bluuebunny/crossref_metadata_2025 huggingface dataset:
Practical solutions for the integration of community alarms, assistive technologies and telecare
Authors: Doughty Kevin , Williams Gareth
Published: September 2011

The use of telecare with appropriate domiciliary care packages may provide the means to manage many of the risks associated with the increasing number of older people who wish to continue to live independently in their own homes. Those who become especially frail or disabled can retain their independence and quality of life if their homes are made ‘smart’. This paper discusses the range of services that are available, or under development, for the prototype ‘MIDAS’ (Modular Intelligent Domiciliary Alarm System) telecare system, which enable traditional community alarm, telecare and assistive technologies to be used in an integrated and intelligent fashion. A range of services that allow autonomous operation within the home (and hence increase the perceived independence of a client by decreasing the reliance on a response centre operator) known as ‘HAMISH’ may be used. It offers a wider range of cost‐effective services of relevance to both the individual, and to society, in different types of home environment including dispersed housing and new sheltered housing schemes.
Developing partnerships with older people and their family carers: The ÄldreVäst Sjuhärad model
Authors: Magnusson Lennart , Nolan Mike , Hanson Liz , Berthold Harriet , Andersson BengtArne
Published: September 2011

This article describes the aims and philosophy of a research centre focusing on the needs of older people and their family carers in West Sweden (ÄldreVäst Sjuhärad). The Centre aims to promote partnerships between older people, their carers and service agencies in order to improve the quality of life and quality of care. In achieving this aim it has adopted a model of working based on principles taken from a constructivist approach to research and evaluation. The quality or ‘authenticity’ criteria of this approach underpin the Centre's modus operandi and, it is suggested, could from the basis of a more user‐friendly perspective on research.
Approaches to improving quality in nursing and residential homes: Recent developments in Australia and their relevance to the UK
Authors: Bartlett Helen , Boldy Duncan
Published: September 2011

Concerns about quality and standards of care in the nursing and residential home sector have exercised policymakers, managers and practitioners in both Australia and the UK for some years. While Australia is a relatively young country, demographically speaking, it has in place a coherent ‘aged care’ policy. The UK on the other hand, with its rapidly ageing profile, has only recently made a serious policy commitment to the health and social care agenda for older people. Australia therefore has several years of experience to be shared with the UK when it comes to policy and practice of quality improvement. In particular, there are valuable lessons to be learnt from Australia's national outcome standards and monitoring system for care homes, and its more recent introduction of a care homes accreditation system. Apart from identifying any issues associated with the implementation of such approaches to quality improvement, it is important to establish whether they have an impact on the quality of care and life of older residents. As the UK moves to implementing national minimum standards in 2002, lessons from Australia are timely and may help inform best practice and policy in long‐term care in the future.
Caring for a relative with dementia: The perceptions of carers and CPNs
Authors: Pickard Susan , Glendinning Caroline
Published: September 2011

Older people with dementia living in the community are most likely to be cared for by other older people, predominantly spouses, who will be at increased risk of stress‐related health problems themselves. Appropriate support of such carers is crucial if carer breakdown and consequent care‐receiver admission to residential homes is to be avoided. This paper examines the experience of older carers of frail older people with dementia and examines the kind of support that is provided to such carers. In practice, the sole source of professional support received by older people in this study was from community psychiatric nurses (CPNs). CPNs' role did not comprise hands‐on care‐giving and family carers carried out most personal/physical and healthcare tasks themselves, aided in some cases by care workers. The paper concludes by suggesting that lack of support for carers in these activities requires redress.
The coping methods of patients with Parkinson's disease, their carers, and the associations between health‐related quality of life and depression
Authors: Hobson Peter , Leeds Lesley , Meara Jolyon
Published: September 2011

The methods of coping and their relationship to disease severity, cognitive function, depression and health‐related quality of life (HRQoL) were examined in 79 Parkinson's disease (PD) patients and their carers. The coping methods of the PD patients were not associated with disease severity, cognitive function, or depression. In general the majority of correlations were weak. However, patients who used avoidance and cognitive coping methods reported improved HRQoL. Impaired cognitive function, poorer HRQoL and increased disease severity were associated with depression in patients. In carers, avoidance coping was associated with depression and cognitive impairment in the patient being cared for. These findings demonstrate the complex relationship in PD between impairment, quality of life, depression, cognitive function and the coping styles adopted by patients and carers. The study also highlights the difficulties in measuring these interactions with quantitative outcome measures.
Growing Older: An ESRC research programme
Authors: Walker Alan
Published: September 2011

