bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing the outcomes of day hospital care for older people: A review of the literature
Authors: Bentley Jane , Meyer Julienne , Kafetz Kalman
Published: September 2011

The current policy context demands that health service providers demonstrate that services are effective, efficient, value for money and of good quality. Recent Government interest in intermediate care has increased pressure on day hospitals in particular to supply such evidence, because they face competition for their core services (such as rehabilitation care) from other community‐based providers. This review was conducted as part of a small study to evaluate a day hospital service in North London. Findings suggest that the outcomes of day hospital care are especially difficult to appraise because of the highly variable nature of both individual facilities and the needs and capabilities of patients attending. Traditional quantitative methods, such as randomised controlled trials or the use of standardised tools to assess treatment outcomes, face severe methodological problems owing to this variability. Three problems in particular would appear to hamper such research: comparability difficulties, owing to great variations in facilities and patient profiles; defining outcomes, because varying need may result in very different intended treatment outcomes, and determining complete costs, because patients rarely receive day hospital treatment in isolation from other health and social care services. The review suggests therefore that future researchers take a more user‐focused and qualitative research approach to the evaluation of day hospital care, such as by evaluating joint care plans with patients and staff, by assessing costs, by following small numbers of users through treatment and by studying users' and carers' views of (and preferences for) care.
Loneliness in later life: Preliminary findings from the Growing Older project
Authors: Victor Christina , Scambler Sasha , Bond John , Bowling Ann
Published: September 2011

Loneliness is consistently presumed to be a specific ‘social problem’, which accompanies old age and growing older. Ninety per cent of the general population of Britain feel that loneliness is particularly a problem associated with old age. Data concerning the prevalence of loneliness amongst the population aged 65 and over are provided from a quantitative survey of 999 people across Great Britain using a special module commissioned from the ONS Omnibus survey. The overall self‐reported prevalence of loneliness shows little change in the post‐war period and challenges the stereotype that the problem of loneliness and isolation has become more prevalent. Socio‐demographic and health factors were associated with loneliness but contact with family and friends was not. Both quantitative and qualitative data sets illustrate the importance of loss as a theme underpinning experiences of loneliness. Further analysis of these data offers the potential to develop a better understanding of what loneliness really is, what it means to those who experience it may offer the potential to develop interventions and strategies to ‘protect’ older people from this problem.
Self‐talk versus needs‐talk: An exploration of the priorities of housebound older people
Authors: Baldock John , Hadlow Jan
Published: September 2011

This article argues that the material and social circumstances of older people living with disabilities mean that their priorities and subjective evaluations of quality of life are likely to be categorically different from those used by service provider organisations. Based on a qualitative study of a purposive sample of older people, who are over 75 and have recently become housebound as a result of disability, the paper describes two modes of understanding: ‘Self‐talk’ and ‘Needs‐talk’. It is suggested that these two modes are to an extent irreconcilable and limit the degree to which care assessments and care‐management can satisfy users.
Staying stronger longer
Authors: Sobczak Julie
Published: September 2011

A growing interest in exercise and life‐style for older people is helping to debunk old myths that reinforce negative attitudes and beliefs, such as that ‘older people should take it easy’ and ‘exercise is for young people’. The promotion of physical activity for older people is the responsibility of many agencies, but health professionals and carers involved in their day‐to‐day care have a unique opportunity to influence older people's lives in a positive way. The research speaks for itself; people who exercise regularly are more likely to maintain bone and muscle mass, stamina, power and suppleness.
Older people in deprived areas: Perceptions of the neighbourhood
Authors: Scharf Thomas , Phillipson Chris , Smith Allison , Kingston Paul
Published: September 2011

Neighbourhoods contribute significantly to shaping their residents' identities. The neighbourhood may be even more important for older than younger people and has been associated with intensification of feelings about locality and space. In the context of a study that examines the concerns of older people living in areas of England characterised by intense social deprivation, this article explores older people's perceptions of the local environment. Early findings are reported from a survey of older people (n=600) conducted in nine socially deprived neighbourhoods of three cities. The article addresses older people's views in relation to positive and negative aspects of their local environment and the degree to which people regard their neighbourhood as a good place in which to grow old. Three key themes are highlighted: older people's attachment to their neighbourhood, variation between areas, and the impact of place on the quality of older people's daily life.
Morale and quality of life among frail older users of community care: Key issues for the success of community care
Authors: Patmore Charles
Published: September 2011

