A scoping review of community holistic interventions for older people with multimorbidity

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711509
Author(s):  
Timothy Smith ◽  
Tahera Patel ◽  
Asangaedem Akpan ◽  
Andrew Clegg ◽  
Dame Caroline Watkins ◽  
...  
Keyword(s):  
Older People ◽  
Cochrane Review ◽  
Management Plan ◽  
Social Needs ◽  
Care Plan ◽  
Holistic Care ◽  
Service Usage ◽  
Community Based ◽  
Self Rated Health ◽  
Healthcare Needs

BackgroundIn many areas, new regional community-based services have been established to provide holistic care to patients with high physical, mental and social needs. Older people represent a group with multimorbidity and high healthcare needs that may benefit from holistic care, although uncertainty remains whether such an approach is effective.AimTo review evidence for community holistic interventions in older people with multimorbidity.MethodThe authors screened studies referenced by an earlier Cochrane Review and Academy of Medical Sciences report, both of which looked at interventions and populations more broadly, and their own searches of Medline, EMBASE, trial registration databases and hand-searching of journals since 2015. The authors included controlled community-based studies of holistic interventions with data for people aged at least 60 years.ResultsStudies found (five published, two ongoing) were heterogeneous. The only significant improvement relating to physical or mental outcomes occurred in self-rated health scores, seen in two studies. One consisting entirely of diabetics showed developing a self-management plan improved self-rated health (P = 0.023), and Mental Component Summary (P = 0.03). The other used a multidisciplinary-team-guided personal care plan and found self-rated overall health improved (P = 0.02). Three studies looked at service usage, only one seeing a benefit, and only in the second year.ConclusionCommunity-based holistic interventions for people with multimorbidity tended to focus on disease management or medication modification, and resulted in few significant benefits, almost entirely in self-rated health measures. Research into interventions focused on those with the highest needs, for example, multimorbidity with frailty; high number of comorbidities may be more likely to demonstrate meaningful benefits.

scholarly journals Physical Therapy Use by Community-Based Older People

2005 ◽  
Vol 85 (1) ◽  
pp. 19-33 ◽  
Author(s):  
Janet K Freburger ◽  
George M Holmes
Keyword(s):  
Physical Therapy ◽  
Managed Care ◽  
Older People ◽  
Physical Therapist ◽  
Private Insurance ◽  
Ordinary Least Squares ◽  
Care Plan ◽  
Community Based ◽  
Negatively Associated ◽  
Factors Associated

Abstract Background and Purpose. Little information is available on factors associated with physical therapy use. Identifying the characteristics of people who use physical therapy and some of the factors associated with its use is a useful first step in determining whether disparities exist in physical therapy use. The purpose of this study was to identify factors associated with physical therapy use by community-based older people. Subjects. The subjects were community-based people 65 years of age or older who participated in the Medicare Current Beneficiary Survey and had at least one physician encounter (N=38,312 person-years across 20,227 individuals). Methods. Logit and ordinary least squares regression analyses were conducted to identify factors associated with physical therapy use. Results. Several measures of health and function were associated with physical therapy use. Several demographic, insurance, and geographic characteristics also were associated with physical therapy use. Income, education, having supplemental private insurance, participating in a managed care plan, and physical therapist supply were positively associated with physical therapy use. Age was negatively associated with physical therapy use. For people who saw a physical therapist, amount of physical therapy received was positively associated with income, having supplemental private insurance, living in a metropolitan area, physical therapist supply, and being African American. Amount of physical therapy received was negatively associated with being in a managed care plan. Discussion and Conclusions. Variation in physical therapy use, explained by factors other than need, suggests potential underuse or overuse of physical therapy by community-based older people.

An overview of enteral feeding in the community

2021 ◽  
Vol 26 (1) ◽  
pp. 26-29
Author(s):  
Sarah Jane Palmer
Keyword(s):  
Enteral Feeding ◽  
Healthcare Professionals ◽  
Social Needs ◽  
Care Plan ◽  
Medical Attention ◽  
Community Settings ◽  
Community Based ◽  
Basic Principles ◽  
Endoscopic Gastrostomy ◽  
Peg Tube

Enteral feeding in community settings is becoming increasingly common, and this article aims to help nurses and other healthcare professionals to refresh their knowledge of the important concepts in the community-based care of patients receiving enteral nutrition via a percutaneous endoscopic gastrostomy (PEG) tube. The article provides an overview on the management and care of the patient, the basic principles surrounding the equipment used, identifying the wider team and essential communication to bear in mind, as well as the importance of tailoring a care plan to the individual's needs, taking into consideration cognition, mental health, social needs and other factors. The article also covers red flags that may be seen in the community after tube insertion that require immediate medical attention.

