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1.
Aten. prim. (Barc., Ed. impr.) ; 52(1): 38-46, ene. 2020. ilus, tab, graf
Artículo en Español | IBECS | ID: ibc-ET2-3527

RESUMEN

Objetivo: Aportar evidencias de la eficacia de una intervención comunitaria en salud, que incluye un programa de estimulación cognitiva, para prevenir el deterioro de las capacidades cognitivas en nuestra población de personas mayores con cognición normal que viven en la comunidad. Diseño: Ensayo clínico aleatorizado (normas grupo CONSORT). Emplazamiento: Centro de salud San José Norte-Centro y Fundación La Caridad (Zaragoza). Participantes: Doscientas una personas de 65 años o más, con puntuación MEC de 28 puntos o más, 101 aleatorizados en el grupo intervención y 100 en el grupo control. Intervenciones: La intervención se realizó en 10 sesiones de 45 min, una por semana, con material propio, los cuadernos de colores de activación mental. Estos cuadernos trabajan las áreas de memoria, orientación, lenguaje, praxis, gnosis, cálculo, percepción, razonamiento lógico, atención-concentración y programación. Mediciones principales: Las variables de resultado fueron MEC, Set-test, Barthel y Lawton-Brody. Resultados: Analizando los incrementos sobre el nivel basal, para la variable MEC el grupo intervención obtiene, en media, 1,58 puntos más que el grupo control en la evaluación realizada inmediatamente después de la intervención. A los 6meses la mejora es de 1,51 puntos y al año de 2,04 puntos. Todos estos incrementos son estadísticamente significativos al nivel usual del 5%. No se observan diferencias estadísticamente significativas entre el grupo intervención y control en las variaciones sobre el nivel basal de las variables en Set-test, Barthel y Lawton-Brody. Conclusiones: La estimulación cognitiva con nuestro programa es eficaz para mantener el rendimiento cognitivo, medido con la variable MEC, en nuestra población de personas mayores con cognición normal que viven en la comunidad. No hay evidencia de que esa mejora se transfiera a las actividades de la vida diaria medidas con Barthel y Lawton-Brody


Objective: To provide evidence of the effectiveness of a community health intervention, that includes a cognitive stimulation program, to prevent the deterioration of cognitive abilities in our population of elderly people with normal cognition that are living in the community. Design: Randomized clinical trial (CONSORT group norms). Location: San José Norte-Centro Health Center and La Caridad Foundation (Zaragoza, Spain). Participants: 201 people aged 65 or older, with a MEC score of at least 28 points, which were randomized between the Intervention group (101) and the Control group (100). Intervention: The intervention was applied in 10 sessions of 45minutes, one per week. It used materials designed by one of the authors, which addressed the following areas: memory, orientation, language, praxis, gnosis, calculation, perception, logical reasoning, attention-concentration and programming. Main measurements: The main outcome variables were MEC, Set-Test, Barthel and Lawton-Brody. Results: Increases of the main result variables over their baseline level were analized. For MEC variable, the Intervention group obtained, on average, 1.58 points more than the Control group in the evaluation performed immediately after the intervention. After 6months, the improvement was 1.51 points and after a year, it was of 2.04 points. All these differences were statistically significant. For Set-Test, Barthel and Lawton-Brody variables, no statistically significant differences were observed between Intervention group and Control group. Conclusions; Cognitive stimulation with our program is effective to maintain or improve cognitive performance, measured with the variable MEC, our population of elderly people with normal cognition that are living in the community. There is no evidence that this improvement is transferred to the activities of daily life measured with Barthel and Lawton-Brody variables


Asunto(s)
Humanos , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Remediación Cognitiva/métodos , Envejecimiento/psicología , Disfunción Cognitiva/prevención & control , Envejecimiento Cognitivo/psicología , Servicios de Salud para Ancianos/organización & administración , Centros de Salud , Salud Mental , Terapia Cognitivo-Conductual
3.
J Clin Nurs ; 29(1-2): 31-52, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31532022