Many social services departments have successfully developed services which meet older people's physical survival needs so that they can continue living in their own homes despite serious disabilities. An emerging priority is to support the morale and quality of life of the same individuals.Assisted by the Social Policy Research Unit (SPRU), a team of social services managers conducted a programme of interviews designed to obtain the views of very old, frail home care clients about their services and their lives in general. A few interviewees expressed very low morale and this seemed to reduce substantially their ratings of satisfaction with the help they received. While it is well established that disability and isolation are linked to depression in older people, it is rare that service providers systematically address these problems. Some practical strategies for this purpose are proposed as a result of this survey.
Advisers, advocates, counsellors and mediators in elder abuse casework
Authors: Craig Yvonne
Published: September 2011

Complex conflicts in elder abuse, its causes, typology, protection and prevention, suggest that co‐operation by multi‐disciplinary social services should be a major consideration in policy decision‐making, planned intervention and support. Casework of the Elder Mediation Project (EMP for empowerment), and related agencies, provides some practical evidence for this view. There are shared casework values and similar as well as different skills. However, when service user interests are paramount, the professional concerns of service providers for defined roles and boundaries raise ethical issues. Are there conflicts between old people's needs for trusting, confidential relationships with one worker, and case co‐ordinators' promotion of varied specialist input? Could approaching elder abuse through a multi‐skilled key worker, as well as by multi‐disciplinary social service workers, offer complementary and co‐operative interventions? Brief anonymised case notes suggest that practitioners may face professional conflicts about social intervention as casework diversifies and service user involvement in decision‐making increases, but some guidelines to good practice are offered.
Committed to caring: Carer experiences after a relative goes into nursing or residential care
Authors: Seddon Diane , Jones Kate , Boyle Mari
Published: September 2011

This article presents the key findings from a collaborative study about the experiences and support needs of carers whose relatives are admitted into a nursing or residential care home. Drawing upon data from carers' qualitative accounts, it considers carers' post‐admission roles, responsibilities and profiles, and the contribution carers make to the continued care of their relative. Carers' post‐admission caring experiences are described in detail and differences between spouse carers and carers involved in looking after a parent are identified. A temporal model depicting the complex and dynamic nature of carers' postadmission experiences is presented. The implications for policy and practice are discussed.
Breaking the death taboo — Older people's perspectives on end‐of‐life decisions
Authors: Vandrevala Tushna , Hampson Sarah , Chrysanthaki Theopisti
Published: September 2011

The greater availability of life‐sustaining technology, such as cardiopulmonary resuscitation, and the medical, legal and moral pressures to use them, often enable the prolongation of lives of older people. The dying process can be extended regardless of quality of life. Further, there is much public debate on the increasing emphasis on individual rights and personal autonomy in the dying process. This qualitative study examined older people's perspectives on end‐of‐life decision‐making and advance care planning. A sample of 12 older people living in the community was recruited and studied in‐depth. A semi‐structured interview explored patients' conceptualisations of decision‐making in the later stages of life and the significant others they would like involved in the process. The data were analysed using ‘content analysis’. The resulting broad categories, themes and sub‐themes formed the foundation of an emerging model of older people talking about end‐of‐life care. Finally, results were discussed with regard to practice and policy development.
In defence of care: The importance of care as a positive concept
Authors: Rønning Rolf
Published: September 2011

This article is about the implications of the different uses of the concept of care in the research and debate on home care. It can be read as a comment on the British debate, seen with Norwegian eyes, and from a starting point where care is a positively loaded concept. The article begins with a definition of care, in order to try to identify some core elements, and then proceeds to examine two main lines of attack on care in the British debate. A distinction between care as an ideal and as practice is introduced, and the article tries to demonstrate how the outcome of caring can be seen as a result both of political attitudes and of different forms of organisation. The article concludes by discussing why we need to save ‘care’ as a positive concept in the evaluation of formal systems providing care as a social service.
Intermediate care: The potential for partnership
Authors: Andrews JoyAnn , Manthorpe Jill , Watson Roger
Published: September 2011

Intermediate care is emerging as performing an increasingly‐significant function in bridging the care gap between hospital and home. It does not emerge from a policy or service vacuum. Relationships between statutory health and social care services and the voluntary sector have their roots in past practices and separate agendas. The findings from this study indicate that any partnership between the statutory and voluntary sectors in delivering packages of intermediate care will inevitably encounter challenges associated with multi‐level, multi‐professional and multi‐agency collaboration. This article explores these challenges and provides some insight on how to meet them.
The social and policy implications of non‐heterosexual ageing ‐ Selective findings
Authors: Heaphy Brian , Yip Andrew , Thompson Debbie
Published: September 2011

