Has your work worked you too hard? Physically demanding work and disability in a sample of the older Irish population

There is a heightened need for the practitioner to be alert to the determinants of functional limitations and disabilities owing to the ageing workforce. This study investigated the association between work type and disability in older age in both the paid and the previously unexplored, unpaid worker (household labour).Data on demographic factors, physical measurements, work history and functional status were collected on three hundred and fifty seven 57-80-year-olds. Past or present work was identified as either physically demanding or not. Functional limitations and activities of daily living (ADL) disabilities were assessed using validated scales. Logistic regression was used to examine the relationship between the dependent variables and work type (physically demanding work or not physically demanding work).Over half of the sample reported doing physically demanding work. 20 % had complete function (n = 67), 65 % (n = 223) functional limitations and 15 % (n = 53) ADL disability. Physically demanding work was associated with functional limitations [OR 2.52 (1.41, 4.51), p = 0.01] and ADL disability [OR 2.10 (1.06, 4.17), p = 0.03] after adjustment for a measure of obesity and gender. When gender stratified, looking only at females, physically demanding work was associated with ADL disability [OR 2.79 (1.10, 7.07), p = 0.03] adjusted for a measure of obesity and household labour. Physically demanding work was related to functional limitations and ADL disability in older age. This is valuable information to inform practitioners in the treatment of older people with functional limitations and disabilities and in guiding interventions in the prevention of work related disability.

Utilizing ICT to prevent loneliness and social isolation of the elderly. A literature review

Ageing of the population is a worldwide phenomenon. Numerous ICT-based solutions have been developed for elderly care but mainly connected to the physiological and nursing aspects in services for the elderly. Social work is a profession that should pay attention to the comprehensive wellbeing and social needs of the elderly. Many people experience loneliness and depression in their old age, either as a result of living alone or due to a lack of close family ties and reduced connections with their culture of origin, which results in an inability to participate actively in community activities (Singh & Misra, 2009). Participation in society would enhance the quality of life. With the development of information technology, the use of technology in social work practice has risen dramatically. The aim of this literature review is to map out the state of the art of knowledge about the usage of ICT in elderly care and to figure out research-based knowledge about the usability of ICT for the prevention of loneliness and social isolation of elderly people. The data for the current research comes from the core collection of the Web of Science and the data searching was performed using Boolean? The searching resulted in 216 published English articles. After going through the topics and abstracts, 34 articles were selected for the data analysis that is based on a multi approach framework. The analysis of the research approach is categorized according to some aspects of using ICT by older adults from the adoption of ICT to the impact of usage, and the social services for them. This literature review focused on the function of communication by excluding the applications that mainly relate to physical nursing. The results show that the so-called ‘digital divide’ still exists, but the older adults have the willingness to learn and utilise ICT in daily life, especially for communication. The data shows that the usage of ICT can prevent the loneliness and social isolation of older adults, and they are eager for technical support in using ICT. The results of data analysis on theoretical frames and concepts show that this research field applies different theoretical frames from various scientific fields, while a social work approach is lacking. However, a synergic frame of applied theories will be suggested from the perspective of social work.

Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study)

Background: Potentially inappropriate prescribing (PIP) is common in older people in primary care and can result in increased morbidity, adverse drug events and hospitalisations. We previously demonstrated the success of a multifaceted intervention in decreasing PIP in primary care in a cluster randomised controlled trial (RCT).
Objective: We sought to determine whether the improvement in PIP in the short term was sustained at 1-year follow-up.
Methods: A cluster RCT was conducted with 21 GP practices and 196 patients (aged ≥70) with PIP in Irish primary care. Intervention participants received a complex multifaceted intervention incorporating academic detailing, medicine review with web-based pharmaceutical treatment algorithms that provide recommended alternative treatment options, and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions at 1-year follow-up. Intention-to-treat analysis using random effects regression was used.
Results: All 21 GP practices and 186 (95 %) patients were followed up. We found that at 1-year follow-up, the significant reduction in the odds of PIP exposure achieved during the intervention was sustained after its discontinuation (adjusted OR 0.28, 95 % CI 0.11 to 0.76, P = 0.01). Intervention participants had significantly lower odds of having a potentially inappropriate proton pump inhibitor compared to controls (adjusted OR 0.40, 95 % CI 0.17 to 0.94, P = 0.04).
Conclusion: The significant reduction in the odds of PIP achieved during the intervention was sustained after its discontinuation. These results indicate that improvements in prescribing quality can be maintained over time.

