Routine use of a standardised assessment instrument for measuring the outcome of social care

This study had as its primary aim determining the extent to which standardised assessment can contribute to monitoring the outcomes of social care. It also addressed the comparison of resource use between individual clients, groups of clients with similar characteristics and between Social Service Departments (SSD's). An important part of the study was exploring the views of Social Workers and Care Managers on assessment in general and standardised assessment and the MDS-HC in particular. It has succeeded in achieving the majority of its goals and its findings have been incorporated into a revised MDS-HC assessment system including the development of a simplified screening assessment. It has also identified how attitudes to assessment, the manner in which assessment is done, and the organisation of assessment and on going management of services provided was significantly different between the two social service departments that took part in the study. Some of the issues identified are important for the development of policy on assessment in community care. It is likely that the findings are widely generalisable

Self-reported visual function in healthy older people in Britain: an exploratory study of associations with age, sex, depression, education and income

Background. Tractable but undetected visual impairment in older people may be relatively common, particularly amongst the very old and in more deprived populations. Measurement of visual acuity is unlikely to be helpful in identifying this impairment, but targeted assessment of visual function may be beneficial. There is uncertainty about the defining characteristics of the target group. Objective. To explore factors associated with self-reported visual impairment in community dwelling older people. Methods. Design: secondary cross sectional analysis of baseline data from a randomised controlled trial. Setting: three large group practices in outer London. Participants: older people aged 65 and over enrolled in a study of health risk appraisal. Method: postal questionnaire using questions from the National Eye Institute Visual Function questionnaire. Results. Moderate or extreme visual function loss occurred in 4 to 12% of community-dwelling older people in this population reporting less than excellent vision, depending on which aspect of visual function is considered. Visual function loss in this subgroup increases in prevalence with advancing age, but is not associated with female sex, low educational attainment or low income. It is associated with depressed mood. Conclusion. Questions about visual function identify a group of older people whose vision and mental state needs further investigatio

The relationship between pain intensity and severity and depression in older people: exploratory study

BACKGROUND: Pain and depression are known to be associated in later life, and both have a negative effect on physical performance both separately and in combination. The nature of the relationships between pain intensity and depression in elderly persons experiencing pain is less clear. The objectives of this study were to explore which factors are associated with depressed mood in older people experiencing pain, and to test the hypothesis that older people experiencing pain are at risk of depressed mood according to the severity or frequency of their pain. In addition we explored whether other potentially modifiable factors might increase the risk of depressed mood in these persons. METHODS: The study is a secondary analysis of baseline data for four hundred and six community-dwelling non-disabled people aged 65 and over registered with three group practices in suburban London who had experienced pain in the past 4 weeks. Intensity and frequency of pain was measured using 24 item Geriatric Pain Measure (GPM) and the presence of depressive symptoms using the 5 item Mental Health Inventory. Risk for social isolation was measured using the 6 item Lubben Social Network scale and instrumental activities of daily living (IADL) were also measured. RESULTS: Overall 76 (19%) had depressed mood. Pain frequency and severity were not statistically significantly associated with depressed mood in this population. In multivariate analyses, significant predictors of the presence of depressive symptoms were difficulties with basic ADLs (OR 2.8, 95% CI 1.1.7.8), risk for social isolation (OR 4.1, 95% CI 1.8-9.3), and basic education only (OR 2.2, 95% CI 1.1-4.4). CONCLUSION: Older people experiencing pain are also likely to experience depression. Among those experiencing pain, social network and functional status seem to be more important predictors of depressive symptoms than the severity of pain. Further studies should evaluate whether improvement of social network and functional status might reduce depressive symptoms in older patients

Health risk appraisal for older people 4: case finding for hypertension, hyperlipidaemia and diabetes mellitus in older people in English general practice before the introduction of the Quality and Outcomes Framework

