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2.
Aten. prim. (Barc., Ed. impr.) ; 52(1): 38-46, ene. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185982

RESUMO

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


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Remediação Cognitiva/métodos , Envelhecimento/psicologia , Disfunção Cognitiva/prevenção & controle , Envelhecimento Cognitivo/psicologia , Serviços de Saúde para Idosos/organização & administração , Centros de Saúde , Saúde Mental , Terapia Cognitivo-Comportamental
3.
J Clin Nurs ; 29(1-2): 31-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31532022

RESUMO

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.


Assuntos
Envelhecimento/psicologia , Cuidadores/psicologia , Transtornos Mentais/psicologia , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Feminino , Serviços de Saúde para Idosos/organização & administração , Humanos , Transtornos Mentais/enfermagem , Serviços de Saúde Mental
4.
Maturitas ; 131: 28-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31787144

RESUMO

OBJECTIVE: To examine whether patterns of home and community care (HACC) use and person-based characteristics were associated with time to enter permanent residential aged care (RAC). STUDY DESIGN: A prospective cohort study. The sample consisted of 8062 participants of the Australian Longitudinal Study on Women's Health who used HACC services between 2001 and 2014. MAIN OUTCOME MEASURES: Time from first HACC use to enter permanent RAC. The median follow-up time was 63 months. Factors associated with time to enter RAC were identified using competing risk regression models. RESULTS: Of the 8062 participants, 60% belonged to the 'basic HACC' group, who used few services minimally; 16% belonged to the 'moderate HACC' group, who predominantly used domestic assistance with moderate use of other services; and 24% belonged to the 'complex HACC' group, who used many services frequently. Being a member of the complex HACC group was associated with a lower cumulative incidence of RAC than basic or moderate HACC (chances 15% versus 30% by the median observation period, p < 0.01). Living in a remote/outer region (sub-distributional hazard ratio (sdHR) = 0.83, 95%CI: 0.74 - 0.93) was associated with delayed admission to RAC. Meanwhile, earlier admission was associated with living in an apartment (sdHR = 1.29, 95%CI: 1.20-1.40) or a retirement village (sdHR = 1.54, 95%CI = 1.38-1.72), having a physical functioning score <40 (sdHR = 1.16, 95%CI = 1.05-1.25), and falls with injury (sdHR = 1.15, 95%CI = 1.05-1.25). CONCLUSIONS: Our findings highlight the importance of providing more community care services, age-friendly housing, falls prevention and physical activity programs to reduce inappropriate admission to RAC.


Assuntos
Acidentes por Quedas/prevenção & controle , Assistência à Saúde , Vida Independente/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Continuidade da Assistência ao Paciente , Exercício , Feminino , Acesso aos Serviços de Saúde , Serviços de Saúde para Idosos/organização & administração , Nível de Saúde , Serviços de Assistência Domiciliar , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Estudos Longitudinais , Estudos Prospectivos
5.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-31702983

RESUMO

CONTEXT: Geriatric hip fractures are increasingly common and confer substantial morbidity and mortality. Fragmentation in geriatric hip fracture care remains a barrier to improved outcomes. OBJECTIVE: To evaluate the impact of a comprehensive geriatric hip fracture program on long-term mortality. DESIGN: We conducted a retrospective cohort study of patients aged 65 years and older admitted to our academic medical center between January 1, 2012, and March 31, 2016 with an acute fragility hip fracture. Mortality data were obtained for in-state residents from the state public health department. MAIN OUTCOME MEASURES: Mortality within 1 year of index admission and overall survival based on available follow-up data. RESULTS: We identified 243 index admissions during the study period, including 135 before and 108 after program implementation in October 2014. The postintervention cohort trended toward a lower unadjusted 1-year mortality rate compared with the preintervention cohort (15.7% vs 24.4%, p = 0.111), as well as lower adjusted mortality at 1 year (relative risk = 0.73, 95% confidence interval = 0.46-1.16, p = 0.18), although the differences were not statistically significant. The postintervention cohort had significantly higher overall survival than did the preintervention cohort (hazard ratio for death = 0.43, 95% confidence interval = 0.25-0.74, p = 0.002). CONCLUSION: Fixing fragmentation in geriatric hip fracture care such as through an orthogeriatric model is essential to improving overall survival for this patient population.