The purpose of this article is to introduce the ESRC's Growing Older Programme and to outline some of the challenges it is facing. I will also put the Programme in context so that its aims, ambitions and potential can be understood. The article opens with a few words about the demographic pressures that overarch this programme and which were influential in its conception.
Quality of life: What, how, why?: The view of healthcare professionals
Authors: McKevitt Christopher , Wolfe Charles
Published: September 2011

Although ‘quality of life’ is thought to be an important concept in healthcare, there is a lack of agreement about what this term means. This paper arises from a study which made the idea of quality of life itself the object of enquiry. We report findings from qualitative interviews with 47 healthcare professionals working with stroke and elderly care patients, which sought their views of the meaning and uses of quality of life. Most defined quality of life in terms of happiness/life satisfaction. Poor health and disability were assumed to reduce quality of life; interviewees represented their work as aiming to improve patient quality of life through improving health. Most regarded formal quality of life measurement as a research tool but not feasible or appropriate in routine care. However, conversations and observations of patients and carers were represented as informal ways of judging patient quality of life, and were generally regarded as a useful or essential part of the therapeutic relationship. Such assessments were said to take place routinely and to provide opportunities for patients/carers to express their wishes, and for ‘real’ patient needs to be identified. This runs counter to evidence of low levels of patient/carer participation in decision‐making and discharge. The real value of the quality of life concept remains unproven but we suggest that in the context of our interviews it was used by professionals to reflect on the nature of the therapeutic encounter and to articulate ideas about healthcare practice.
Spiritual belief and quality of life: The experience of older bereaved spouses
Authors: Coleman Peter , McKiernan Fionnuala , Mills Marie , Speck Peter
Published: September 2011

Spiritual wellbeing is a neglected aspect of quality of life in British research on ageing. US research emphasises the health and other benefits of religious belief for American older people. However, whereas the US is still a strongly religious society, in Britain there has been a steady erosion of membership of Christian churches, accompanied by a loss of respect for the authority of the church and an increased freedom of expression in belief. In an exploratory study the implications of spiritual belief for adjustment have been studied in a sample of 28 older bereaved spouses, who have been followed from the first to the second anniversary of the death. Using a recently developed measure of strength of spiritual belief, a clear pattern was found of greater depressive symptomatology and lower perception of personal meaning among those of moderate belief; ie those who still held to a belief in a spiritual power outside of themselves but who were not sure of its efficacy. Investigation of this group of 11 moderate believers provided many illustrations of spiritual questioning, uncertainty and unease. It appears likely that a substantial proportion of the older population in Britain has become isolated from their churches of origin, yet maintains forms of spiritual belief, often hesitant in character. Some may benefit from renewed contact. Statutory health and welfare agencies need to consider their own role in promoting such re‐engagement.
Listening to the dementia workforce: Local providers' perceptions of dementia services
Authors: Manthorpe Jill , Alaszewski Helen
Published: September 2011

This article reports on the findings of a small research study exploring provision at local level for people with dementia. The study involved a survey of practitioners and managers, and the difficulties of this approach are illustrated and explored. Responses contained a range of relevant opinions about service delivery, particularly perceived levels of quality and adequacy. Those providing care pointed to the unfulfilled potential of services for people with dementia, and their views provide a perspective on the workings of local services and their inter‐relationships. The views of staff may be helpful to the development of planning and quality mechanisms. While they cannot substitute for those of users and carers, they are views emanating from experience and concern.
The Caring in Later Life report: A secondary analysis of the 1995 General Household Survey
Authors: Milne Alisoun , Hatzidimitriadou Eleni
Published: September 2011

Caring in Later Life is a review of the needs and roles of older carers (Milne et al, 2001). It brings together a wide‐ranging review of academic and policy literature with an original meta‐analysis of the 1995 General Household Survey (OPCS, 1995). This paper focuses on the findings of the GHS analysis. The picture of older carers that emerges is significantly different from that of carers overall.It is clear that older carers constitute a large and growing number of the carers and represent an increasingly large proportion of the total number of UK carers. They can be distinguished from other groups of carers in a number of ways: older carers are more likely to live with the person they care for, caring is likely to take place within the context of a long term relationship, dementia is a dominant feature and carers are more likely to be involved in intimate and personal care. Many also have health problems of their own. The analysis confirms a distinction between older carers who offer support on a co‐resident basis and those who are extra resident. There is clearly a high level of devotion to caring amongst many co‐resident carers, with many providing intensive care over long periods of time with little or no support from services. Most of these carers are spouses. The authors suggest that more should and can be done by policy and services to improve the health and quality of life of older carers.
Entry to nursing homes in Taiwan, Republic of China — The role and involvement of families
Authors: Liu Li‐Fan , Tinker Anthea
Published: September 2011

