Search results

This paper synthesises the literature on the issues related to the older patient, health service quality and its measurement. It discusses the need to consider these perspectives in the definition and assessment of quality of a community‐focused aged healthcare programme, and critically examines the existing evaluation of quality in healthcare, contrasting the patient's role and impact on the quality of the service and its outcome. The paper then reviews the documented problems associated with using satisfaction as an indicator of the patient's view of quality. An alternate validated approach to measuring the patient's perception of the quality of the service is identified in the services literature; this multidimensional hierarchical tool and scale, which specifically measures the patient's view of quality, is presented. The tool covers nine sub‐dimensions, four dimensions and the global perspective of quality as perceived by the patient. An adaptation of this tool is presented to measure the patient's view of quality using the relatively new Transition Aged Care programme as an example, and make the argument for the holistic measurement of transitional aged care quality, using a validated and reliable patient‐specific tool. Importantly, the paper proposes that the identification of the patient view of service quality will offer information that could specifically assist with service improvement.

This study aims first, to provide a typology of complaints concerning the treatment of elderly patients in geriatric wards; second, to estimate reported satisfaction with treatment; and third, to assess the link between verbal concerns and satisfaction.

Using the “Survey of Geriatric Wards, 2019” a sample of 4,725 family members of patients, hospitalized in 99 geriatric wards in Israel were asked to rate their overall satisfaction with treatment; they also were asked to provide verbal information on the hospitalization experience through an open-ended question. A content analysis was applied to the verbal answers, to classify them into distinct qualitative categories; a regression analysis was applied to examine the impact of the concerns on the level of patient satisfaction, net of patient’s characteristics.

Level of satisfaction among family members is very high (8.16 on a scale from 1–10), with only very few expressing verbal concerns (2.3%). Content analysis reveals five reoccurring themes: physical violence (33.3%), verbal violence (19.2%), discrimination (21.2%), lack of dignified hospitalization conditions (8.1%) and communication (18.2%). Further analysis reveals that satisfaction among those who complained, especially about interpersonal relations, is considerably and significantly lower than others.

Despite high levels of satisfaction with medical care in geriatric wards, the findings underscore voiced complaints as major source for explaining dis-satisfaction with hospitalization. Complaints in the realm of interpersonal relations, especially regarding verbal violence, discrimination and communication, seem to be most consequential for lowering levels of satisfaction with treatment.

This quantitative phase of a mixed-methods study aims to describe the effect of the Transitional Care Bridge (TCB) programme on functional decline, mortality, health-care utilisation and health outcomes compared to usual care in a regional hospital in the Netherlands.

In a pre- and post-cohort study, patients aged ≥70 years, admitted to the hospital for ≥48 h and discharged home with an Identification of Seniors at Risk score of ≥2, were included. The TCB programme, started before discharge, encompassed six visits by the community nurse (CN). Data were obtained from the hospital registry and by three questionnaires over a three months period, addressing activities of daily living (ADL), self-rated health, self-rated quality of life and health-care utilisation.

In total, 100 patients were enrolled in this study, 50 patients in the TCB group and 50 patients in the usual care group. After three months, 36.7% was dependent on ADL in the TCB group compared to 47.1% in the usual care group. Mean number of visits by the CN in the TCB group was 3.8. Although the TCB group had a lower mortality, this study did not find any statistically significant differences in health outcomes and health-care utilisation.

Challenges in the delivery of the programme may have influenced patient outcomes. More research is needed on implementation of evidence-based programmes in smaller research settings. A qualitative phase of the study needs to address these outcomes and explore the perspectives of health professionals and patients on the delivery of the programme.

This study provides valuable information on the transitional care programme in a smaller setting.

The purpose of this paper is to set out the similarities and differences between the legal frameworks for safeguarding children and adults. It presents the case for developing a Transitional Safeguarding approach to create an integrated paradigm for safeguarding young people that better meets their developmental needs and better reflects the nature of harms young people face.

