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

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 85
Author(s):  
Pritti Aggarwal ◽  
Stephen J. Woolford ◽  
Harnish P. Patel

Multi-morbidity and polypharmacy are common in older people and pose a challenge for health and social care systems, especially in the context of global population ageing. They are complex and interrelated concepts in the care of older people that require early detection and patient-centred shared decision making underpinned by multi-disciplinary team-led comprehensive geriatric assessment (CGA) across all health and social care settings. Personalised care plans need to remain responsive and adaptable to the needs and wishes of the patient, enabling the individual to maintain their independence. In this review, we aim to give an up-to-date account of the recognition and management of multi-morbidity and polypharmacy in the older person.

Author(s):  
Pritti Aggarwal ◽  
Stephen Woolford ◽  
Harnish Patel

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.


2020 ◽  
Vol 49 (6) ◽  
pp. 901-906 ◽  
Author(s):  
Sarah J Richardson ◽  
Camille B Carroll ◽  
Jacqueline Close ◽  
Adam L Gordon ◽  
John O’Brien ◽  
...  

Abstract Older people are disproportionately affected by the COVID-19 pandemic, which has had a profound impact on research as well as clinical service delivery. This commentary identifies key challenges and opportunities in continuing to conduct research with and for older people, both during and after the current pandemic. It shares opinions from responders to an international survey, a range of academic authors and opinions from specialist societies. Priorities in COVID-19 research include its specific presentation in older people, consequences for physical, cognitive and psychological health, treatments and vaccines, rehabilitation, supporting care homes more effectively, the impact of social distancing, lockdown policies and system reconfiguration to provide best health and social care for older people. COVID-19 research needs to be inclusive, particularly involving older people living with frailty, cognitive impairment or multimorbidity, and those living in care homes. Non-COVID-19 related research for older people remains of critical importance and must not be neglected in the rush to study the pandemic. Profound changes are required in the way that we design and deliver research for older people in a world where movement and face-to-face contact are restricted, but we also highlight new opportunities such as the ability to collaborate more widely and to design and deliver research efficiently at scale and speed.


2019 ◽  
Vol 19 (2) ◽  
pp. 168-185
Author(s):  
John Adlam

“Reflective practice” is a term imprecisely understood and used to describe a wide range of different activities or interventions. In this article I examine the Reflective Practice Group (RPG) as an intervention offered to multidisciplinary teams (MDTs) in mental health and social care settings. Drawing extensively upon the work of Wilfred Bion and on the “Northfield I” experiment which he led in 1942, I formulate the existential, conceptual, and functional challenges of the MDT in terms of the problematic interplay between the drive towards autonomy and the exigencies of interdependence. I take this interplay as the figure, with the ground being the baseline disarray of traumatised systems that both defines and contextualises the individual worker’s predicament within the team. Analysing the nature of the MDT sheds new light on longstanding controversies about what ailment the RPG is there to address; what skill set is needed to facilitate it; and what methodology may be most appropriately used for its delivery.


2011 ◽  
Vol 10 (2) ◽  
pp. 151-162 ◽  
Author(s):  
Caroline Glendinning ◽  
Nicola Moran ◽  
David Challis ◽  
José-Luis Fernández ◽  
Sally Jacobs ◽  
...  

As in other countries, improving collaboration between health and social care services is a long-established objective of English social policy. A more recent priority has been the personalisation of social care for adults and older people through the introduction of individualised funding arrangements. Individual budgets (IBs) were piloted in 13 English local authorities from 2005 to 2007, but they explicitly excluded NHS resources and services. This article draws on interviews with lead officers responsible for implementing IBs. It shows how the contexts of local collaboration created problems for the implementation of the personalisation pilots, jeopardised inter-sectoral relationships and threatened some of the collaborative arrangements that had developed over the previous decade. Personal budgets for some health services have subsequently also been piloted. These will need to build upon the experiences of the social care IB pilots, so that policy objectives of personalisation do not undermine previous collaborative achievements.