Cold weather plan for England

The cold weather plan gives advice to help prevent the major avoidable effects on health during periods of cold weather in England. The documents for the 2015 to 2016 winter season include: cold weather plan making the case: why long-term strategic planning for cold weather is essential to health and wellbeing letter for local authorities chief executives, directors of public health, directors of adult and child services, chairs of health and wellbeing boards, NHS England regional, clinical leads of CCGs

Life expectancy: recent trends in older ages

Over the last 30 years there has been an upward trend in life expectancy at older ages in England. Figures 1 and 2 show life expectancy in England at ages 65, 75, 85 and 95 from 1981 to 2014. The data points shaded red in Figures 1 and 2 indicate where life expectancy in that year was lower than in the previous year, showing that there is some fluctuation in life expectancy at these age groups, although the overall trend has been upwards. Male life expectancy was lower in 2012 than 2011 at ages 85 and 95, and at ages 65 and 75 it was the same in both years. There were no further falls in 2013. This flattening of the recent trend has not continued in 2014, which saw a rise in male life expectancy at all four ages. Male life expectancy increased by 0.3 years at age 65 and 0.2 years at ages 75, 85 and 95. For females, life expectancy at all four ages was lower in 2012 than 2011. At age 65, that was the first fall since 1995 and at age 75 the first fall since 2003. At ages 85 and 95, there have been frequent occasions when life expectancy in a year was lower than in the previous year. Between 2012 and 2013, there were no further falls in life expectancy at any of these ages. Between 2013 and 2014, there was an increase in female life expectancy at all four ages. Female life expectancy increased by 0.3 years at age 65 and by 0.2 years at ages 75, 85 and 95.  

Coimbra: cidade amiga das pessoas idosas?!

