Health informatics for older people: a review of ICT facilitated integrated care for older people

Growing demands on welfare services, arising from expanding populations of older people in many countries, has led policy makers to consider the use of information and communications technologies (ICTs) as a means to transform the cost-effective delivery of health and social care. The evidence for these claims is examined by reporting the main findings of a review of worldwide published literature documenting the adoption of health informatics applications to improve health and social care for older people. It focuses around two dimensions of the UK government's programme for 'modernising' public services, which emphasise the use of ICTs to facilitate the sharing of health and social services information and its potential to foster person-centred approaches to independent living. Findings suggest that there is little evidence that these dimensions have been realised in practice and the perceived incompatibility between them is more likely to produce expensive and ineffective health informatics outcomes.     

An exploration of adopters' views regarding children's ages at the time of placement

This paper describes a project undertaken as part of a masters degree at Kingston University that looked at factors which influence adopters' decisions about the ages of children that they want to adopt. This subject is topical because currently many adoptive parents want to adopt very young children, but many of the children waiting for placements are older. Relevant literature is reviewed to place the project in context and to provide a theoretical perspective on adopters' decision-making on the preferred ages of children at the time of placement. The views of adopters and adoption social workers were sought using questionnaires and semi-structured interviews. The majority of adopters who responded wanted to adopt children who were as young as possible. Adoption social workers who responded reported difficulties finding placements for older children. Data obtained suggests that the strategies designed to encourage adopters to consider adopting older children may have limited effect. In the conclusion, tentative suggestions are made about the implications of this project for adoption practice.     

For the Sake of their Health: Older Service Users' Requirements for Social Care to Facilitate Access to Social Networks Following Hospital Discharge

Facilitating older service users’ requirements for accessto or re-engagement in social networks following hospital dischargeis recognized in social care analysis and policy as criticallyimportant. This is because of the associated benefits for restoringphysical health and psychological well-being. However, it tendsto be a neglected dimension of current social care/intermediatecare. Our paper draws on a qualitative study of voluntary sectorhospital aftercare social rehabilitation projects in five UKlocalities, which focused on addressing this issue. Throughexamining older service users’ feedback and experience,our study confirms the health benefits of social care facilitatingaccess to social networks at this crucial juncture. By providingsensitive interpersonal interaction, advocacy and ‘educational’assistance, social care workers supported older service users’re-engagement in a variety of networks. These included friendship,recreational and family groups, health care treatment programmesand locality based contacts and organizations. As a result,material, interpersonal and health care resources were accessed,which contributed to restoring and sustaining physical healthand psychological well-being. The process of such social carealso emerged as critical. This included ensuring that objectivesreflected service users’ priorities; integrating ‘low-level’home care; offering befriending; and challenging the pre-settime frame of intermediate care.     

Examining collaboration across organizations in an age-friendly community

ABSTRACT

Collaboration among organizations is fundamental to promoting age-friendly environments. This study questions: To what extent do organizations collaborate with other organizations in age-friendly communities to provide services to older adults? This study draws on 48 semi-structured qualitative interviews with representatives of organizations that provide services to older adults in an age-friendly community. Findings demonstrated that organizations can engage in collaboration and cooperation across multiple sectors of service delivery and across multiple types of organizations. Nevertheless, some organizations were not collaborating; older adults receiving services at these organizations may miss opportunities to connect to complementary services that can meet their holistic needs.     

Helping Older People in Residential Care Remain Full Citizens

New Labour’s project of modernization has involved thepromotion of interlocking ideas about active citizenship andnew modes of democratic engagement combining to produce whathas described as ‘participative governance’. Concernsabout legitimacy, a ‘democratic deficit’ and theneed to shift power and responsibility to the ‘citizen’have led to the emergence of a range of new deliberative foraand democratic processes. This has led to debates about howto ensure that social diversity can be represented in the decision-makingprocess. A challenge has been how to engage with the issuesof an ageing population and represent older people in all theirdiversity. In recent years, there have been growing calls toextend advocacy rights to older people living in residentialcare. Mostly, this has been to ensure that as consumers, theyhave a fuller say in how their service is run. Older care homeresidents are service users but, as persons, should not be reducedto this role only; they are also citizens in the broadest senseand should not be cut adrift from debates at the national, localand community levels on issues that concern them. This paperexamines how the moves to bring older people into deliberativedemocratic processes have tended to focus on those in their‘Third Age’. Those in institutional settings, beingin the ‘Fourth Age’, occupy a much more marginalposition. This effective disenfranchisement is yet another reasonwhy, for many, the move into residential care—a difficulttransition for a variety of reasons—becomes regarded asthe ‘last refuge’. It contributes to the sense ofloss of identity, lowering of self-esteem and a reduced senseof personhood. This article accepts that there should be moreeffective involvement of care home residents in decision makingabout their personal care. However, there are dangers in adoptinga too narrowly consumerist approach. This can reinforce a reductionistview of care home residents simply as ‘service users’—aform of ‘othering’ in itself. As citizens and membersof a wider community, they should be included in consultationsabout any community and wider political debates that affectthem. Such a proposal implies a widening and deepening of advocacyservices available to this group. As most older people in residentialcare are there following the intervention of a social care professional,then ensuring that they have access to advocacy must surelybe a key task. This paper argues that this is frustrated bythe lack of suitable services. Without a significant investmentby the Government in independent advocacy services, not onlyis the social work task with one of social care’s coreclient groups rendered impossible, but the Government cannotdeliver on its own agenda of empowerment, active citizenshipand inclusion.     

