Search results

Mental health problems in old age have attracted policy attention in the UK over the past decade. An important issue is how to improve services for people who have both mental health and other problems. This article sets out some of the challenges facing planners and commissioners in developing integrated services for older adults, by using the case study of people with dementia and incontinence problems. It uses integrated service models and observations from the EVIDEM‐C study to suggest some incremental actions that would help develop the long‐term strategy for integrated services.

The purpose of this paper is to investigate the presence of bladder and bowel symptoms in women recently imprisoned in Western Australian prisons, specifically; stress, urge and mixed urinary incontinence, faecal incontinence, nocturia, nocturnal enuresis and constipation and the impact on the quality of life (QOL).

Over a 12-month period 29 women, recently released from Western Australia’s female prisons, were surveyed using a questionnaire previously validated for the prison population. The Short Form King’s Health Questionnaire and a modified version of the Manchester Health Questionnaire were used to assess the effects of these symptoms on QOL.

Of those surveyed only one respondent reported having no bladder or bowel symptoms following release from prison. Trends assessed by Chi-square analysis suggest women imprisoned for any period of time are more likely to develop both bladder and bowel symptoms which persist after release back into the community. A history of substance or alcohol abuse is often concurrent with the presence of symptoms. QOL scores are also lower for those reporting either bladder or bowel symptoms affecting total scores and the domains of both activities of daily living and mental health.

Women imprisoned for any length of time developed bladder and bowel symptoms which had a negative impact on their QOL. Larger studies need to be conducted to investigate these trends and whether small changes in conservative measures can influence outcomes.

The purpose of this paper is to discuss the question of how to meet the needs of older people living at home with dementia who have problems with continence. The paper is focused on social care practice in community settings.

This paper is practice focused and draws on the authors’ research and experiences in clinical care, workforce development and service improvement.

This paper summarises research on incontinence and its negative effects on quality of life and care relationships. It describes the impact of incontinence in terms of social embarrassment, restricted social activity, extra work (such as laundry) and costs, but also distress. It links research with care practice, with a focus on people with dementia who may be at particular risk of both continence problems and of assumptions that nothing can be done to assist them.

This paper provides questions that could be addressed in commissioning and provision of services and argues that they need to be informed by care practitioners’ experiences. It provides details of sources of support that are available at national and local levels.

This paper draws together research on continence and social care practice to provide a series of self-assessment questions for local services. It focuses on social care workers who are at the frontline of practice including personal assistants and carers.

This paper aims to raise awareness of the ways in which faecal incontinence can impact the provision of dementia care by examining this through the lens of stigma.

This paper contains a scoping review of available literature relating to faecal incontinence, dementia and stigma.

Literature was organised into three themes: the origins of the stigma, the purpose of stigma and the care context.

Limitations of this paper include the lack of literature discussing faecal incontinence and dementia in relation to stigma.

Stigma regarding faecal incontinence has the potential to impact quality of life of people with a dementia and contributes towards the invisible work of unqualified care workers.

Stigma and faecal incontinence have only a small amount of research around them in residential dementia care.

Falls are a significant burden on the Australian health care budget and can result in loss of personal independence, injury or death. A sustained high rate of inpatient falls in a 550‐bed acute care hospital has made it imperative for nurses to identify patients at highest risk, in order to implement preventive interventions. This study examined the prevalence of “intrinsic high risk” characteristics identified by the literature in people who fell during hospitalisation, to confirm the validity of these predictors in detecting risk. Over ten weeks 91 inpatients fell (total 118 falls) and were assessed for intrinsic risk factors. Most prevalent was impaired ambulatory status resulting in balance instability. Other high prevalence factors included cognitive impairment and age > 75. Commonly cited factors, such as urinary or faecal incontinence, medications and history of prior falls, were found less frequently. No significant differences in risk factors by gender were identified.

The purpose of this article is to discuss the value of health‐related quality of life (HR‐QOL) measurement and describe its development with a few examples.

The methodology is a literature review of various articles published in the last 25 years on health‐related quality of life.

HR‐QOL tools are health status instruments, which are utilized to assess the changes in the health status of patients. These surveys are of increasingly importance as healthcare providers are challenged to justify treatment approaches and rationale for any intervention. Objective criteria can be used to determine whether there is clinical evidence of disease. However, the impact of disease on the individual's life is not included in such a clinical assessment. The use of validated and reliable health instruments is directed at measuring this impact in a reproducible and valid fashion. In patient‐centred research, “experimental” conditions are constantly changing because human beings with values, feelings, perspectives and social relationships are being treated. It is especially important to use valid measurement tools when assessing these impacts.

This article is written from the authors' own experience and knowledge and adds those benefits to the literature already available.

This paper demonstrates that three intermediate care services in Shepway, East Kent each cater for distinct patient groups, and that data from a single assessment process (SAP) tool can be used to differentiate between them. By applying statistical techniques, inferences can be made about the likelihood of admission to a particular service, given specific health characteristics. In conclusion, we highlight the utility of standardised assessment as a means of providing data for audit and planning, and stress the importance of the SAP as a means of developing care services.

Purpose – The purpose of this paper is to verify whether an evolutionary model outperforms logistic regression in determining the institutional placement decisions made by a London social service department panel. Design/methodology/approach – Genetic chromodynamics models an algorithm within the Michigan evolutionary classifier. Hence multiple classification rules evolve simultaneously. The dataset as described by Xie et al. is used. Two‐thirds of randomly selected cases are for training and one third for testing. Indicator weights are set between 0 and 1. Findings – Of 275 placements, 40 per cent represent residential homes, 48 per cent nursing homes, 12 per cent nursing long‐stay and two hospital long‐stay. In ten runs, 89.18 per cent were correctly placed (range 81.6 to 97.7 per cent); 5.07 per cent wrongly placed (range 1.2 to 8.0 per cent) and 5.75 per cent unplaced (range 0.0 to 11.5 per cent). Changing the 0.99 weights to 0.90 and 0.80 placed 87.6 and 87.9 per cent correctly. Research limitations/implications – Data came from written records. Errors in transcription and placement could not be checked. Other facts, or the weights, may be influencing placement decisions. Practical implications – Xie et al. matched 78 per cent of 195 placements. The evolutionary model outperformed logistic regression both in placements evaluated (275/195) and accuracy (89/78 per cent). Therefore, it could be used as a first line management information tool, revealing whether guidelines are followed. Originality/value – The authors have developed and tested a computational model, which could be used to evaluate institutional placement decisions in the UK “market”. Further development and exploitation would facilitate greater understanding of the needs old people and the resources necessary for their appropriate management.