Abstract: This article reports investigation of prevalent understandings and systems of beliefs that underpin older people's attitudes towards making plans for their future. The Mental Capacity Act 2005 (MCA) enables adults with capacity to make plans and decisions in advance, to arrange proxy decision-making and provides safeguards for those who might lose the capacity to make decisions for themselves in the future. This study explored the attitudes of a diverse sample of 37 self-declared well older people living in the community in England about their views on drawing up statements of wishes and documenting their decision-making preferences. The study was conducted in early 2009. Findings revealed that most individuals had a personal tendency or preference towards planning, guided by personality, beliefs, living situation and the relevancy of planning to their situation. Financial plans and funeral arrangements were most commonly drawn up with an absence of health and social care plans, which participants tended to postpone considering. Housing and residential care were important for all. Overall, few participants had heard of the MCA and most were unsure where to turn for support. Participants appreciated support when discussing these issues; some turned to family, while others felt professionals were a more appropriate source of advice. The family doctor was cited as trustworthy and a potential place to begin inquiries. Conceptualising onset of certain debilitating conditions also encouraged participants to think about planning for them. This study has implications for public education campaigns and health-related information that could potentially impact on many older people who are interested in making plans but are unaware that legal safeguards and practical support are available to aid this.
Abstract: BACKGROUND: Older people living in a care home have a limited life expectancy, and care homes are an important setting for end-of-life care provision. AIM: This research aimed to explore the views, experiences and expectations of end-of-life care among care home residents to understand if key events or living in a residential environment influenced their views. DESIGN: The research used a prospective design. The paper draws on the qualitative interviews of 63 care home residents who were interviewed up to three times over a year. This was a sub-sample of the larger data set of 121 care home residents. Setting/Participants: The residents were recruited from six care homes (providing personal care with no on-site nursing) in the UK. Results: Four main themes were identified; Living in the Past, Living in the Present, Thinking about the Future and Actively Engaged with planning the future. Many residents said they had not spoken to the care staff about end-of-life care; many assumed their family or General Practitioner would take responsibility. CONCLUSIONS: Core to the older person's ability to discuss end-of-life care is their acceptance of being in a care home, the involvement of family members in making decisions and the extent to which they believed they could influence decision making within their everyday lives. Advance care plans should document ongoing dialogue. These findings can inform how primary health and palliative care services introduce, discuss and tailor existing frameworks and programmes of end-of-life care.
Abstract: Migrant workers are increasingly important to the care sector in England as well as in other developed countries. The profile of migrants is likely to continue changing due to reforms in immigration policy and legislation limiting the range of jobs open to migrants from non-EU countries while facilitating migration from the new European Union accession countries. This article reports on detailed secondary analysis of newly available data on the characteristics of migrants working in the care sector as their first job. The analysis was undertaken in 2009 as part of research investigating the contribution made by migrant care workers in England. The sample was identified from the new National Minimum Data Set for Social Care (NMDSSC), which is completed by social care employers in England. Workers whose ethnicity was identified as not White British and who had their previous job abroad were used as a proxy of recent migrants. The analysis shows that this group of workers has a significantly different profile compared with other workers. Recent migrants in the care sector were significantly younger and held higher qualifications relevant to social care; however, there were no significant gender differences. They were also significantly concentrated in the private and voluntary sectors and in direct care work. There were variations between recent migrants' ethnicity and their job roles, with Asian workers more prevalent in senior care positions. These findings have a number of possible implications for social care workforce and providers, particularly within the current context of changing migration rules and social care reforms.
Abstract: Aim and objective.  To examine the factors affecting the extent to which English policy on the introduction of community matrons for people with chronic conditions was implemented. Background.  Improving health services for people with chronic diseases (long-term conditions) is an international priority. In England, the new post of community matron, a case management role, was introduced. A target was set for 3000 community matrons to be in post by 2008, but this was not achieved. Design.  A realist, pragmatic evaluation of the introduction of community matron posts. Method.  The study used mixed methods at multiple levels: an analysis of national and local strategy and planning documents, a national survey and a stakeholder analysis using semi-structured interviews in three primary care organisation case study sites. Results.  National policy established targets for the introduction of community matron posts, but there was local variation in implementation. Pragmatic decisions reflected the history of local service configurations, available finance, opportunities or challenges created by other service redesigns and scepticism about the value of the community matron role. There was resistance to 'bolt on' nursing roles in primary care. Conclusions.  The implementation of the community matron role is an example of how a policy imperative that valued the clinical skills and expertise of nurses was reinterpreted to fit with local patterns of service delivery. Before new nursing roles are introduced through national policies, a more nuanced understanding is required of the local factors that resist or support such changes. Relevance to clinical practice.  There is a need for consultation and understanding of local conditions before the implementation of workforce initiatives. For clinicians, it is important to understand how the context of care shapes priorities and definitions of new nursing roles and how their expertise is recognised and used.
