Outcomes for Older Telecare Recipients: The Importance of Assessments

The article explores both telecare in relation to its composition of assistive technologies, including sensors; and associated services that use such technologies as a means by which, often vulnerable, people can obtain help through their activation - with signals being routed to monitoring centres. The context is one where there are changes to such technologies and ongoing growth in the use of telecare services - despite there being no indicated benefits from a major study (the Whole System Demonstrators). The 'curious' investment in such technologies and services by Adult Social Care Departments in England is investigated through an interview survey that elicited over 100 valid responses. Iy gave particular attention to the assessment process by which effective targeting (to those who would be most likely to benefit) would, it had been assumed, have taken place. Key outcomes point to needed improvements to social care practice - including the need to balance a narrow focus on risk (determined in a largely top-down way) with other telecare offerings that could more proactively address (e.g. loneliness) and involve the user more proactively in relation to technology and service options. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Summary This article explores the role of telecare assessment, review and staff training in meeting the needs of older people living at home. Using original empirical data obtained from an online survey of English local authorities it reveals considerable variation in assessment and review practice and in training given to social work and other staff who assess and review, which may impact on outcomes for telecare users. The study findings are situated within an English policy context and earlier findings from a large, government funded randomised controlled trial. This trial concluded that telecare did not lead to better outcomes for users. Findings Our survey findings suggest that it may be the way in which telecare is used, rather than telecare itself that shapes outcomes for people who use it, and that ‘sub-optimal’ outcomes from telecare may be linked to how telecare is adopted, adapted and used; and that this is influenced by staff training, telecare availability and a failure to regard telecare as a complex intervention. Application The findings may help to reconcile evidence which suggests that telecare does not deliver better outcomes and local authority responses to this which either discount or contest its value. The article suggests that to use telecare to achieve optimal outcomes for older people, social workers, care managers and other professionals involved in assessing for telecare will need to be given enhanced training opportunities, and their employers will need to perceive telecare as a complex intervention rather than simply a ‘plug and play’ solution

Participation as means for adaptation in dementia: A conceptual model

Maciver, Donald - ORCID 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XReplaced AM with VoR 13 Jan 2020.Objectives: There are a number of conceptual models of dementia, capturing a range of biopsychosocial factors. Few integrate the lived experience of dementia. The aim of this study was to develop a conceptualisation grounded in the first-hand accounts of living with the condition and reflecting its complexity.Method: The study was conducted within an explanatory, critical realist paradigm. An overarching narrative approach, informed by a previously completed systematic review and metasynthesis of research on the lived experience of dementia and the assumptions of complexity theory, was used to guide data collection and analysis. Data were contributed by 31 adults, including 12 people living with dementia and 19 family caregivers.Results: The experience of living with dementia was conceptualised as a process of adaptation through participation, emerging from ongoing, dynamic and nonlinear interactions between the adaptive capacity of a person with dementia and the adaptive capacity within the environment. The proposed conceptual model describes contexts and mechanisms which shape this capacity. It identifies a range of potential outcomes in dementia. These outcomes reflect interactions and the degree of match between the adaptive capacity of a person and the adaptive capacity within the environment.Conclusion: By recognising and exploring the potential for adaptation and enduring participation in dementia, findings of this research can support practitioners in facilitating positive outcomes for people affected by the condition.work completed as part of PhD process supported by Queen Margaret University Edinburgh.https://doi.org/10.1080/13607863.2019.169574025pubpub

Psychometric evaluation of the ACHIEVE assessment

AM deposited 2020-04-22. Kept embargoed till publication at author's request.Miriam Crowe - ORCID 0000-0002-8941-5442 https://orcid.org/0000-0002-8941-5442Donald Maciver - ORCID 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XReplaced AM with VoR 2020-06-12Objective: There has been a significant change within clinical practice in childhood disability from ‘treating’ at the level of body function to ecological approaches that address the child’s involvement in everyday life. Clinical assessment, and robust tools to support this, are of key importance. The aim of this study was to assess the psychometric properties of the ACHIEVE Assessment in a clinical dataset. The ACHIEVE assessment is a parent and teacher report of participation in home, school and community settings, important contributory factors for participation, and environmental factors.Design: ACHIEVE scores of children were collected from parents and teachers. The Rasch Rating Scale Model produced model estimates with WINSTEPS software.Setting: Clinical rehabilitation settings in Scotland (United Kingdom).Subjects: 401 parents and 335 teachers of 402 children participated resulting in a final sample of 736 responses. Children (78% male) were 4-17 years old (mean 7.91 years SD 2.61). Children had a range of disabilities including Developmental Coordination Disorder, Autism Spectrum Disorder, and Attention Deficit Hyperactivity Disorder.Results: The study includes a large clinical sample of children with disabilities. The results demonstrate that the ACHIEVE Assessment can provide unidimensional measurements of children’s participation and important contributory factors for participation. Differential item functioning analysis indicated majority of items were comparable between parent and teacher report.Conclusions: The results confirm evidence of appropriate psychometric properties of the ACHIEVE Assessment. ACHIEVE is a comprehensive tool that enables identification of patterns and issues around participation for clinical and research purposes.https://doi.org/10.3389/fped.2020.002458pubpu

