The relationships between sarcopenic skeletal muscle loss during ageing and macronutrient metabolism, obesity and onset of diabetes

Skeletal muscle is integral to the metabolism and utilisation of macronutrients; however, substantial muscle loss and morphological changes occur with ageing. These are associated with loss of muscle function and accelerate rapidly from the age of 60 years, leading to the conditions of sarcopenia and frailty. As the relationship between muscle ageing and macronutrient metabolism and utilisation has seen limited research to date, this review focuses on the interactions between skeletal muscle changes during ageing, metabolism and utilisation of fat, carbohydrates and overall energy expenditure. Skeletal muscle contributes less to resting energy expenditure during ageing, potentially contributing to onset of obesity from middle age. Age-related changes to skeletal muscle lead to glucose dysregulation, with consequent reduction in glycaemic control, increased insulin resistance and ultimately onset of type-2 diabetes. Recent studies indicate that high total fat and SFA intake are detrimental to skeletal muscle, while higher intakes of PUFA are protective. Age-associated changes in skeletal muscle may also reduce total fatty acid utilisation. In conclusion, further research is needed to understand the relationships between macronutrient metabolism and utilisation and age-related changes to skeletal muscle. No dietary recommendations exist specifically for skeletal muscle health during ageing, but we advise individuals to follow healthy eating guidelines, by consuming sufficient protein, fruit and vegetables, and limited SFA and to maintain physically active lifestyles. Clinicians responsible for managing type-2 diabetes need to be aware of growing evidence relating age-related skeletal muscle changes to diabetes onset and progression

Service user and carers perspectives of joint and integrated working between health and social care

Purpose – The purpose of this paper is to provide an update to a review of the joint working literature in the field of health and social care for adults, with particular emphasis given to the experiences of users and carers. Design/methodology/approach – The aims of the literature review remained largely the same as those of the original, they were to identify: models of joint working, evidence of effectiveness and cost-effectiveness and the factors promoting or hindering the models. However, to reflect the growing interest in the experiences of users and carers a fourth aim was added to map these experiences. Given their prominence in terms of policy debates about integration, the review focused on jointly organised services for older people and people with mental health problems in the UK only. Findings – The review demonstrates tentative signs that some initiatives designed to join-up or integrate services can deliver outcomes desired by government. Importantly some studies that report the experiences of users of services and carers suggest that they perceive benefits from efforts to join-up or integrate services. However it is our contention that the evidence is less than compelling and does not justify the faith invested in the strategy by current or previous governments. Originality/value – The study updates our knowledge of the impact of joint working in the field of health and social care for adults. Importantly the paper highlights what is known about the experiences of users and carers of joint/integrated services

Developing child-centred methods to better understand the impacts of music tuition: an exploration of In Harmony, Opera North

This thesis examines the impacts that arise from participation in the music education programme In Harmony, Opera North (IHON). The value of music education is often described in terms of the impacts that music has on personal, social, and academic development. Such impacts may apply to IHON, which delivers free instrumental and vocal tuition to children in areas of deprivation in Leeds. However, IHON’s specific contribution to extra-musical impacts cannot be assumed based on existing research from different contexts or the popularity of these narratives. Furthermore, engaging with the perspectives of children participating in IHON is essential to understand the programme’s impacts. This research therefore aims to understand how IHON specifically contributes to extra-musical impacts based on the perspectives of the children involved. The research consists of three studies examining IHON’s potential impact on children’s (aged 7-11 years) emotional, social, and academic experiences. The emotions study collaboratively developed a questionnaire with focus group participants which explored emotional experiences and was completed by 51 participants. The social study devised a visual social mapping method which was carried out with 31 participants. The academic study explored academic and musical self-efficacy beliefs through questionnaires interviews which were completed by seven participants. Findings suggest a diversity of impacts arising from participation in IHON as discussed in relation to key themes: 1) the amount and type of contact that IHON offers; 2) the unique and individual experience of IHON; 3) IHON’s difference to and isolation from other aspects of schooling and life; and 4) the interconnected and multidirectional nature of IHON’s impacts. On this basis a model of factors determining IHON’s impacts is proposed. Findings also explore the efficacy of the new methods developed throughout the research highlighting the merits and challenges associated with this form of child-centred research

Older people’s perspectives on living in integrated housing and care settings: the case of extra care housing

Purpose This paper explores residents’ perceptions and experiences of extra care housing as an integrated model of housing with care. Design Data were collected in a longitudinal qualitative study based in four extra care housing schemes. Interviews were held with residents, care workers, managers and local commissioners. Data were analysed thematically. Findings The study found that the integration of housing with care enabled many older people to manage their care proactively. However, the increasing number of residents with complex health and care needs led some residents to question the ability of the model to support residents to live independently when living with chronic illness. Research limitations The study struggled to recruit sufficient residents from the specialist dementia setting who were able to communicate their consent to take part in the research. In addition, the quality of qualitative data collected in interviews with participants at this setting reduced over successive rounds of interviews. Implications The study suggests the need to ensure residents are fully appraised of what levels of care and support are available when they decide to move into extra care housing schemes. Originality This paper provides a timely opportunity to consider extra care housing as an example of an integrated housing service, particularly in light of the current challenges facing the sector

The challenges of joint working: lessons from the Supporting People Health Pilot evaluation

Purpose: This paper reports the findings of the evaluation of the Supporting People Health Pilots programme which was established to demonstrate the policy links between housing support services and health and social care services by encouraging the development of integrated services. The paper highlights the challenges of working across housing, health and social care boundaries. <br><br> Method: The evaluation of the 6 health pilots rested on two main sources of data collection: Quarterly Project Evaluation Reports collected process data as well as reporting progress against aims and objectives. Semi-structured interviews - conducted across all key professional stakeholder groups and agencies and with people who used services - explored their experiences of these new services. <br><br> Results: The ability of pilots to work across organisational boundaries to achieve their aims and objectives was associated not only with agencies sharing an understanding of the purpose of the joint venture, a history of joint working and clear and efficient governance arrangements but on two other characteristics: the extent and nature of statutory sector participation and, whether or not the service is defined by a history of voluntary sector involvement. In particular the pilots demonstrated how voluntary sector agencies appeared to be less constrained by organisational priorities and professional agenda and more able to respond flexibly to meet the complex needs of individuals. <br><br> Conclusion and discussion: The pilots demonstrate that integrating services to support people with complex needs works best when the service is determined by the characteristics of those who use the service rather than pre-existing organisational structures