East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

SpotMe Emergency Location Service

This document delves into our disaster relief application that allows people who are helpless due to a natural disaster to find a way out and get help. The purpose of this document is to explain how the application works, but more specifically the design of the application, use cases, and conceptual models. Starting with a brief introduction, this paper will dive into the necessary requirements needed to build an application at this scale while presenting several use cases. To help the reader understand the application at a finer detail, activity diagrams will be shown along with models. Lastly, the document will cover what technologies will need to be used as well as a test plan and risk analysis

Program Evaluation of a Community-Based Door-Through-Door Medical Escort Service

This report summarizes the program evaluation findings of a Boston-based organization’s Medical Escort program. This “door-through-door” service strives to provide medical transportation, physical assistance, and emotional support to elders on their way to the doctor’s office, during medical appointments and on the way back home again. By offering added assistance the program attempts to remove environmental barriers associated with access to health care. This evaluation combines previously collected program statistics with surveys (32) from program volunteers and phone interviews (78) with recipients

Using abm in managing territorial health services: the “home-care”.

In recent years in Italy, as in other European countries, profound changes have been introduced in health care at both the central and the regional levels. Most of them were oriented towards a shift from “hospital-centred” healthcare to healthcare based more on territorial services. This transition pursues two objectives: giving more effective responses to citizens’ needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. Starting from the experiences of the healthcare system of the Tuscan Region of Italy, the paper aims to provide an experience of the ABM approach to measure both output and efficiency of territorial health services. Activity Based Management provides an appropriate method to examine territorial activities and to meet the fact-finding needs of national and regional policy, by considering the issues indicated by the territorial managers of the Tuscan healthcare system and the regional and national experiences in recent years. ABM focuses on managing activities as the route to improving value for users and for the local healthcare unit; this is accomplished by the measurement of activities and resources that determine the costs and performance of territorial services. This approach requires organization and integration of sets of data belonging to different systems such as financial and operational systems. The ABM model is complex but it can be used by policy makers for strategic perspective and for continuous improvement. Moreover, ABM meets managers’ demands, as the Tuscan territorial managers have confirmed in interviews. On the basis of experience obtained in territorial long term homecare , the paper underscores the principal issues arising from the process of conducting an ABM project in territorial health services through strong involvement of healthcare workers. The paper also presents the main outputs achieved.Home care, performance measurement, ABM.

The satisfaction of the elderly with moderate and severe disability in geriatric nursing institutions: a case study of geriatric nursing institutions in Chengdu

Facing severe challenges of aging population, China’s geriatric nursing market has a substantial development potential. However, there are insufficient resources in terms of providing nursing service and medical treatment to the elderly and the market develops at a slow speed. This thesis intends to apply the empirical research approach to investigate the satisfaction of the disabled elders and their families with the geriatric nursing hospitals in Chengdu in terms of the environment, medical treatment, service, administration and trust perception. Through theoretical analysis and construction of DES model (the Disabled Elder's Satisfaction in elder hospital, DES) and field investigation, it is found that there is a positive correlation between the respondents’ satisfaction of environment, medical treatment, service, administration and trust perception on one hand and the overall satisfaction of the nursing hospital. The environmental satisfaction is the most influential factors and service perception is second to it. Based on the current development of geriatric nursing hospitals in Chengdu and the conclusion of this thesis, this thesis puts forward countermeasures and suggestions for the development of the geriatric medical and nursing market in Chengdu.Considerando os diferentes desafios que se colocam ao evelhecimento da população, a enfermagem geriática apresenta um substancial potencial de desenvolvimento. Contudo, há atualmente recursos insuficientes em temos de oferta de serviços médicos e de enfermagem aos idosos e o desenvolvimento deste sector desenvolve se muito lentamente. Esta tese pretende, através de uma abordagem empírica, identificar a satisfação dos idosos e respetivas famílias com os hospitais de cuidados continuados em Chengdu (em temos de meio envolvente, tratamento médico, serviço prestado, administração e a confiança que detém na instituição). Através de uma análise teórica baseada no modelo DES (the Disabled Elder's Satisfaction in Elder Hospital) e investigação de terreno, foi identificada uma correlação positiva entre a satisfação dos respondentes com a envolvente, o tratamento médico, o serviço administrado e a confiança por um lado e a satisfação global do corpo de enfermagem do hospital por outro. A envolvente é o fator mais significativo que influencia a satisfação, seguido da perceção da qualidade do serviço prestado .Basedo no desenvolvimento atual dos hospitais de cuidados continuados em Chengdu, esta tese baseada nas conclusões alcançadas apresenta propostas e sugestões para o desenvolvimento da medicina e enfermagem geriática em Chengdu

