlebec ◽  
Andrej Srakar ◽  
Boris Majcen
Keyword(s):  
Social Policy ◽  
Older People ◽  
Rural Areas ◽  
Urban Areas ◽  
Unmet Needs ◽  
Old People ◽  
Enabling Factors ◽  
Term Care ◽  
Formal Services ◽  
Informal Carers

Abstract Background Population ageing has significant effects on societies. The organization of care for dependent old people is one of the key issues for ageing societies. The majority of care for homebound dependent old people in Slovenia is still performed by informal carers, even though the use of formal services has been increasing over the last 20 years. The proportion and characteristics of people with unmet needs are important for the development of long term care social policy. MethodThe SHARE (Survey of Health, Ageing and Retirement in Europe) survey was used to assess the determinants of care arrangements and of unmet needs of the aging population in Slovenia. Multinomial regression analysis was used to evaluate individual and contextual determinants of care arrangements and unmet needs. Results The proportion of older people with unmet needs is 4%. As expected, “needs” (Functional impairment OR=4.89, P=0.000, Depression OR=2.59, P=0.001) were the most important determinant, followed by the predisposing factor “age” (age OR 1.15, P=0.000) and two enabling factors, namely:“community setting and “availability of informal care within household” (Urban areas OR=.47, P=0.021; Household size 3+ OR=2.11, P=0.030). Conclusion This study showed that there are a proportion of older people in Slovenia with severe needs for care, which are being unmet. As shown by the importance of enabling factors, social policy should encourage the development of formal services in rural areas and elaborate policy measures for informal carers.

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