RESUMEN

AIMS AND OBJECTIVES: To analyse the experiences of older people with a diagnosed functional mental illness and their carers in relation to mental health service delivery and analyse the experiences of health and social care professionals who care for and treat older people who have a diagnosed functional mental illness. BACKGROUND: The prevalence of functional mental illness in older adults is notable but to date has received less research attention than dementia. Older adults with functional mental illness have life expectancy of up to 20 years less than the rest of the population. Therefore, the experiences of older adults with functional mental illness, their carers and healthcare professionals, in relation to mental health services, need further exploration. DESIGN: Integrative literature review. METHODS: A five-stage process was informed by Whittemore and Knafl. MeSH was used. Keyword searches of MEDLINE, CINAHL, Cochrane Library, PsycINFO, EMBASE and AMED were conducted between January 2000-October 2017. Titles were screened, and data were extracted manually and analysed using narrative synthesis. The PRISMA checklist was used. RESULTS: A total of 342 articles were deemed potentially relevant to this review. Once inclusion and exclusion criteria were applied, 28 articles were included. The literature presented an overarching theme "determinants influencing older people with functional mental illness use of services." The overarching theme is supported by two main themes: inevitable consequences of ageing and variations of the availability of healthcare services for older people with functional mental illness. CONCLUSION: Several determinants influence use of services by older people with functional mental illness. Older people with functional mental illness often perceived they did not have a mental health need. Within the literature, there was little acknowledgement of the experiences of older people with functional mental illness regarding their support needs. RELEVANCE TO CLINICAL PRACTICE: This integrative review has highlighted that some older people with functional mental illness do not seek mental health support because they believe that functional mental illness is an inevitable consequence of ageing; this is mirrored at times by healthcare professionals and carers. In addition to this finding, different views prevail regarding the impact that ageless and age-defined mental health service delivery models have on the needs of older people with functional mental illness. Further research is required to understand these findings.


Asunto(s)
Envejecimiento/psicología , Cuidadores/psicología , Trastornos Mentales/psicología , Anciano , Anciano de 80 o más Años , Actitud del Personal de Salud , Actitud Frente a la Salud , Femenino , Servicios de Salud para Ancianos/organización & administración , Humanos , Trastornos Mentales/enfermería , Servicios de Salud Mental
4.
Z Gerontol Geriatr ; 52(Suppl 4): 212-221, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31628613

RESUMEN

BACKGROUND: Older general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment). METHODS: A cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients' cognitive status. RESULTS: Care challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations. CONCLUSION: The findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.


Asunto(s)
Disfunción Cognitiva/epidemiología , Servicios de Salud para Ancianos/organización & administración , Hospitales Generales/estadística & datos numéricos , Cuidados a Largo Plazo , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/terapia , Cuidados Críticos , Estudios Transversales , Femenino , Alemania/epidemiología , Humanos , Masculino
5.
Rev Lat Am Enfermagem ; 27: e3166, 2019.
Artículo en Portugués, Inglés, Español | MEDLINE | ID: mdl-31596406

RESUMEN

OBJECTIVE: to identify patterns of associations between the degree of compliance to laboratory test requests by risk strata and the parameters of quality of care outcomes in primary health care (PHC). METHOD: a cross-sectional study involving 108 elderly patients with hypertension and/or diabetes treated in PHC. A semi-structured questionnaire and electronic medical record data were used. To evaluate the quality of care, the Patient Assessment of Chronic Illness Care (PACIC) questionnaire was used. Descriptive analysis, multiple correspondence analysis and k-means grouping were performed. RESULTS: it was observed low compliance of the care practice, standing out as the worst parameter the evaluation of the diabetic foot (2.2%). Three clusters were identified, with cluster 1 having the highest number of individuals (37.0%), with better indicators of quality of care, evidenced by above 50% of compliance with laboratory tests (75.0%), high PACIC score (47.2%), control of blood pressure (70.0%) and metabolic levels (95.0%), and satisfaction with health (92.5%) and health access (90.0%). In contrast, cluster 3 (29.6%) was made up of individuals with worse outcomes of care. CONCLUSION: low compliance of care practice and asymmetries among health actions and users' needs were observed, indicating failures in the care process in PHC.


