Las caídas de las personas mayores que viven en la comunidad: una revisión crítica

Falls are the most prevalent and serious accident older people suffer in their homes and also, they are the main reason for their hospital admission. In a great part of the cases falls expose at risk elderly people’s well-being and quality of life. A critical narrative literature review was undertaken to inform research in the area of falls in older people living in the community. Articles were retrieved from Medline and Scopus data bases from November 2011 to January 2013. Citation searching was also used as a complement by hand searching of relevant journals. Additionally, an alert mechanism was established in Scopus for a period of one year to identify relevant studies or literature. Reviewed studies have provided valuable evidence about falls in older people and potential prevention strategies. However, evidence from relatives, caregivers and significant others is conspicuously absent. Falls in the community and falls prevention happen in social and family contexts that must be empirically studied and reported.Las caídas son el accidente más serio y prevalente que los mayores sufren en sus domicilios y son la principal razón de ingreso hospitalario. Las caídas ponen en riesgo el bienestar y la calidad de vida de los mayores. Se llevó a cabo una revisión narrativa crítica de la bibliografía a fin de informar estudios de investigación en el área de las caídas de los mayores que viven en la comunidad. Se recuperaron estudios de las bases de datos Medline y Scopus de Noviembre 2012 a Enero 2013. Se usó también búsqueda de citaciones que se complementó con búsqueda manual en revistas relevantes. Se estableció un sistema de alertas en Scopus a lo largo de un año para identificar estudios relevantes o bibliografía. Los estudios revisados han proporcionado una evidencia valiosa sobre las caídas de las personas mayores y las estrategias potenciales de prevención. No obstante, evidencia proveniente de sus familiares, cuidadores y otros significativos esta notablemente ausente. Las caídas en la comunidad y su prevención suceden en contextos familiares y sociales que deben ser empíricamente estudiados y registrados

Service developments for managing people with long-term conditions using case management approaches: an example from Cheshire in the UK

INTRODUCTION: This research has considered current developments in the provision of services for people with long-term conditions within the NHS of England. Community Matrons are being employed and by adopting a case management approach they are aiming to improve patient care and reduce their demands for acute hospital care. DESCRIPTION: Qualitative research was undertaken to explore experiences of community matrons and service leads on the development, implementation and provision of services for people with long-term conditions. CONCLUSIONS: This research provides evidence of what is being done to meet the challenge of long-term conditions and provides lessons for similar challenges and service development for different areas of care and in other countries. Continual system and role change has had effects on service delivery and on the whole care. These effects relate to; defining the role of community matron and structure of service, training staff, identifying patients, providing infrastructure, demonstrating benefits, identifying gaps in services, ability to reduce avoidable admissions and identifying the advantages and difficulties of the role. DISCUSSION: All of these aspects should be used to inform future development

Improving end of life care in care homes; an evaluation of the six steps to success programme

BACKGROUND: There are approximately 426,000 people residing within care homes in the UK. Residents often have complex trajectories of dying, which make it difficult for staff to manage their end-of-life care. There is growing recognition for the need to support care homes staff in the care of these residents with increased educational initiatives. One educational initiative is The Six Steps to Success programme. METHOD: In order to evaluate the implementation of Six Steps with the first cohort of care homes to complete the end-of-life programme in the North West of England., a pragmatic evaluation methodology was implemented in 2012–2013 using multiple methods of qualitative data collection; online questionnaire with facilitators (n = 16), interviews with facilitators (n = 9) and case studies of care homes that had completed the programme (n = 6). The evaluation explored the implementation approach and experiences of the programme facilitators and obtain a detailed account of the impact of Six Steps on individual care homes. Based upon the National Health Service (NHS) End of Life Care (EoLC) Programme, The Route to Success in EoLC – Achieving Quality in Care Homes. RESULTS: The programme was flexibly designed so that it could be individually tailored to the geographical location and the individual cohort requirements. Facilitators provided comprehensive and flexible support to care homes. Challenges to programme success were noted as; lack of time allocated to champions to devote to additional programme work, inappropriate staff selected as ‘Champions’ and staff sickness/high staff turnover presented challenges to embedding programme values. Benefits to completing the programme were noted as; improvement in Advance Care Planning, improved staff communication/confidence when dealing with multi-disciplinary teams, improved end-of-life processes/documentation and increased staff confidence through acquisition of new knowledge and new processes. CONCLUSIONS: The findings suggested an overall positive impact from the programme. This flexibly designed programme continues to be dynamic, iteratively amended and improved which may affect the direct transferability of the results to future cohorts. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12904-016-0123-6) contains supplementary material, which is available to authorized users

A discrete choice experiment to explore carer preferences. Quality in Ageing and Older Adults.

© Emerald Publishing Limited. Purpose - The purpose of this paper is to describe a case study to test the applicability of the discrete choice experiment (DCE) method to assess the preferences of carers of people with dementia. The focus of enquiry was home care provision. Design/methodology/approach - A multi-method approach was adopted for this pilot study. A literature review identified key characteristics of home care for dementia. This informed consultations with lay representatives. Key attributes of home care for the DCE were identified and formed the basis for the schedule. In all, 28 carers were recruited by two voluntary organisations to complete the DCE. A multinomial logistic regression model was used to analyse the data. Findings - Seven attributes of home care for people with dementia were identified from the consultation. The use of the DCE approach permitted the identification of those most important to carers. Despite the modest sample, statistically significant findings were reported in relation to five of the attributes indicating their relevance. A lay involvement in the identification of attributes contributed to the ease of administration of the schedule and relevance of the findings. Originality/value - This study demonstrated the utility of a DCE to capture the preferences of carers of people with dementia and thereby gather information from carers to inform policy, practice and service development. Their involvement in the design of the schedule was critical to this process