This brief paper presents selective findings from a project that explored the issue of ageing in a non‐heterosexual context, and the implications for social policy. The study generated studied the life circumstances of lesbians, gay men and bisexuals aged between the fifties and eighties, and generated prospective and retrospective data on non‐heterosexual ageing. There are diverse definitions and meanings of ‘old age’ among participants, and a range of possibilities exist for how ageing is negotiated. The participants acknowledged that ageing generally affects their self‐perception and the ways they live. The research documented a range of experience in terms of confidence in sexual identity and financial security. While a high proportion of the sample lived alone, many were in couple relationships. Relationships with families of origin, partners, and especially friendships, were considered important. Very few participants had made plans for old age or health crises, and only a small proportion believed that health professionals were positive towards their sexuality. Most considered care/residential homes as an undesirable housing option for old age. Most would like housing and support services to be gay‐friendly, but they were generally not confident about this prospect. The participants generally believed that they were discriminated on the basis of sexuality, and that older non‐heterosexuals were an invisible constituency to policy makers and service providers.
Older people and research partnerships
Authors: Tetley Josephine , Haynes Lorna , Hawthorne Maud , Odeyemi Joe , Skinner Jeanne , Smith Dora , Wilson Vanlis
Published: September 2011

Increasing consumer consultation is a priority for those involved in health and social care research and practice, with promoting greater public participation being widely accepted as ‘a good thing’ (Reason, 1994: 3). However, whilst such consultation may improve the quality of research and practice, there is a need to recognise the considerable investment of time and energy that is required for success (Baxter et al., 2001). Given the extra resources needed, it is important to understand how consultation and user involvement can work to benefit all parties.This paper describes our experiences of working together on a research project exploring people's involvement in decision‐making processes when using care services in later life. When we started the project in March 2001 each of us could draw on a range of experiences that we hoped would make a valuable contribution. We have now worked together for over two years and this paper describes how our combined efforts have not only enhanced the overall quality of the research but also had personal benefits that we did not anticipate when we started out.
Working with older women in research: Some methods‐based issues
Authors: Warren Lorna , Cook Joe , Clarke Norma , Hadfield Pat , Haywood‐Reed Pam , Millen Lilieth , Parkinson Movania , Robinson Judy , Winfield Winnie
Published: September 2011

Commentators have highlighted the growing political and research interest in user involvement, with particular reference to social policy (Kemshall & Littlechild, 2000). Beresford (2002) has noted the tendency to present it as a ‘good thing’ pointing out, however, that it has both liberatory but also regressive potential. At the same time, Barnes (2001) has illuminated the limitations of ‘mainstream’ theory and practice in user participation in their failure to accommodate emotional experience, storytelling and diverse debates, as well as to develop more creative ways of working.This paper describes elements of the above as part of a critical reflection on the experiences of working with older women from a range of communities in research. The focus is on the practicalities of setting up and carrying out the research, though implications for the process of policy‐making are also briefly highlighted.
Developing partnerships at 67 Birch Avenue Nursing Home: The Support 67 Action Group
Authors: Davies Sue , Darlington Elizabeth , Powell Ann , Aveyard Barry
Published: September 2011

This article describes a partnership project between staff, residents and relatives at a nursing home for older people with dementia, and researchers at the University of Sheffield. The aim of the partnership is to develop care within the home and to create a positive environment for living, working and learning. The main principle guiding our work is the need to ensure that all participants: residents, relatives and staff, feel that they are valued members of the community. The project is using an action research approach and a range of methods, including: observation; interviews; questionnaires; process recording of meetings; and focus groups, to gather evidence about the research process and impact of the project. The article includes a summary of achievements to date and suggestions for future activity.
Involving older people in research to examine quality of life in residential aged care
Authors: Edwards Helen , Courtney Mary , O'Reilly Maria
Published: September 2011

This article describes a research study conducted in Brisbane, Australia, that sought to establish older people's views on what contributes to their quality of life in residential settings. Focus group interviews were used to explore the key aspects of residential life that equated with a high‐quality experience. A number of key themes were identified, particularly relating to issues about autonomy, control and staff‐resident interactions. The article concludes with recommendations for those working in, or providing, residential care.
Subjective age perceptions in the UK: An empirical study
Authors: Sudbury Lynn
Published: September 2011

