Improving public services through open data: public toilets

Bichard’s work for the TACT3 project (Bichard REF Output 3) found that UK toilet provision is not centrally collated and no national map or database of toilets exists. In contrast, the UK government’s white paper Open Public Services (2011) emphasised its commitment to incorporating the use of Open Data in public services provision that could be tailored to community preferences, and therefore be more sustainable. Incorporating Open Data on public toilet provision, Bichard and Knight (RCA) developed The Great British Public Toilet Map (GBPTM). Whilst a number of other websites and applications map toilets by ‘crowd surfing’, GBPTM is entirely populated by Open Data, and not only uses the data as information for users, but informs members of the public that such information is available and accessible for their use. This paper presents the development of the GBPTM, including inclusive design research and studies that compare accuracy of information directly provided by users with Open Data collected by local authorities. It suggests that, to meet the health and well-being of an ageing population, a sustainable and cost-effective solution must be found for ‘publicly accessible’ toilet provision, including opening up provision beyond that ‘for customers only’ and providing accurate information on current public provision. The paper highlights the barriers encountered in the production of Open Data by local authorities. A review of the paper in the journal Civil Engineering (May 2013) described the design of the GBPTM as a ‘simple and elegant solution’. The development of a digital output and an understanding of digitally based research led to Bichard’s successful submission to an EPSRC Digital Economy sandpit, in which she developed an interdisciplinary project with the Universities of Newcastle, Bournemouth and the West of England. The project, Family Rituals 2.0, secured £750,000 in research funding with Bichard as co-investigator (2013–15)

‘If you’d had my life, you’d have done it too’: exploring the experiences of adult males who rape elderly females

This study focused on adult males who have committed a sexual offence against elderly victims (aged 55 and over) in order to increase our understanding of this group of offenders. Semi-structured interviews were conducted with five such individuals. Interview data were analysed using Interpretative Phenomenological Analysis (IPA). Four main themes emerged: life's been really tough (where participants talked about difficulties they had faced); I'm not bad, I did what anyone would do (where participants sought to explain their behaviour); Other people haven't helped or have made things worse (where participants highlighted challenges they faced in relationships and the impact they felt this had); and Coping and pleasure (which highlights the use of sex and alcohol in their lives). Implications for the practice and treatment of individuals offending against elderly victims are discussed

Active Residents in Care Homes (ARCH) : study protocol to investigate the implementation and outcomes of a whole-systems activity programme in residential care homes for older people

OBJECTIVES: To evaluate the effectiveness, acceptability and costs of Active Residents in Care Homes, ARCH - a programme aiming to increase opportunities for activity in older care home residents. DESIGN: Feasibility study. SETTING: Residential care homes for older people. PARTICIPANTS: 10-15 residents, staff and family members will be recruited in each of the three participating care homes. INTERVENTION: ARCH is a 12-month 'whole-systems' programme implemented by occupational therapists and physiotherapists. They will conduct a comprehensive assessment of each care home, considering the physical environment, working practices and organisation structure as well as residents' individual needs, and recommend ways to address barriers and increase residents' activity levels. The therapists will then work with staff to improve understanding of the issues, instigate training, environmental, organisational and working practice changes as necessary. MAIN OUTCOME MEASURES: Residents' activity levels, health and quality of life will be tested using several measures to see which are practicable and appropriate for this population in this context. This includes: Assessment of Physical Activity in Frail Older People; Pool Activity Level Checklist; Dementia Care Mapping observations; and EQ-5D-5L. Residents will be assessed prior to programme implementation then 4- and 12-months post-implementation. Semi-structured interviews will explore the experiences of residents, staff, family members and therapists. CONCLUSIONS: Providing evidence of effectiveness and acceptability of ARCH, and documenting factors that impede/facilitate implementation will help us identify ways to enhance the care and quality of life of older people in residential care, and our understanding of how to implement them

Why are relatives of care home residents reluctant to ‘rock the boat’? Is there a culture of acceptance?