For elderly people the decision to enter an institution is usually the result of complex interactions which involves not only themselves but also professionals and family members. This research concerns the role of families in the decision‐making process over the admission of their elderly relatives to nursing homes in Taiwan. The families' views, including their influence and involvement in the process, were examined. It was found that most elderly people in Taiwan were cared for in their own homes by family members, but under certain circumstances, nursing home entry seemed inevitable. The decision‐making process, mainly within a family context, was influenced by the needs of the elderly people, by their adult children, including their availability, and by perceptions about nursing home entry. The pattern of family care and involvement may change and reasons are suggested for this.
Grief and loneliness in older people: Case study accounts of conjugal bereavement
Authors: Costello John
Published: September 2011

Grief and its concomitant loneliness are common problems in the social process of ageing. Using case study accounts, this paper describes the perceptions of four elderly bereaved people and their experiences of loneliness following conjugal bereavement. Case study accounts provide an opportunity to explore, describe and interpret data that may not yield to a simple analysis. In this paper the accounts include a collection of information on the respondents' experience of loss in the form of ‘durable biographies’ (Walter, 1996) that were typical, revelatory and critical. The respondents took part in semi‐structured interviews about their experiences as part of a larger ethnographic study. This paper reflects on their comments and raises a number of interesting theoretical and practical issues to do with loneliness following conjugal bereavement. The paper points out that bereavement research is dominated by psycho‐analytical conceptualisations which place emphasis on the ‘grief work’ hypoThesis, with less attention paid to bereavement models that highlight the social impact of loss on older people.
Care at home for people with dementia: Routines, control and care goals
Authors: Redfern Sally , Norman Ian , Briggs Kate , Askham Janet
Published: September 2011

The aim of the study was to further our understanding of the nature of care at home for people with dementia, with particular emphasis on routines, control and care goals. Its objective was to examine the nature of care as a form of social organisation in the home of people with dementia whose care was at least partly provided by relatives or friends. Twenty situations were included in which the carers and people with dementia were interviewed. Each participating pair was observed for an average of nine hours.Findings cover the ways in which carers and people with dementia accomplished personal and household care through routines and exerting control, and how they dealt with aspects like setting and matching care goals. Accomplishing care is shown to be a major challenge for people with dementia and their caregivers, yet in most cases participants developed effective coping strategies. Three themes emerged from the findings: handling competing goals or means to goals, controlling the situation and maintaining a preferred sense of self. This study shows that observational research in the homes of people with dementia is feasible and, when combined with conversational interviewing, is valuable in understanding the processes of caring and what it means to live with dementia. The expertise of carers and care‐receivers in managing home care has been identified. Policies and practices that acknowledge such expertise will go some way towards encouraging and helping people to continue, and rewarding them for the vital part they play.
The relationship between the NHS and residential and nursing care for older people: A survey of home owners and managers in East Sussex, Brighton and Hove
Authors: Garvican Linda , Bickler Graham
Published: September 2011

In view of the decline in the number of residential and nursing homes over the last few years, East Sussex, Brighton and Hove Health Authority was concerned about optimum usage of places. This project aimed to ascertain the views of home owners and managers on their working relationship with the health authority, local hospitals and social services.Respondents felt that the incoming residents were generally frailer and more dependent than a few years ago, funding allocations were inadequate, given the standards now expected of care homes, and there were delays of up to a year in reaching agreement. Several indicated that they would no longer take publicly funded clients unless the families could top up the payments. Ten percent of the private residential homes surveyed were for sale or due to close. Between 40 and 50 older people were estimated to be awaiting transfer to EMI or nursing homes in East Sussex. Over 35% of homes complained about inappropriate discharges of their residents from hospital, and a poor standard of nursing care. Communication with hospitals was poor and relationships with the health authority and social services needed strengthening. Routine admissions were appropriate, but hospital discharges may have been premature. Home owners/managers were dissatisfied with their relationship with the NHS. Improvements are needed if partnership working is to be developed.
Is there a future for the informal homecare of older people in a changing society?
Authors: Smith Christine , Snelgrove Sherrill , Armstrong‐Esther Chris , Clark June
Published: September 2011