The number of years a person has lived is a poor indicator of their self‐perceptions, attitudes and behaviours. For these reasons, gerontologists have looked to alternative measures of age, including self‐perceived or subjective age. While American researchers have built up a body of knowledge pertaining to self‐perceived age for more than half a century, little is known about the concept in the UK. This paper presents the findings of an empirical study into the self‐perceived age of a group of UK citizens (n = 356) aged 50‐79 (mean age 60.2 years). Using the cognitive age scale, respondents were asked how old they perceived themselves to be on the dimensions of feel, look, act and interests. Overall, respondents indicated a self‐perceived age of more than 10 years younger than their chronological age. These results suggest that the phenomenon is at least as extensive as in the US, where it is frequently argued that youth is valued over age. Policy and practice implications are discussed.
Age does not come alone: Identifying and implementing older people's views of quality in home care services
Authors: Raynes Norma , Coulthard Lydia , Glenister Charlotte , Temple Bogusia
Published: September 2011

This paper describes a study that explored older people's views and priorities on what made for quality in home care services, ways of accessing these and enabling them to become part of mainstream service monitoring. It took place in a city in the north of England, in 2000. The research was funded by the Joseph Rowntree Foundation. Older people's definitions of a quality home care service go outside the service boundaries that are set by social service departments who define the quality specifications for home care services and commission them. Older people had a joined‐up perspective of what contributes to quality in a home care service including, for example, in their definitions of a quality service: access to transport to get out of the house, aids, adaptations and health care. They emphasised the importance of domestic help, which has been reported in other studies. To obtain information on their definitions of a quality service older people were offered the choice of a home‐based interview or participation in a focus group. Following the collection of the data on quality a round table discussion was arranged. The purpose of this was to explore how older people's views on the quality of home care services could become part of routine monitoring, to shape further development and assist in commissioning. Older people who had participated in the first part of the study were invited to attend this, as were local commissioners, service providers and elected members with executive responsibility for older people's services. The recommendations of this round table are discussed.
Communicating in family aged care dyads Part 1: The influence of stereotypical role expectations
Authors: Edwards Helen , Chapman Helen
Published: September 2011

This paper contends that dysfunctional patterns of communication can develop in family aged care dyads in response to stereotypical role expectations in the caregiving‐carereceiving relationship, thus giving rise to a role predicament of caring. If this argument holds it follows that more productive and effective forms of communication and relationship are dependent upon both members of the aged care dyad understanding the expectations of their role and if necessary reconstructing them. Part 1 of this two part conceptual paper develops the Communication Predicament of Ageing Model to include role expectations. The conceptions are grounded in important conclusions drawn from data contained in a large comprehensive study of older people and their family caregivers. Part 2 of the paper (to be published in the next issue of Quality in Ageing) introduces the health promoting communication model which was developed as a framework for guiding both prevention and intervention strategies to prevent or transform a role predicament of caring.
Communicating interviews: The experience of research with minority ethnic older people in Britain
Authors: Sin Chih
Published: September 2011

Interviewing minority ethnic older people can seem daunting. It is easy for stereotypical views of minority ethnic groups and of older people to lead to pathologising approaches being adopted unwittingly. This article attempts to illuminate several key aspects of conducting interviews with such population groups by drawing partially on the experience of working on a Growing Older project funded by the Economic and Social Research Council of Britain. This project looked at the social network and social support of older people from different ethnic groups in Britain and the relationship between these and their quality of life. The research instrument comprised both structured and unstructured components. Interviews were conducted by a multi‐ethnic team of interviewers speaking a range of community languages. By focussing attention on the interactional nature of interviewing, this article explicates the process of conducting research. Issues pertaining to the choice of language, the use of interpreters, ethnic matching of interviewers and interviewees, the use of standardised instruments and the interview itself as a tool for data‐generation are examined. This article contends that a reflexive approach to methodology can lead to a more robust approach to data by confronting the practical, methodological and ethical issues encountered in doing research with such population groups. The issues raised are not merely in terms of ‘white’ researchers working with ‘non‐white’ respondents, but relate to the improvement of research practice in general regardless of the ethnic background of researcher and respondent.
Crossroads after 50: Approach with care
Authors: Hirsch Donald
Published: September 2011

