People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID.
Future research needs to explore the efficacy of interventions on multiple clinical outcomes and which combination of interventions (components) would have the most significant effects when using CBT. The generalization of treatment effects in different countries and carers of different types of dementia also need to be addressed. More research is needed to test the efficacy of modern forms of CBT, such as ACT.
Health status is critically important to experiencing quality of life, self-sufficiency, and full participation in society. For the 54 million Americans with disabilities, maintaining health and wellness is especially important to reduce the impact of impairment on functioning in these critical life areas. Yet, people with disabilities may be the largest underserved subpopulation demonstrating health status disparities that stem from preventable secondary conditions. Healthy People 2010, the nation’s blueprint for improved health, addresses this problem in its objectives. In 2002 and 2005, the U.S. Surgeon General asked for public health efforts to improve the health and wellness of persons with disabilities. This article examines the concepts of health and wellness, summarizes currently available information documenting disparities in health for people with disabilities, and provides a framework for policy recommendations to reduce health disparities among people with disabilities.
Purpose The purpose of this paper is to explore the impact of attending a Recovery College (RC) on NHS staff attitudes towards mental health and recovery, clinical and peer interactions, and personal wellbeing. Design/methodology/approach Qualitative and quantitative data were collected via online surveys from 94 participants. Thematic analysis and descriptive statistics were used. Findings Themes were identified for change in attitudes towards mental health and recovery: new meanings of recovery; challenging traditional views on recovery; hope for recovery; and increased parity. The majority felt that the RC positively influenced the way they supported others. Themes relating to this were: using or sharing taught skills; increased understanding and empathy; challenging non-recovery practices; and adopting recovery practices. Responses highlighted themes surrounding impacts on personal wellbeing: connectedness; safe place; self-care; and sense of competency and morale at work. Another category labelled “Design of RC” emerged with the themes co-learning, co-production and co-facilitation, and content. Research limitations/implications It is important to understand whether RCs are a useful resource for staff. This research suggests that RCs could help to reconcile Implementing Recovery through Organisational Change’s 10 Key Challenges and reduce staff burnout, which has implications for service provision. Originality/value This is one of the first papers to directly explore the value of RCs for staff attending as students, highlighting experiences of co-learning.
Background Dementia care staff working in long‐term care settings are often exposed to a variety of complex situations that can be emotionally challenging, and a lack of adequate support and limited training opportunities may contribute to high levels of staff turnover in this area. Good‐quality training may be beneficial for improving the quality of care provided, and in improving staff confidence and morale. This systematic review aimed to establish how dementia care home staff perceived their own competence and confidence in relation to the care they deliver, whether there are any specific interventions that improve these feelings, and whether feeling more competent and confident impacts on care delivery. Method A search of the literature focusing on staff perceptions of competence and confidence identified 14 873 studies. Following the removal of duplicates and papers that did not meet the inclusion criteria, 19 studies were included in the review and subject to quality assessment. Results Studies varied in terms of quality and design, and were categorised as either intervention or non‐intervention studies. Four studies found a significant increase in feelings of competence and confidence following intervention, although many studies did not statistically analyze their data. The most successful interventions seemed to be those that involved practical support alongside education, and non‐intervention studies highlighted the importance of specific dementia and palliative care training with regard to feelings of competence and confidence. Conclusion Teaching alone may not be an adequate method of training dementia care staff, and the most successful interventions were those where practical support was also provided. Most studies suggested that improvements in competence and confidence also had benefits for care delivery and staff wellbeing. More research needs to be done using validated outcome measures and with competence and confidence as the primary aim.
Purpose Including the views of service users, carers and clinical staff when prioritising health research can ensure future projects are meaningful and relevant to key stakeholders. One National Health Service Foundation Trust in England, UK undertook a project to identify the top 10 research priorities according to people with experience using or working in services for dementia and older adult mental health. The paper aims to discuss these issues. Design/methodology/approach Service users with dementia and mental health difficulties; informal carers, family and friends of service users; clinical staff working in the Trust. Participants were surveyed for research ideas. Ideas were processed into research questions and checked for evidence. Participants were then asked to prioritise their personal top 10 from a long list of research questions. A shortlist of 26 topics was discussed in a consensus workshop with a sample of participants to decide on the final top 10 research priorities. Findings A total of 126 participants provided 418 research ideas, leading to 86 unique and unanswered research questions. In total, 58 participants completed interim prioritisation, 11 of whom were invited to the consensus workshop involving service users, carers and clinical staff. The final top 10 priorities were dominated by topics surrounding care, psychosocial support and mental health in dementia. Research limitations/implications Future research from the Trust and collaborating organisations can use these results to develop relevant projects and applications for funding. Originality/value This project has demonstrated the possibility of including key stakeholders in older adult mental health research priority setting at the local level.
People with disabilities are more susceptible to compromised health status and preventable secondary conditions. A Healthy Lifestyles curriculum was developed as a health promotion program for people with disabilities. Using the curriculum, ten free 2½-day workshops were provided for people with various disabilities in Oregon and Southwest Washington. Workshops were conducted in collaboration with local entities such as Centers for Independent Living. The workshops took an integrated approach to health, addressing connections among physical, social, emotional, and spiritual health, and health through meaningful activities. During workshops, the participants obtained health information and experienced healthy activities such as yoga and non-impact aerobics, both tailored for people with disabilities. At the end of the workshop, each participant identified two healthy lifestyle goals to work toward. Progress and/or barriers in accomplishing those goals were shared in support groups for 6-9 months. Preliminary results indicate early and sustained improvements in health behaviors and health-related attitudes. The Healthy Lifestyles program offers a promising approach to promoting health among people with disabilities.
Purpose The purpose of this paper is to provide a viewpoint about why people with dementia should be able to choose Recovery and how this approach might be experienced by them. Design/methodology/approach This paper addresses some key challenges to accepting Recovery as an approach for people with dementia by making comparisons with people with mental health difficulties. It then discusses key concepts of Recovery using the connectedness, hope, identity, meaning and empowerment framework and how each one might be experienced by the person with dementia. Findings The challenges which cause concerns about the applicability of Recovery to people with dementia are shared by people with mental health difficulties, therefore Recovery should be perceived as an approach suitable for anyone regardless of their diagnosis. Recovery for people with dementia could mean: connecting to the self, others and the world to promote feelings of purposefulness; having hope for the here and now; preserving one’s identity; finding meaning in retaining skills and incorporating dementia into one’s life; and, feeling empowered by keeping one’s mind working, adopting a positive attitude, having control and making decisions. Practical implications People with dementia can choose to access Recovery, and commonly voiced concerns can be answered and supported with evidence. Originality/value This is one of the only papers written to provide an understanding of how Recovery might be experienced by people living with dementia, and directly answers some concerns.
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