The general self-efficacy of older adults receiving care: A systematic review and meta-analysis

Lucy Whitehall - ORCID 0000-0002-1090-2767 https://orcid.org/0000-0002-1090-2767Replaced AM with VoR 2020-05-20Background and Objectives: General self-efficacy (GSE) encourages health-promoting behaviors in older adults. It is unsurprising then, that older adults receiving healthcare services are reported to have a greater risk of low GSE than older adults who are not. Despite this, there is currently limited evidence investigating whether the effect differs based on the environment in which care is received. This review aims to determine whether the GSE of older adults is affected by the receipt of healthcare services, and whether GSE varies based on the setting in which care is received.Research Design and Methods: In accordance with PRISMA guidelines (PROSPERO registration number CRD42018092191); a systematic search was undertaken across seven databases. Standardized mean differences (SMD) and mean General Self-Efficacy Scale scores, with 95% confidence intervals, were pooled for meta-analysis.Results: A total of 40 studies were identified, they consisted of 33 different population cohorts that were included in the meta-analysis. Older adults receiving healthcare services were found to be at greater risk of having lower GSE than those who do not (SMD = -0.62; 95% CI: -0.96 to -0.27, p<.0001). Following identification of sources of heterogeneity, older adults receiving acute inpatient care were more likely to have lower GSE than those receiving care in other healthcare settings.Discussion and Implications: Older adults receiving inpatient care have a greater risk of lower GSE, and consequently poorer health-promoting behaviors. Further research is recommended that focuses on the GSE of older adults and health outcomes following discharge from inpatient care.This work was supported by a PhD scholarship from Queen Margaret University and National Health Service (NHS) Lothian.https://doi.org/10.1093/geront/gnaa03661pubpub

Exploring the needs of people with dementia living at home reported by people with dementia and informal caregivers: A systematic review and meta-analysis

Maciver, Donald - ORCID 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XReplaced AM with VoR 09 Jan 2020Curnow, Eleanor - ORCID 0000-0001-9332-8248 https://orcid.org/0000-0001-9332-8248Objectives: To provide prevalence estimates of needs of people with dementia living at home, and to determine sources of variation associated with needs for this population.Method: A systematic review and meta-analysis was performed searching CINAHL, MEDLINE, PsycINFO and ASSIA databases. Following quality checks, random effects meta-analysis produced prevalence estimates for needs reported by people with dementia and by their informal caregivers. Fixed effects models were undertaken to compare caregiver and person with dementia reported needs. Heterogeneity was explored through sensitivity analysis. The study protocol was registered with Prospero #CRD42017074119Results: Six retrieved studies published between 2005 and 2017 including 1011 people with dementia and 1188 caregivers were included in the analysis. All data was collected using Camberwell Assessment of Need for the Elderly. Prevalence estimates are provided for 24 needs reported by participants in The Netherlands, United Kingdom, Poland, Ireland, Germany, Norway, Portugal, Italy and Sweden. Most prevalent needs reported by people with dementia were Memory 0.713 [95% CI 0.627, 0.791]; Food 0.706 [95% CI 0.547, 0.841]; Household activities 0.677 [95% CI 0.613, 0.738]; and Money 0.566 [95% CI 0.416, 0.711]. Caregivers reported greater prevalence than people with dementia did for 22 of 24 needs, although the priority ranking of needs was similar. Exploration of heterogeneity revealed that people with young onset dementia were the major source of variation for 24 out of 44 analyses.Conclusion: Increased understanding of prevalence of needs of people with dementia and associated heterogeneity can assist in planning services to meet those needs.https://doi.org/10.1080/13607863.2019.169574125pubpub

Living With Dementia: A Meta-synthesis of Qualitative Research on the Lived Experience