The objective of the research reported here was to provide an opportunity to raise issues relevant to the ongoing debate on informal care of older people by exploring the attitudes of both men and women towards the care of dependent older people. The sample (n = 174) was drawn from age cohorts 20‐39 years (n = 90) and 40‐59 years (n = 84). The men and women who participated in the study were members of the general public. The self‐administered survey questionnaire was designed to examine attitudes towards the informal care of older people and to determine if men and women differ not only in attitude but also in their willingness to undertake certain aspects of care, and whether the age of the respondent was likely to be a defining factor. Statistical analysis was conducted using SPSS. The results established that an overwhelming majority of women demonstrated a greater willingness to provide care to a dependent older relative.
Assistive technology and its role in housing policies for older people
Authors: Tinker Anthea
Published: September 2011

The term assistive technology (AT) is relatively new but its origins go back a long way. Some of the elements of assistive technology, such as aids and adaptations, have been a feature of policies for many years. Before the late 1990s it was more usual to focus on the most common types ‐ telephones, alarms, aids and adaptations. More recently telemedicine and smart houses have come to the fore in policies and research. What is confusing now is that a variety of other terms are being used. In this paper the development of these terms in recent policies and the changing terminology are traced. It is suggested that a narrow interpretation can play down the important role of AT in enabling older people to maintain their independence but that it must be seen in conjunction with other services, especially housing.
Gauging quality in constructivist research: The Äldre Väst Sjuhärad model revisited
Authors: Nolan Mike , Hanson Elizabeth , Magnusson Lennart , Andersson Bengt‐Arne
Published: September 2011

This article outlines a model for gauging the quality of a partnership approach to research that was developed for use in a Research Centre in West Sweden. The Äldre Väst Sjuhärad Centre has as its main goal the promotion of partnerships between older people and their families, service providers and researchers. In pursuing these goals the Centre adopts a broadly‐constructivist approach to undertaking research that is ‘authentic’ and meaningful to those who take part. In order to make judgements about the quality of its activity the Centre has adapted the authenticity criteria originally suggested by Guba and Lincoln (1989), so that they are more readily understood by older people, carers and service providers. These criteria can be applied at all stages of research activity, and it is suggested here that they can be utilised more widely in order to make inferences about the effects of partnership working in other contexts.
Older people in Wales, their transport and mobility: A literature review
Authors: Windle Gill , Burholt Vanessa
Published: September 2011

Older people are reported to be the largest group to suffer from mobility deprivation. This paper reviews the literature relating to the mobility of older people in the context of transport opportunities and provision. The findings show that older people regard car ownership as an aid to independence and mobility. Car ownership is considered the norm and a necessity in rural areas. However within Wales, older people are more likely to be on a low income and live in a rural area, and are less likely to have a car than the rest of the population. Mobility, hearing and visual problems have a higher prevalence in the older population, rendering the use of public transport problematic. Difficulties include problems with getting on and off buses, difficulties with reading passenger information, missing information and communicating with service personnel. Improved access to public transport for older and disabled people can make a major contribution to the financial and social independence of this large and growing sector of the population (TRL Project Report, 1994) and will further promote the social inclusion of older people into society.
Researching the informal theories of nurses working with older people using a holistic, bio‐psychosocial approach
Authors: Smith Christine
Published: September 2011

This paper presents a research study that demonstrates the inadequacy of the traditional biomedical approach to caring for older people and shows the benefits of using a more holistic, bio‐psychosocial approach. An ethnographic inductive approach was taken. Non‐participant observation was performed on complete episodes of nursing practice, followed by semi‐structured interviews to explore and ratify theories in use. Phase one of the data analysis used qualitative inductive analysis to generate main categories and themes. Phase two was a process of factor isolation, which identified factors of practice theories in use. The themes identified were: nursing therapeutics; preventative nursing; communication; nurse‐patient relationships; collaborative nursing; nursing assessment; decision making; and management of patient care. Further analysis identified that important theoretical factors included: encouraging; responding; comforting; explaining; maintaining ability; judgement in action; and collaborating. This knowledge is embedded in the practice theories of practitioners but it is only by exploring and critiquing these that we can hope to understand the complex nature of nursing practice as it relates to the care of older people.
The impact of falls on quality of life: Empowering older women to address falls prevention
Authors: Weeks Lori , Roberto Karen
Published: September 2011