Assuntos
Assistência Integral à Saúde/métodos , Serviços de Saúde para Idosos , Fraturas do Quadril/terapia , Idoso , Idoso de 80 Anos ou mais , Assistência Integral à Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Fraturas do Quadril/mortalidade , Humanos , Masculino , Estudos Retrospectivos , Análise de Sobrevida
6.
BMC Health Serv Res ; 19(1): 875, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752826

RESUMO

BACKGROUND: Vouchers are increasingly used as a demand-side subsidy to reduce financial hardship and improve quality of services. Elderly Healthcare Voucher Scheme has been introduced by the Hong Kong Government since 2009 to provide subsidy to elderly aged 65 and above to visit ten different types of private primary care providers for curative, preventive and chronic disease management. Several enhancements have been made over the past few years. This paper (as part of an evaluation study of this unique healthcare voucher scheme) aims to assess the long term impact of the voucher scheme in encouraging the use of primary care services. METHODS: Two rounds of cross-sectional survey among elderly in Hong Kong were conducted in 2010 and 2016. Propensity score matching and analysis were used to compare changes in perception and usage of vouchers over time. RESULTS: 61.5% of respondents in 2016 agreed "the scheme encourages me to use more private primary care services", a significant increase from 36.2% in 2010. Among those who agreed in 2016, the majority thought the voucher scheme would encourage them to use acute services (90.3%) in the private sector, rather than preventive care (40.3%) and chronic disease management (12.2%). Respondents also reported that their current usual choice of care was visiting "both public and private doctors" (61.9%), representing a significant increase (up from 48.4%) prior to their use of voucher. CONCLUSIONS: The voucher scheme has encouraged the use of more private care services, particularly acute services rather than disease prevention or management of chronic disease. However, there needs to be caution that the untargeted and open-ended nature of voucher scheme could result in supply-induced demand which would affect long term financial sustainability. The dual utilization of health services in both the public and private sector may also compromise continuity and quality of care. The design of the voucher needs to be more specific, targeting prevention and chronic disease management rather than unspecified care which is mainly acute and episodic in order to maximize service delivery capacity as a whole for equitable access in universal health coverage and to contribute to a sustainable financing system.


Assuntos
Serviços de Saúde para Idosos/organização & administração , Atenção Primária à Saúde/organização & administração , Idoso , Doença Crônica/terapia , Estudos Transversais , Assistência à Saúde/economia , Financiamento Governamental/organização & administração , Pesquisas sobre Serviços de Saúde , Gastos em Saúde , Hong Kong , Humanos , Setor Privado/organização & administração , Avaliação de Programas e Projetos de Saúde , Pontuação de Propensão , Cobertura Universal do Seguro de Saúde
8.
Z Gerontol Geriatr ; 52(Suppl 4): 212-221, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31628613

RESUMO

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.


Assuntos
Disfunção Cognitiva/epidemiologia , Serviços de Saúde para Idosos/organização & administração , Hospitais Gerais/estatística & dados numéricos , Assistência de Longa Duração , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/terapia , Cuidados Críticos , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino
9.
Rev Lat Am Enfermagem ; 27: e3166, 2019.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31596406

RESUMO

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.


Assuntos
Diabetes Mellitus/terapia , Serviços de Saúde para Idosos/organização & administração , Hipertensão/terapia , Atenção Primária à Saúde , Qualidade da Assistência à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Brasil , Doença Crônica , Feminino , Serviços de Saúde para Idosos/normas , Humanos , Masculino , Cooperação do Paciente , Satisfação do Paciente , Encaminhamento e Consulta , Medição de Risco , Inquéritos e Questionários
11.
Prim Health Care Res Dev ; 20: e132, 2019 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-31524124

