Overview of systematic reviews: Effective home support in dementia care, components and impacts-Stage 1, psychosocial interventions for dementia.

AIM: To synthesize evidence to identify the components of effective psychosocial interventions in dementia care to inform clinical practice, policy and research. BACKGROUND: With population ageing, dementia represents a significant care challenge with 60% of people with dementia living at home. DESIGN: Overview of systematic reviews with narrative summary. DATA SOURCES: Electronic searches of published systematic reviews in English using Cochrane Database of Systematic Reviews, DARE and EPPI-Centre, between September 2013 - April 2014. REVIEW METHODS: Systematic reviews were appraised against Cochrane Collaboration levels of effectiveness. Components of psychosocial interventions were identified with their theoretical rationale. Findings were explored with a Patient, Public and Carer Involvement group. RESULTS: Thirty-six systematic reviews were included. From interventions, 14 components were identified, nine for people with dementia and five for carers, mostly undertaken in nursing/care homes. For people with dementia, there was evidence of effectiveness for cognitive stimulation and cognitive training, but less evidence for sensory stimulation, reminiscence, staff education, behavioural therapy and ADL training. For carers, there was evidence of effectiveness for education and training, psychotherapy and counselling. CONCLUSION: There was a lack of definitive evidence of effectiveness for most psychosocial interventions. Further studies with stronger methodology or replication of existing studies would strengthen the evidence base. Few interventions were undertaken with people with dementia and their carers living at home. Further work will investigate the extent to which components identified here are present in models of home support for people with dementia and carers and their effectiveness.

An examination of factors influencing delayed discharge of older people from hospital.

OBJECTIVE: This study aimed to investigate the factors associated with the delayed discharge of older people from hospital and their length of stay (LOS). METHODS: Data were collected retrospectively from inpatient records and adult social care services on older patients referred to the latter prior to hospital discharge. RESULTS: Data on two related measures--delayed discharge and LOS--were analysed separately within a four-stage sequential framework. Using bivariate analysis, we found that cognitive impairment and dependency were significantly associated with delay. Patients admitted to trauma and orthopaedics specialties were significantly more likely to be delayed on discharge. Respiratory illness was negatively associated with delay. Factors related to care received as an inpatient associated with delayed discharge from hospital were not being in the responsible consultant's bed for part of their stay, two or more moves between specialties and receipt of rehabilitation services. Admission to a care home and receipt of domiciliary care if returning to a private dwelling on discharge were associated with delay. In the multivariate analysis, dependence and cognitive impairment impacted differently on delay and LOS. Hospital variables were the most important predictors of LOS and social care variables in respect of delayed discharge. CONCLUSION: Patient characteristics and especially the organisation of care in hospital and the provision of services on discharge are related to the likelihood of delayed discharge and LOS. Improved services and structures to systematically assess and treat patient needs in hospital, together with the timely provision of services providing post-discharge services tailored to individual circumstances, are required.

Social care in older people's services--facilitating the flexible use of resources.

Personal budgets in social care are a mechanism for the allocation of resources for care that permits users'greater choice and flexibility. This study was designed to explore developments in care coordination arrangements by examining the flexible use of resources. Two national surveys identified agencies with such arrangements in older people's services in advance of this agenda, described here as innovative authorities. Telephone interviews with their representatives explored salient factors in the development, focus, and operation of personal budgets. Carers were the main recipients, and there was also evidence of more appropriate use of resources structured around service users' needs. Implementation of personal budgets requires authorities to be more creative and flexible in respect of internally held budgets to meet the needs and wishes of older service users. This study provides evidence that some of these requirements have already been adopted by a few agencies.

Promoting personalization in social care services for older people.

This article presents findings on 4 themes associated with the personalization of social care for older people: integration of health and social care services; initiatives that prevent the need for more costly interventions; services to maintain people at home; and systems that promote choice, control, and flexibility. The quantitative study utilized data from a national postal survey conducted in England. Findings suggest variable progress regarding the range and style of support available to older people. These are discussed in the context of service integration, community-based services, and consumer-directed care. Implications for service development and future research are highlighted.

Changing patterns of care coordination within old-age services in England.

There has been a focus internationally in recent years on policies and strategies to divert the long-term care of frail older people away from residential and nursing home care and enhance provision of community-based care by improving care coordination through increased differentiation within care management arrangements and service integration between health and social care. The aim of this article is to explore variations over time in care coordination arrangements within old-age services using data from national postal surveys of English local authorities. Indicators of differentiation and integration developed from earlier research were used to compare changes over time. There appeared to be some evidence of change relating to integration at both organizational and practice levels, but little change was detected in respect of differentiation within care management arrangements. The impact of the findings in the context of four enduring themes related to international case/care management literature--eligibility, integrated health and social care, shared information, and targeting--are discussed and the relevance of these in relation to possible future trends is explored.