The role of home adaptations in improving later life

This report summarises the findings of a systematic review of the best, available scientific evidence on how home adaptations can contribute to improving later life. Living in a suitable home is crucially important to a good later life. The right home environment can maintain or improve people’s physical and mental health, wellbeing and social connections,enable them to carry out day-to-day activities safely and comfortably, and help them to do thethings that are important to them. More than 90% of older people in England live in mainstream housing, as opposed to specialist housing or residential care. However, current UK housing stock is often not accessible or adapted to meet people’s needs as they get older, with small room sizes, steep internal stairs, baths rather than showers and steps outside.While many people will maintain good health and fitness for much of their later years, the likelihood of having one or more long-term condition, physical impairments,disabilities and frailty that make day-to-day life at home more difficult does increase with age. The percentage of people who have difficulty with at least one activity of daily living (basic routine activities like eating, bathing and dressing) increases dramatically from 16% at age 65 to around half of those aged 85. By people’s late 80s, more than one in three people have difficulty undertaking fiveor more activities of daily living unaided (Marmot et al 2016). Installing aids and adaptations into people’s homes, such as grab rails and level access showers, can improve the accessibility and usability of a person’s home environment, maintaining or restoring their ability to carryout day-to-day activities safely and comfortably.The last comprehensive review of the evidence on home adaptations was published in 2007. Since then, there has been increasing policy attention paid to the benefits of home adaptations, particularly in relation to how they can reduce health and social care costs, many of which are outlined in this review. However, there should be much greater focus and action given to the widely acknowledged and unsustainable pressures on our health and social care systems, coupled with the fact that we are living for longer and the proportion of older people in our society is growing. In the last Spending Review, the budget for the Disabled Facilities Grant was increased to enable greater access to home adaptations for more people, yet there is still an unacceptable and under-reported number of people not getting the equipment and support they need. This review aims to provide an up-to-date analysis of evidence of the importance and effectiveness of home adaptations

Disabled Facilities Grant (DFG) and other adaptations – external review

A review of the operation of the Disabled Facilities Grant (DFG) in England. The aim is to keep people living independently for longer and make the case for more joined-up action across housing, health and social care. It is a practical review that examines the evidence for what should change and how it should change. The first part covers the current situation including: funding; who receives the grant; type of work; costs and benefits to authorities; and processing times. The second part considers how the grant should change which includes: strategic oversight; local delivery options; how teams can work better together and more closely with health and social care; allocation of resources; other funding issues; the means test; regulation and the upper limit; procurement; developing a market; helping people outside of the DFG; and finally, tenure, equality and grants for common parts. There are 43 recommendations for government to improve the way the grant operates

Disabled Facilities Grant (DFG) and other adaptations: external review - summary

This is a summary of the findings of a review of the Disabled Facilities Grant (DFG) in England. The aim is to keep people living independently for longer and make the case for more joined-up action across housing, health and social care. It is a practical review that examines the evidence about the current situation and how it should change. The summary covers: how the grant is used now; the main challenges; how delivery of the grant might be joined up both strategically and operationally; the distribution of resources; the various regulations, such as the means test and the upper limit; how the grant can be updated and how outcomes can be measured. It lists some of the main recommendations. Further detail can be found in the main report

Towards an age friendly Bristol? Understanding the context and development of the Bristol Ageing Better programme

The Bristol Ageing Better (BAB) programme began in 2015 during a time of significant demographic, social, economic, political and policy change. This report looks, not at the projects commissioned by BAB, but at the underlying context. Using research and policy reports, archive material, and interviews with people who played key roles in the BAB programme, it paints a picture of the factors at national and local level that influenced the outcomes. BAB began midway through a decade of austerity that cut funding to both statutory and voluntary services. This inevitably cast a shadow over the programme, but also opened up opportunities as organisations learnt to work in new and more collaborative ways

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Second homes in the Calgary hinterland

Bibliography: p. 213-227