Asunto(s)
Diabetes Mellitus/terapia , Servicios de Salud para Ancianos/organización & administración , Hipertensión/terapia , Atención Primaria de Salud , Calidad de la Atención de Salud/normas , Anciano , Anciano de 80 o más Años , Brasil , Enfermedad Crónica , Femenino , Servicios de Salud para Ancianos/normas , Humanos , Masculino , Cooperación del Paciente , Satisfacción del Paciente , Derivación y Consulta , Medición de Riesgo , Encuestas y Cuestionarios
7.
Best Pract Res Clin Rheumatol ; 33(2): 205-226, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-31547979

RESUMEN

Hip fractures are common among older people, and the prognosis is serious in terms of mobility, independence in daily life activities, and cognition, with 42% of patients never achieving the same function as before the fracture. Norway has the highest incidence of hip fractures, and the important tasks are to improve patient care and prevent new fractures. The aim was to develop Norwegian Guidelines for Interdisciplinary Care for Hip Fractures, which included models of care, organization, and clinical issues. These guidelines were based on review of the literature, including existing guidelines such as the NICE guidelines, as well as clinical experience of the members of the group, where consensus was reached after discussions. The guidelines focus on interdisciplinary patient management through a clinical pathway from admission to discharge. Here, we will present a shortened and internationally adapted version of these guidelines, which has newly been released.


Asunto(s)
Fracturas de Cadera/terapia , Grupo de Atención al Paciente , Anciano , Anciano de 80 o más Años , Femenino , Servicios de Salud para Ancianos/organización & administración , Fracturas de Cadera/epidemiología , Humanos , Masculino , Modelos Biológicos , Modelos Organizacionales , Noruega/epidemiología , Ortopedia , Guías de Práctica Clínica como Asunto
8.
Best Pract Res Clin Rheumatol ; 33(2): 278-289, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-31547983

RESUMEN

In view of the high imminent risk of having subsequent fractures after a fracture, early evaluation and treatment decisions to prevent subsequent fractures are advocated. After a hip fracture, the fracture liaison service (FLS) and orthogeriatric care are considered the most appropriate organisational approaches for secondary fracture prevention following a recent fracture. Their introduction and implementation have been shown to increase evaluation and treatment of patients at high risk for subsequent fracture. Of real-world cohort studies, most, but not all studies, indicate a lower incidence of fracture and longer survival after treatment with nitrogen-containing bisphosphonates.


Asunto(s)
Servicios de Salud para Ancianos/organización & administración , Fracturas Osteoporóticas/prevención & control , Prevención Secundaria , Anciano , Prestación de Atención de Salud/organización & administración , Femenino , Humanos , Incidencia , Masculino , Atención Dirigida al Paciente
9.
Best Pract Res Clin Rheumatol ; 33(2): 301-309, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-31547985

RESUMEN

Osteoporosis and fragility fractures have become a major healthcare challenge globally in the recent years. However, this problem has only recently been accorded its due importance in developing countries such as India. India is a model case study for the management of osteoporosis and fragility fractures in a resource-limited setting, as it harbors a large geriatric population and has the highest prevalence of osteopenia globally. It is imperative to identify the myriad factors contributing to poor bone health and understand the many hurdles encountered to tackle this healthcare problem in a developing country. Innovative methods for managing fragility fractures are commonly seen. Collaborative multidisciplinary care and structured, evidence-based management has finally found its place in India with the establishment of a regional fragility fracture network. This chapter outlines the current status of management of fragility fractures in India by focusing on the disease burden, hurdles, innovative treatment methods, and the challenges lying ahead.


Asunto(s)
Fijación de Fractura/métodos , Anciano Frágil , Servicios de Salud para Ancianos/organización & administración , Fracturas Osteoporóticas/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , India/epidemiología , Masculino , Fracturas Osteoporóticas/epidemiología
10.
Clin Interv Aging ; 14: 1451-1460, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31496672

RESUMEN

Introduction: After hospitalization, 11% of the older patients are referred to rehabilitation facilities. Nowadays, there is a trend to formalize the rehabilitation process for these patients in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support and the environment on a rehabilitation ward. However, since literature on the principles of CRE is scarce, this review aimed to explore and describe the principles of CRE. Methods: A search was made in PubMed for relevant literature concerning CRE. Then, articles were hand searched for relevant keywords (ie, task-oriented training, therapy intensity, patient-led therapy, group training), references were identified, and topics categorized. Results: After evaluating 51 articles, 7 main topics of CRE were identified: 1) Therapy time; ie, the level of (physical) activity; the intensity of therapy and activity is related to rehabilitation outcomes, 2) group training; used to increase practice time and can be used to achieve multiple goals (eg, activities of daily living, mobility), 3) patient-regulated exercise; increases the level of self-management and practice time, 4) family participation; may lead to increased practice time and have a positive effect on rehabilitation outcomes, 5) task-oriented training; in addition to therapy, nurses can stimulate rehabilitants to perform meaningful tasks that improve functional outcomes, 6) enriched environment; this challenges rehabilitants to be active in social and physical activities, and 7) team dynamics; shared goals during rehabilitation and good communication in a transdisciplinary team improve the quality of rehabilitation. Discussion: This is the first description of CRE based on literature; however, the included studies discussed rehabilitation mainly after stroke and for few other diagnostic groups. Conclusion: Seven main topics related to CRE were identified that may help patients to improve their rehabilitation outcomes. Further research on the concept and effectivity of CRE is necessary.


