Bertini, Lavinia

Dargan, Alan

Ogunleye, Della

Raats, Monique

Rand, Stacey

Sharp, Rebecca

Webb, Karin

Kent Academic Repository

Food and drink-related needs/outcomes of older people who use community-based social careStacey Rand¹, Lavinia Bertini², Monique Raats³, Alan Dargan¹ Becky Sharp†, Karin Webb & Della Ogunleye§1 Personal Social Services Research Unit (PSSRU), University of Kent2 Brighton and Sussex Medical School (BSMS), University of Sussex3 Food, Consumer Behaviour and Health Research Centre, University of Surrey † NIHR Applied Research Collaboration, Kent, Surrey and Sussex (ARC KSS) § Research Advisors (PPI) AcknowledgementsThis presentation summarises independent research funded by the National Institute forHealth and Care Research School for Social Care Research (NIHR SSCR). The viewsexpressed are those of the authors and not necessarily those of the NIHR SSCR, theNIHR or the Department of Health and Social Care.Images are from the Centre for Better Ageing’s library of age-positive images.Further information about ASCOT is available here: www.pssru.ac.uk/ascotBackground• An estimated 1.3 million UK older adults, aged 65+, are undernourished• Malnutrition and dehydration are major causes of health deterioration • Older people using social care services (incl. homecare) are at higher risk• Complex inter-related risk factors• How do we understand food and drink-related needs/outcomes…? • Thinking beyond (risk of) malnutrition and dehydration to also consider quality of life• Community-based services play a vital role in supporting people • But their role is relatively underexploredAims and Objectives• What is already known about food and drink-related needs and outcomes* of older adults using homecare?• What is the profile of and factors related to the food and drink-related needs and outcomes* in England?* Defined broadly, to include ‘food and drink care-related quality of life’Methods 1. Scoping literature review2. Analysis of the English Adult Social Care Survey (ASCS) 3. Developing a guide to findings and recommendations Work Package (WP) 1 - Scoping Literature ReviewObjectives• Conduct a systematic search of published works• To gain an overview of the international literature on food and drink-related needs/outcomes of older adults using homecare• What is already known and where are the gaps? Eligibility criteria • Published reports of research studies (journal articles, grey literature) • Published in English language• Published after 2000• Relates to: • Older adults, aged 65 or over… • Using homecare, and… • Food and drink-related needs or outcomes • Including: (mal)nutrition, (de)hydration and/or quality of life Work Package (WP) 1 - Scoping Literature ReviewDatabase searchesTitle/abstract reviewFull-text review & chartingQualitative analysis and interpretation  Work Package (WP) 1 - Scoping Literature Review• Understandings of food and drink needs/outcomes• Narratives around (mal)nutrition  health deterioration  hospitalization  • Person-centred care for food/eating and drink/drinking • What is the role of homecare in supporting older adults? • In most studies, the role of homecare was not explicitly considered • Some studies explore person-centred care and the challenges to delivery • Innovations • Combination with other services or assistive technology • Improving or supporting communication between family/unpaid carers, healthcare professionals, homecare and/or other services WP2 - Analysis of Adult Social Care Survey Dataset• Annual survey of adults using publicly-managed social care in England• Adult Social Care Outcomes Toolkit (ASCOT)food & drink care-related quality of lifeBased on capability approach(i.e. the ability to do and be, as you wish…)   = Ideal state= No needs= Some needs= High-level needsNeeds metUnmet needsASCS wave/yearInvited Sample NRespondent Sample NResponse Rate %Unmet needN (%)1. 2010/11 67,890 29,650 43.7% 1,273 (4.3%)2. 2011/12 63,947 28,204 44.1% 1,246 (4.4%)3. 2012/13 68,213 28,618 42.0% 1,311 (4.6%)4. 2013/14 71,253 29,255 41.1% 1,390 (4.8%)5. 2014/15 72,739 28,449 39.1% 1,665 (5.9%)6. 2015/16 73,534 28,584 38.9% 1,714 (6.0%)7. 2016/17 73,342 27,902 38.0% 1,726 (6.2%)8. 2017/18 70,536 23,582 33.4% 1,506 (6.4%)9. 2018/19 76,052 25,206 33.1% 1,616 (6.4%)10. 2019/20 77,592 23,598 30.4% 1,561 (6.6%)11. 2020/21 9,126 2,535 27.8% 147 (5.8%)12. 2021/22 81,474 23,193 28.5% 1,879 (8.1%)TOTAL 805,698 298,776 37.1% 17,034 (5.7%)An increase in % with unmet needs from 4.3% to 8.1% Decreasing response rate to ASCSVoluntary survey due to pandemicWP2 - Analysis of Adult Social Care Survey Dataset• What are the factors* related to unmet need? • Ethnicity• Sex/gender• Health and care needs (difficulty with everyday activities, anxiety & depression) • Informal help from family & friends• Suitability of home design• Financial contribution towards cost of care • By the person, their family or person & family (combined)• Survey year   • Type of local authority*These are limited by data available in the ASCS dataset or linked data.  