‘Active ageing’ was once a term associated mainly with a physically active, even sporty, retirement. In recent years, economic and demographic circumstances, together with employment trends, have given it another important meaning. This is the prolonging of work, whether paid or in useful unpaid roles such as grandparenting or community‐based activity. This conception of ageing is not just about people keeping moving to keep healthy, but about continuing to make clear economic and social contributions.
A falls prevention exercise programme in a primary care trust
Authors: Dobrzanska Linda , Crossland Debbie , Domanski Maggie , Towriss Sue
Published: September 2011

The Falls Exercise Prevention Programme for older people was introduced as a new project for North Bradford Primary Care Trust in 2002. The introduction of this new service was in response to an identified need to help reduce the incidence of falls, reduce serious injuries as a result of falling, and help improve and maintain the quality of life for those older people who had been identified as having had a fall or being at high risk of falling. The service was not established to be a front line service but to be incorporated into the falls referral pathway. The exercises undertaken are all evidence based and proven to be effective with this population. However, the Group promotes other aspects of quality of life for older people and promotes a holistic approach including health promotion and education. The group has now expanded to incorporate a ‘Walking for Health’ project; a ‘Walk From Home’ project and a ‘Buddy‐Up’ system. The Group is continually growing and future plans are to incorporate ‘Walks for Fallers’. Evaluation of the service provides information to continually improve and extend the services on offer.
Older adults' beliefs about physical activity and exercise: Life course influences and transitions
Authors: Scanlon‐Mogel Jennifer , Roberto Karen
Published: September 2011

Using a life course perspective, we identified perceived events, transitions and trajectories in older adults' lives that contributed to and inhibited continuous participation in physical activities and exercise at three stages of their lives (ie, young adulthood, middle adulthood, late adulthood). In‐depth interviews with nine men and six women provided an understanding of how societal processes and opportunities, life course roles and transitions and individual meanings of physical exercise influenced the older adults' perceptions of and current participation in physical activity and exercise.
Measures to assess the quality of life for people with advanced dementia: Issues in measurement and conceptualisation
Authors: Thompson Lauren , Kingston Paul
Published: September 2011

With the increase in the development of treatments that aim to improve the symptoms of dementia, more attention is focussed upon the effect that these treatments have on the patient's quality of life (QoL). There are specific challenges to be met in measuring the QoL of a patient who is in the later, more severe, stages of dementia. The main challenge to be met is whether the QoL measure can measure QoL in an individual who is unable to provide a subjective report of his or her own QoL. This paper presents five QoL measures that have been designed or used to measure the QoL of patients with severe dementia who are unable to provide self‐reports and to examine whether these measures are a valid and reliable means of assessing QoL in patients with severe dementia. It was found that all of the QoL measures have moderate to good reliability and validity, but the question still remains that without a subjective account, such as a self‐report from the person with dementia, is the outcome of these QoL measures a true reflection of the patient's QoL?
Dignity and older Europeans: Methodology
Authors: Calnan Michael , Tadd Win
Published: September 2011

This paper describes the methods used within the Dignity and Older Europeans (DOE) Project and in particular the approach involved in developing the bibliographical database, the philosophical methods used in creating the theoretical model of dignity, together with the empirical methods involved in data collection with older people, health and social care practitioners and the younger and middle‐aged adults, will be described.The paper will attempt to provide the reasoning for the chosen methods and highlight some of the difficulties involved in carrying out comparative cross‐cultural research.
Dignity and older people: The voice of professionals
Authors: Ariño‐Blasco Sergio , Tadd Win , Boix‐Ferrer Josep
Published: September 2011

Professionals' views concerning the importance of dignity and how this can best be maintained is important for the planning and provision of appropriate services, especially for older people.Dignity was described as an integral part of being human and closely related to respect. Overall, participants painted a negative image of the lives of older people, although clear distinctions were drawn between fit and frail older people. Indignities associated with old age arose from ill health, dependency, vulnerability, frailty and loss of competence. It was considered that technological advances and information technology had left many older people behind. However, many described working with older people as an enjoyable experience offering variety, intellectual challenge and satisfaction, while recognising that working with older people was often given low status.Professionals identified the following factors as essential to dignified care: promotion of autonomy and independence; a person‐centred and holistic approach; maintenance of identity and encouragement of involvement, participation and empowerment; effective communication and respect. Undignified care was associated with: invisibility; de‐personalisation and treatment of the individual as an object; humiliation and abuse; narrow and mechanistic approaches to care.Policy development and professional education should give greater prominence to dignity and a greater emphasis ought to be placed on living with dignity in old age rather than solely dying with it.
Dignity and older people: The voice of society
Authors: Stratton David , Tadd Win
Published: September 2011