Asunto(s)
Servicios de Salud para Ancianos/organización & administración , Grupo de Atención al Paciente/organización & administración , Rehabilitación/organización & administración , Resultado del Tratamiento , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Femenino , Humanos
11.
Artículo en Inglés | MEDLINE | ID: mdl-31480290

RESUMEN

Background: Awareness of physical activity guidelines are low, particularly the "forgotten guidelines" of strength and balance. Increasing awareness of guidelines, but also of appropriate local services that can be utilised, is an important step towards active ageing. Co-creation can inform tailored service provision to potentially increase uptake and adherence. The aim was to co-create recommendations to redesign and promote local leisure services, emphasising strength and balance activity provision. Method: Twenty-four ageing and older adults engaged in 10 co-creation workshops. Workshops consisted of interactive tasks, and fieldwork tasks were undertaken externally. Data were collected using field notes, worksheet tasks and facilitator reflections and were analysed using qualitative content analysis. Results: Retention and adherence rates were 92% and 85%. Co-creators cited group cohesion, scientific input from experts and perceived knowledge development as enjoyable elements of the process. Four key themes emerged from analysis: (1) localised strategies for awareness raising, (2) recruitment of volunteer champions to increase uptake and maintenance, (3) accessibility of activities, including what they are and when they are, and (4) evaluation of impact. Conclusion: This has been the first study, to our knowledge, to utilise co-creation for informed leisure service provision improvement. Future work should aim to implement these recommendations to ascertain what impact these themes might make.


Asunto(s)
Ejercicio , Servicios de Salud para Ancianos/organización & administración , Fuerza Muscular , Balance Postural , Anciano , Inglaterra , Ejercicio/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad
13.
Z Gerontol Geriatr ; 52(5): 487-502, 2019 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-31346679

RESUMEN

Heat waves increase the morbidity and mortality in Germany, particularly of older patients in need of care. Due to climate change the number of heat waves in Germany will increase threefold by the end of the century. In addition, the proportion of patients at risk will grow due to demographic change. Therefore, the Government and the Federal States have developed recommendations for heat action plans, in which the medical profession should also participate in the prevention of heat-related damage to health. Physicians and their team should first become acquainted with the topic. In addition, they should inform patients at risk and their relatives of the risks and preventive measures. In the summer a critical check of drugs is also needed because medications impair cooling mechanisms in heat waves, the pharmacokinetics can change and unwanted side effects of drugs occur more frequently. Lastly, due to their central position in the healthcare system, physicians should participate in the coordination of a good nursing care and intensification of social contacts during heat waves.


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Servicios de Salud para Ancianos/organización & administración , Trastornos de Estrés por Calor/prevención & control , Calor/efectos adversos , Anciano , Prestación de Atención de Salud , Alemania , Trastornos de Estrés por Calor/epidemiología , Humanos
14.
Cien Saude Colet ; 24(6): 2173-2183, 2019 Jun 27.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31269176

RESUMEN

Primary health centers (PHCs) should consider the demographic and epidemiological profile of the health region to respond to population aging and structure service delivery around networks based on macro and micro-level management to ensure the provision of comprehensive services. A normative evaluation of micro-level management in four PHCs in a health region in the Federal District of Brazil was conducted to inform the development of recommendations for enhancing the delivery of comprehensive and integrated long-term care for older persons. A management evaluation matrix was used where management stages were classified as advanced, intermediate and incipient. The findings show that none of the PHCs were at the advanced stage, three were at the intermediate stage, and one at the incipient stage. The lowest scores were obtained for the subdimensions care model (which was shown to be predominantly traditional) and humanization (fragmentation of care). Lack of infrastructure and staff absenteeism were shown to be constraining factors, while effective communication with local administrators was as facilitating factor. Improvements need to be made in micro-level management to enhance the delivery of comprehensive and timely care to older persons in this health region.