This paper draws on the key principles of the Children Act 1989 and the Care Act 2014 and discusses their similarities and differences. It then introduces two approaches to safeguarding: Making Safeguarding Personal (MSP); and transitional safeguarding; that can inform safeguarding work with young people. Other legal frameworks that influence safeguarding practices, such as the Mental Capacity Act 2005 and the Human Rights Act 1998, are also discussed.

Safeguarding practice still operates within a child/adult binary; neither safeguarding system adequately meets the needs of young people. Transitional Safeguarding advocates an approach to working with young people that is relational, developmental and contextual. MSP focuses on the wishes of the person at risk from abuse or neglect and their desired outcomes. This is also central to a Transitional Safeguarding approach, which is participative, evidence informed and promotes equalities, diversity and inclusion.

Building a case for developing MSP for young people means that local partnerships could create the type of service that best meets local needs, whilst ensuring their services are participative and responsive to the specific safeguarding needs of individual young people.

This paper promotes applying the principles of MSP to safeguarding practice with young people. It argues that the differences between the children and adult legislative frameworks are not so great that they would inhibit this approach to safeguarding young people.

Transitional care is increasingly important in reducing readmission rates and length of stay (LOS). Singapore is focusing on transitional care to address the evolving care needs of a multi-morbid ageing population. This study aims to investigate the impact of transitional care programs (TCPs) on acute healthcare utilization.

A retrospective, longitudinal, interventional study was conducted. High-risk patients were enrolled into a transitional care program of local tertiary hospital. Patients received either telephone follow-up (TFU) or home-based intervention (HBI) with TFU. Readmission rates and LOS were assessed for both groups.

There was no statistically significant difference in readmissions or LOS between TFU and HBI. After excluding demised patients, TFU had statistically significant lower LOS than HBI. Both interventions demonstrated statistically significant reductions in readmissions and LOS in pre–post analyses.

TFU may be more effective than HBI in patients with lower clinical severity, despite both interventions showing statistically significant reductions in acute healthcare utilization. Study findings may be used to inform transitional care practices. Future studies should continue to examine the comparative effectiveness of transitional care interventions and the patient populations most likely to benefit.

Previous studies demonstrated promising outcomes for TFU and HBIs, but few have evaluated their comparative effectiveness on acute healthcare utilization and specific patient populations most likely to benefit. This study evaluated interventional effectiveness of both, which might be useful for informing allocation of resources based on clinical complexity and care needs.

ADHD is the commonest neurodevelopmental disorder of children and adolescents. ADHD is no longer conceptualized as a predominantly childhood disorder but is a chronic disorder that persists into adolescence and adulthood. The paper aims to analyse the transitional care of adolescents diagnosed with ADHD in childhood into adult specialist ADHD services in a local district. The paper also seeks to review current practice and to design a multi‐disciplinary transitional care pathway to adult services for adolescents with complex health needs based on best practice and available clinical guidelines.

Adolescents diagnosed with ADHD from childhood who were eligible for transition to adult ADHD services and who reached the age of 16 years over a period of two years consecutively (July 2009 to June 2011) were studied by a retrospective analysis of their clinical records. The current transitional care pathway was reviewed and revised.

Out of 504 patients on the specialist ADHD database, 104 adolescents were eligible for transition to adult services. A total of 19 patients (18 per cent) were referred to CAMHS. A total of 68 adolescents (65 per cent) were discharged from the paediatric services following voluntary discontinuation of medications and non‐attendance at follow‐up clinics. Only 16 patients (15 per cent) were successfully referred to the specialist adult ADHD services (three of them already discharged). A multi‐disciplinary transitional care pathway to adult services for young people with complex health needs and learning difficulties and information for the carers and young people have been designed and adopted in the local city borough, agreed by all the stakeholders.

A total of 73 per cent of eligible patients were either discharged or lost to follow‐up. There must be some flexibility in the referral pathway to the adult ADHD services to allow some of the adolescents who were previously lost to follow‐up to be re‐referred by other primary or secondary care healthcare professionals if the need arises in the future.

The paper shows that there is a high rate of discontinuation of medications, loss to follow‐up and a remarkably low rate of successful transition to locally commissioned adult ADHD services among adolescents diagnosed with ADHD in childhood.