The Single Assessment Process in Primary Care: Older People's Accounts of the Process

Recent government policies have been active in addressing socialinclusion and active participation of older people in many aspectsof societal life. Independence and well-being animate thesedevelopments and are evident in the emphasis on person-centredservices within the single assessment process for older people(Department of Health, 2002b). Drawing on a feasibility study of the Single Assessment Processas a ‘case-finding’ approach, this paper presentsfindings drawn from older people’s accounts of this experience.These accounts indicate the potential of the process for identifying‘low-level’ need, whilst raising issues of accessto formal services and resource constraint; also they underlinethe importance of understanding how older people seek ways ofmanaging their own health and well-being, whilst continuingto contribute to the social cohesion of society by providingsupport to their peers and to younger generations. Interdependence, it is suggested, rather than dependence shouldunderlie any approach to assessing older people’s needs,if we are to appreciate and build upon the complexity of olderpeople’s strategies for actively managing their lives.     

An Aging Workforce in an Increasingly Global World

Summary

The aim of this article is to demonstrate the diversity in delivery of long-term care at the provincial level, within a national legislative framework that provides universal health insurance and public administration. Not all provinces have legislated provision of long-term care, but mandates for provincial long-term care programs typically address the needs of those with chronic health needs and maintain them in the community for as long as possible. Eligibility is based on common criteria of residency, health need, facility, assessment, and consent. The three common components of the service delivery system are institutional care, community-based services, and home-based services; the kinds of services within each component and the mix among them vary from province to province. There are also five common features in provincial service delivery systems: single point of entry, assessment, client classification, case management, and single administration. Throughout the article, examples from different provinces show the varying ways in which these aspects of service delivery have been addressed, and recent innovations have furthered this diversity. A detailed account of quality management systems also shows that while all provinces have adopted a common set of principles, they use a range of methods to pursue quality of care and to promote good practice.     

Raising Self-esteem through Social Networking Intervention for Older Chinese Adults in Hong Kong

Sudden physical changes can take a toll on older adults' self-esteem. Broadening their social support networks is one approach to retaining their self-esteem. This quasi-experimental study aims to test the effectiveness of a social networking program to raise self-esteem. The results from split-group analyses demonstrate that those who maintained active participation exhibited higher self-esteem. The results provide significant implications for future practice, especially to the less-educated males.     

Living with Elder Wisdom

Abstract

This study is based on interview research with over a hundred creative elders. Their spirituality is explored through their life experiences as re-interpreted in later years. Spirituality is often expressed in “non-religious” language. They speak of inner empowerments: cultivating self-esteem, harvesting memories, transformative turning points, life-long learning, themes of humor and gratitude, and encountering mortality. They also explore outward empowerments: developing new purposes, welcoming possibilities, fostering more freedom, cultivating family and friends, forming intentional communities, and taking on larger social causes re peace, justice and ecology. This elder spirituality manifests important changes in their earlier views of religion.     

The increase in marital status differences in mortality up to the oldest age in seven European countries, 1990–99

We investigate mortality differentials by marital status among older age groups using a database of mortality rates by marital status at ages 40 and over for seven European countries with 1 billion person-years of exposure. The mortality advantage of married people, both men and women, continues to increase up to at least the age group 85–89, the oldest group we are able to consider. We find the largest absolute differences in mortality levels between marital status groups are at high ages, and that absolute differentials are: (i) greater for men than for women; (ii) similar in magnitude across countries; (iii) increase steadily with age; and (iv) are greatest at older age. We also find that the advantage enjoyed by married people increased over the 1990s in almost all cases. We note that results for groups such as older divorced women need to be interpreted with caution.