This paper describes the findings from 89 focus groups held with 505 young (13‐39 years) and middle‐aged (40‐59 years) adults in the UK, Ireland, Spain, France, Slovakia and Sweden.There were many similarities across all countries and most differences were between the different age groups, rather than the different countries. Five major themes were identified from the comparative data: views of dignity; old age and ageing; views of older people's lives; across the generations and adding dignity to older people's lives. Many of these findings confirmed those of the focus groups with older people and health and social care professionals. Dignity was important to people of all ages but particularly to older people. Being treated as an individual was critical for the maintenance of dignity. In the participating countries older people were generally treated negatively and undervalued and seen as vulnerable, second‐class citizens.Old age was perceived as a time of physical and mental deterioration, poverty and dependency. Intergenerational activities were important for both individual self‐esteem and the ability to participate fully in society. Suggestions for enhancing dignity included greater public awareness about the dignity of older people and about existing care and support services for them. Health policies should tackle ageism in service provision and the development of standards in health and social care for older people could do much to improve dignity.
The role of professional education in promoting the dignity of older people
Authors: Askham Janet
Published: September 2011

This paper considers the education of social and health care professionals who work with and care for older people. It asks whether education can promote the dignity of older people, how this may be done, what factors may ease or impede the promotion of dignity within professional education, and what part education plays alongside other influences on care practices.Beginning with consideration of research on the nature of professional education, the paper reviews principles of professional education, cultures and methods of teaching and learning and processes of practical apprenticeship. The paper argues that there are a number of challenges to the promotion of dignity within professional education, for example, inconsistencies in development of professional values, curriculum contradictions such as those between education for management and for direct care of older people, the balance between theory and practice and education for practice under changing real‐world conditions.
Care of Europe's older people
Authors: Dayé Gertaud
Published: September 2011

This paper explores dignity from the viewpoint of older Europeans themselves. General recommendations concerning policies for older persons are considered together with commitments included in action plans on ageing, in relation to the question of to what extent these texts can be seen as a means to guarantee the dignity of the older person? The inter‐relatedness of recommendations concerning health, labour market and those on social protection policies are stressed and the impact on the dignity of older citizens highlighted.The use of language is explored, as is the presentation of older persons in the media and advertising and the impact on dignity. The paper also questions whether dignity, or rather the loss of dignity, is experienced similarly by all groups of older persons. Is there a difference for men and women, for persons from ethnic minorities and for persons with a disability who are becoming old?Finally it considers what kind of care we want when we are old ‐ how do we wish to be taken care of once we are no longer able to live fully independent lives in our own homes?
An analysis of allied health professional training in care homes for older people in Glasgow
Authors: Clelland Jeanette , Scott Danny , McKenzie Donna
Published: September 2011

The training of care staff in care homes for older people is important to ensure the maintenance of evidence‐based and effective care. Moreover, training can assist in changing attitudes and promoting improved quality care for residents.To this end the Allied Health Professional (AHP) Care Homes Training Team provides training to care staff throughout the greater Glasgow area. This study sought to elicit service user views and opinions about the team's current provision to assist in informing prospective developments and enhancing future performance. Many of the responses discussed training in general in care homes and so should be of interest to all AHPs and others with an interest in care homes. Ten semi‐structured interviews were undertaken with home management staff, which were thematically analysed. The response rate was 100%. 648 care staff had received training from the team in the ten care homes. However, only 36% of these staff remained employed by the homes at the time of the study. Therefore, only the remaining staff received postal semi‐structured questionnaires. The response rate was 14% for these staff. A range of service users' opinions and views were elicited.Topics covered included: induction training, career progression through training, training records, team training and support provision, changes implemented as a result of training, barriers to implementing training, structure/times/content and delivery of training sessions, training gaps, information and training for managers and appropriate topics for training. Feedback was extremely positive but the study raised wider implications for older people's care in care homes, which merit further research and debate.
Smarter Working in Social and Health care (SWISH)
Authors: Iliffe Steve , Kharicha Kalpa , Goodman Claire , Swift Cameron , Harari Danielle , Manthorpe Jill
Published: September 2011