Abstract: ABSTRACTBackground: Consensus recommends early recognition of memory problems through multi-disciplinary assessment in memory clinics; however, little is known about the experiences of people accessing such services. The aim of this review was to synthesis empirical evidence on patient and carer experiences in the transition to dementia.Methods: This review updates an earlier review (Bamford et al., 2004) on the topic of disclosure of the diagnosis of dementia. Key electronic databases were searched including OVID Medline, CINAHL, Web of Science, EMBASE, and Sociological Abstracts; this was supplemented by hand searching of reference lists and contact with experts in the field. Only papers published after 2003 were included.Results: Of the 35 papers included in the review, only one study observed the process of disclosure and only two papers explored the effects on the person with dementia's health. The vast majority of people with dementia wished to know their diagnosis. The key challenges for the person with dementia were coming to terms with losses on multiple levels. Although there may be short-term distress, the majority of people with dementia do not appear to experience long-term negative effects on their psychological health. For family carers, becoming the main decision-maker and adjusting to increased responsibility were common concerns.Conclusions: There is still little empirical research observing the process of diagnostic disclosure in dementia. Studies exploring the views of patients and their families suggest this should be an ongoing process with the provision of support and information tailored to individual needs. The term "Alzheimer's disease" appears to have more negative connotations than the word "dementia".
Abstract: New models of interprofessional working are continuously being proposed to address the burgeoning health and social care needs of older people with complex and long-term health conditions. Evaluations of the effectiveness of these models tend to focus on process measures rather than outcomes for the older person. This discussion paper argues that the concept of frailty, and measures based on it, may provide a more user-centred tool for the evaluation of interprofessional services - a tool that cuts across unidisciplinary preoccupations and definitions of effectiveness. Numerous frailty scales have been developed for case identification and stratification of risk of adverse outcomes. We suggest that they may also be particularly suitable for evaluating the effectiveness of interprofessional working with community-dwelling older people. Several exemplars of frailty scales that might serve this purpose are identified, and their potential contributions and limitations are discussed. Further work is required to establish which is the most suitable scales for this application. The development of an appropriate frailty scale could provide an opportunity for interprofessional debate about the forms of care and treatment that should be prioritised to improve the health and well-being of this population.
Abstract: manthorpe j. (2011) Nurse champions of older people: a national audit and critical review. International Journal of Older People Nursing doi: 10.1111/j.1748-3743.2011.00276.x Aims.  This paper aims to equip nurses working with older people with an understanding of the roles and activities of Champions for Older People. Background.  The position of Older People's Champion was established in England to help implement the National Service Framework for Older People at local level. Methods.  This paper reports on the findings of a national survey of older people's Champions. It sets this in the context of developments around health polices for older people. Findings.  Forty-three of the 209 Champions who participated in this study were nurses. Nurses were the most commonly appointed clinical Champions in National Health Service Trusts responding to the survey; they used this position to promote changes within their organisation and locality. While focusing on the implementation of National Service Framework for Older People targets and requirements, some used their position to work with organisations of local older people and advocated for older patients' interests. Conclusion.  Nurses conceived their position as clinical Champions broadly and reported that they used this role to promote service improvements for older people. Those who established networks with other Champions and older people's groups found this useful. Their role as Champions appeared to encourage a proactive and outward-looking perspective and provides evidence of the workings of one model of Championship. Implications for practice.  Embedding championing roles within organisations may be one way of bringing about change in the way that services to older people are developed.
Abstract: Suicide in later life is a public health concern. Given the need for practical guidance and policy implementation, this paper aims to provide a critical interpretive synthesis approach to prioritize the likely relevance of publications and the contribution that they make to understanding of the problem.
Abstract: In September 2008 the Nursing and Midwifery Council (NMC) approved plans to change pre-registration nursing education in England to an all-graduate qualification in 2015. In 2001 the Department of Health announced a similar decision for social work qualifying education and the first graduate-only qualifying programmes began in 2003-2004. This article presents findings from a national in-depth evaluation of the social work degree in England and describes ways in which efforts have been made to improve the quality of social workers, raise the status of the profession and link practice and theory as part of the transformation to a degree level qualification. Messages for nurse educators are drawn in the light of the professions' commonalities.