RESUMO

AIM: To identify discrete approaches to specialist healthcare support for older care home residents in the UK and to estimate their prevalence. BACKGROUND: Internationally, a range of new initiatives are emerging to meet the multiple and complex healthcare needs of care home residents. However, little is known about their relative effectiveness and, given their heterogeneity, a classification scheme is required to enable research staff to explore this. METHOD: A UK survey collected information on the funding, age, coverage, aims, staffing and activities of 64 specialist care home support services. Latent class analysis (LCA) was used to allocate the sample into subgroups with similar characteristics. FINDINGS: Three classes were identified. Class 1 (55% of sample) contained services with a high probability of providing scheduled input (regular preplanned visits) and support for all residents and a moderate probability of undertaking medication management, but a low probability of training care home staff ('predominantly direct care'). Class 2 (23% of sample) had a moderate/high probability of providing scheduled input, support for all residents, medication management and training ('direct and indirect care'). Class 3 (22% of sample) had a low probability of providing scheduled input, support for all residents and medication management, but a high probability of providing training for care home staff ('predominantly indirect care'). Consultants were more likely to be members of services in Class 1 than Class 2, and Class 2 than Class 3. CONCLUSIONS: LCA offers a promising approach to the creation of a taxonomy of specialist care home support services. The skills and knowledge required by healthcare staff vary between classes, raising important issues for service design. The proposed classification can be used to explore the extent to which different organisational forms are associated with better resident, process and service outcomes.


Assuntos
Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , Especialização , Medicina Estatal/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Reino Unido
12.
Afr J Prim Health Care Fam Med ; 11(1): e1-e12, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31478747

RESUMO

BACKGROUND: One of the most important primary health challenges currently affecting older people in South Africa (SA) is the increasing prevalence of non-communicable disease (NCD). Research is needed to investigate the current state of care and self-management support available to older diabetic patients in SA and the potential for interventions promoting self-management and community involvement. AIM: This study aimed to review current policies, programmes and any other interventions as they relate to older people with diabetes with a view to assess the potential for the development of a self-management programme for older persons attending public sector primary health care services in Cape Town, South Africa. SETTING: Eighteen community health centres (CHCs) formed the sampling frame for the study. METHODS: This study aimed to review current policies and programmes as they relate to older people with diabetes. It involved a documentary review and qualitative individual interviews with key informants in the health services and Department of Health. RESULTS: Several national initiatives have sought to advance the health of older people, but they have only been partially successful. There are however multiple efforts to re-orientate the health-care system to focus more effectively on NCDs, which benefit older patients with diabetes. The establishment of community-based services to provide self-management support, promote health and ease access to medicine helps overcome many of the commonly cited barriers to care experienced by older patients. What may be equally important is that practitioners gain the communication skills and educational resources to effectively educate and counsel patients on lifestyle behaviour change and self-care management. CONCLUSION: This article alerts policy-makers and clinicians to some of the specific issues considered to be pertinent and important in the care and management of older diabetic patients. Many of these would also be applicable to older patients with other chronic conditions.


Assuntos
Serviços de Saúde Comunitária/legislação & jurisprudência , Diabetes Mellitus , Política de Saúde , Serviços de Saúde para Idosos/legislação & jurisprudência , Atenção Primária à Saúde/legislação & jurisprudência , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/organização & administração , Feminino , Serviços de Saúde para Idosos/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Sistemas de Apoio Psicossocial , Pesquisa Qualitativa , Autogestão , África do Sul
13.
Clin Interv Aging ; 14: 1451-1460, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496672

RESUMO

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.


Assuntos
Serviços de Saúde para Idosos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Reabilitação/organização & administração , Resultado do Tratamento , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos
14.
Artigo em Inglês | MEDLINE | ID: mdl-31480290

RESUMO

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.


Assuntos
Exercício , Serviços de Saúde para Idosos/organização & administração , Força Muscular , Equilíbrio Postural , Idoso , Inglaterra , Exercício/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Australas J Ageing ; 38 Suppl 2: 83-89, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31496058

RESUMO

OBJECTIVE: To explore how Australian residential dementia aged care providers respond to regulation via organisational culture, level, processes and interpretation. METHODS: Observation took place in three provider organisations. Qualitative, semi-structured in-depth interviews were conducted with aged care staff (n = 60) at three different levels of each organisation: senior management from three head offices (n = 17), facility management (n = 13) and personal care workers (n = 30) from eight residential care facilities. RESULTS: Orientations towards regulation included the following: "above and beyond;" "pushing back;" and "engineering out." Regulation was interpreted differently depending on the level of authority within an organisation where boundaries were managed according to strategic, operational and interactional priorities. DISCUSSION: Examining regulation within an organisational context and at different staff levels suggests ways to balance dementia care with regulatory control. Both generate stress, mitigated by culture and interdependent role differentiation.