Successive policy documents concerning older people's health and well‐being have aimed to improve their care, by raising standards and promoting independence. These policies also emphasise the need for research to prevent disability, and reduce admission to hospitals and long‐term care settings. This paper reports an evaluation in progress of a health technology approach designed to achieve these objectives. An ‘expert system’ is described that is intended to improve older people's access to health and social care information, to enable service providers to review the health and social care needs of older people, and to allow planners to assess the needs of whole populations. The paper ends by inviting discussion and responses from readers of this journal.
City Memories: Reminiscence as creative therapy
Authors: Joyce Chris
Published: September 2011

This paper describes and evaluates a recent innovative project in Liverpool that brought together the skills and creative vision of a major national museums group in partnership with the housing action trust. ‘City Memories’ created opportunities for older people to take part in reminiscence activities at the museums and in a large extra care housing setting in the community. Training was provided for community leaders, care home managers and care workers in order to help them apply some of the ideas in their own work. The project looked at outcomes for older people who participated in terms of increased stimulus and sense of well‐being, with a special focus on those with conditions such as stroke and dementia. It is hoped that such work will inspire others to put therapeutic reminiscence into practice in their own settings and circumstances; and that it may be possible at some stage to conduct a more systematic study to test the benefits of this approach in relation to measurable health gain.
What has architecture got to do with dementia care?: Explorations of the relationship between quality of life and building design in two EQUAL projects
Authors: Torrington Judith
Published: September 2011

Two projects in the EQUAL programme explore aspects of the influence of building design on the quality of life of people with dementia. Design in Caring Environments (DICE) examined the quality of life of people in residential care homes in relation to building design features. INDEPENDENT (Investigating Enabling Environments for People with Dementia) is a current project with the aim of developing technologies to enhance quality of life by supporting enjoyable activities. One aspect of INDEPENDENT is an exploration of the interaction between spatial settings and meaningful activity, to highlight factors that support and enable activity and to identify barriers. Findings from both projects suggest that a more creative approach to the management of buildings would enhance the well‐being of residents; under‐use of facilities is common. Meaningful space that supports activity is therapeutic but spaces that give confused messages are common in buildings used by older people. Tools to evaluate buildings have a potential role in the long‐term management of facilities to help identify underused spaces, spatial confusion and barriers to activity. Quality of life was shown to be poorer in buildings that prioritise safety and health; buildings that support activity positively by providing good assistive devices, giving people control of their environment and affording good links with the community have a positive association with well‐being.
Staff perceptions of ageist practice in the clinical setting: Practice development project
Authors: Billings Jenny
Published: September 2011

This study was undertaken in response to the audit requirements for the National Service Framework for Older People Standard 1 ‘Rooting Out Ageism’. The aim of this study was to identify and describe the nature of any age‐discriminatory practice in the clinical setting through the perceptions and experiences of staff working with older people.The study adopted a qualitative approach using focus group design. Six focus groups were conducted with 57 members of staff. An aim of the study method was to isolate consensus areas of ageist practice that would facilitate targeted intervention. To assist this, statements relating to common practice experiences were developed following the first two focus groups. This was used as a discussion tool for the subsequent groups.Perceived ageist practice could be grouped under the following themes:• access to services• communication and attitudes• treatment and care• the role of relatives• resources.On the basis of the findings, greater choice and control for older people need to be key features of the recommendations, through the development of a co‐ordinated development programme involving all stakeholders
The CARE (Combined Assessment Of Residential Environments) profiles: a new approach to improving quality in care homes
Authors: Faulkner Mark , Davies Sue
Published: September 2011

This paper briefly describes the rationale for and the development of the CARE (Combined Assessment of Residential Environments) profiles. The CARE profiles represent a new approach to quality improvement in care homes for older people that seeks to gain the views of residents, relatives and staff, and to use these as a basis for celebrating what works well in a home and identifying areas that need attention. The paper begins with a consideration of the limitations of existing quality initiatives and argues for a model that is more inclusive. Subsequently, the theoretical underpinnings of the CARE profiles, positive events, the Senses Framework, and a relationship‐centred approach to care are outlined. The process by which the CARE profiles were developed is then described and a case study highlighting how they might be used is presented.
The joys and tribulations of partnership working in care homes for older people
Authors: Froggatt K , Davies S , Atkinson L , Aveyard B , Binney S , Kent Y , McCaffrey S , Townend C
Published: September 2011