Introdução: Em Portugal, bem como nos restantes países mundiais, tem sido registado, em virtude de múltiplas transformações societárias, um aumento crescente do envelhecimento demográfico. Este novo cenário demográfico originou uma reflexão, por parte de organizações supranacionais, sobre as cidades na sua relação com os munícipes mais velhos. Desta reflexão surge o projeto Cidade Amiga das Pessoas Idosas que apresenta referenciais de avaliação das cidades para que estas possam adaptar as suas estruturas e serviços aos seus munícipes mais velhos. Beneficiando desta forma do potencial que as pessoas mais velhas representam para a humanidade. Objetivos: O presente estudo tem como objetivo central verificar se a cidade de Coimbra é uma cidade amiga das pessoas idosas. Metodologia: A pesquisa remete para um estudo qualitativo exploratório a partir dos procedimentos metodológicos que constam do Protocolo de Vancouver. O focus group decorreu em duas sessões. Participantes: Foram auscultados 16 pessoas, 15 (93,8%) do sexo feminino. A idade média situa-se nos 79,88 anos (dp= ± 10,658), são maioritariamente viúvos (7= 43,8 %) e 7 (43,8%) e têm como habilitações a 4ª classe. Autoclassificam-se maioritariamente na classe média baixa (7 =43,8). Resultados: Das oito categorias analisadas três categorias “espaços exteriores e edifícios”, “transportes” e “respeito e inclusão social” são avaliadas com aspetos positivos e negativos. O “suporte comunitário e serviços de saúde” é avaliado como positivo enquanto a “habitação”, “participação social” e “comunicação e informação” são avaliados como negativos. As sugestões efetuadas referem-se a um único tópico “espaços exteriores e edifícios”. Conclusões: Se partilharmos a tese que uma cidade amiga das pessoas idosas estimula o envelhecimento ativo porque otimiza as oportunidades de participação no ambiente urbano melhorando, desta forma, a qualidade de vida das pessoas envelhecem. Os resultados que obtivemos, a partir da auscultação de um grupo de idosos, permitem-nos afirmar que Coimbra precisa de se adaptar aos seus munícipes mais velhos. Só assim Coimbra se poderá tornar uma cidade amiga das pessoas idosas. Importa igualmente registar que os resultados encontrados devem ser mediados pelo perfil sociodemográfico dos idosos entrevistados. / Introduction: In Portugal, as well as in other countries worldwide, has been registered by virtue of multiple associated transformations, an increasing growing of population. This new demographic scenario triggered, led to a reflection on the part of supranational organizations, about the cities in their relationship with the older residents. This reflection comes with the project Friendly City of Older Persons that presents benchmarks for the evaluation of cities so that they can adapt their structures and services to its older citizens. Enjoying this way the potential that older people represent for humanity. Objectives: This study aims to check if the city of Coimbra is an elderly friendly city. Methodology: The research refers to an exploratory qualitative study from the methodological procedures of the Vancouver Protocol. The focus group was held in two sessions. Participants: 16 people were sounded out, 15(93.8%) were female. The average ages tends at79.88 years (dp = ±10,658), are mostly widowers (7=43.8%) and 7 (43.8%) have the qualifications to4th grade. They are classified mostly in the lower middle class(7=43.8). Results: Of the eight analyzed categories three categories" outdoor spaces and buildings", "transport" and "respect and social inclusion" are evaluated on positive and negative aspects. The "community support and health services" is evaluated as positive as the"housing", "social participation "and "communication and information" are evaluated as negative. The suggestions are related to a single topic "buildings and outdoor areas." Conclusions: If we share the view that an elderly friendly citizen courages active aging because it optimizes the opportunities for participation in the urban environment improving, in this manner, the quality of life of the elderly. The results we obtained from the consultation of a group of elderly allow us to say that Coimbra needs to adapt to its older citizens. Only then Coimbra can become a friendly city of the elderly. It should also be noted that the results should be mediated by socio-demographic profile of elderly respondents.

Famílias Unipessoais Idosas: um estudo das redes sociais pessoais de idosos que vivem sós