Although older women are at disproportionate risk of falling and becoming injured, little is known about the effect of falling on their quality of life. In this qualitative study, we examined the perceived causes of falling among older women, identified how older women's quality of life is influenced by falls, and explored how women can be empowered to prevent falls from occurring in their lives. Women who participated in focus groups indicated that the consequences of falling ranged in severity and duration and encompassed physical and psychosocial domains. The women took some ownership of preventing falls in their lives and believed that falls were caused by factors in the physical environment and personal health factors and practices. The results allow us to gain insight into the consequences of falls on the lives of older women, and that older women can influence change by preventing falls from occurring in their lives.
Health needs assessment: Involving older people in health research
Authors: Horne Maria , Costello John
Published: September 2011

This paper reports on an action research study whose aim was to elicit the health needs of older people as part of a wider health needs assessment exercise. The sample consisted of twelve older people (n=12) who lived in East Lancashire. Focus groups were used to identify perceived health needs. The majority of older people in the sample expressed concern about access to primary care, lengthy out‐patient department appointments and poor transport facilities to access health resources. An indirect consequence of their perceived health needs was reduced socialisation due to fear of going out, particularly at night. The findings raise issues to do with developing a more considered view of methods for eliciting the views, beliefs and attitudes of older people about health needs. The study has implications for primary care trusts and statutory services regarding the provision of health care to older people.
The provision of information and advice for older people: What more do they want?
Authors: Raynes Norma , Margiotta Pat , Lawson John , Pagidas Dimitrios
Published: September 2011

The importance of providing clear, relevant information and advice for older people has been recognised by health care professionals, politicians and policy makers. Key policies (Better Government for Older People, 1998; Better Care Higher Standards, 2000; National Service Framework for Older People, 2001) have restated the importance of such provision specifically in relation to older people. A literature search and an examination of local authority websites were key sources of information for the study designed to explore the elements of guidelines for good practice. In addition we examined the websites of three major providers of information and advice for older people. Older people's views as to what constitutes good quality information and advice were explored in three focus groups. These four sources of data are the basis for the findings reported in this paper. This paper reports the limitations in the existing provision of information and advice for older people. Key features emerging from the research were that the involvement of older people in every stage of the process of design, production, dissemination and monitoring of information and advice was necessary. Older people valued face‐to‐face contact in the provision of information and advice.
Growing research with older people
Authors: Mountain Gail
Published: September 2011

It makes sense to involve people in the services being provided for them, with benefits to be gained for all involved. For older people their participation can aid ownership and inclusion, thus promoting citizenship, particularly on the part of those who have previously been excluded (Barnes, 1997).This paper is concerned with the involvement of older people in research into health and social care services. Drawing upon the policy and evidence base, consideration will be made of the different forms that this can take and how best practice regarding the involvement of older people can be promoted.
Building on carers' stories to enrich research: Lessons from a recent study
Authors: Brereton Louise , Dawes Heather
Published: September 2011

This paper provides an account of how family carers were involved in a longitudinal research study that aimed to investigate the needs of ‘new’ family carers of stroke survivors. An account of how the researcher involved carers is provided, followed by one carer's description of the benefits and negative consequences of being involved in the study. Suggestions are made about how to develop good practice with regard to involving people in research. The conclusions highlight that, although rewarding, being involved in research is not without its challenges. However, research participants have much to contribute to the entire research process and its products. It is important therefore to learn lessons about how best to maximise the expertise that carers and others have to offer.
Supporting carers in paid employment: Developing a needs‐led approach
Authors: Seddon Diane , Robinson Catherine , Bowen Shirley , Boyle Mari
Published: September 2011

This paper presents some of the key findings from a study about supporting carers in employment. It describes the qualitative experiences of family carers for older people who are in paid employment, paying particular attention to their views on assessment and service provision. The perspectives of other key stakeholders, including staff from statutory and independent sector agencies, are also considered. Support for carers in employment is one of the five priority action areas underpinning the National Strategy for Carers (DoH, 1999). However, the findings from this study reveal that carers in employment have a limited profile at strategic level and their specific needs are rarely addressed in mainstream health and social care planning processes. The findings also suggest that assessment and care management practices are failing to support carers in relation to their employment aspirations. The effectiveness of health and social care assessments in identifying and exploring the needs of carers in employment is limited and very few separate carer assessments are completed. Carers' first‐hand experiences of service provision are described. Deficits in current services are identified and examples of good practice are highlighted. The paper concludes by outlining the implications for policy and practice. It is suggested that flexible support, underpinned by partnerships between employers and staff from statutory and independent sector agencies, is the key to supporting carers in employment.
Quality in home care for older people: Factors to pay heed to
Authors: Patmore Charles
Published: September 2011

