Care services for frail older people in South Korea

This paper examines the changed social circumstances of older people in South Korea and specifically the increased need for formal health and social services for those who are frail and have no informal carers. The article begins with a summary account of the country's exceptionally rapid demographic, economic and social transformations, which demonstrates a widening gap between the population's expectations and needs, and health and social service provision. It then examines the recently initiated and now burgeoning welfare programmes, with particular attention to health and social services for sick and frail older people. Most extant care services are accessed mainly by two minorities: the very poor and the rich. The dominant policy influence of physicians and a history of conflict between traditional and western medicine probably underlies the low current priority for ‘care’ as opposed to ‘cure’, as also for the management of chronic conditions and rehabilitation. Neither long-term care services nor personal social services are well developed. There is a marked disparity between the acute services, which are predominantly provided by private sector organisations in a highly competitive market and broadly achieve high standards, and public primary care and rudimentary residential services. The latter are weakly regulated and there are many instances of low standards of care

Policy and service responses to rough sleeping among older people

Rough sleeping in Britain has a long history, and interventions have alternated between legal sanctions and humanitarian concern. This paper critically examines recent changes in homeless policies and services, with particular reference to the needs of older people who sleep rough. The characteristics and problems of the group are first described. Single homeless people were formerly accommodated in direct-access hostels but, from the 1970s, individualised rehabilitation and resettlement have spread. Most recently, services dedicated to older people have begun (although remain few and are unevenly provided). Their achievements are reviewed and drawn upon in formulating normative proposals of the appropriate service mix. The 1990s ‘Rough Sleepers Initiative’ and related programmes promoted a ‘social care market’ of not-for-profit organisations that compete for increased (but short-term) funds to provide services, and the new Labour government will build upon these changes and increase funds. Low tolerance towards the ‘social exclusion’ of homelessness is promised but unerringly constructed as exclusion from work; while rough sleeping is dubbed as anti-social, coercive approaches to achieve a two-thirds reduction are foreseen. The proposed target might stall the development of diverse and effective services, or reduce providers' capacity to combat the perversities of resource allocation. The overall prospects for the improvement and expansion of services to provide significant help to single older homeless people are uncertain

The well-being of British expatriate retirees in southern Europe

This article examines the personal outcomes of overseas residence in later life, by analysing some findings from the first large-scale, comparative study of the retirement of British citizens to southern Europe. Four study areas are compared: Tuscany in Italy, Malta, the Costa del Sol of Spain, and the Algarve region of Portugal. The analysis focuses on the expressed reasons for moving to and residing in the areas, the reported advantages and disadvantages, and the respondents' predictions of whether they would stay or leave in response to adverse and beneficial events. Overall the subjects give very positive reports, but there are considerable differences among the four areas. The associations of individual variation in well-being with both a person's ‘temporal commitment’ to the area and to facets of their social integration are analysed. The onset of severe incapacity, sufficient to prevent the continued running of a home, is the event most likely to cause people to leave their adopted areas of residence

The diversity and welfare of older migrants in Europe

This paper sets the scene and provides a conceptual framework for the articles in this special issue. They present the findings of research on European residents who have reached or are on the threshold of old age and whose current circumstances have been strongly influenced by a migration across an international border. Such ‘older migrants’ are scattered throughout Europe and they have especially diverse characteristics. They include some of the most deprived and socially excluded, and some of the most affluent and accomplished, but all to a greater or lesser extent are disadvantaged through an interaction between social policies and their ‘otherness’ by living in a foreign country. Some claim attention through the severity of their unmet health and welfare needs and poor capacity to access advice and treatment, while the affluent groups are of great interest to social gerontology because of their enterprising, developmental and positive approaches to old age. They include among the most innovative of the latest generation of older people, who pursue new combinations of family responsibilities, leisure pursuits and income generation. The paper proposes that the concept ‘human capital’ summarises variations in preparedness for old age, that is, the resources by which people cope with demands for income, roles, treatment, care and support. A typology of the ‘welfare position’ of international migrants in contemporary Europe is presented

SARS-CoV-2 Spike triggers barrier dysfunction and vascular leak via integrins and TGF-β signaling

Severe COVID-19 is associated with epithelial and endothelial barrier dysfunction within the lung as well as in distal organs. While it is appreciated that an exaggerated inflammatory response is associated with barrier dysfunction, the triggers of vascular leak are unclear. Here, we report that cell-intrinsic interactions between the Spike (S) glycoprotein of SARS-CoV-2 and epithelial/endothelial cells are sufficient to induce barrier dysfunction in vitro and vascular leak in vivo, independently of viral replication and the ACE2 receptor. We identify an S-triggered transcriptional response associated with extracellular matrix reorganization and TGF-β signaling. Using genetic knockouts and specific inhibitors, we demonstrate that glycosaminoglycans, integrins, and the TGF-β signaling axis are required for S-mediated barrier dysfunction. Notably, we show that SARS-CoV-2 infection caused leak in vivo, which was reduced by inhibiting integrins. Our findings offer mechanistic insight into SARS-CoV-2-triggered vascular leak, providing a starting point for development of therapies targeting COVID-19

Single homeless people in London Profiles of service users and perceptions of needs; a study for Bondway, St Mungo's and Thames Reach

Available from British Library Document Supply Centre-DSC:m01/40672 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Effectiveness of a rapid response service for frail older people

AIM: Many innovative community-based intermediate care services have been initiated to address the care needs of older people with chronic health conditions, but there is little evidence about their outcomes or how they are best configured and delivered. This study aimed to evaluate one practice innovation, a rapid response service (RRS). METHOD: This study focused on the RRS's clinical and therapeutic achievements, and patients' satisfaction with its care. A mixed design of quantitative and qualitative methods was used. RESULTS: Patients were satisfied with staff attitudes; being treated at home or in a home-like environment; and receiving a quick response to their needs and access to services/ help. Aspects of care that they were dissatisfied with were inconvenient facilities and insufficient equipment or material supplies; arrangements for their care and recovery; lack of communication; inappropriate medical care; and insufficient or limited duration of care. CONCLUSION: The RRS provided holistic assessments for a previously under-served group of older people with chronic health problems and disabilities, and identified and responded to several unmet needs, partly through its own treatment and partly by referring patients to other health and social services

Migration after retirement The implications for health and mental health services

SIGLELD:6224.11(12) / BLDSC - British Library Document Supply CentreGBUnited Kingdo