Objetivos: O presente estudo tem como objetivo analisar as características estruturais, funcionais e relacionais-contextuais das redes sociais pessoais de famílias unipessoais idosas. Metodologia: Utilizámos para recolha de dados um questionário para caracterizar sociodemograficamente a amostra, o Instrumento de Análise da Rede Social Pessoal (versão para idosos) (IARSP-Idosos) (Guadalupe, 2010; Guadalupe e Vicente 2012) e a escala de solidão UCLA (Neto, 1989). Participantes: A amostra é constituída por 567 indivíduos com média de idades de 75,53 anos, maioritariamente do sexo feminino (63,0%; n = 357). Predominam os sujeitos casados (53,7%; n = 304), com filhos (87,8%; n = 498) e em situação de coabitação (n = 450; 79,4%). Contudo, 20,6% (n = 117) vivem sós, constituindo as famílias unipessoais. Resultados: As redes sociais dos idosos têm em média 7,99 elementos, predominantemente familiares (M = 76,89%). Os participantes percecionam um nível elevado de apoio por parte das suas redes. São redes coesas, pouco dispersas e os contactos entre os elementos são frequentes. As mulheres, os indivíduos solteiros, viúvos ou divorciados e os idosos sem filhos têm uma maior probabilidade de viverem sós (p < 0,05) e estes apresentam uma maior probabilidade de necessitar de apoio social formal (p < 0,05). As famílias unipessoais, quando comparadas com os que não vivem sós, apresentam um maior número de campos relacionais e maior proporção de relações de amizade e de vizinhança (p < 0,05). Têm menor perceção de apoio material e instrumental, informativo, companhia social, acesso a novos vínculos e reciprocidade de apoio (p < 0,05). Além disso, referem menor frequência de contactos e uma maior dispersão geográfica (p < 0,05). Nas famílias unipessoais, observou-se a existência de correlações negativas significativas (p < 0,05) entre a percepção de solidão e o tamanho da rede, a proporção das relações familiares na rede, o apoio emocional e informativo e a reciprocidade de apoio. CONCLUSÃO: Os idosos com famílias unipessoais percecionam menor apoio por parte das suas redes, tendo uma maior propensão à solidão. É fundamental, ao longo do ciclo vital, promover a quantidade e qualidade dos vínculos, no sentido de manter a efetividade do suporte das redes mesmo quando se vive só. / Objectives: The present study aims to analyze the structural, functional and relational-contextual characteristics of older single-person households. Methodology: We used as instruments a questionnaire to evaluate sociodemographic data, the Instrumento de Análise da Rede Social Pessoal (version for elderly people: IARSP-Idosos) (Guadalupe, 2010; Guadalupe e Vicente 2012) and the UCLA Loneliness Scale (Neto, 1989). Participants: The sample consists of 567 individuals with an average age of 75.53 years, mostly females (63.0%; n = 357). There is a predominance of married individuals (53.7%; n = 304) with children (87.8%; n = 498). Older people live mainly in cohabitation (n = 450; 79.4%), however 20.6% oh them live alone, constituting one-person households. Results: The elderly personal social networks have 8 elements, on average, with a predominance of family relationships (M = 76.89%). The participants perceived a high level of support from their networks. In general the networks are cohesive, with low dispersion and have frequent contacts. The women, single, widowed or divorced and childless elderly are more likely to live alone (p < 0.05) and to need social services support (p < 0.05). The single-person households, compared with those who do not live alone, have a greater number of relational fields and a higher proportion of friendships and neighborhood relations (p < 0.05). They have a lower perception of material and informative support, social company and acess to new ties and reciprocal support (p < 0.05). They also refer lowest frequency of contacts and a wider geographical dispersion (p < 0.05). In single-person households there was a negative significant correlation between the perception of loneliness and the social network size, the proportion of family relationships in the network, emotional and informational support and reciprocal support. Conclusions: The elderly single-person households perceived less support from their networks and a greater propensity to loneliness. It is critical to promot the quality of ties, rather then their quantity, throughout the life cycle, in order to maintain the network effectiveness even when the person lives alone.

Tackling Ageing Continence through Theory, Tools & Technology (TACT3)

The complexity of issues surrounding continence management, have been investigated by a UK multi-disciplinary research team working under the project title Tackling Ageing Continence through Theory Tools and Technology (TACT3). The team comprising engineers, chemists, health researchers, designers and social anthropologists is funded by the New Dynamics of Ageing Programme, ‘a seven year multidisciplinary research initiative with the ultimate aim of improving quality of life of older people. The programme is a unique collaboration between five UK Research Councils , and is the largest and most ambitious research programme on ageing ever mounted in the UK’ (www.newdynamics.group.shef.ac.uk). The TACT3 project comprises four work packages that are individually managed by members of the research team. One work package focuses solely on knowledge transfer of the research outputs and the management of the overall project. Another work package, entitled ‘Challenging Environmental Barriers’ has focused on the barriers in the built environment that prevent older people with continence concerns from participating in wider social life, namely access to publicly available toilet facilities. We also have a work package entitled ‘Improving Continence Interventions and Services’ which is exploring patient, carer and service providers experiences in receiving and delivering National Health Service (NHS) continence management treatments. The fourth workpackage ‘Developing Assistive Technologies’ has worked with users to develop devices that promote confidence, improve health and therefore may facilitate greater social interaction for older people with continence management concerns.