Twenty‐three home care providers were interviewed concerning what promotes or impedes quality aspects of service giving, as defined by older customers ‐ like service from familiar staff or flexible help. The influence of Social Services purchasers and of structures for purchasing care proved notably important. Purchasers affected service quality through the amounts of time that they commissioned and through whether they would purchase help for customers' quality of life as well as for their physical survival. Quality was affected through whether care was purchased through fixed quantities of time or through the fulfilment of specified tasks. Some purchasers controlled details of everyday care giving, which other purchasers left to providers' discretion. Also influential was the attitude of providers themselves to giving miscellaneous occasional help like changing light bulbs, finding reliable private tradesmen or taking customers with them on shopping trips. Some providers readily gave such help and found it unproblematic to do so. Others prohibited it, although this seemed to not always be implemented earnestly. The most marked differences in willingness to give flexible help occurred between different independent sector providers, rather than between independent and Social Services in‐house providers. A third type of influence on quality of home care was ‘economic’ factors like the purchasing power of local home care pay rates within the local labour market, local geography and demography. Some questions are itemised which merit inclusion in any evaluation of the quality of a home care provider.
Duration of stay and outcome for inpatients on an assessment ward for elderly patients with cognitive impairment
Authors: Ball Sue , Simpson Steve , Beavis Diane , Dyer John
Published: September 2011

The move away from the provision of long‐stay beds by the NHS inevitably meant a change in function for wards for elderly patients with cognitive impairment to a more acute way of working. Literature is scarce on the role or effectiveness of the new assessment wards that have replaced them and the factors affecting outcome and the duration of stay. Evidence suggests that those patients with higher dependency levels and behavioural problems stay in hospital longer, as do those awaiting a nursing home placement.This paper reports a prospective study of a consecutive group of 101 patients who died on or were discharged from an acute assessment ward for elderly patients with cognitive impairment. Clinical characteristics were recorded according to an in‐patient dementia care pathway, which included Mini‐MOUSEPAD, Crichton activities of daily living, Mini‐Mental State Examination and the Burvill physical health score evaluations. Outcome measures were duration of stay, destination on discharge or death on the ward.Most patients had cerebrovascular disease (48%) or Alzheimer's disease (32.9%), and their average Mini‐Mental State Examination score was 14.9. The mean duration of stay was 7.9 weeks. Self‐funding status and lack of behavioural and psychological complications were associated with a reduced duration of stay. 22.2% of patients were successfully rehabilitated to their own homes, but 20% died. Discharge home was most strongly predicted by having a spouse at home, and the need for nursing home rather than residential care was related to the severity of cognitive impairment. This study concludes that patients can expect to stay in hospital for 8 weeks but two areas of concern are highlighted. Firstly, the importance of the funding of community rehabilitation for patients with memory disorders and, secondly, the importance of a spouse at home to look after the patient.
Caregiver—carereceiver communication Part 2: Overcoming the influence of stereotypical role expectations
Authors: Edwards Helen , Chapman Helen
Published: September 2011

Part 1 of this paper explored the premise that a role predicament of caring exists within family caregiving relationships. It was argued that dysfunctional patterns of communication develop in family caregiving relationships not only in response to stereotypical expectations about older people but also in response to stereotypical expectations of both caregiver and carereceiver concerning their role in the caregiving relationship. The argument was grounded in data contained within a large comprehensive study of older people and their family caregivers. This paper builds on the earlier contention and holds that more productive and effective forms of communication and caregiving relationships can be promoted through modification of role expectations and behaviours. The Health Promoting Communication Model is introduced and proposed as an appropriate framework for guiding both prevention and intervention strategies for health promoting communication in family caregiving.
A concise alternative for researching health‐related quality of life in older people
Authors: Windle Gillian , Edwards Rhiannon , Burholt Vanessa
Published: September 2011