Purpose - The purpose of this paper is to explore whether relatives of care home residents are best placed to act as ‘champions’ or advocates for their family members, as is often the expectation. Design/methodology/approach - Focus groups and interviews were conducted with 25 relatives of residents in four care homes for older people in the South East of England. Two rounds of focus groups were held in each participating care home: the first was to discuss any issues arising from the care received, or concerns about the home itself; the second was to enable a deeper exploration of the key themes that arose from the first round and explore why relatives, in this case, failed to complain. Findings - Thematic analysis revealed a complex range of emotions experienced by relatives that contributed to a conflict between what they believed to be the correct response and how they behaved in reality, which led to a culture of acceptance. Analysis revealed some relatives were reluctant to ‘interfere’ for fear of possible negative repercussions, thus they downplayed issues in an attempt not to ‘rock the boat’. Originality/value - This paper discusses the flaws in the policy emphasis on personalisation and the reliance on family members as advocates, and concludes with suggestions on how care homes may foster an environment where relatives, and indeed residents, feel comfortable to raise issues and concerns

The acceptability and feasibility of using the Adult Social Care Outcomes Toolkit (ASCOT) to inform practice in care homes

Background: The Adult Social Care Outcomes Toolkit (ASCOT) measures social care related quality of life (SCRQoL) and can be used to measure outcomes and demonstrate impact across different social care settings. This exploratory study built on previous work by collecting new inter-rater reliability data on the mixed-methods version of the toolkit and exploring how it might be used to inform practice in four case study homes. Method: We worked with two care home providers to agree an in-depth study collecting SCRQoL data in four case-study homes. Data was collected about residents’ age, ethnicity, cognitive impairment, ability to perform activities of daily living and SCRQoL in the four homes. Feedback sessions with staff and managers were held in the homes two weeks after baseline and follow-up data collected three months later. Interviews with managers explored their views of the feedback and recorded any changes that had been made because of it. Results: Participant recruitment was challenging, despite working in partnership with the homes. Resident response rates ranged from 23 to 54 % with 58 residents from four care homes taking part in the research. 53 % lacked capacity to consent. Inter-rater reliability for the ASCOT ratings of SCRQoL were good at time one (IRR = 0.72) and excellent at time two (IRR = 0.76). During the study, residents’ ability to perform activities of daily living declined significantly (z = -2.67, p < .01), as did their expected needs in the absence of services (z = -2.41, p < .05). Despite these rapid declines in functionings, residents’ current SCRQoL declined slightly but not significantly (Z = -1.49, p = .14). Staff responded positively to the feedback given and managers reported implementing changes in practice because of it. Conclusion: This exploratory study faced many challenges in the recruitment of residents, many of whom were cognitively impaired. Nevertheless, without a mixed-methods approach many of the residents living in the care homes would have been excluded from the research altogether or had their views represented only by a representative or proxy. The value of the mixed-methods toolkit and its potential for use by providers is discussed

Psychosocial factors and ageing in older lesbian, gay and bisexual people: a systematic review of the literature