Preliminary Results of an International Study Exploring and Comparing Positive Aspects and Concerns of Growing Older in Different Societies

This paper aims to gain an understanding and insight into the older person’s experiences and perceptions of growing older within their own societies in relation to their independence, choice and decision making. In an attempt to identify what is happening in different countries and cultures and to share these experiences, attitudes and perceptions from older people, this study asked people from three developing countries (Tanzania, Indonesia and Peru), from three different continents, to take part in this study.

Human motivation and professional practice: of knights, knaves and social workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self-interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy-makers have sought to effect such changes has been through the "new community care" of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide-ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self-interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client-centred ethos. The definitive version is available at www.blackwell-synergy.com

Falls and other geriatric syndromes in Blantyre, Malawi: a community survey of older adults

Background The prevalence of geriatric syndromes (falls, immobility, intellectual or memory impairment, and incontinence) is unknown in many resource-poor countries. With an aging population such knowledge is essential to develop national policies on the health and social needs of older people. The aim of this study was to provide a preliminary survey to explore the prevalence of falls and other geriatric syndromes and their association with known risk factors in people aged > 60 years in urban Blantyre, Malawi. Methods This was a cross-sectional, community survey of adults aged > 60 years. Subjects were recruited at home or in the waiting areas of chronic care clinics. They were interviewed to complete a questionnaire on ageassociated syndromes and comorbid problems. The Abbreviated Mental Test (AMT) and Timed Up and Go (TUG) tests were carried out. Results Ninety-eight subjects were studied; 41% reported falling in the past 12 months, 33% of whom (13% of all subjects) were recurrent fallers. Twenty-five percent reported urine incontinence, 66% self-reported memory difficulties, and 11% had an AMT score < 7. A history of falling was significantly associated with urine incontinence (p=0.01), selfreported memory problems (p=0.004) and AMT score < 7 (p=0.02). Conclusions Geriatric syndromes, including falls, appear to be prevalent in older people in Blantyre, Malawi. Falling is associated with cognitive impairment and urinary incontinence. There is an urgent need for more understanding of geriatric problems in this setting to develop national policies on health and social needs of older people. It is likely that many of the contributory factors to falls would be amenable to multifactorial interventions similar to those found to be effective in developed countries.

Pneumonia and influenza: specific considerations in care homes

This review provides an update on current evidence surrounding epidemiology, treatment and prevention of lower respiratory tract infection, with special reference to pneumonia and influenza, in care home residents. The care home sector is growing and provides a unique ecological niche for infections, housing frail older people with multiple comorbidities and frequent contact with healthcare services. There are therefore considerations in the epidemiology and management of these conditions which are specific to care homes. Opportunities for prevention, in the form of vaccination strategies and improving oral hygiene, may reduce the burden of these diseases in the future. Work is needed to research these infections specifically in the care home setting and this article highlights current gaps in our knowledge.

Avaliação da qualidade sentida e satisfação dos clientes de uma estrutura residencial para idosos

O aumento da esperança média de vida leva a que muitos idosos vivem para além dos 85 anos e consequentemente precisam cada vez mais de respostas sociais adequadas às suas necessidades, numa época em que as famílias se desresponsabilizam gradualmente dos cuidados aos seniores. As respostas sociais mais conhecidas no nosso país são os lares de idosos, ou seja, as estruturas residenciais para idosos e estas têm vindo a assumir um papel cada vez mais relevante na nossa sociedade. Este estudo procurou avaliar a qualidade sentida e a satisfação dos clientes residentes de uma estrutura residencial para idosos. Para que esta pesquisa fosse o mais fidedigna possível foram realizadas 12 entrevistas semi-estruturadas aos residentes do Centro Social da Nossa Senhora das Necessidades em Alcaria no Concelho do Fundão durante os meses de dezembro de 2015 e fevereiro de 2016. A análise dos resultados deste estudo permitiu perceber a perceção que os idosos residentes nos lares têm sobre os serviços e cuidados prestados e que vai influenciar a sua satisfação e qualidade de vida. Com este estudo procuramos ajudar as Direções e Corpos Gerentes das Instituições a melhor avaliarem e valorizarem o tipo de serviços e cuidados que disponibilizam e a atenção às necessidades sentidas pelos residentes, nomeadamente no que respeita à melhoria da qualidade de vida dos idosos