Modeling an ontology on accessible evacuation routes for emergencies

Providing alert communication in emergency situations is vital to reduce the number of victims. However, this is a challenging goal for researchers and professionals due to the diverse pool of prospective users, e.g. people with disabilities as well as other vulnerable groups. Moreover, in the event of an emergency situation, many people could become vulnerable because of exceptional circumstances such as stress, an unknown environment or even visual impairment (e.g. fire causing smoke). Within this scope, a crucial activity is to notify affected people about safe places and available evacuation routes. In order to address this need, we propose to extend an ontology, called SEMA4A (Simple EMergency Alert 4 [for] All), developed in a previous work for managing knowledge about accessibility guidelines, emergency situations and communication technologies. In this paper, we introduce a semi-automatic technique for knowledge acquisition and modeling on accessible evacuation routes. We introduce a use case to show applications of the ontology and conclude with an evaluation involving several experts in evacuation procedures. © 2014 Elsevier Ltd. All rights reserved

"Just coming in the door was hard": supporting students with mental health difficulties

A student in your writing center displays such high level of anxiety that it also begins to impact on those working in the writing center. The student's behavior might tip over into the unacceptably aggressive and thus provoke a sharp response from the writing center director. Is this just everyone having a bad day or could it indicate a much deeper problem?. Students with mental health difficulties have been a growing concern for us in recent years in our study support team in a UK university. The UK Higher Education Statistics Agency indicates that, in 2003-4, 12.03% of the total numbers of students declaring a disability disclosed a mental health problem. In our college, LCC (London College of Communication, University of the Arts London), our statistics showed that 29.5% of our students, declaring a disability, had disclosed a mental health issue by the end of the same academic year. We are at present half way through our 2005-6 academic year and that number has increased to 37.14% of our students with disabilities. Students will frequently not disclose their disability before they apply because they are worried that they may not be accepted onto the program or even because the initial onse

EMPLOYMENT AND WELFARE

In consideration of the Lisbon Agenda, the Romanian Government drew up the National Programme for Reform for 2007-2010, which established national priorities, and ways and tools to achieve economic reform and growth. Transition in Romania implied a complex and extensive system of regulations and institutions for stimulating employment and creating a flexible system of social protection. The new regulations were focused on harmonisation with the Community labour law. Increasing investment in human capital is essential for a competitive and dynamic economy. Besides, labour market policies were formulated for correcting labour market imbalances.Demographic Economics; Labour Standards; Labour-Management Relations; Welfare and Poverty; Quality of Life

Mediterranean Models of Welfare Towards Families and Women

After an historical Excursus on Malta's history, society, culture and institutions with their effects on female condition and on family structure and concept, the paper gives a survey of most recent Malta's economic and demographic trends with special attention to families and women, based on statistical data of the National Institute of Statistics and on the results of a sample research. After drawing this scenario, the paper makes a short History of Malta's Welfare State specially concerning family and women. In this treatment a deeper investigation is devoted to the latest "Action Plan", the national social plan in its general lines of intervention towards family and women. The strategic lines (public, private, non profit) of welfare mix are examined in relation to their amounts, results and to the coherence with the moving social context. Finally the paper develops a comparison between different european models of welfare towards family, more specifically between Malta and Italy.