Researchers have a wide range of tools for health assessments to choose from, some of which can be lengthy and time consuming. The purpose of this paper is to examine a potentially shorter alternative, the EQ‐5D instrument, with a community dwelling population sample of older people. Data was obtained using trained interviewers from a randomly sampled crosssectional survey of community dwelling older people. 423 people aged 70‐99 were interviewed. Information was obtained relating to activities of daily living, the EQ‐5D, the EQ‐VAS, the SF‐36, use of health and social care services and the presence or absence of a limiting illness, disability or infirmity. In terms of construct validity, the EQ‐5D was able to distinguish between hypoThesised differences in the sample that could be expected to reflect differences in health‐related quality of life. The EQ‐5D items correlated well with conceptually similar items. Completion rates for the EQ‐5D items were good, ranging from 98.3‐98.8%. Completion rates for the EQ‐VAS were 98.1%. The results suggest that the EQ‐ 5D may provide a valid measure of health‐related quality of life in a cross‐sectional population sample of older adults, although the emphasis of the scale is very much on physical health and functioning. The results for the depression/anxiety item suggest that additional information may be needed if mental health is of concern.
Do older people who self‐harm receive the hospital care they need?
Authors: Barr Wally , Leitner Maria , Thomas Joan
Published: September 2011

Although self‐harm is most common in younger people in Britain, the risk of suicide subsequent to an initial act of self‐harm is considerably greater in older age groups. Four characteristics have been shown to be associated with increased vulnerability in older people who self‐harm: increased suicidal intent, physical illness, mental illness and social isolation. This paper is part of a broader analysis of all self‐harm presentations to a British hospital accident and emergency department over a five‐year period. It examines the prevalence of these vulnerability indicators in patients aged 65 or over, and considers whether greater vulnerability in older patients is reflected in their clinical management within the hospital and in community support planning on discharge.At the first presentation older patients (n=91) exhibited greater vulnerability than did younger patients (n=2,326). Despite this, we found no evidence that older self‐harm patients were any more likely than younger patients to routinely receive either a psychosocial assessment from a member of staff with specialist mental health training, or community aftercare planning on discharge from the hospital. This study lends weight to recently published national guidelines recommending that all acts of self‐harm in older people be regarded as evidence of serious suicidal intent at the outset.
Readmissions ‐ An evaluation of reasons for unplanned readmissions of older people: A United Kingdom and international studies literature review
Authors: Dobrzanska Linda
Published: September 2011

The measuring of emergency readmission rates to hospital following discharge is one of fifteen health outcomes the United Kingdom government monitors on an annual basis. There is a wide variation between readmission rates, and it is especially important to older people that there is a reduction in unacceptable variations. A closer understanding of reasons for readmission is therefore necessary to inform future developments, identify patients who may be at high risk of readmission and target resources more appropriately. A review of literature from the United Kingdom and international studies may help in determining the reasons for the unplanned readmission of older people. This could then allow for a re‐allocation of resources in the most cost‐effective and cost‐efficient manner. The literature review was conducted via keywords and combination of keyword searches from 1990‐2003 using various electronic databases. There were several themes that emerged from the literature, and these have been described within the paper. Following the review of the literature it emerged that many international studies into the causes of readmission of older people have an inconsistent approach in defining certain terms. However, in the United Kingdom, there appears a more consistent approach. Most studies agree that the majority of readmissions occur as a result of a relapse or complication of an initial illness. However, some American studies associate the readmission of older people with a specific disease, and the antecedent care process. The findings in the literature have identified several gaps that enable recommendations for future research to be made.
Core values in healthcare or why the patient isn't an afterthought
Authors: Campbell Alastair
Published: September 2011

This paper begins by discussing two contrasting approaches to health care. The first approach is that of principlism, which emphasises four universal principles: respect for autonomy; beneficence; non‐maleficence; and justice. The second approach is the ethics of care that emphasise the importance of the relationship between the cared‐for and the one caring, rather than abstract principles. The problems with both of these approaches are highlighted, before arguing that an approach based on virtue ethics is more appropriate and better suited to health care ethics. Finally, by drawing on the conclusions of research undertaken with chronically ill people, the paper explores what this approach might mean for an approach that stresses dignity as a core value in health care ethics.
The four notions of dignity
Authors: Nordenfelt Lennart , Edgar Andrew
Published: September 2011