Partnership working in care homes for older people does happen, but the nature of this approach to improving the care provided in care homes has not been well articulated. Drawing on the experiences of participants (researchers, relatives and care home managers) from three projects the benefits and challenges of partnership working in this care setting are discussed. The benefits of working in partnership extended beyond the specific remit for each project, through the development of closer relationships between people in the care home. The challenges of partnership working derived largely from the process of learning to work together and the practicalities of finding time to invest in projects beyond the normal care demands. Requirements for successful partnership working were identified and included a need for time, a core group of committed participants and preliminary groundwork.
Assessing care home quality using routine regulatory information
Authors: Worden Angela , Challis David
Published: September 2011

Quality is an essential criterion by which care homes for older people are judged. However the measurement of quality is both challenging and potentially costly. This paper examines the potential of using routinely generated data from inspection processes as quality indicators. It indicates that generation of such information is possible, providing material that may be used in research and also for more general guidance.
Competition and choice in the care home sector for older people: A case study of the market in Surrey
Authors: Knibb Wendy
Published: September 2011

Competition in the care home sector for older people is encouraged as a means of increasing efficiency, driving down prices and raising quality. Choice is promoted to meet user expectations of healthcare and to improve service provision. The purpose of this study is to consider the evidence of care home provider competition and enhanced user choice through analysis of a discrete market area in the south of England. Data were collected from care home directories compiled by the National Care Standards Commission and the inspection reports on care homes. Longitudinal changes to the structure of the care home market are analysed from 1999‐2003. Choice is investigated with reference to fees paid and vacancy rates in homes. Results indicate that the Surrey market reflects national evidence. This exemplifies how immediate choice is only realistically available for those with a willingness and ability to pay higher fees.
Transitions to a care home ‐ the importance of choice and control: Seminar report
Authors: Reed Jan , Stanley David
Published: September 2011

This paper reports on a seminar organised as part of an ESRC‐funded series on older people and care homes that focused on the period of transition into a care home and the experiences of older people immediately before and after they made the move. The papers presented suggested that there were ways in which older people could exercise choice and control over the process, but that problems existed, ranging from the ways in which assessment and referral systems were crisis or service led, to how people were supported after their move. This paper outlines these arguments, and concludes that such processes need to be addressed if the quality of care at this difficult period is to be improved.
Improving care transitions of older people: Challenges for today and tomorrow
Authors: Cheek Julianne , Ballantyne Alison , Gillham David , Mussared Jane , Flett Penny , Lewin Gill , Walker Marita , Roder‐Allen Gerda , Quan James , Vandermeulen Suzanne
Published: September 2011

Enabling optimal care transitions for older people remains a key challenge facing policy‐makers and service providers. This qualitative Australian study aimed to provide a comprehensive picture of the factors/issues surrounding care transitions from the perspective of older people and their carers. It documents how supports and services are searched for and gained during the care transition process and the effect of this process on older people and their families. These findings have implications for service provision and policy relating to both assisting older people to age in place wherever possible and facilitating optimal care transitions when they are required.
Professionalising the care of older people: Transforming the workforce
Authors: Eyers Ingrid , Bryan Karen
Published: September 2011

Key to successfully addressing the ongoing transitions being experienced in the care home sector is a transformation of the workforce. This is required in order to respond appropriately to the increasing dependency of older people moving into care homes. This article considers the policy framework surrounding the provision of care services in England and reviews the relevant research into the workforce and the changes needed if the sector is to meet the needs of vulnerable older people living in care homes. Building on present policy and practice, consideration is given to how this change could be achieved.
Flooring as an intervention to reduce injuries from falls in healthcare settings: an overview
Authors: Drahota Amy , Gal Diane , Windsor Julie
Published: September 2011

Background: The ageing population is generating increasing concern over the occurrence and associated costs of falls in healthcare settings. Supplementary to the investigation of strategies to prevent falls, is the consideration of ways to reduce the number of injuries resulting from falls in these settings.Aims: This overview assesses the status of research on flooring in healthcare settings to reduce the incidence of injury resulting from falls.Methods: A comprehensive literature search, carried out in conjunction with a Cochrane Systematic Review on hospital environments for patient health‐related outcomes, identified the available evidence. Searches were also conducted in Medline and Scopus specifically to identify studies on flooring types, falls, and injuries. Reference lists of relevant studies and reviews were scanned and relevant authors were approached for further information.Conclusions: Flooring should be considered as a possible intervention for reducing injuries from falls, however, more rigorous and higher quality research is needed to identify the most appropriate materials for use.