Carers in the welfare state : on informal care and support for carers in Sweden

  The general aim of this dissertation is to describe and analyse patterns of informal care and support for carers in Sweden. One specific aim is to study patterns of informal care from a broad population perspective in terms of types of care and types of carer. A typology of four different care categories based on what carers do revealed that women were much more likely than men to be involved at the ‘heavy end’ of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely than women to provide some kind of practical help (Study I). Another aim is to investigate which support services are received by which types of informal caregiver. Relatively few informal caregivers in any care category were found to be receiving any kind of support from municipalities or voluntary organizations, for example training or financial assistance (Study II). The same study also examines which kinds of help care recipients receive in addition to that provided by informal carers. It appears that people in receipt of personal care from an informal caregiver quite often also receive help from the public care system, in this case mostly municipal services. However, the majority of those receiving personal, informal care did not receive any help from the public care system or from voluntary organizations or for-profit agencies (Study II). The empirical material in studies I and II comprises survey data from telephone interviews with a random sample of residents in the County of Stockholm aged between 18 and 84. In a number of countries there is a growing interest among social scientists and social policymakers in examining the types of support services that might be needed by people who provide informal care for older people and others. A further aim of the present dissertation is therefore to describe and analyse the carer support that is provided by municipalities and voluntary organizations in Sweden. The dissertation examines whether this support is aimed directly or indirectly at caregivers and discusses whether the Swedish government’s special financial investment in help for carers actually led to any changes in the support provided by municipalities and voluntary organisations. The main types of carer support offered by the municipalities were payment for care-giving, relief services and day care. The chief forms of carer support provided by the voluntary organizations were support groups, training groups, and a number of services aimed primarily at the elderly care recipients (Study III). Patterns of change in municipal carer support could be discerned fairly soon. The Swedish government’s special allocation to municipalities and voluntary organisations appears to have led to an increase in the number of municipalities providing direct support for carers, such as training, information material and professional caregiver consultants. On the other hand, only minor changes could be discerned in the pattern of carer support services provided by the voluntary organizations. This demonstrates stability and the relatively low impact that policy initiatives seem to have on voluntary organizations as providers (Study IV). In studies III and IV the empirical material consists of survey data from mail questionnaires sent to municipalities and voluntary organizations in the County of Stockholm. In the fields of social planning and social work there appears to be a need to clarify the aims of support services for informal carers. Should the support be direct or indirect? Should it be used to supplement or substitute caregivers? In this process of reappraisal it will be important to take the needs of both caregivers and care recipients into account when developing existing and new forms of support. How informal caregivers and care recipients interact with the care system as a whole is undeniably a fertile field for further research.

Impact on hip fracture mortality after the establishment of an orthogeriatric care program in a colombian hospital

El objetivo del estudio es evaluar la mortalidad a un año en pacientes con fractura de cadera, mayores de 65 años tratados en un programa establecido de orto-geriatría. 298 se trataron de acuerdo al protocolo de orto-geriatría, se calculo la mortalidad a un año, se establecieron los predictores de mortalidad orto-geriátrico. La sobrevida anual se incremento de 80% a 89% (p = .039) durante los cuatro años de seguimiento del programa y disminuyo el riesgo de mortalidad anual postoperatorio (Hazard Ratio = 0.54, p = .049). La enfermedad cardiaca y la edad maor a 85 años fueron predictores positivos para mortalidad.