2018 ◽  
Author(s):  
Jolien Vos ◽  
Kathrin Gerling ◽  
Conor Linehan ◽  
Aloysius N Siriwardena ◽  
Karen Windle

BACKGROUND Health and social care systems were designed to be used primarily by people with single and acute diseases. However, a growing number of older adults are diagnosed with multiple long-term conditions (LTCs). The process of navigating the intricacies of health and social care systems to receive appropriate care presents significant challenges for older people living with multiple LTCs, which in turn can negatively influence their well-being and quality of life. OBJECTIVE The long-term goal of this work is to design technology to assist people with LTCs in navigating health and social care systems. To do so, we must first understand how older people living with LTCs currently engage with and navigate their care networks. No published research describes and analyses the structure of formal and informal care networks of older adults with multiple LTCs, the frequency of interactions with each type of care service, and the problems that typically arise in these interactions. METHODS We conducted a mixed-methods study and recruited 62 participants aged ≥55 years who were living in England, had ≥2 LTCs, and had completed a social network analysis questionnaire. Semistructured interviews were conducted with roughly a 10% subsample of the questionnaire sample: 4 women and 3 men. On average, interviewees aged 70 years and had 4 LTCs. RESULTS Personal care networks were complex and adapted to each individual. The task of building and subsequently navigating one’s personal care network rested mainly on patients’ shoulders. It was frequently the patients’ task to bridge and connect the different parts of the system. The major factor leading to a satisfying navigation experience was found to be patients’ assertive, determined, and proactive approaches. Furthermore, smooth communication and interaction between different parts of the care system led to more satisfying navigation experiences. CONCLUSIONS Technology to support care navigation for older adults with multiple LTCs needs to support patients in managing complex health and social care systems by effectively integrating the management of multiple conditions and facilitating communication among multiple stakeholders, while also offering flexibility to adapt to individual situations. Quality of care seems to be dependent on the determination and ability of patients. Those with less determination and fewer organization skills experience worse care. Thus, technology must aim to fulfill these coordination functions to ensure care is equitable across those who need it.


Author(s):  
Kaisu Pitkala ◽  
John Gladman ◽  
Martin Connolly

Older people are major users of health and social care in many developed countries, and so all health and social care systems in such countries need to be fit for older users such as those with deafness, blindness, or dementia. Despite this, specific services for older people with the most complex or challenging problems have developed. These models of healthcare for older people are diverse. They can deal with both acute and chronic health problems including rehabilitation. They can be provided in or across community, long-stay, and hospital settings, and often involve a wide range of professionals. They have developed in different ways in different countries. This chapter describes specific models of older people’s care, and outlines the role of geriatricians and other professionals in the models.


2017 ◽  
Vol 18 (2) ◽  
pp. 157-167 ◽  
Author(s):  
Roger Beech ◽  
Bie Nio Ong ◽  
Sue Jones ◽  
Vicky Edwards

Purpose This paper is an evaluated case study of the Wellbeing Coordinator (WBC) service in Cheshire, UK. WBCs are non-clinical members of the GP surgery or hospital team who offer advice and support to help people with long-term conditions and unmet social needs remain independent at home. The paper aims to discuss this issue. Design/methodology/approach A mixed method design assessed the outcomes of care for recipients and carers using interviews, diaries and validated wellbeing measures. Service utilization data, interviews and observations of WBC consultations enabled investigation of changes in processes of care. Data were analysed using simple descriptive statistics, established instrument scoring systems and accepted social science conventions. Findings The WBC complements medical approaches to supporting people with complex health and social care problems, with support for carers often a key service component. Users reported improvements in their wellbeing, access to social networks, and maintenance of social identity and valued activities. Health and social care professionals recognized the value of the service. Practical implications The WBC concept relieves the burden on health and social care professionals as the social elements of ill-health are addressed. A shift in thinking from ill-health to wellbeing means older people feel more able to regain control over their own lives, being less dependent on consulting professionals. Originality/value The WBC is a new service focussing on the individual in their health, social and economic context. Process and outcomes evaluations are rare in this field.


Author(s):  
Syed Fahad Javaid ◽  
Aishah Al-Zahmi ◽  
Munir Abbas

Dementia represents a significant problem in the Middle East. Sociocultural and political factors that shape conceptions of health and care tend to stifle research and the dissemination of knowledge throughout the Middle East. These socio-political challenges concerning engagement with individuals living with dementia and their carers include language barriers, stigmatization, logistical constraints, lack of informal support outside of hospitals, and over-dependence on clinicians for dementia information. There is an urgent need in the Middle East to increase care and support for adults with dementia and their carers, enhance research efforts and improve the dissemination of information related to dementia in the region. One possible way to do so is to begin to promote a knowledge-based culture throughout the Middle East. This can be achieved by aligning traditional deterministic and spiritual perspectives of mental health with more Western, scientific, and evidence-based models. We suggest employing practical, multidimensional approaches to deal with the stated challenges, both at individual and societal levels. Doing so will improve knowledge of dementia and allow health and social care systems in the Middle East to begin to address a growing problem.


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