Purpose of the Study: To identify and examine the published qualitative research evidence relative to the experience of living with dementia. Design and Methods: Metasynthesis was used as the methodological framework to guide data collection and analysis. Results: Three themes were identified. The first theme considered the main condition-related changes experienced by people with dementia (PWD) and showed how these are interlinked and impact upon various areas of people's lives. The second theme indicated that amidst these changes, PWD strive to maintain continuity in their lives by employing various resources and coping strategies. The third theme underlined the role of contextual factors. The reviewed evidence indicates that, the emerging experience of PWD and their potential to adjust to the continuous changes is influenced by access to and quality of both personal and contextual resources which remain in a constant, transactional relationship to each other. Implications: The findings were interpreted and discussed in the context of relevant theoretical frameworks and research evidence. It was considered that current evidence and findings presented in this review can be further explored and expanded upon in a more systematic way through research conducted within the theoretical framework of dynamic systems theory. Further research would be also beneficial to explore the subjective experience of dementia from a participatory perspective. Exploring the application of these theoretical standpoints would contribute to the current state of knowledge and offer both PWD and carers fresh perspective on the nature of change and potential for adaptability in dementia.sch_occ58pub4643pub

Incite to practice: Development of a realist-informed program theory to support implementation of intersectoral partnerships

Donald Maciver - ORCID: 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XPolicy internationally is supportive of intersectoral partnerships (ISPs) for promoting positive outcomes among people with complex social, psychological, and physical needs. This realist-informed study describes the development of a program theory to provide insight into enactment of effective ISPs. Interviews were completed with 18 senior staff with leadership roles in six ISPs, including voluntary, statutory, and commercial organizations, supporting people with complex health and social care needs. An iteratively developed and refined program theory, termed the “Incite” model, was developed, with collaboration with participants and an advisory group, including people with lived experience. Important contextual conditions that emerged included organizational culture, historical perspectives, policy, and social determinants of health. Mechanisms included desire for change, creating safe psychological spaces, establishing shared values, and talking about power. Outcomes included transformed world view, increased psychological safety, clarity of purpose, fluidity of relationships, and power shifting. Three phases of partnership development were also identified within the model. This study has led to a clearer, more rigorous, and systematic understanding, with recommendations for how ISPs might be developed or expanded. How the Incite model may be operationalized is discussed, as well as implications for policy, practice, and research.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: We acknowledge funding contributions from the Scottish Government’s Third Sector Division and Mental Health Division and Community Covenant Grant.https://doi.org/10.1177/2158244021103831611pubpub

Using stakeholder involvement, expert knowledge and naturalistic implementation to co-design a complex intervention to support children’s inclusion and participation in schools: The CIRCLE framework

Donald Maciver - ORCID: 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XReplaced AM with VoR 2021-03-16Whist inclusion is recommended for most children most of the time it remains difficult to implement. In this paper, we present the process undertaken to review and redesign a pre-existing complex intervention (The CIRCLE Framework) which was designed to enhance teachers confidence and competence in provision of universal first level supports for 5-12 year old children with additional support needs. The approach presented draws on the Medical Research Council guidance for the development of complex interventions. A series of ten co-design workshops with 70 stakeholders was completed, applying interactive and participatory methods. Analysing outputs of each workshop revealed recurring design ideas that became the main aspects of the new framework and associated manuals. Intervention content, theoretical frameworks, manuals to support use in practice and implementation strategies were developed. On completion, the updated intervention was extended up to 18 years of age and redistributed to all teachers in the participating local authority. We present the main conclusions and interpretations around the design and naturalistic implementation of the framework, and reflections on use in practice, including a detailed list of recommendations for implementation across schools and staff.Funding: This work was supported by the City of Edinburgh Council.https://doi.org/10.3390/children80302178pubpub

Making Use of Evidence in Commissioning Practice: Insights into the Understanding of a Telecare Study’s Findings

The paper draws on (100+) survey responses from social services authorities in England. It established their generally minimal understandings of (largely negative) outcomes of the government promoted (Whole System Demonstrator (WSD) project. The WSD project involved over 5000 mainly older people - half of whom were, following assessment, assigned telecare equipment (others telehealth). The robustness of the outcomes are discussed; issues about the effectiveness of assessments are raised; and the appropriateness of the methodology (an RCT) is questioned. In sum the paper provides an example where shortcomings of RCTs are exposed in a context where technological changes impact on ‘traditional’ (health and) social care service frameworks. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.In less than a generation, telecare has become a significant new resource for local authority (LA) Adult Social Care Departments (ASCDs) in England and other European countries to offer to people eligible for social care and support. All English ASCDs either have directly managed, or commissioned, telecare services, and telecare is often used as a 'first line' service (that is, before other forms of intervention). The Whole Systems Demonstrator Project (WSD), a very large clinical trial funded by the English Department of Health (DH) concluded that it does not deliver better outcomes. Despite this, and in the context of unprecedented reductions in adult social care expenditure over the last decade (Innes and Tetlow, 2015), investment in telecare has continued in the UK. This article explores the extent and nature of the evidence used in LAs to support investment in telecare