A report said that there was now a significant cohort of people in the United Kingdom who were living with HIV and were aged over 50, and that this presented new challenges to the way in which HIV care and treatment were designed, managed, and delivered. Recommendations included: for a national patient experience survey of people living with HIV, to be funded by NHS England; for mandatory basic training in HIV for all those working in health and social care; for ongoing support for peer networks; for the development of personal health budgets among HIV patients; and for groups and charities working with the elderly to be brought together with those supporting people living with HIV to help meet the needs of the ageing cohort.
Source: Gail Beer, Matt James, and Sean Summers, Growing Older Positively: The challenge of ageing with HIV, 2020health
A think-tank report provided the findings from the Commission on Residential Care, which drew on academics, practitioners, and other experts to consider the future of residential care (including care homes, extra care villages, and supported living) for older people and people with disabilities in England. It said that there was much innovative and excellent practice in the sector, but negative public perceptions were widespread, with care settings often seen as a last resort option. The report made extensive recommendations, including: for a broader definition of 'housing with care' to be adopted within government policy; for changes in the approach to funding; for the redefinition of residential status in care homes (to provide people with tenancies); for consideration of co-operative, mutual, or profit sharing ownership models; for co-location of care settings with other community services; for an expanded role for the Care Quality Commission; and for workforce-related changes, including payment of a living wage and the introduction of a licence to practice for care staff.
Source: The Commission on Residential Care, Demos
A think-tank report examined the findings of an inquiry into the extent of the challenges posed by age-related hearing loss in the United Kingdom, and how it could be addressed. The report made a range of recommendations to the Department of Health and healthcare providers and commissioners.
Source: Commission on Hearing Loss: Final report, International Longevity Centre – UK
An article examined the role of social factors in healthy ageing in developed (OECD) countries, using a longevity index of centenarians. It said that governments needed to strengthen their preventive social programmes and increase their existing support services for the elderly through increased financing of the health sector.
Source: Jong In Kim, 'Association between social factors of health ageing and longevity: determinants of the longevity index (LI) in OECD countries', Ageing International, Volume 39 Number 2
An article examined the nature of the political settlements for the English National Health Service and the Medicare and Medicaid programmes in the United States of America. It argued that rationing was designed into the NHS and out of Medicare, and compared the rationing of care for older people within the two systems.
Source: Gwyn Bevan and Lawrence Brown, 'The political economy of rationing health care in England and the US: the "accidental logics" of political settlements', Health Economics, Policy and Law, Volume 9 Issue 3
An article examined trends in place and causes of death for centenarians in England, drawing on death registration data linked with area-level indices of multiple deprivations for people aged 100 years or over who died between 2001 and 2010 in England, compared with those dying at ages 80-99. It said that centenarians were more likely to die as a result of acute conditions such as pneumonia and conditions related to frailty, and less likely to have causes of death of cancer or ischemic heart disease, compared with younger elderly patients. Most were found to have died in a care home (nursing or residential), but 27 per cent died in hospital. It noted implications for policy on residential and anticipatory care for the oldest old.
Source: Catherine Evans, Yuen Ho, Barbara Daveson, Sue Hall, Irene Higginson, and Wei Gao, 'Place and cause of death in centenarians: a population-based observational study in England, 2001 to 2010', PLoS Medicine, Volume 11 Number 6
A report provided the response of the Leadership Alliance for the Care of Dying People to the recommendations set out in the independent review of the Liverpool Care Pathway (an end of life care pathway used in the National Health Service that had been withdrawn following concerns). The report outlined five new 'priorities for care', which set out the standards of care that dying people and their families should expect to receive. The report was published alongside another report that outlined the commitments of Alliance members to implement the new priorities, and a summary of public engagement into the Alliance's proposed approach.
Source: One Chance to Get it Right: Improving people's experience of care in the last few days and hours of life, Leadership Alliance for the Care of Dying People
Links: Report | Commitment statements | Engagement summary | Original review | Written ministerial statement | DoH press release | CQC press release | NHS Employers press release | PHE press release | RCN comment
An article examined the literature around joint working in health and social care for older people and people with mental health problems in the United Kingdom. Updating an earlier literature review, it said there were signs that some joint working or integration initiatives could deliver outcomes desired by government, and some evidence to suggest benefits to service users or carers. However, the authors concluded that the available evidence did not support the current or previous government's faith in the strategy of health and social care integration.
Source: Ailsa Cameron, Lisa Bostock, and Rachel Lart, 'Service user and carers perspectives of joint and integrated working between health and social care', Journal of Integrated Care, Volume 22 Number 2
A report said that older people in Northern Ireland were being denied access to assessments for NHS Continuing Healthcare, a package of National Health Service-funded ongoing care for individuals found to have a 'primary health need'. The report said that there was no clear guidance on the issue in Northern Ireland and, as a result, many older people were paying for care that should be paid for by the NHS. The report called for a range of measures, including: for the publication of guidance on NHS Continuing Healthcare in Northern Ireland; for trusts to meet their obligations to make a determination of NHS Continuing Healthcare prior to any placement in a care setting; and for the Health, Social Services and Public Safety Committee and the Commissioner for Older People to make formal investigations.
