Editorial

Citation

Poland, F. (2015), "Editorial", Quality in Ageing and Older Adults, Vol. 16 No. 3. https://doi.org/10.1108/QAOA-07-2015-0036

Editorial

Article Type: Editorial From: Quality in Ageing and Older Adults, Volume 16, Issue 3.

Fiona Poland

Finding the balance of partners in coordinating care quality

Pressure on care services grows exponentially, reflected in the many age-divisive public and policy discussions which seem seek to address the constraints by narrowing responsibility for care demands, to be taken by specific age groups, rather than wider social solutions. Such pressures more emphatically point up the importance of having means to ensure quality, to identify and then to coordinate an appropriate balance between characteristics of personalised care. The work reported by Hughes et al. to develop a framework to categorise care coordination arrangements for older people in England promises to provide particularly timely guidance on how to develop service specifications, conduct care coordination, promote quality assurance and ensure fidelity in delivery. As collaborative service delivery for frail elders becomes even more complex, with health and social care become more closely integrated, such initiatives to frame coordination are therefore likely to have relevance well beyond the UK context.

This focus on care quality within user-oriented care can be seen to resonate in the Swedish care context in the study reported by Kazemi and Kajonius. This sought to validate concepts of user-oriented care which can cross home care and nursing home settings, drawing on observational data to identify what characterises well-functioning care relationships, in terms which particularly aim to reflect how older people themselves wish to be treated. This emphasises the need for policymakers and care practitioners not to assume what individuals are generally likely to prefer, without taking the time and having a means to ask and positively find this out from older people themselves.

How expert guidance may inform therapeutic assessment in specific and challenging circumstances is well-illustrated by Kindell et al. through their nominal group technique study of building speech and language practitioner consensus on managing communication in semantic dementia. This extends the person-centred focus of work to include the carer, so that partnerships in communication can be created, that can better take into account the practical communication environment. Here, their research findings indicate that, in response to the therapeutic dilemma concerning whether the condition should be treated as primarily aphasia or as dementia, it should be addressed by referring to features of both aphasia and dementia.

It therefore appears to be in the agreed interests of many groups, centrally those of older people themselves, to find a variety of means to support them to exercise self-determination for as long as possible if they are to be enabled to "age in place" in any sense that is meaningful to them. Ekelund and Eklund report on randomised controlled trial findings that a "Continuum of Care" intervention could support older peoples’ self-determination over time, especially in their activities in and around the house if their care planning meetings were held in their own homes, led by them and supported by a coordinated multidisciplinary care approach.

The final paper in this issue, an opinion piece by Newman and Booi, aspires to redress some of the age divisions widely raised within other debates, the starting point for this editorial, by considering millennial legacy events organised to address Global Action on Dementia. They highlight how the Canadian Young Leaders event in this programme particularly endorsed the need for the inclusion of the voices of those most closely affected by dementia in determining ways forward. It also advocated the need for more partnership building with youth so that they can be as active as possible in devising the solutions to dementia and dementia care. Perhaps such global discussions promoting inter-generational actions can help encourage a wider sense of responsibility for providing well-integrated support for more and different groups of older people to continue to exercise self-determination in addressing the multiple challenges of their later life.