This paper presents the theoretical model of dignity that has been created within the Dignity and Older Europeans (DOE) Project. The model consists of four kinds of dignity: the dignity of merit; the dignity of moral stature; the dignity of identity; and Menschenwurde.1) The dignity of merit depends on social rank and formal positions in life. There are many species of this kind of dignity and it is very unevenly distributed among human beings. The dignity of merit exists in degrees and it can come and go.2) The dignity of moral stature is the result of the moral deeds of the subject; likewise it can be reduced or lost through his or her immoral deeds. This kind of dignity is tied to the idea of a dignified character and of dignity as a virtue. The dignity of moral stature is a dignity of degree and it is also unevenly distributed among humans.3) The dignity of identity is tied to the integrity of the subject's body and mind, and in many instances, although not always, dependent on the subject's self‐image. This dignity can come and go as a result of the deeds of fellow human beings and also as a result of changes in the subject's body and mind.4) Menschenwurde is the universal dignity that pertains to all human beings to the same extent and cannot be lost as long as the person exists.
Dignity: The voice of older people
Authors: Bayer Tony , Tadd Win , Krajcik Stefan
Published: September 2011

This paper reports the findings of 89 focus groups and 18 individual interviews (involving 391 older people in 6 European countries) that were held to explore how older people view human dignity in their lives. Participants were all aged over 60 years and 25% were aged 80+ years. They were from a range of educational, social and economic backgrounds. 72% were women and 17% were living in residential or nursing homes.There was substantial agreement about the meaning and experience of dignity in older people's everyday lives. It was seen as a highly relevant and important concept, enhancing self‐esteem, self‐worth and well‐being. Three major themes were identified: respect and recognition; participation and involvement; and dignity in care.The theoretical model of human dignity developed in the project was reflected in many of the findings from the empirical data. Of particular importance and relevance was the notion of ‘dignity of personal identity’, not least because it is perhaps most vulnerable to the actions of others. Menschenwurde (expressed as the innate dignity of human beings) was also important.For dignity of older people to be enhanced, communication issues, privacy, personal identity and feelings of vulnerability need to be addressed. Education of all professionals should pay attention to practices that enhance or detract from the experience of dignity. Policies and standards need to go beyond the merely mechanistic and easily quantifiable, to identify meaningful qualitative indicators of dignity in care.
Educating for dignity
Authors: Tadd Win , Dieppe Paul
Published: September 2011

This paper describes the creation of the educational materials developed as part of the Dignity and Older Europeans Project. Following a discussion of the development process, the materials themselves are described. The materials includes a poster of the dignity balance, which contains five core messages and illustrates the impact of both enhancing and violating individual dignity. The second product is a leaflet that also includes the dignity balance and lists of actions and approaches that will promote dignity or result in indignity. The final product to date is a multidisciplinary workbook which is described in some detail. The workbook Educating for Dignity provides a brief outline of the theoretical model of dignity, and four different sections based on the empirical findings:• understanding dignity• old age ‐ what is it like to be an older person?• dignity in care• the impact of the system.In each section quotations from participants, supplemented with images and cartoons, are used to illustrate various aspects of dignity. Readers are then set exercises to promote reflection about the issues raised. The workbook also contains a discussion of the exercises, an extensive bibliography and some policy implications. Finally, dissemination and use of the materials are explored.
Dignity and the older European: Policy recommendations
Authors: Edgar Andrew , Nordenfelt Lennart
Published: September 2011

The Dignity and Older Europeans Research Group has produced a series of recommendations on policy. We propose that these recommendations should be considered by European legislators, national governments, professional organisations and all institutions and practitioners who provide services for older citizens.Our policy recommendations are inspired by the data gathered from focus groups, as well as by the theoretical reflections on the concept of ‘dignity’. This article introduces four core policy recommendations. The first reflects the rights of the older person, the second calls for the removal of ageism and ageist practices; the third concerns the regulatory frameworks needs in service provision and the fourth reflects the welfare entitlements of older people.
Longer working: Imposition or opportunity? Midlife attitudes to work across the 1990s
Authors: Ginn Jay , Arber Sara
Published: September 2011

Population ageing has intensified the need to maximise employment rates among those aged 50‐69, yet the perspective of midlife men and women themselves concerning employment and retirement, and how these may shift in response to policy trends, is little understood. The research analyses attitudes to employment among British midlife men and women, focussing on changes during the 1990s.Data from the British sample of two cross‐sectional surveys of the International Social Survey Programme, 1989 and 1997, that provide information on work orientations, are used to measure differences between two cohorts in the same age groups.Where there were differences between the two cohorts, some indicated less positive orientation towards employment. Thus the perceived importance of work declined significantly across the 1990s. However, the later cohort showed a slightly less instrumental attitude to work than the earlier, explained by their longer education. Those who were employed were more likely to show work commitment, valuing a job irrespective of financial need, compared with those who were not employed. Among employed men, those in the later cohort were less likely to think their job was secure or their pay high, compared with the earlier cohort.