How High-Need Patients Experience the Health Care System in Nine Countries

In this study, high-need patients are defined as those aged 65 and older with at least three chronic conditions or a functional limitation in activities of daily living. The brief analyses data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults to investigate health care use, quality, and experiences among high-need patients in nine countries (Australia, Canada, France, Germany, the Netherlands, Norway, Sweden, Switzerland, and the United States) compared with other older adults. The study found that high-need adults use more health care – especially avoidable Emergency Department visits –, experience more cost-related barriers to care, and poorly coordinated care. Given that high-need adults consume a much greater proportion of health services than other adults – for example, five percent of the U.S. adult population accounts for 50 percent of the nation’s health care costs – the brief suggests that the comparative success of some countries, particularly in reducing ...

Goal planning in person-centred care supports older adults receiving case management to attain their health-related goals

Care for older adults should preferably be provided in a person-centred way that includes goal planning. The aim of the present cohort study is to gain an insight into the results of goal planning, in a person-centred care setting for community-living older adults.

Exploring Patient-Reported Barriers to Advance Care Planning in Family Practice

Although patient-centred care has become increasingly important across all medical specialties, when it comes to end of life care, research has shown that treatments ordered are not often concordant with people's expressed preferences. Patient and family engagement in Advance Care Planning (ACP) in the primary care setting could improve the concordance between patients' wishes and the healthcare received when patients cannot speak for themselves. 

Telemedicine for housebound older persons during the Covid-19 pandemic

Hollander and Brendan highlighted the benefit to decision-making that may be drawn from the use of automated screening algorithms in prioritizing patient care to better allocate resources during the Coronavirus disease 2019 (Covid-19) pandemic.  A strategy to screen older community dwellers at risk for home confinement-related adverse consequences must, therefore, be adopted based on an efficient and effective forward triage framework. In older community dwellers, assessing frailty is a definite cornerstone of triage, as it provides insight into the degree of vulnerability in their health status and their risk for adverse consequences. 

The Centre of Excellence on Longevity of McGill University (Quebec, Canada) designed, in late March 2020, a short assessment known as “Evaluation SOcio-GERiatrique” (ESOGER) for Montreal’s housebound community-dwelling older adults. It acts as the first step in connecting older community dwellers who are housebound during the ...

Prevalence of non-communicable chronic conditions, multimorbidity and its correlates among older adults in rural Nepal: a cross-sectional study

The population of older adults is increasing globally and is projected to increase to over 1.5 billion by 2050. A similar demographic transition is occurring in Nepal. While we celebrate longevity, health and quality of life are two crucial agendas for the older population. Older adults have a higher prevalence of non-communicable chronic conditions, and with longevity, the likelihood of experiencing more than one non-communicable chronic condition also increases.

This study’s objectives were to estimate the prevalence of major non-communicable conditions and multimorbidity among older adults in rural Nepal and examine the associated socioeconomic and behavioural risk factors.

OPEN ARCH integrated care model: experiences of older Australians and their carers

There is worldwide recognition of the need to redesign health service delivery with a focus on strengthening primary health care and aligning health and social care through integrated models. A defining feature of integrated models is improved patient and carer experience of care. This study explored the experiences of older people and their carers enrolled in a unique model of integrated care that provides a specialist geriatric intervention in the primary care setting for older adults with complex needs in Far North Queensland. A qualitative exploratory descriptive design using semistructured interviews was used to address the study aims. Seventeen older people and nine carers took part in the study. Data were analysed inductively, guided by the principles of thematic analysis. Three themes emerged: getting by; achieving positive change; and improving and maintaining the OPEN ARCH (Older Persons ENablement And Rehabilitation for Complex Health conditions) approach. The findings indicate that enablement ...

Transitional Care Experiences of Patients with Hip Fracture Across Different Health Care Settings

Transitions of care often result in fragmented care, leading to unmet patient needs and poor satisfaction with care, especially in patients with multiple chronic conditions.

This project aimed to understand how experiences of patients with hip fracture, caregivers, and healthcare providers differ across different points of transition.

How staff characteristics influence residential care facility staff’s attitude toward person-centered care and informal care

Staff members, and their attitudes, are crucial for providing person-centered care in residential care facilities for people with dementia. However, the literature on the attitudes of nursing staff regarding person-centered care is limited. The objective of this study is to explore the association between staff characteristics (age, education level, years of work experience and function, i.e., care or welfare) and staff attitudes toward perceived person-centered care provision and including informal caregivers in the caregiving process in residential care facilities.