Abstract: This paper reports the findings of a scoping study designed to describe the evidence base with regard to support workers in social care in the United Kingdom and to identify gaps in knowledge. Multiple bibliographic databases were searched for studies published since 2003. The results revealed that the support worker role, though not well-defined, could be characterised as one aimed at fostering independence among service users, undertaking tasks across social and health-care, and not being trained in, or a member of, a specific profession. The studies identified were predominantly small-scale qualitative projects which considered issues such as role clarity, training and pay, worker satisfaction, service user views and the amount of time support workers are able to spend with service users compared to other staff. The review concluded that the research base lacks longitudinal studies, there is definitional confusion and imprecision, and there is limited evidence about employment terms and conditions for support workers or about their accountability and performance. The desirability and value of training and how it is resourced need further analysis. It is concluded that moves to self-directed support or personalisation and the increased reliance on and use of support workers, in the form of personal assistants, call for closer scrutiny of the role.
Abstract: To write a narrative review of the role of primary care physicians in the long-term care of people with dementia living at home, with a focus on psychosocial interventions, the provision of information and carer support, behavioural and psychological symptoms and case management.
Abstract: This article provides an insight into the support needs of health and social care commissioners seeking to develop world class commissioning competencies and the role of service improvement agencies in meeting these needs. Reporting findings from the evaluation of one service improvement agency based in England, we focus on the 'improvement supports' (the products and services) that were delivered by the 'Care Services Improvement Partnership' through its 'Better Commissioning Programme'. In-depth interviews were carried out with 25 care commissioners (n = 25) exploring how the Programme was used in their day to day work, its perceived value and limitations. Given the lack of employer-led training and induction we conclude that service improvement agencies play an important role in developing commissioners' skills and competencies. However, we suggest that achieving world class commissioning may depend on a more fundamental rethink of commissioning organisations' approaches to learning and development.
Abstract: Successive English government policies about older people's health and well-being aim to improve health and quality of life by promoting independence. Improving access to information and services that can improve health and well-being and reduce health risks is central to the modernisation of health and social care. Most recently, tailored and person-centred approaches with a strong emphasis on promoting health and well-being are central to policy, including the proposals for 'Life Checks' and the recent emphasis on commissioning 'community well-being'. We carried out a qualitative study to identify the key aspects of social situations that affect health and well-being, from the perspectives of older people and professionals, to enrich and expand an existing health risk appraisal tool so that it could be used for self-assessment of health and social well-being. This tool, Health Risk Appraisal in Older people (HRAO), has been evaluated in different European settings, including English general practice. Focus groups were recruited from general practice, older people's forums, social care and voluntary organisations in two London boroughs where the HRAO tool had previously been tested. The social factors determining health that were prioritised by older people and service providers and recommended for inclusion in the health risk appraisal tool were recent life events, housing and garden maintenance, transport, both public and private, financial management, career status & needs, the local environment and social networks and social isolation. This study has identified key social determinants of health that could usefully be added to 'Life Checks' for older people and that could also inform the commissioning of community well-being. Modified with the addition of social domains, the HRAO technology could be a suitable tool to achieve current policy objectives.
Abstract: More people will receive personal budgets to pay for social care services in England. Such people may or may not continue using services such as adult day care centres. Many day centres are under threat of closure. These trends will affect those working in adult day care. This article examines the profile of this workforce, using recent NMDS-SC data and applying multinomial statistical modelling. We identified nearly 6000 adult day care workers, over half supporting adults with learning disability. The results of the analysis show significant variations between the adult day care, residential care and domiciliary workforces. At the personal level, day care workers are significantly older and less ethnically diverse than other workers. They tend to have been working in the sector for longer, and their work patterns are more stable. The findings are discussed within the context of policy changes affecting learning disabilities and social care workforce strategies.
Abstract: The need for healthcare practitioners to respect the dignity of older people is widely recognised in England, where it has been given attention by politicians, professionals and health service regulators. This article aims to provide examples of how such ambitions may be used in practice development.
Abstract: The promotion of health checks for adults with learning disabilities in England is government policy based on the need to address lack of access to healthcare services and poor health outcomes for this group of citizens. This article reports the findings of a scoping review of the literature carried out in 2009 to explore the implications of a national system of health checks for the work of practitioners in social care services. The review found little in the research literature relevant to social care practice and concluded that there is a need to consider the possible roles of social care staff in initiating health checks; their possible involvement in decision making around issues of consent; social care practice in recording and implementing the recommendations of such checks; possible roles as escorts, chaperones and supporters with communications; and the presence of regulatory scrutiny of their participation in this activity.
Abstract: A number of studies have investigated the relationship between suicide and perfectionism but none to our knowledge have been based on studies of completed suicides. This article aims to provide important insight into the potency that certain profiles of perfectionism can claim in the path to suicide by presenting three case studies from a U.K. study of student suicide. Collectively, these case studies provide theoretical support for existing frameworks and are consistent with other literature which emphasizes those forms of perfectionism that engender severe self-criticism and self-doubt and fear of failure as most destructive.