Assuntos
Acreditação/legislação & jurisprudência , Pessoal Administrativo/legislação & jurisprudência , Demência/terapia , Pessoal de Saúde/legislação & jurisprudência , Serviços de Saúde para Idosos/legislação & jurisprudência , Instituição de Longa Permanência para Idosos/legislação & jurisprudência , Casas de Saúde/legislação & jurisprudência , Formulação de Políticas , Acreditação/organização & administração , Pessoal Administrativo/organização & administração , Pessoal Administrativo/psicologia , Atitude do Pessoal de Saúde , Austrália , Demência/diagnóstico , Demência/psicologia , Fidelidade a Diretrizes , Pessoal de Saúde/organização & administração , Pessoal de Saúde/psicologia , Serviços de Saúde para Idosos/organização & administração , Instituição de Longa Permanência para Idosos/organização & administração , Humanos , Entrevistas como Assunto , Descrição de Cargo , Casas de Saúde/organização & administração , Estresse Ocupacional/etiologia , Cultura Organizacional , Papel Profissional , Pesquisa Qualitativa , Local de Trabalho/legislação & jurisprudência
16.
Australas J Ageing ; 38 Suppl 2: 68-74, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31496059

RESUMO

OBJECTIVE: A clustered domestic model of residential aged care has been associated with better consumer-rated quality of care. Our objective was to examine differences in staffing structures between clustered domestic and standard models. METHODS: A cross-sectional study involving 541 individuals living in 17 Australian not-for-profit residential aged care homes. RESULTS: Four of the homes offered dementia-specific clustered domestic models of care with higher personal care attendant (PCA) hours-per-resident-per-day (mean [SD] 2.43 [0.29] vs. 1.74 [0.46], P < 0.001), slightly higher direct care hours-per-resident-per-day (2.66 [0.35] vs. 2.58 [0.44], P = 0.006), higher staff training costs ($1492 [258] vs. $989 [928], P < 0.001) and lower registered/enrolled nurse hours-per-resident-per-day (0.23 [0.10] vs. 0.85 [0.17], P < 0.001) compared to standard models. CONCLUSIONS: An Australian clustered domestic model of care had higher PCA hours, more staff training and more direct care time compared to standard models. Further research to determine optimal staffing structures within alternative models of care is warranted.


Assuntos
Demência/terapia , Pessoal de Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Instituição de Longa Permanência para Idosos/organização & administração , Modelos Organizacionais , Casas de Saúde/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos Transversais , Demência/diagnóstico , Demência/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/organização & administração , Carga de Trabalho
17.
Australas J Ageing ; 38 Suppl 2: 90-97, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31496062

RESUMO

OBJECTIVE: Examine policies of aged care organisations relating to healthcare and lifestyle decision-making. METHODS: Seven aged care organisations submitted policy documents. Policies were analysed using the Australian Law Reform Commission (ALRC) "Decision-Making Principles" as a framework. Senior staff (N = 9) with policy development roles participated in follow-up interviews. RESULTS: The structure and content of policy documents varied significantly between organisations. Most acknowledged the need to support the rights of care recipients in decision-making; however, the nature of this support was often unclear. Interview themes included factors relating to "organisational contexts" "policy development and implementation" and "ethical challenges." An overarching theme among high-performing organisations was "proactive response aimed at pre-empting decision-making dilemmas". We provide recommendations for policy development, including a self-assessment audit tool. CONCLUSION: Aged care provider organisations may need to review policies in the areas of healthcare and lifestyle decision-making to meet current best practice principles.


Assuntos
Comportamento de Escolha , Demência/terapia , Geriatria/legislação & jurisprudência , Serviços de Saúde para Idosos/legislação & jurisprudência , Estilo de Vida , Cultura Organizacional , Participação do Paciente/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Formulação de Políticas , Acreditação/legislação & jurisprudência , Austrália , Demência/diagnóstico , Demência/psicologia , Geriatria/organização & administração , Serviços de Saúde para Idosos/organização & administração , Humanos , Autonomia Pessoal
18.
Australas J Ageing ; 38 Suppl 2: 98-106, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31496063

RESUMO

OBJECTIVE: To evaluate the implementation of a model of care known as the Confused Hospitalised Older Persons (CHOPs) program to improve recognition, assessment and management of older persons with cognitive impairment (delirium and/or dementia) admitted to acute hospitals. METHODS: The model of care was implemented in six selected hospitals across New South Wales. Pre- and postimplementation medical record audits, environmental audits, and staff knowledge and care confidence surveys were performed. Interviews with clinical leads postimplementation identified enablers and barriers. RESULTS: There were significant increases in cognitive screening within 24 hours (OR = 3.32 [2.50-4.91]), delirium risk identification (OR = 4.04 [2.89-5.64]), assessment of cognitive impairment (OR = 2.55 [1.90-3.43]) and interaction with families (OR = 2.81 [2.09-3.79]). Staff education and care confidence were improved, and positive environmental changes occurred in all hospitals. Barriers and enablers to implementation were identified. CONCLUSION: The CHOPs program improved identification, risk assessment and management of cognitive impairment in older hospitalised patients.


