Health status of UK care home residents: a cohort study

Gordon, Adam L; Franklin, Matthew; Bradshaw, Lucy; Logan, Pip; Elliott, Rachel A.; Gladman, John

doi:10.1093/ageing/aft077

Cited by 299 publications

(287 citation statements)

References 18 publications

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“…Care home residents have been shown to use out-of-hours services frequently and, when admitted to hospital, to have either very short or long stays 1 . They are subject to polypharmacy and frequent medication errors .…”

Section: Methodsmentioning

confidence: 99%

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The Optimal Study: Describing the Key Components of Optimal Health Care Delivery to UK Care Home Residents: A Research Protocol

Gordon

Goodman

Dening

et al. 2014

Journal of the American Medical Directors Association

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Long term institutional care in the UK is provided by care homes. Residents have prevalent cognitive impairment and disability, have multiple diagnoses and are subject to polypharmacy. Prevailing models of healthcare provision -ad hoc, reactive and co-ordinated by general practitioners -result in unacceptable variability of care. A number of innovative responses to improve health care for care homes have been commissioned. The organisation of health and social care in the UK is such that it is unlikely that a single solution to the problem of providing quality healthcare for care homes will be identified that can be used nationwide.Realist evaluation is a methodology which uses both qualitative and quantitative data to establish an in depth understanding of what works, for whom, in what settings. In this paper we describe a protocol for using realist evaluation to understand the context, mechanisms and outcomes which shape effective health care delivery to care home residents in the UK.By describing this novel approach, we hope to inform international discourse about research methodologies in long-term care settings internationally.

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Section: Methodsmentioning

confidence: 99%

“…They are commonly prescribed seven or more medications and have six or more diagnoses. A significant proportion are clinically depressed, exhibit behavioural symptoms, have mobility problems and are in pain 1 .…”

Section: Introductionmentioning

confidence: 99%

The Optimal Study: Describing the Key Components of Optimal Health Care Delivery to UK Care Home Residents: A Research Protocol

Gordon

Goodman

Dening

et al. 2014

Journal of the American Medical Directors Association

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“…The focus of our study was on single comorbidities rather than multimorbidity and we excluded those living in care homes where there are likely to be considerable levels of dementia and comorbidity. 207 The support that people with dementia and multiple health conditions need may be different from the support required by those with less complex needs. Moreover, our study did not distinguish between those people who developed a comorbidity in the presence of already diagnosed dementia and those who had a health condition such as diabetes and who then developed dementia.…”

Section: Limitationsmentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

115

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…The acceptability and feasibility of the EQ-5D for administration with individuals exhibiting mild to moderate cognitive impairment and living in residential aged care and has been demonstrated in a number of published studies internationally [12][13][14][15]. For individuals who are unable to selfcomplete the EQ-5D due to more severe levels of cognitive impairment a proxy version is available (CEQ-5D).…”

Section: Introductionmentioning

confidence: 99%

An Empirical Comparison of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U in a Post-Hospitalisation Population of Frail Older People Living in Residential Aged Care

Ratcliffe

Flint

Easton

et al. 2016

Appl Health Econ Health Policy

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Running head: quality of life of frail older people in residential aged care Results: There was a large divergence in mean (SD) utility scores at baseline for the EQ-5D-5Land DEMQOL-U [EQ-5D-5L mean 0.21 (0.19); DEMQOL-U mean 0.79 (0.14)]. However, at 4 weeks a stronger degree of convergence was evident [EQ-5D-5L mean 0.45(0.38); DEMQOL-U mean 0.58 (0.38). The EQ-5D was more responsive to the physical recovery trajectory experienced by frail older people following surgery to repair a fractured hip, whereas the DEMQOL-U and DEMQOL-Proxy-U instruments were more responsive to the changes in cognitive functioning often experienced by frail older people in this period. Conclusions

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Health status of UK care home residents: a cohort study

Cited by 299 publications

References 18 publications

The Optimal Study: Describing the Key Components of Optimal Health Care Delivery to UK Care Home Residents: A Research Protocol

The Optimal Study: Describing the Key Components of Optimal Health Care Delivery to UK Care Home Residents: A Research Protocol

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

An Empirical Comparison of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U in a Post-Hospitalisation Population of Frail Older People Living in Residential Aged Care

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