Person-centred care for older people in care homes

The Social Care Institute for Excellence has published  Person-centred care for older people in care homes

This resource covers the implications of the personalisation agenda for owners and managers of care homes. It summarises information, advice and guidance which will support care home owners and managers as they develop a person-centred (or personalised) approach to care in their homes.

The resource covers the following areas:

Download the full publication: Person-centred care for older people in care homes

Video: What is person-centred care?

 

The future burden of disability in the UK

2.8 million people over 65 will need nursing and social care by 2025 – largely because of a significant rise in dementia-related disability, research finds.

Research published by the Lancet Public Health medical journal says cases of disability related to dementia will rise by 40% among people aged 65 to 84, with other forms of disability increasing by about 31%.

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The investigators used a detailed model to produce estimates of the prevalence of disability due to cardiovascular disease, dementia, and other causes in people aged 65 years or older in England and Wales to the year 2025.

They found a 25% increase from 2015 in the number of older people who will be living with disability, representing 560 000 additional elderly people in England and Wales who will need care for their disabling condition, and showed that the largest relative increases will be in dementia cases.  They also predicted that although life expectancy among people older than 65 years will increase by 1·7 years, 0·7 of these years will be lived with disability.

Having identified these challenges, the authors have recommended increased capacity in formal social care and improved support for informal social care arrangements, along with enhanced interventions against predictable risk factors for non-communicable diseases disability, such as smoking, diet, and physical activity.

Full reference: Guzman-Castillo, Maria et al. | Forecasted trends in disability and life expectancy in England and Wales up to 2025: a modelling studyThe Lancet Public Health Published online 23rd May 2017

Older People’s Care in Acute Settings

The Older People’s Care in Acute Setting project content has been developed in partnership with British Geriatric Society and  explores the pathway that people take through the acute hospital, beginning in A&E and assessment units, and moving through to inpatient wards and supported discharge teams | NHS Benchmarking

Three key messages have emerged from the 2016/17 project that impact on the quality of care delivered for older people;

  • the use of CGA is increasing;
  • readmission rates are rising;
  • delayed transfers of care continue to grow.
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Image source: NHS Benchmarking

Further findings from the Older People’s Care in Acute Settings 2016 project (2015/16) data include:

  • 40% of organisations have a dedicated geriatric team located in the A&E department. The average number of hours that these teams are available during the week is 9 hours, at weekends this reduces to 6 hours.
  • 77% of trusts delivered Comprehensive Geriatric Assessments on the elderly care wards, and 42% delivered these assessments on other specialty wards.
  • The ratio of qualified to unqualified nursing staff on the care of the elderly wards was found to be 55% registered and 45% unregistered. The RCN recommends a ratio of 65:35 skill mix for “ideal, good quality care,” and 50:50 for “basically safe care” across the participants (Safe staffing on older people’s wards, RCN, 2012).
  • 85% of trusts operate Early Supported Discharge schemes, and 77% of trusts have an Integrated Discharge team.
  • The average time for a continuing healthcare assessment to be undertaken is 10 days.
  • 74% of organisations set estimated discharge dates within 24 hrs of admission.
  • 83% of delayed transfers of care were attributable to people age 65 and over in 2015/16.
  • 56% of patients admitted to the care of older people wards had been admitted to hospital within the previous 12 months.
  • 14% of pay costs spent on bank & agency across the pathway.

The full report is available here

Telecare has the power to create care networks for older people

Telecare is a range of remote care technologies and associated services that have been developed to accommodate an ageing population while helping people to stay in their homes | The Conversation

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Image source: Moyan Brenn – Flickr // CC BY 2.0

Over the next 25 years, the percentage of people aged over 85 is set to more than double, with one in four in this age group already counting as “frail”. In the over 65s, this is estimated at one in ten. At the same time, the number of people, such as family, who might be caregivers is reducing due to different patterns of marriage and parenting, people living apart at greater distances and more women in paid employment.

Traditionally, elderly people who need care in their own homes rely on paid or unpaid carers. Telecare can be thought of as a form of care at a distance, which can allow older and frailer people to live independently. While some might see a risk of decreasing social contact, it can provide safety and security to those people who because of mobility problems and other health issues are housebound. Telecare should be considered as an aid, not a solution to growing demands for care.

Telecare can provide some care on a personal level through attachments that can develop between users and telephone operators, who regularly check in with the telephone operators for weekly test calls.

Read the full blog post here

How empowering is hospital care for older people with advanced disease?

Selman, L.E. et al .(2017) Age Ageing. 46(2) pp. 300-309.

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Background: patient empowerment, through which patients become self-determining agents with some control over their health and healthcare, is a common theme across health policies globally. Most care for older people is in the acute setting, but there is little evidence to inform the delivery of empowering hospital care.

Conclusions: empowering older people in the acute setting requires changes throughout the health system. Facilitators of empowerment include excellent staff–patient communication, patient-centred, relational care, an organisational focus on patient experience rather than throughput, and appropriate access to SPC. Findings have relevance for many high- and middle-income countries with a growing population of older patients with advanced disease.

Read the full abstract here

Helping older people maintain a healthy diet

This review of evidence looks at ‘what works’ in supporting older people to maintain a healthy diet and reduce the risk of malnutrition. | Public Health England

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Malnutrition in older people can have a significant impact on their health and social care needs.It has been estimated that the greater use of healthcare because of malnutrition results in:

  • 65% more GP visits
  • 82% more hospital admissions
  • 30% longer hospital stay

Identifying and treating malnutrition is an important preventative measure that will reduce demands on health and care services

This review of evidence is intended for anyone working on older people’s health, particularly those working on nutrition and those supporting older people in daily living. It reviews the relevant national standards, such as nutritional and catering standards, relevant NICE standards and guidance, national and international evidence.

Finally, it looks at promising practice from England, to see what others are doing and the impact their work is having. For the purposes of this study older people are defined as being aged 65 or over.

Full Impact assessment : Helping older people maintain a healthy diet: A review of what works

 

Seeing the same GP associated with fewer admissions

Older patients who see the same general practitioner over time experience fewer avoidable admissions to hospital, new research shows. | BMJ | OnMedica

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The Health Foundation research, published in The BMJ, shows that if patients saw their most frequently seen GP two more times out of every 10, this was associated with 6% fewer admissions for ambulatory care sensitive conditions such as asthma, diabetes, influenza and pneumonia.

 

The researchers examined whether continuity of care with a general practitioner is associated with hospital admissions for ambulatory care sensitive conditions for older patients. Data was analysed from over 230,000 anonymised patient records for older people aged 62-82 years.

The research found there were fewer hospital admissions for certain conditions when patients saw the same GP more consistently. The authors stress this is an observational study so no firm conclusions can be drawn about cause and effect. However, they conclude, “strategies to improve the continuity of care in general practice may reduce secondary care costs, particularly for the heaviest users of healthcare.”

Full reference: Barker Isaac, Steventon Adam, Deeny Sarah R. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data