Background Early intervention can help to reduce the burden of disability in the older population, but many do not access preventive care. There is uncertainty over what factors influence case finding in older patients in general practice. Aim To explore factors associated with case finding for hypertension, hyperlipidaemia and diabetes mellitus in older patients. Method Two thousand four hundred and ninety-one patients aged 65 years and above were recruited from three large practices in suburban London before the introduction of the Quality and Outcomes Framework (QOF) completed a questionnaire on health, functional status, health behaviours and preventive care. Findings Those not reporting heart disease, diabetes or hypertension were included in a secondary data analysis to explore factors influencing uptake of preventive care measures. Approximately one-third denied having had a blood pressure check in the previous year. They were more likely to have had little contact with doctors and to have an unhealthy lifestyle (smoking and a high-fat diet). One-third reported a cholesterol test in the previous five years. Cholesterol measurement was reported more often by men and those with a high body mass index. Those with unhealthy lifestyles (smoking and high-fat diet), those who had only received the state pension and those who limited their activities because of a fear of falling were less likely to report cholesterol measurement. About 10% reported a fasting blood glucose measurement and were more likely to consult more often and have more medications, but they were less likely to have a high-fat diet. Preventive care uptake was associated with frequent contacts with doctors, but overall the uptake of preventive care was low. Older people with healthier lifestyles were more likely to have primary preventative care interventions. These findings provide a baseline against which the effect of the QOF on the care of older people can be measured in future studie

Health risk appraisal for older people 5: self-efficacy in patient-doctor interactions

Objective Enhancing self-efficacy is central to programmes promoting self-care and self-management. However, little is known about older people's self-efficacy in doctor-patient interactions. This paper investigates lifestyle, medical and demographic factors associated with self-efficacy in doctor-patient interactions in older people in general practice. Methods A cross-sectional analysis of data from a randomised controlled trial of older people was conducted in a health risk appraisal study in London. Self-efficacy was measured using the Perceived Efficacy in Patient-Physician Interactions Questionnaire. Results Older people with higher self-efficacy were significantly more likely to report having had recent preventive care measures such as recent blood pressure measurement and influenza immunisation. Women were less likely to have higher self-efficacy than men. Older people were significantly less likely to have high self-efficacy if they reported having poor memory, low mood, limited activities due to fear of falling, basic education, difficulties with at least one activity of daily living, reduced physical activity, living alone, or risk of social isolation. Conclusion A third of people had low self-efficacy in doctor-patient interactions. They appear to be a vulnerable group. Low self-efficacy in interactions with doctors may be a symptom or a characteristic of older people who experience social isolation and depression. Policies that depend on enhancing self-care and self-management need to consider the large number of older people with low self-efficacy in using medical services, and understanding characteristics in older people associated with lower confidence in doctor-patient interactions may be useful in clinical practice and researc

Promotion of health in older people: a randomised controlled trial of health risk appraisal in British general practice

Background: there is inadequate evidence to support currently formulated NHS strategies to achieve health promotion and preventative care in older people through broad-based screening and assessment in primary care. The most extensively evaluated delivery instrument for this purpose is Health Risk Appraisal (HRA). This article describes a trial using HRA to evaluate the effect on health behaviour and preventative-care uptake in older people in NHS primary care. Methods: a randomised controlled trial was undertaken in three London primary care group practices. Functionally independent community-dwelling patients older than 65 years (n=2,503) received a self-administered Health Risk Appraisal for Older Persons (HRA-O) questionnaire leading to computer-generated individualised written feedback to participants and general practitioners (GPs), integrated into practice information-technology (IT) systems. All primary care staff received training in preventative health in older people. The main outcome measures were self-reported health behaviour and preventative care uptake at 1-year follow-up. Results: of 2,503 individuals randomised, 2,006 respondents (80.1%) (intervention, n=940, control n=1,066) were available for analysis. Intervention group respondents reported slightly higher pneumococcal vaccination uptake and equivocal improvement in physical activity levels compared with controls. No significant differences were observed for any other categories of health behaviour or preventative care measures at 1-year follow-up. Conclusions: HRA-O implemented in this way resulted in minimal improvement of health behaviour or uptake of preventative care measures in older people. Supplementary reinforcement involving contact by health professionals with patients over and above routine clinical encounters may be a prerequisite to the effectiveness of IT-based delivery systems for health promotion in older peopl

