Trends over the past 15 years in long-term care in Switzerland: a comparison with Germany, Italy, Norway, and the United Kingdom.

BACKGROUND: The demographic changes affecting Switzerland and other European countries, including population ageing, will continue to challenge policymakers in building accessible, affordable, comprehensive and high-quality long-term care (LTC) systems. The purpose of this paper is to investigate how Switzerland's LTC system compares to other European countries, in order to inform how to respond to the increasing need for LTC. We carried out a descriptive study using secondary data from key national and international organizations. METHODS: By comparing the financing, workforce, service delivery and need for LTC in Switzerland, Germany, Italy, Norway and the United Kingdom, we described similarities and differences in these five European countries between 2005-2019. Thirty-three indicators within five domains were analysed: (1) Population statistics and health expenditure, (2) Need for LTC, (3) LTC financing, (4) LTC service delivery, and (5) LTC workforce. RESULTS: Switzerland has the highest life expectancy in comparison to the other four high-income countries. However, similarly to other countries, the years lived with disability are increasing in Switzerland. Switzerland's public expenditure on LTC as a share of GDP is lower than that of Norway and Germany, yet out-of-pocket expenditure on LTC is highest in Switzerland. Switzerland has the highest proportion of persons receiving formal LTC both in institutions and at home. Switzerland has had the most pronounced increase in the proportion of over 65-year-olds receiving LTC at home. Even though more than fourfold more persons receive care at home, Switzerland still has more workforce in LTC institutions than in home-care. In comparison to Germany and the UK, Switzerland has a lower number of informal carers as a proportion of 50-year-olds and over, as well as fewer nationally available services for informal carers compared to Germany, Italy, Norway and the UK. CONCLUSIONS: Our comparative study corroborates the importance of improving the affordability of LTC, continuing to support the movement towards home care services, improving the support given to both the professional workforce and informal carers, and improving the amount and quality of LTC data. It also provides a valuable contrast to other European countries to support evidence-informed policymaking.

Rehabilitation in primary care for an ageing population: a secondary analysis from a scoping review of rehabilitation delivery models.

BACKGROUND: The world population is ageing rapidly. Rehabilitation is one of the most effective health strategies for improving the health and functioning of older persons. An understanding of the current provision of rehabilitation services in primary care (PC) is needed to optimise access to rehabilitation for an ageing population. The objectives of this scoping review are a) to describe how rehabilitation services are currently offered in PC to older persons, and b) to explore age-related differences in the type of rehabilitation services provided. METHODS: We conducted a secondary analysis of a scoping review examining rehabilitation models for older persons, with a focus on PC. Medline and Embase (2015-2022) were searched to identify studies published in English on rehabilitation services for people aged 50 + . Two authors independently screened records and extracted data using the World Health Organization (WHO)'s operational framework, the Primary Health Care Systems (PRIMASYS) approach and the WHO paper on rehabilitation in PC. Data synthesis included quantitative and qualitative analysis. RESULTS: We synthesised data from 96 studies, 88.6% conducted in high-income countries (HICs), with 31,956 participants and identified five models for delivering rehabilitation to older persons in PC: community, home, telerehabilitation, outpatient and eldercare. Nurses, physiotherapists, and occupational therapists were the most common providers, with task-shifting reported in 15.6% of studies. The most common interventions were assessment of functioning, rehabilitation coordination, therapeutic exercise, psychological interventions, and self-management education. Environmental adaptations and assistive technology were rarely reported. CONCLUSIONS: We described how rehabilitation services are currently provided in PC and explored age-related differences in the type of rehabilitation services received. PC can play a key role in assessing functioning and coordinating the rehabilitation process and is also well-placed to deliver rehabilitation interventions. By understanding models of rehabilitation service delivery in PC, stakeholders can work towards developing more comprehensive and accessible services that meet the diverse needs of an ageing population. Our findings, which highlight the role of rehabilitation in healthy ageing, are a valuable resource for informing policy, practice and future research in the context of the United Nations Decade of Healthy Ageing, the Rehab2030 initiative and the recently adopted WHA resolution on strengthening rehabilitation in health systems, but the conclusions can only be applied to HICs and more studies are needed that reflect the reality in low- and middle-income countries.

Perceived barriers and facilitators to good end of life care: Focusing on people with intellectual disabilities.

BACKGROUND: People with intellectual disabilities are often left out of research on important topics. This exploratory study investigated their views on barriers and facilitators to accessing care at end of life, both at home and in a hospice setting. METHOD: This qualitative study used reflexive thematic analysis. Two focus groups were held via Zoom with a total of four participants. RESULTS: Three themes were produced: Unsettling Transitions, Maintaining Familiarity, and Respecting People's Wishes. Keeping things as unchanged as possible at end of life was highlighted as an ideal. Respecting people's wishes and education were highlighted as facilitators to good end of life care. CONCLUSIONS: The themes identified in this study highlight the fears and wishes of this population with regards to receiving quality end of life care. Training for staff and families, as well as advanced care planning, could focus on enhancing facilitators and decreasing barriers for this population.

Rehabilitation delivery models to foster healthy ageing-a scoping review.

Introduction: Rehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing. Methods: We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models. Results: Out of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of person-centred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent. Conclusions: Focusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings.

Are healthy ageing trajectories suitable to identify rehabilitation needs of the ageing population? An exploratory study using ATHLOS cohort data.