Assuntos
Cognição , Disfunção Cognitiva/terapia , Delírio/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Demência/terapia , Serviços de Saúde para Idosos/organização & administração , Hospitais , Pacientes Internados/psicologia , Fatores Etários , Envelhecimento/psicologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Delírio/diagnóstico , Delírio/psicologia , Demência/diagnóstico , Demência/psicologia , Humanos , Auditoria Médica , New South Wales , Equipe de Assistência ao Paciente/organização & administração , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Fatores de Risco
19.
Australas J Ageing ; 38 Suppl 2: 59-67, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31496066

RESUMO

OBJECTIVE: To examine the overlap between priorities expressed by representatives from national and local campaigning organisations and the views of key voices in relation to dementia. METHODS: Semi-structured, in-depth telephone interviews were conducted with 19 representatives from campaigning organisations, including nine countries and six local community initiatives in Australia. Responses were categorised into nine priorities. Views were compared to the voices of people with dementia (n = 19), carers (n = 28), and health-care (n = 21), social work (n = 23) and service professionals (n = 20). RESULTS: Local groups prioritised user-led decision-making and community normalising agendas. National groups were influenced by service frameworks and increasing public awareness. Professional and carer groups focused on increasing understanding and communication skills while people with dementia valued being a normal part of society. CONCLUSION: Future campaigning should use both national and local approaches to changing social relations, through interpersonal connections, advocacy and social mobilisation, to promote a normalising approach to attitude change.


Assuntos
Cuidadores/organização & administração , Demência/terapia , Geriatria/organização & administração , Pessoal de Saúde/organização & administração , Promoção da Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Pacientes , Saúde Pública , Assistentes Sociais , Pessoal Administrativo , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Cuidadores/legislação & jurisprudência , Cuidadores/psicologia , Demência/diagnóstico , Demência/psicologia , Feminino , Geriatria/legislação & jurisprudência , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/legislação & jurisprudência , Pessoal de Saúde/psicologia , Promoção da Saúde/legislação & jurisprudência , Serviços de Saúde para Idosos/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/organização & administração , Pacientes/legislação & jurisprudência , Pacientes/psicologia , Saúde Pública/legislação & jurisprudência , Parcerias Público-Privadas/organização & administração , Assistentes Sociais/legislação & jurisprudência , Assistentes Sociais/psicologia , Participação dos Interessados
20.
Australas J Ageing ; 38 Suppl 2: 53-58, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31496067

RESUMO

OBJECTIVE: To describe the co-design process in a project that "evaluated how the key worker role can best support people living with dementia in the community setting." METHODS: People with dementia, care-partners, aged-care service experts, policymakers and academics utilised a co-design process to undertake a systematic literature review and a qualitative evaluation study. RESULTS: The development of a successful co-design process that includes people living with dementia and their care-partners ("consumers") at all stages of the research process and addresses their individual needs. CONCLUSIONS: The co-design approach utilised in this project provided support, for consumers living in the community to be fully involved in the research design, conduct and plans for dissemination and implementation of the findings. Consequently, the research outcomes are based on solid evidence and consumer need. Additionally, a successful model for supporting consumers to facilitate their involvement in all aspects of the research process, was developed.


Assuntos
Pessoal Administrativo/organização & administração , Pesquisa Biomédica/organização & administração , Cuidadores/organização & administração , Demência/terapia , Geriatria/organização & administração , Serviços de Saúde para Idosos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Parcerias Público-Privadas/organização & administração , Adaptação Psicológica , Pessoal Administrativo/psicologia , Cuidadores/psicologia , Efeitos Psicossociais da Doença , Demência/diagnóstico , Demência/psicologia , Humanos , Vida Independente , Comunicação Interdisciplinar , Pesquisa Qualitativa , Apoio Social , Participação dos Interessados
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