Aims and objectives: To synthesise and evaluate the extant literature investigating the psychosocial influences on ageing as a lesbian, gay or bisexual person, in order to develop understanding about these influences and guide future research in the area. Background: Research suggests there may be specific psychological and social factors relevant to ageing for individuals with a non-heterosexual identity. Design: A systematic review was conducted on empirical research involving lesbian, gay and bisexual individuals aged 60 or above. Methods: The Cochrane Database, PsychINFO, MEDLINE, Web of Science and Google Scholar were searched and 41 studies met inclusion criteria. The majority had not been reviewed in earlier review articles. Results: Findings were within two domains: psychological, consisting of sub-themes relating to identity, mental health and body image; and social, consisting of relationships, social support, discrimination, caregiving and receiving, community, accessing services and housing. The results suggest lesbian, gay and bisexual individuals mostly adjust well to ageing identities, with mediating influences including self-acceptance and connection with peers. Challenges experienced included ageism and heteronormative health and social care services; intimate friendships, social support and respectful professionals mitigated such threats and facilitated successful ageing. Methodological issues related to sampling procedures, such as purposive sampling through the gay community and limited generalisability due to the homogeneity of participants. Additionally, there was a widespread lack of heterosexual control groups. However, most studies used appropriate measures and acknowledged inherent limitations. Conclusion: Psychosocial influences included the challenge of societal stigma, but also resilience individuals demonstrate through a positive attitude. These factors must continue to be investigated for services to best meet the needs of this population. Relevance to clinical practice: Clinicians are well placed to assist individuals draw on resilience when facing ageing challenges. Also, clinicians should be aware older people may have prior negative experiences of accessing services and try to involve ‘families of choice’ in care planning

Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: study protocol for a randomised trial

<p>Abstract</p> <p>Background</p> <p>Falls in older people are a major public health problem, with at least one in three people aged over 65 years falling each year. There is increasing evidence that foot problems and inappropriate footwear increase the risk of falls, however no studies have been undertaken to determine whether modifying these risk factors decreases the risk of falling. This article describes the design of a randomised trial to evaluate the efficacy of a multifaceted podiatry intervention to reduce foot pain, improve balance, and reduce falls in older people.</p> <p>Methods</p> <p>Three hundred community-dwelling men and women aged 65 years and over with current foot pain and an increased risk of falling will be randomly allocated to a control or intervention group. The "usual cae" control group will receive routine podiatry (i.e. nail care and callus debridement). The intervention group will receive usual care plus a multifaceted podiatry intervention consisting of: (i) prefabricated insoles customised to accommodate plantar lesions; (ii) footwear advice and assistance with the purchase of new footwear if current footwear is inappropriate; (iii) a home-based exercise program to strengthen foot and ankle muscles; and (iv) a falls prevention education booklet. Primary outcome measures will be the number of fallers, number of multiple fallers and the falls rate recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the Medical Outcomes Study Short Form 12 (SF-12), the Manchester Foot Pain and Disability Index, the Falls Efficacy Scale International, and a series of balance and functional tests. Data will be analysed using the intention to treat principle.</p> <p>Discussion</p> <p>This study is the first randomised trial to evaluate the efficacy of podiatry in improving balance and preventing falls. The trial has been pragmatically designed to ensure that the findings can be generalised to clinical practice. If found to be effective, the multifaceted podiatry intervention will be a unique addition to common falls prevention strategies already in use.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trials Registry: ACTRN12608000065392</p

Suicide in an ageing UK population: problems and prevention

Purpose Suicide can be an emotive, and at times, controversial subject. The purpose of this paper is to reflect on the social, health, personal, and cultural issues that can arise in later life and the potential reasons for suicide. It will analyse already recognised risk factors of suicide in older adults and focus on improving knowledge about the social meaning and causation of suicide for older people. It will also consider suicide prevention policies, their practice implications, and whether they are successful in protecting this potentially vulnerable cohort. Design/methodology/approach A synopsis of available literature in the form of a general review paper of suicide of older adults. Findings There is evidence that the ageing process often leads to a set of co-morbidities and a complex and diverse set of individual challenges. This in turn equates to an increased risk of suicide. There is no easy answer to why there is evidence of a growing number of older adults deciding that suicide is there only option, and even fewer suggestions on how to manage this risk. Social implications The entry of the “baby boom” generation into retirement will lead to the potential of an increase in both suicide risk factors and older adults completing suicide. This is on the background of a demographic surge which is likely to place additional pressures on already under-resourced, and undervalued, statutory and non-statutory services. Originality/value A literature search found very little information regarding older adults and suicide risk, assessment, treatment or prevention. </jats:sec