Older adults who are or have been incarcerated constitute a growing population in the USA. The complex health needs of this group are often inadequately addressed during incarceration and equally so when transitioning back to the community. The purpose of this paper is to discuss the literature on challenges older adults (age 50 and over) face in maintaining health and accessing social services to support health after an incarceration and to outline recommendations to address the most urgent of these needs.

This study conducted a narrative literature review to identify the complex health conditions and health services needs of incarcerated older adults in the USA and outline three primary barriers they face in accessing health care and social services during reentry.

Challenges to healthy reentry of older adults include continuity of health care; housing availability; and access to health insurance, disability and other support. The authors recommend policy changes to improve uniformity of care, development of support networks and increased funding to ensure that older adults reentering communities have access to resources necessary to safeguard their health and safety.

This review presents a broad perspective of the current literature on barriers to healthy reentry for older adults in the USA and offers valuable system, program and policy recommendations to address those barriers.

The purpose of this paper is to set out the evidence base to date for Transitional Safeguarding to support authors of Safeguarding Adult Reviews (SARs) where Transitional Safeguarding is a key theme in the review.

This paper draws on key evidence from several published sources about Transitional Safeguarding in England. This evidence is presented in this paper as a framework for analysis to support SAR authors. It follows the same four domains framework used in other adult safeguarding reviews: direct work with individuals; team around the person; organisational support for team members; and governance. This framework was then applied to two SARs written by two of the article’s authors.

The framework for analysis for Transitional Safeguarding SARs was applied as part of the methodology of two separate SARs regarding three young people. Key reflections from applying the framework to both SARs are identified and discussed. These included: providing an effective framework for analysis which all participants could use and a contribution for developing knowledge. Whilst many issues arising for safeguarding young people are similar to those for other adults, there are some unique features. The ways in which the gaps between children and adults systems play out through inter-agency and multi-professional working, as well as how “lifestyle choices” of young people are understood and interpreted are key issues.

This paper presents an evidence base regarding Transitional Safeguarding for SAR authors who are tasked with completing a SAR where Transitional Safeguarding is a key theme.

This paper draws together key literature and evidence about Transitional Safeguarding practice with young people. This paper argues that this framework for analysis provides SAR authors with a useful tool to support their analysis in this complex area of practice.

The purpose of this paper is to test the relationship between cognitive age and the adoption of defensive ageing consumption activities and its effect on life satisfaction in an Asian context. The relationship between the antecedent variables of chronological age, biological age and transitional life events and cognitive age is examined.

Survey method. The study was conducted in Malaysia, an Asian country that is characterized as collectivistic. Data collection method used is convenience sampling method, using a sample of adults aged 40 years or older based on previous research. Measures used include cognitive age developed by Barak and Schiffman and validated by Wilkes. Life stage transitional events include a list of ten major life events that respondents experienced in the past 12 months. Biological changes are summated index of the number of biological changes (e.g. lengthy hospitalization or rehabilitation, hearing impairment) adopted from Mathur and Moschis. Defensive ageing consumption activities include skin care products, health supplements, beauty treatment and exercising, that are commonly adopted to fight ageing.

The paper finds that in the context of an Asian country, consumers view themselves to be several younger than their chronological age, consistent with past research. Biological changes, transitional life events and chronological age had a significant positive relationship with cognitive age, consistent with the findings of past research. To the extent that cognitive age was found to be positively related to transitional life events, regression analysis showed that life event was not a predictor of cognitive age, further contributing to the inconclusive evidence regarding the effect of life events on cognitive age. Research results supported the negative relationship between cognitive age and anti‐ageing consumption behaviour.

Study of this nature will help to shape marketers' approach to attract older consumers. Marketers should shift their focus away from regarding older consumers as old since older consumers tend to view themselves as younger than their chronological age. An understanding of how consumers perceive themselves in terms of their cognitive age is useful for segmentation. Knowing how older adults view “age” is useful for communication strategies.

This paper examines the effect of cognitive age on defensive ageing consumption activities in an Asian country, a collectivist society. The defensive consumption strategies included in this study were a range of products were commonly known but not tested. It extends the research by looking at the effect of defensive ageing consumption activities on life satisfaction.