scholarly journals Urgent care for older people

2021 ◽  
Author(s):  
Simon Conroy ◽  
Matt Thomas
Keyword(s):  
Older People ◽  
Geriatric Medicine ◽  
Adverse Outcomes ◽  
Urgent Care ◽  
Holistic Care ◽  
Pressure Sores ◽  
Community Based ◽  
Clinical Specialty ◽  
Emergency Department Care ◽  
Clinical Competencies

Abstract Geriatric medicine is the clinical specialty that focuses upon the care of older people—especially those with frailty (a state of increased vulnerability). In hospital, older people living with frailty are at high risk of developing a range of unpleasant outcomes such as delirium, falls, fractures, pressure sores and death. Comprehensive geriatric assessment is a form of holistic care that incorporates a specific set of clinical competencies that are able to reduce these adverse outcomes. Over the years, geriatric medicine has moved from being more of a community-based service towards a more acute specialty—encroaching now upon emergency department care. The challenge now is to work out how best to deliver geriatric care across the whole hospital (older people with frailty are not just cared for in geriatric wards!). The themed collection published on the Age & Ageing journal website outlines key articles that are attempting to develop solutions to this challenging conundrum. We hope that you enjoy reading them.

scholarly journals Study protocol of a systematic review and qualitative evidence synthesis using two different approaches: Healthcare related needs and desires of older people with post-stroke aphasia

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e039348
Author(s):  
Nadine Janis Pohontsch ◽  
Thorsten Meyer ◽  
Yvonne Eisenmann ◽  
Maria-Inti Metzendorf ◽  
Verena Leve ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Research Question ◽  
Treatment Success ◽  
Qualitative Studies ◽  
Qualitative Evidence Synthesis ◽  
Healthcare Needs ◽  
Qualitative Evidence

IntroductionStroke is a frequent disease in the older population of Western Europe with aphasia as a common consequence. Aphasia is known to impede targeting treatment to individual patients’ needs and therefore may reduce treatment success. In Germany, the postacute care of patients who had stroke is provided by different healthcare institutions of different sectors (rehabilitation, nursing and primary care) with substantial difficulties to coordinate services. We will conduct two qualitative evidence syntheses (QESs) aiming at exploring distinct healthcare needs and desires of older people living with poststroke aphasia. We thereby hope to support the development of integrated care models based on needs of patients who are very restricted to communicate them. Since various methods of QESs exist, the aim of the study embedding the two QESs was to determine if findings differ according to the approach used.Methods and analysisWe will conduct two QESs by using metaethnography (ME) and thematic synthesis (ThS) independently to synthesise the findings of primary qualitative studies. The main differences between these two methods are the underlying epistemologies (idealism (ME) vs realism (ThS)) and the type of research question (emerging (ME) vs fixed (ThS)).We will search seven bibliographical databases. Inclusion criteria comprise: patients with poststroke aphasia, aged 65 years and older, studies in German/English, all types of qualitative studies concerning needs and desires related to healthcare or the healthcare system. The protocol was registered in the International Prospective Register of Systematic Reviews, follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and includes three items from the Enhancing Transparency in Reporting the synthesis of Qualitative Research checklist.Ethics and disseminationEthical approval is not required. Findings will be published in a peer-reviewed journal and presented on national conferences.

scholarly journals Factors Associated with Patients’ Connection to Referred Social Needs Resources at a Federally Qualified Health Center

2021 ◽  
Vol 12 ◽  
pp. 215013272110243
Author(s):  
Tyler Lian ◽  
Kate Kutzer ◽  
Diwas Gautam ◽  
Howard Eisenson ◽  
Jane C. Crowder ◽  
...  
Keyword(s):  
Health Center ◽  
Social Services ◽  
Social Needs ◽  
Phone Call ◽  
Community Based ◽  
Factors Associated ◽  
Federally Qualified Health Center ◽  
Or Applications ◽  
Improve Health

Introduction: In an effort to improve health outcomes and promote health equity, healthcare systems have increasingly begun to screen patients for unmet social needs and refer them to relevant social services and community-based organizations. This study aimed to identify factors associated with the successful connection (ie, services started) to social needs resources, as well as factors associated with an attempt to connect as a secondary, intermediate outcome. Methods: This retrospective cohort study included patients who had been screened, referred, and subsequently reached for follow-up navigation from March 2019 to December 2020, as part of a social needs intervention at a federally qualified health center (FQHC). Measures included demographic and social needs covariates collected during screening, as well as resource-related covariates that characterized the referred resources, including service domain (area of need addressed), service site (integration relative to the FQHC), and access modality (means of accessing services). Results: Of the 501 patients in the analytic sample, 32.7% had started services with 1 or more of their referred resources within 4 weeks of the initial referral, and 63.3% had at least attempted to contact 1 referred resource, whether or not they were able to start services. Receiving a referral to resources that patients could access via phone call or drop-in visit, as opposed to resources that required additional appointments or applications prior to accessing services, was associated with increased odds (aOR 1.95, 95% CI 1.05, 3.61) of connection success, after adjusting for age, sex, race, ethnicity, education, number of social needs, and resource-related characteristics. This study did not find statistically significant associations between connection attempt and any variable included in adjusted analyses. Conclusion: These findings suggest that referral pathways may influence the success of patients’ connection to social needs resources, highlighting opportunities for more accessible solutions to addressing patients’ unmet social needs.