Source: Judith Cross and Brenda Kearns, The Denial of NHS Continuing Healthcare in Northern Ireland, Age NI
A report said that a recent audit of end of life care had found significant variations in standards across hospitals in England. It said that major improvements were needed to ensure better care for dying people, and better support for family, carers, and friends. Recommendations included: for the provision of a face-to-face specialist palliative care service, 7 days per week; for mandatory training for all staff caring for dying patients; for regular pain monitoring; and for the decision that the patient was in the last hours or days of life to be made by a multidisciplinary team, discussed with the patient where possible, and documented by the senior responsible doctor.
Source: National Care of the Dying Audit for Hospitals, England, Royal College of Physicians
A study examined the impact of paperwork requirements on the care of older people in residential settings in England. The report said that regulatory and other requirements meant that care homes completed many separate items of paperwork, some duplicated, and that this was often fuelled by fear of blame or litigation. The report called for care homes, commissioners, and regulators to generate more collective approaches to accountability and to improve shared learning and calculated risk-taking across the care home sector.
Source: Joy Warmington, Asif Afridi, and William Foreman, Is Excessive Paperwork in Care Homes Undermining Care for Older People?, Joseph Rowntree Foundation
A report examined the challenges in caring for increasing numbers of frail older people in the United Kingdom. It made recommendations for change, including: improvements to information sharing; wider use of technology, such as telemedicine; annual frailty checks for people over the age of 75, along with priority access and rapid assessment schemes; personal or per capita budgeting to fund home repairs, adaptations, and homecare support; and changes in responsibilities, alongside new commissioning/funding models, for health and social care providers.
Source: Better Care for Frail Older People: Working differently to improve care, Deloitte Centre for Health Solutions, Deloitte LLP
A report said that care for terminally ill people needed to be reviewed and improved, to ensure that they had access to around the clock care when needed. It said that people found the current system difficult to understand and navigate, and that there was a need for: greater availability of hospice care (in-patient and day services), palliative and specialist end of life care for people with non-cancer diagnoses; more effective pain relief at home; and better out-of-hours services.
Source: Difficult Conversations with Dying People and their Families, Marie Curie Cancer Care
A report examined health and care services for older people in England, in the context of an ageing population. It said that a fundamental shift was required, moving towards co-ordinating care around individual needs rather than single diseases, alongside the prioritization of prevention and support for maintaining independence. The report outlined areas of good practice, identified aspects of care that required improvement, and highlighted the need for integrated working across teams to ensure that sufficient and appropriate services would be available in the right locations.
Source: David Oliver, Catherine Foot, and Richard Humphries, Making Our Health and Care Systems Fit for an Ageing Population, King's Fund
An article examined media scandals involving nursing homes for older persons in Canada, Norway, Sweden, the United Kingdom, and the United States, considering whether and how different social, political, and economic contexts might influence events. It said that a number of common factors were present in all of the scandals and, while government action was taken in each case, it generally did not address the underlying structural conditions.
Source: Liz Lloyd, Albert Banerjee, Charlene Harrington, Frode Jacobsen, and Marta Szebehely, 'It's a scandal! Comparing the causes and consequences of nursing home media scandals in five countries', International Journal of Sociology and Social Policy, Volume 34 Issue 1/2
An article reported a review that sought to identify longitudinal or nationally representative cross-sectional sources of information on the health and well-being of older adults residing in care homes in the United Kingdom and Ireland. Most studies did not include or follow up older adults in care homes. It said systematic data collection on the health of older adults in care homes should be a priority, to inform policy development and enable monitoring of care delivery and health outcomes.
Source: Danielle Collingridge Moore and Barbara Hanratty, 'Out of sight, out of mind? A review of data available on the health of care home residents in longitudinal and nationally representative cross-sectional studies in the UK and Ireland', Age and Ageing, Volume 42 Issue 6
An audit report in Scotland said that progress on the Scottish government's ten-year project to improve health and social services for older people had been slow, and monitoring of its implementation and impact needed to improve. It said that the government needed to: work with its partners to plan the movement of resources from institutions such as hospitals into the community; gain greater understanding of the geographical variations in activity and spending on services; and improve and maintain data on costs, activity and outcomes for health and care services.
Source: Reshaping Care for Older People, Audit Scotland
A report examined specialist provision for older people with drug and alcohol misuse problems. It called for more specialist, age-appropriate services, stable funding, and improved awareness and support in care settings, including primary and social care.
Source: It's About Time: Tackling substance misuse in older people, DrugScope/Recovery Partnership
An article examined the health status and healthcare resource use of care home residents. It said that residents from both residential and nursing settings were dependent, cognitively impaired, had mild frequent behavioural symptoms, multimorbidity, polypharmacy, and they frequently used National Health Service resources. Effective care for such a cohort required broad expertise from multiple disciplines delivered in a co-ordinated and managed way.
Source: Adam Lee Gordon, Matthew Franklin, Lucy Bradshaw, Pip Logan, Rachel Elliott, and John Gladman, 'Health status of UK care home residents: a cohort study', Age and Ageing, Volume 43 Issue 1
A report provided the findings from a policy commission on healthy ageing. It said that the experience of ageing was complex, bore little relationship to age, and was viewed in a variety of ways by people from the wide range of nationalities, ethnicities, languages, faiths, and cultures that resided in the United Kingdom. The report said that health inequalities associated with socio-economic disadvantage were also found in the older population, and that longer term planning was needed to provide services that respected older people's desire for control and independence alongside meeting their need for security, care, and support. The report made recommendations for commissioners and providers of health and social care, as well as for ongoing research.
Source: Birmingham Policy Commission, Healthy Ageing in the 21st Century: The best is yet to come, University of Birmingham