BACKGROUND: The ageing process is highly heterogeneous leading to diverse ageing trajectories. Such trajectories have been modelled to study trends and determinants of ageing and could potentially be used to inform the planning of rehabilitation services at population level. The objective of this paper was to explore whether healthy ageing trajectories are suitable to identify targets for rehabilitation interventions for the ageing population. METHODS: Data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) harmonized cohort and the English Longitudinal Study of Ageing (ELSA), which is included in ATHLOS, were used. Growth mixture models were implemented to replicate healthy ageing trajectories modelled elsewhere as 'high stable', 'low stable', and 'rapid decline'. Regularized partial correlation networks were used to estimate expected-influence and bridge expected-influence centrality measures. RESULTS: Healthy ageing trajectories modelled with ATHLOS (N = 131116) and ELSA (N = 14904) were consistent with previous work. At the first individual wave, prevalence of problems of respondents in the 'high stable' and 'rapid decline' trajectories were comparable; at the last individual wave, prevalence remained similar for the 'high stable' but increased substantially in all domains for the 'rapid decline' trajectory. Expected-influence centrality measures provided different results than prevalence estimates. For instance, in the first individual wave mobility and carrying, moving, and handling objects had highest impact on overall functioning for the 'rapid decline' and 'high stable' trajectories, while the most prevalent functioning problems concerned cognition, pain, as well as energy and drive functions. CONCLUSIONS: Our study stressed the relevance of healthy ageing trajectories for identifying functioning domains and categories that need to be targeted by rehabilitation services in a heterogeneous ageing population. The use of such trajectories at country level has the potential to make a meaningful contribution to the planning and delivery of rehabilitation interventions through health systems and to informed policy making.

Can we still ensure no one is left behind by 2030? Demonstrating the potential of the implementation of the WHO Functioning and Disability Disaggregation Tool (FDD11) in existing survey platforms for disaggregating SDG indicators by disability.

Purpose: The world is approaching the sustainable development goals deadline, but many countries still do not produce the data required to track their indicators by disability. Integrating valid and relievable disability measurement tools into existing data platforms is key to ensuring that "no one is left behind." In this paper, we aim to demonstrate that it is possible to gather valid data on disability for disaggregation using the WHO Functioning and Disability Disaggregation Tool.Materials and methods: Using representative data from India, Lao PDR, and Tajikistan collected through the Gallup World Poll, we estimated the likelihood of a positive sustainable development indicator by disability level. Logit regression was used, adjusted for age, sex, household size, number of children, marital status, urban or rural area, and country-fixed effects.Results: Our estimates showed a consistent disability gradient across all countries and indicators: the higher the level of disability, the lower the probability of having a positive outcome in barely any sustainable development goal.Conclusion: Our study demonstrates that it is not too late to generate sound and precise data about inequalities faced by persons with mild, moderate, or severe disability. This data is essential for reducing inequalities through evidence-based policymaking.

The disability gradient observed across all countries and indicators included in this study showed that the higher the level of disability (mild, moderate, or severe), the lower the probability of having a positive outcome in any sustainable development goal.An underestimation of inequalities is observed when people with no, mild and moderate disability are combined into a group called "no severe disability" and used as the comparator to people with "severe disability."Rehabilitation policy and planning must consider the disability gradient and respond to the different needs of persons with mild, moderate, and severe disability.

The Sociodemographic Factors Related to Disability of Applicants of Welfare Benefits in Greece: A Cross-Sectional Survey Based on the World Health Organization Disability Assessment Schedule (WHODAS) 2.0.

INTRODUCTION: The aim of the present study was to report on the prevalence of disability and its association with sociodemographic factors among welfare benefit applicants in Greece. The study also compared the disability scores between different health conditions using the WHODAS 2.0 (12-item version), a biopsychosocial-model-based measure. METHODS: The Greek WHODAS 2.0, 12-item version, was administered by interview. A three-member medical committee assessed the medical records of the applicants and assigned a disability percentage based on the biomedical measure of disability percentage determination (Barema scale). RESULTS: The majority of the participants were female (56.65%). Certain health conditions were presented more frequently among welfare benefit applicants (mental health disorders and neoplasms). The domains with the highest rate of difficulty were the "participation" and "life activities" domains. Significant differences were found between WHODAS 2.0 and Barema scores for all eight different health condition categories. The factorial ANOVA (8x2) showed a significant interaction effect between health condition category and gender with respect to the WHODAS 2.0 score (F = 19.033, p <.001, η2 = 0.13). The WHODAS 2.0 score was negatively correlated to gender, years of studies, and marital status and positively correlated to age, working status, and the Barema score. The results revealed that male participants with a partner who were younger, had more studies, were actively working, and had a lower Barema score would have lower WHODAS scores. CONCLUSION: Sociodemographic characteristics of welfare benefit applicants are associated with disability levels based on WHODAS 2.0. Certain health conditions, like mental health or neuromusculoskeletal conditions, are associated with higher disability scores. There are differences between the biopsychosocial and the biomedical approaches to disability assessment. The implementation of WHODAS 2.0 may contribute to a better understanding of the lived experience of patients and is a feasible and efficient tool. Combining biomedical and biopsychosocial approaches may enhance the procedures of disability assessment and help in the development of policies that support people with disabilities.