B SE ORGender: male -.115*** .021 .891Ethnicity: categories other than white .148*** .030 1.160Local authority †Unitary -.014 .026 .986Shire county -.052 .027 .949Inner London .202*** .034 1.224Outer London .082** .030 1.085I/ADLs with difficulty .121*** .005 1.128Eating and drinking with difficulty .498*** .025 1.646Suitability of home †Meets most needs .657*** .024 1.929Meets some needs 1.429*** .026 4.176Totally inappropriate 1.842*** .040 6.310Informal care / Practical help Outside home 1.347*** .027 3.845Inside and outside home  † .286*** .047 1.332None 1.665*** .033 5.283Privately purchased care (‘top up’)  †Yes, family money -.047 .038 .954Yes, own & family money .078 .058 1.081None -.164*** .020 .849Response by proxy report .096** .030 1.101Preliminary analysis …. Analysis is still ongoing† Base categoryLocal authority - metropolitan Suitability of home - meets all needsInformal care - inside homePrivately purchased care - own money** p<0.01*** p<0.001B SE ORSurvey year †2012 .008 .047 1.0082013 .025 .046 1.0252014 .036 .046 1.0372015 .136** .044 1.1462016 .179*** .044 1.1962017 .199*** .044 1.2212018 .179*** .046 1.1962019 .213*** .045 1.2382020 .230*** .046 1.2592021 .080 .107 1.0842022 .449*** .044 1.567Constant -5.300*** .053 .005McFadden’s pseudo r 2 12.0%χ²12,366, df = 29, p<.001† Base categorySurvey year (2011)** p<0.01*** p<0.001WP2 - Analysis of Adult Social Care Survey Dataset• ASCS dataset does not include individual-level care intensity• Estimate of average care intensity per older person using services per LA• From 2015 to 2022 only, due to data availability • Results are similar except…. • Ethnicity – no longer significant • Privately purchased care - with own and family money – significant (higher likelihood of unmet need) • Survey year, 2021 – significant (lower likelihood of unmet need) *• Survey year, 2022 – significant (higher likelihood of unmet need) • Average care intensity per person, by LA - significant (lower likelihood of unmet need) * Survey conducted on a voluntary basis vs mandatory, due to the pandemic. Food and drink care-related QoL (‘outcome’) = care intensity + care quality + functional care needs + individual characteristics Summary and Conclusions • Estimated 4% to 8% of older adults living at home using social care have unmet food and drink care-related needs• % increased between 2011 and 2022 • Factors related to unmet need…. • Survey year (i.e. an increase over time) • Does this reflect wider sector impacts (e.g. workforce shortages, chronic underfunding) or context (e.g. pandemic, cost of living increases)? • Average intensity of homecare per older person in each local authority• This indicates that social care investment ‘works’ overall… • But we are limited by what we can consider in the dataset, so it is hard to say more • Further analysis… • Data linkage – but a challenge with current data collection and reporting• New possibilities based on changes to social care data collection in England…?  WP3 – Brief guide to key findings and Recommendations Development, Dissemination and Implementation • Share preliminary findings from WP1/2: • Identify key stakeholders and reasons for interest• Explore how the findings could be used to inform, engage, influence • Development of a brief guide - summarising key findings and recommendations, tailored to different audiences  • Consider contextual issues, in relation to implementation  • Facilitate discussion and commitment to further research • Blog post(s) • Project guide and recommendations  • On-line event (spring 2024) Informed by the Knowledge Exchange, Impact and Engagement (KEIE) PlanAny questions? s.e.rand@kent.ac.uk@DrStaceyRandFood and Care“Food is loaded with meaning, is grown and cooked bysome people for others, who eat it jointly or alone, with allthe social specificities this entails – while it is also physical.Living bodies die if they go without it.”Harbers, Mol, Stollmeyer, 2002,p.207The language and practices of care are underrepresented in public debates.Disseminating and implementing the findingsTwo questions for you:1. Who is the target audience (i.e., who may be interested in this research)?2. What terminology would you use to disseminate the findings (i.e., how would you frame the issue)? Who is the target? Audience/stakeholders• Adult Social Care• Commissioners, providers, care workers• Adults with support needs, using care services • Family and friends• Healthcare professionals• Public Health• Researchers and academicsFraming the issue(s) Public Health – a focus on ‘healthy eating’; eating and drinkingare framed as individual ‘choices’; impact of food poverty… but whatabout care poverty?Medicine – ‘Nutrition’ and ‘illness’; eating and drinking are framedas ‘natural processes’.Social Care – ‘Quality of life’ or supporting a person to live well,i.e., person-centred care; eating and drinking are framed as a ‘task’,i.e., ‘caring’: “wilful and responsive, creative and adaptive, infusedby desire and attuned to the circumstances” (Mol, 2021,p.88).Why is it important?IMPACT FUNDSAWARENESS INCLUSIONAny questions? Contact us: Dr Stacey Rand: s.e.rand@kent.ac.ukDr Lavinia Bertini: L.Bertini@bsms.ac.ukProject website: www.pssru.ac.uk/foodanddrink/

Food and drink-related needs/outcomes of older people who use community-based social care

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Food and drink-related needs/outcomes of older people who use community-based social care

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