Asunto(s)
Atención Integral de Salud/organización & administración , Prestación de Atención de Salud/organización & administración , Servicios de Salud para Ancianos/organización & administración , Atención Primaria de Salud/organización & administración , Anciano , Envejecimiento , Brasil , Prestación Integrada de Atención de Salud/organización & administración , Humanos , Cuidados a Largo Plazo/organización & administración
16.
R I Med J (2013) ; 102(5): 30-32, 2019 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-31167525

RESUMEN

According to the Centers for Medicare & Medicaid Services (CMS), the future of older adult care in the United States has arrived in a provider-sponsored health plan model that integrates medical, behavioral, and social care for frail elders. This approach gives the provider complete control over patient outcomes and total cost of care and enables participants to live safely in the community - rather than a nursing home - for an extra four years, on average. This article reviews the Program of All-inclusive Care for the Elderly (PACE) model, whose roots go back to the 1970s in California, and offers case studies on two PACE-RI participants with chronic healthcare needs. In both examples, the patients reduced hospitalizations and increased mental and physical health, all while alleviating caregiver stress. With the older population slated to double by 2060, the time has come to expand PACE to more people. A few years ago, the acting administrator of the Centers for Medicare & Medicaid Services (CMS) said he was "glimpsing into our future" when he visited a provider-sponsored health plan that integrated medical, behavioral, and social care for frail elders, allowing them to remain in the community rather than live in a nursing home.[1] This approach to aging services successfully braided Medicare and Medicaid funding and gave the provider complete control over patient outcomes and total cost of care over a significant period - the key elements to delivering "value-based care." What is noteworthy is that this program of the "future" has been in Rhode Island since 2005 and in other parts of the country since 1973! It helps its medically complex participants live at home for an extra four years on average and retain a much higher quality of life, all while controlling associated costs for the government through capitated payment arrangements.[5] The program is called PACE - short for Program of All-inclusive Care for the Elderly - and it is a comprehensive and community-based model of care that coordinates medical, behavioral, and social services for individuals ages fifty-five and older who have high care needs but can remain safely in the community. PACE is currently offered in 31 states.[2] The model is backed by the National PACE Association and serves 50,000 seniors in 126 sponsoring organizations at 260 PACE centers across the country. While PACE has already had some success at scaling its integrated services, emerging demographics and heightened outreach poise the program for significant growth.


Asunto(s)
Atención Integral de Salud/economía , Atención Integral de Salud/organización & administración , Servicios de Salud para Ancianos/economía , Servicios de Salud para Ancianos/organización & administración , Anciano , Anciano Frágil , Humanos , Comunicación Interdisciplinaria , Medicaid , Medicare , Modelos Teóricos , Rhode Island , Estados Unidos
18.
Trials ; 20(1): 193, 2019 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-30947737

RESUMEN

BACKGROUND: Primary care access can be challenging for older, rural, socio-economically disadvantaged populations. Here we report the I-ACT cluster feasibility trial which aims to assess the feasibility of trial design and context-sensitive intervention to improve primary care access for this group and so expand existing theory. METHODS: Four general practices were recruited; three randomised to intervention and one to usual care. Intervention practices received £1500, a support manual and four meetings to develop local, innovative solutions to improve the booking system and transport. Patients aged over 64 years old and without household car access were recruited to complete questionnaires when booking an appointment or attending the surgery. Outcome measures at 6 months included: self-reported ease of booking an appointment and transport; health care use; patient activation; capability; and quality of life. A process evaluation involved observations and interviews with staff and participants. RESULTS: Thirty-four patients were recruited (26 female, eight male, mean age 81.6 years for the intervention group and 79.4 for usual care) of 1143 invited (3% response rate). Most were ineligible because of car access. Twenty-nine participants belonged to intervention practices and five to usual care. Practice-level data was available for all participants, but participant self-reported data was unavailable for three. Fifty-six appointment questionnaires were received based on 150 appointments (37.3%). Practices successfully designed and implemented the following context-sensitive interventions: Practice A: a stacked telephone system and promoting community transport; Practice B: signposting to community transport, appointment flexibility, mobility scooter charging point and promoting the role of receptionists; and Practice C: local taxi firm partnership and training receptionists. Practices found the process acceptable because it gave freedom, time and resource to be innovative or provided an opportunity to implement existing ideas. Data collection methods were acceptable to participants, but some found it difficult remembering to complete booking and appointment questionnaires. Expanded theory highlighted important mechanisms, such as reassurance, confidence, trust and flexibility. CONCLUSIONS: Recruiting older participants without access to a car proved challenging. Retention of participants and practices was good but only about a third of appointment questionnaires were returned. This study design may facilitate a shift from one-size-fits-all interventions to more context-sensitive interventions. TRIAL REGISTRATION: ISRCTN18321951 , Registered on 6 March 2017.