BMI calculation in older people: The effect of using direct and surrogate measures of height in a community-based setting

2017 ◽  
Vol 22 ◽  
pp. 112-115 ◽  
Author(s):  
Rose Butler ◽  
Jane McClinchy ◽  
Claudia Morreale-Parker ◽  
Wendy Marsh ◽  
Kirsten L. Rennie
Keyword(s):  
Older People ◽  
Community Based ◽  
Surrogate Measures

scholarly journals Patterns of Sedentary Behavior in a Community-Based Cohort of Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 790-790
Author(s):  
Dori Rosenberg ◽  
Rod Walker ◽  
Mikael Anne Greenwood-Hickman ◽  
KatieRose Richmire ◽  
John Bellettiere ◽  
...  
Keyword(s):  
Older Adults ◽  
Epidemiologic Study ◽  
Epidemiologic Studies ◽  
Community Based ◽  
Covariate Data ◽  
Self Rated Health ◽  
Measurement Protocol ◽  
Sleep Logs ◽  
Hispanic White ◽  
Difficulty Walking

Abstract Few epidemiologic studies have examined device-measured sitting patterns by demographics and health status. The Adult Changes in Thought (ACT) study is an on-going epidemiologic study of adults age ≥65 years. We conducted a sub-study that added a thigh-worn activPAL device and sleep logs for 7 days to the measurement protocol. A total of 997 had valid wear time (≥4 days with 10-20 hours of data per day) and covariate data. activPAL sedentary pattern measures included number of sitting bouts lasting 30 minutes or more and mean sitting bout duration. On average, participants (56% female, 57% > age 75, 89% non-Hispanic white) sat in bouts lasting 17 minutes (SD = 12) and had 5.9 (SD = 1.7) bouts of sitting lasting 30 minutes or more. Participants who were older, were male, had obesity, had worse self-rated health, had depression, and had difficulty walking had longer sitting bouts and more prolonged bouts.

Evaluating a Model of Service Integration for Older People with Complex Health Needs

2005 ◽  
Vol 4 (1-2) ◽  
pp. 34-41 ◽  
Author(s):  
Steve Bird ◽  
William Kurowski ◽  
Gillian Dickman
Keyword(s):  
Health Care ◽  
Older People ◽  
Service Integration ◽  
Evaluation Process ◽  
Target Population ◽  
Multiple Chronic Conditions ◽  
Health Care Needs ◽  
Care Needs ◽  
Community Based ◽  
Quantitative And Qualitative Methods

Background Older people with multiple chronic conditions and complex health care needs require a comprehensive, accessible and well-coordinated system of services. To address this growing problem, a consortium of acute and community-based health care organisations implemented a ‘Patients First’ model of service integration for the target population. The project evaluation utilised a combination of quantitative and qualitative methods in an action research framework. Findings The evaluation process not only demonstrated the benefits of the project to patients and the health care system, but also contributed to the identification of pivotal components in the model, aspects requiring attention and consequently their refinement. It was also a vehicle for the development of a sense of ownership amongst staff and has evolved into an integral part of the model.

Evaluating the Impact and Effectiveness of Community-Based Health Insurance Policy Among Informal Sector in Lagos State Using Donabedian Model

2021 ◽  
Vol 5 (2) ◽  
pp. 65-80
Author(s):  
Afeez Kolawole Shittu ◽  
Kikelomo Aboyowa Mbada ◽  
Temitayo Isaac Odeyemi
Keyword(s):  
Health Insurance ◽  
Informal Sector ◽  
Urban Areas ◽  
National Level ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Healthcare Needs ◽  
Lagos State ◽  
Donabedian Model ◽  
The Impact

The study used the Donabedian model (process, structure, and outcome) to evaluate the impact and effectiveness of the Community Based Health Insurance Scheme (CBHIS) among informal sector population in rural and semi-urban areas of Lagos State, and the respondents were drawn among the market men and women, motorist, among others. Three hundred and eighty-four (384) respondents were sampled based on the research advisor's sampling size. Lagos State is stratified along with its three senatorial districts and a local government each is purposively selected based on the full implementation of CBHIS. Data were analysed using descriptive and interferential statistics and the result revealed that 55% of respondents attested to the effectiveness of CBHIS in drastically reducing the cost of medical services and enhancing equal accessibility for healthcare needs. On the other hand, the implementation of CBHIS has no significant impact on healthcare service delivery due to the unfriendly attitude of healthcare providers towards the beneficiaries. The study concluded by providing information on the outcomes of CBHIS implementation at the sub-national level of government in Nigeria and suggest ways of improvement.

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