A Randomized Trial of Effects of Health Risk Appraisal Combined With Group Sessions or Home Visits on Preventive Behaviors in Older Adults

Background. To explore effects of a health risk appraisal for older people (HRA-O) program with reinforcement, we conducted a randomized controlled trial in 21 general practices in Hamburg, Germany. Methods. Overall, 2,580 older patients of 14 general practitioners trained in reinforcing recommendations related to HRA-O-identified risk factors were randomized into intervention (n = 878) and control (n = 1,702) groups. Patients (n = 746) of seven additional matched general practitioners who did not receive this training served as a comparison group. Patients allocated to the intervention group, and their general practitioners, received computer-tailored written recommendations, and patients were offered the choice between interdisciplinary group sessions (geriatrician, physiotherapist, social worker, and nutritionist) and home visits (nurse). Results. Among the intervention group, 580 (66%) persons made use of personal reinforcement (group sessions: 503 [87%], home visits: 77 [13%]). At 1-year follow-up, persons in the intervention group had higher use of preventive services (eg, influenza vaccinations, adjusted odds ratio 1.7; 95% confidence interval 1.4-2.1) and more favorable health behavior (eg, high fruit/fiber intake, odds ratio 2.0; 95% confidence interval 1.6-2.6), as compared with controls. Comparisons between intervention and comparison group data revealed similar effects, suggesting that physician training alone had no effect. Subgroup analyses indicated favorable effects for HRA-O with personal reinforcement, but not for HRA-O without reinforcement. Conclusions. HRA-O combined with physician training and personal reinforcement had favorable effects on preventive care use and health behavio

Effects of a twelve-week exercise intervention on subsequent compensatory behaviours in adolescent girls: an exploratory study

This is an accepted manuscript of an article published by Human Kinetics Publishers Inc. in Pediatric Exercise Science on 19/07/2019, available online: https://doi.org/10.1123/pes.2019-0012 The accepted version of the publication may differ from the final published version.Purpose: Chronic exercise programmes can induce adaptive compensatory behavioural responses through increased energy intake (EI) and/or decreased free-living physical activity in adults. These responses can negate the benefits of an exercise-induced energy deficit; however, it is unclear whether young people experience similar responses. This study examined whether exercise-induced compensation occurs in adolescent girls. Methods: Twenty-three adolescent girls, heterogeneous for weight status, completed the study. Eleven, 13-year-old adolescent girls completed a twelve-week supervised exercise intervention (EX). Twelve body size matched girls comprised the non-exercise control group (CON). Body composition, EI, free-living energy expenditure (EE) and peak oxygen uptake (V ̇O_2) were measured repeatedly over the intervention. Results: Laboratory EI (EX: 9027, 9610, 9243 kJd-1 and CON: 9953, 9770, 10052 kJd-1 at 0, 12 and 18 weeks respectively) (ES = 0.26, P = 0.46) and free living EI (EX: 7288, 6412, 5273, 4916 kJd-1 and CON: 7227, 7128, 6470, 6337 kJd-1 at 0, 6, 12 and 18 weeks respectively) (ES ≤ 0.26, P = 0.90) did not change significantly over time and were similar between groups across the duration of the study. Free-living EE was higher in EX than CON (13295 vs. 12115 kJd-1, ES ≥ 0.88, P ≥ 0.16), but no significant condition by time interactions were observed (P ≥ 0.17). Conclusion: The current findings indicate that compensatory changes in EI and EE behaviours did not occur at a group level within a small cohort of adolescent girls. However, analysis at the individual level highlights large inter-individual variability in behaviours, which suggest a larger study may be prudent to extend this initial exploratory research