Older Adults’ Demand for Integrated Care and Its Influencing Factors: A Scoping Review

Integration has become a major concern for governments, healthcare and aged care systems in many countries. However, the research on and implementation of integrated care in China started relatively late, and there is no review on the needs of older adults with regard to integrated care and the influencing factors. Therefore, this paper aims to provide a scoping review by searching, evaluating, and summarizing the Chinese and international literature on the need for and the factors influencing integrated care for older people. In addition, this review highlights evidence of the gap between China and the world in integrated care.

A Digital Health Platform for Integrated and Proactive Patient-Centered Multimorbidity Self-management and Care (ProACT):Protocol for an Action Research Proof-of-Concept Trial

Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practices around the provision of well-coordinated, person-centered care for persons with multimorbidities. Present health systems across the European Union (EU) focus on supporting a single-disease framework of care; the primary challenge is to create a patient-centric, integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale project funded by the European Commission under the Horizon 2020 programme, that involved the design, development, and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged ≥65 years) living with multimorbidity.

Effects of a person-centred and health-promoting intervention in home care services- a non-randomized controlled trial

Home care recipients have reported little self-determination and opportunity to influence their own care. Person-centred care focusing on involvement has improved the quality of life of older adults in health care and nursing homes; however, knowledge about the effects of person-centred interventions in aged care at home is sparse. The aim of this study was to study the effects of a person-centred and health-promoting intervention, compared with usual care, on health-related quality of life, thriving and self-determination among older adults, and on job satisfaction, stress of conscience and level of person-centred care among care staff.

Provider and Manager Perspectives on the Use of an Integrated Clinical Pathway for Community-Dwelling Older Adults: A Qualitative Case Study

Integrated care pathways (ICPs) could improve the organisation and delivery of care for community dwelling older adults. An ICP was developed and implemented in Québec to support home care processes. This study explores the perspectives of home care staff on the use of an ICP to support the organisation and delivery of health and social care to community-dwelling older adults with complex needs.

Community Volunteers and Primary Care Providers Supporting Older Adults in System Navigation: A Mixed Methods Study

Primary care providers and community volunteers have important roles in supporting patient system navigation and utilization of community-based health and social services (CBHSS). This study aimed to explore the experiences and impacts of system navigation in a complex intervention supporting older adults. Primary care teams’ practice of system navigation was impacted by programme participation, including through learning about local CBHSS.

Community-Based Integrated Care Units: Intermediate Care Units for Older Adults in Japan

Demographic changes caused by the global aging of the population are leading to increased medical and care costs. Several models of care that avoid admission to general acute care hospitals, increased medical costs, and poor outcomes after hospitalization are being explored. Ribbink et al. reported on the subacute care unit (SCU) in Spain and the acute geriatric care hospital (AGCH) in the Netherlands as intermediate care units that provided an alternative to admission to a general hospital. In the present letter, we introduce the characteristics and outcomes of community-based integrated care units (CICUs) in Japan, which function as intermediate care units.

The Care Coordinator’s Tasks During the Implementation of an Integrated Care Pathway for Older Patients: A Qualitative Study Based on the French National “Health Pathway of Seniors for Preserved Autonomy” Pilot Program

Although integrated care and care coordination are known to be beneficial for older adults’ population, the specific tasks of a Care Coordinator (CC) for integrated care pathways for this population have not been studied in detail. In this study, the CC’s tasks in an integrated care pathway for older adults shows that the CC’s overall workload was greater than expected and appreciated by healthcare professionals.

IFIC Scotland Integrated Care Matters: Webinar Series 6

IFIC Scotland and partners have launched series 6 of IFIC Integrated Care Matters webinars. The series kicked off with some webinars led by IFICs SIGs then begin to explore how we can work together to promote health and wellbeing, inclusion and participation in communities. This builds on IFIC`s plenary session at ICIC21 – you can view that session here.

Guest panelists from different systems will share insights and challenge us to create age friendly, compassionate, healthy communities that leave no one behind. Each webinar is accompanied by a topic resource with links to further information. All who register will receive links to the recordings and topic resources. 
 

Enhancing inter-organisational partnerships in integrated care models for older adults: a multiple case study

The purpose of this paper was to develop deeper insights into the practices enacted by entrepreneurial healthcare managers to enhance the implementation of a partnership logic in integrated care models for older adults.

The impact of including a medication review in an integrated care pathway: A pilot study

The objective of the present study was to measure the impact of the intervention of combining a medication review with an integrated care approach on potentially inappropriate medications (PIMs) and hospital readmissions in frail older adults.

Use of a Self-Report Electronic Comprehensive Geriatric Assessment by an Interprofessional Integrated Care Team to Support Older Adults Living with Frailty: A Pilot Project

Comprehensive geriatric assessment (CGA) is effective in supporting older persons with frailty, though access remains limited by human resource shortages. We investigated the feasibility and acceptability of a self-re- port CGA instrument to support care planning by an Integrated Care Team (ICT).