Healthcare support to older residents of care homes: a systematic review of specialist services

Abstract

Purpose A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised healthcare support for care home residents has resulted in poorer outcomes, compared with community-dwelling older people. However, little is known about the forms, staff mix, organisation and delivery of such services for residents’ physical healthcare needs. The paper aims to discuss these issues. Design/methodology/approach This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to provide an overview of the range of healthcare services delivered to care homes and to identify core features of variation in their organisation, activities and responsibilities. The eligibility criteria for studies were services designed to address the physical healthcare needs of older people, permanently residing in care homes, with or without nursing. To search the literature, terms relating to care homes, healthcare and older people, across ten electronic databases were used. The quality of service descriptions was appraised using a rating tool designed for the study. The evidence was synthesised, by means of a narrative summary, according to key areas of variation, into models of healthcare support with examples of their relative effectiveness. Findings In total, 84 studies, covering 74 interventions, identified a diverse range of specialist healthcare support services, suggesting a wide variety of ways of delivering healthcare support to care homes. These fell within five models: assessment – no consultant; assessment with consultant; assessment/management – no consultant; assessment/management with consultant; and training and support. The predominant model offered a combination of assessment and management. Overall, there was a lack of detail in the data, making judgements of relative effectiveness difficult. Recommendations for future research include the need for clearer descriptions of interventions and particularly of data on resident-level costs and effectiveness, as well as better explanations of how services are implemented (review registration: PROSPERO CRD42017081161). Originality/value There is considerable debate about the best means of providing healthcare to older people in care homes. A number of specialist initiatives have developed and this review seeks to bring these together in a comparative approach deriving models of care of value to policy makers and commissioners.

Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis

“… [9] Care facilities across the world forms diverse congregant settings with substantial differences in the dependency level of the residents and provision of wide variety of services with or without delivering skilled nursing care. [10] The gathering of residents, healthcare professionals, and visitors in settings like aged care facilities contributes to an increased risk of disease transmission, making the control of an outbreak with non-pharmacological interventions difficult. [ 11 , 12 ] Moreover, the SARS-CoV-2 has a long incubation period and an individual may remain asymptomatic while infectious.…”

Specialist healthcare services for UK care home residents: a latent class analysis

“…Although latent class membership is not directly observable, it can be inferred from patterns in core sample components (predictor variables), with each service placed in a class based on the highest probability of membership. The choice of predictor variables in this study was clinically driven and was made by the research team (a multidisciplinary group including a senior consultant geriatrician, a nurse and a social worker) taking into account the findings of a literature review (Clarkson et al, 2018) and professional guidelines (eg, British Geriatrics Society, 2016). Four predictor variables capturing key aspects of the support provided by the different services were employed: 'scheduled input', 'all residents', 'medication management' and 'training'.…”

“…A self-administered questionnaire was developed to capture information on the organisation, responsibilities and activities of specialist healthcare support services for older care home residents in the UK. The tool was designed by the researchers and was informed by a systematic literature review of specialist care home support services undertaken by the research team (Clarkson et al, 2018) and guidance on effective survey design (Dillman, 2007;Fowler, 2009).…”

“…Third, questionnaires were sent to a further 27 service contacts identified by a systematic literature review of specialist care home support services for care homes (Clarkson et al, 2018) or other sources (mainly a small number of individuals who approached the researchers directly nominating their service for inclusion in the study).…”

Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: Protocol for a systematic review

“…Similar initiatives have been trialled internationally (Clarkson et al., ). For example, Pain, Stainkey, and Chapman (), described an in‐house model of general practice in Australia whereby a core group of GPs were rostered to provide weekly sessional clinics in a care home, whilst as part of the Evercare demonstration programme in the US, nurse practitioners assessed and managed residents on an ongoing basis, supplementing the support provided by primary care practitioners (Kane, Keckhafer, Flood, Bershadsky, & Siadaty, ).…”