Asunto(s)
Citas y Horarios , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud para Ancianos/organización & administración , Modelos Organizacionales , Atención Primaria de Salud/organización & administración , Servicios de Salud Rural/organización & administración , Transporte de Pacientes/organización & administración , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Inglaterra , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/organización & administración , Satisfacción del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Población Rural , Teléfono , Factores de Tiempo , Poblaciones Vulnerables
19.
J Aging Soc Policy ; 31(3): 250-270, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31012806

RESUMEN

Four years after an age-friendly city (AFC) assessment across Indonesia, this article presents a comparative analysis of policy changes that have taken place across different AFC dimensions and factors associated with more and less change. Nine of fourteen cities initiated changes, ranging from public declarations, regulations, and creation or expansion of services. Our findings suggest that the AFC assessment can offer a means to engage policy makers, which in turn may facilitate city-level change, particularly for larger cities with more substantive budgets and more consolidated rather than dispersed leadership; however, no single factor represented a sufficient or necessary condition for change.


Asunto(s)
Planificación Ambiental , Servicios de Salud para Ancianos , Política Pública , Salud Urbana , Envejecimiento , Ciudades , Planificación de Ciudades , Guías como Asunto , Reforma de la Atención de Salud , Servicios de Salud para Ancianos/organización & administración , Humanos , Indonesia , Calidad de Vida , Características de la Residencia , Medio Social , Organización Mundial de la Salud
20.
Int J Nurs Stud ; 94: 32-41, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30933871

RESUMEN

BACKGROUND: An intervention 'Better Oral Health in Home Care' was introduced (2012-2014) to improve the oral health of older people receiving community aged care services. Implementation of the intervention was theoretically framed by the Promoting Action on Research Implementation in Health Services framework. Process outcomes demonstrated significant improvements in older people's oral health. OBJECTIVE: To evaluate the extent to which the intervention has been embedded and sustained into routine community aged care practice 3 years after the initial implementation project. DESIGN: A Realist Evaluation applying Normalisation Process Theory within a single case study setting. SETTING: Community aged care (home care) provider in South Australia, Australia. PARTICIPANTS: Purposeful sampling was undertaken. Twelve staff members were recruited from corporate, management and direct care positions. Two consumers representing high and low care recipients also participated. METHODS: Qualitative methods were applied in two subcases, reflecting different contextual settings. Data were collected via semi-structured interviews and analysed deductively by applying the Normalisation Process Theory core constructs (with the recommended phases of the Realist Evaluation cycle). Retrospective and prospective analytic methods investigated how the intervention has been operationalised by comparing two timeframes: Time 1 (Implementation June 2012-December 2014) and Time 2 (Post-implementation July 2017-July 2018). RESULTS: At Time 1, the initial program theory proposed that multi-level facilitation contributed to a favourable context that triggered positive mechanisms supportive of building organisational and workforce oral healthcare capacity. At Time 2, an alternative program theory of how the intervention has unfolded in practice described a changed context following the withdrawal of the project facilitation processes with the triggering of alternative mechanisms that have made it difficult for staff to embed sustainable practice. CONCLUSION: Findings concur with the literature that successful implementation outcomes do not necessarily guarantee sustainability. The study has provided a deeper explanation of how contextual characteristics have contributed to the conceptualisation of oral healthcare as a low priority, basic work-ready personal care task and how this, in turn, hindered the embedding of sustainable oral healthcare into routine community aged care practice. This understanding can be used to better inform the development of strategies, such as multi-level facilitation, needed to navigate contextual barriers so that sustainable practice can be achieved.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Servicios de Salud para Ancianos/organización & administración , Higiene Bucal , Anciano , Anciano de 80 o más Años , Humanos , Salud Bucal , Australia del Sur
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