Abstract: Since July 2004, employers of social care staff working with vulnerable adults in England and Wales have been legally required to refer workers or volunteers dismissed for misconduct because they have harmed vulnerable adults or placed them at risk of harm to the Protection of Vulnerable Adults (POVA) list. The POVA list is unique to England and Wales, and is a powerful tool of quality assurance for the care sector and for the safeguarding of vulnerable adults. This article reports on part of a multi-method study including quantitative and qualitative elements to produce a rounded picture of the factors involved in decisions to place staff members on the POVA list. Based on secondary data analysis of all records of POVA referrals from August 2004 to November 2006 (5294 records) as well as a detailed sample of 298 referrals, this article focuses on the prevalence of different types of alleged harm and their association with various staff, employer and service-users' characteristics. The most common form of alleged abuse was physical abuse (33%), while the least was sexual abuse (6%). Some of the other key findings are the over-representation of men referred (31% compared to an average of 15% in the workforce) and significantly different types of abuse in care home and domiciliary settings, where financial abuse was less likely in care homes [odds ratio (OR) 0.17; P < 0.001], while physical abuse more likely in the same setting (OR 3.60; P < 0.001).
Abstract: There have been few national studies of the prevalence of elder mistreatment (abuse and neglect) in private households. This article provides an overview of the UK National Prevalence Study of Elder Mistreatment that took place in 2006. It addressed 2,111 respondents in four countries who answered a face-to-face survey questionnaire. The achieved sample was weighted to be representative of the UK older population. Of respondents, 2.6% reported mistreatment by family members, close friends, or care workers. The predominant type of reported mistreatment was neglect (1.1%) followed by financial abuse (0.6%), with 0.4% of respondents reporting psychological abuse, 0.4% physical abuse, and 0.2% sexual abuse. Women were significantly more likely to have experienced mistreatment than men, but there were gender differences according to type of abuse and perpetrator characteristics. Divergent patterns were found for neglect, financial, and interpersonal abuse. Further analysis of the data indicated that the likelihood of mistreatment varied with socioeconomic position and health status.
Abstract: This paper aims to support the critical development of user involvement in systematic reviews by explaining some of the theoretical, ethical and practical issues entailed in 'getting ready' for user involvement.
Abstract: Addressing the problems of meeting the needs of ageing populations in rural areas is recognised as a political and service delivery challenge. The National Service Framework (NSF) for Older People (NSFOP) set out a series of service standards to raise quality, to redress variations in service use and to enhance the effectiveness of services across health and social care in England and alluded to the challenges of meeting such standards in rural communities. This paper reports findings from the consultations undertaken with 713 elderly people as part of the midpoint review of the NSFOP in 2006, presenting and analysing the views and experiences of elderly people from rural areas. The consultations to engage with elderly people employed a mixed methodology that included public events, focus groups and individual interviews. The data reveal participants' views of how different patterns of social change in diverse country areas in England influence health and well-being in later life. The costs and benefits of centralization of services, and the pivotal issue of transport are important themes. The findings raise questions about the unclear and contradictory usages of the term 'rural' in England and the portrayal of rural ageing as a homogeneous experience.
Abstract: In the UK policy recommends that service users (patients, carers and the public) should be involved in all publicly funded health and social care research. However, little is known about which approaches work best in different research contexts and why. The purpose of this paper is to explain some of the theoretical limitations to current understandings of service user involvement and to provide some suggestions for theory and methods development. This paper draws upon findings from a review of the research 'evidence' and current practice on service user involvement in the design and undertaking of nursing, midwifery and health visiting research.
Abstract: A transformation of healthcare is underway, from a sellers' market to a consumers' market, where the satisfaction of the patient's needs is part of the definition of quality. Patient satisfaction surveys are widely used to judge service quality, but clinicians are sceptical about them because they are too often poorly designed measures that do not lead to improvements in the quality of care.
Abstract: This study aimed to interrogate the decisions and approaches used by family doctors in responding to the needs of young people in distress. The research sought to explore how practitioners balanced young people's needs for confidentiality and self-determination with their parents' concerns and needs as caregivers.
Abstract: AIM: This article explores the involvement of older people in research and inspection, reflecting on the learning from the recent 'joint review' of the National Service Framework for Older People in England. METHODOLOGICAL CONTEXT: Working in 10 different localities, the 'joint review' comprised a formal inspection of health and local council services (carried out by the Healthcare Commission, Commission for Social Care Inspection and the Audit Commission) and an externally commissioned university-led research project designed to ascertain the views and experiences of older people living in the 10 inspection sites. In total, 1839 older people were interviewed individually and through focus groups and an additional 4200 older people completed questionnaires. A distinctive feature of the research was the inclusion of a team of older researchers who had undertaken training in research methods in later life. Reflections of the older researchers and other members of the research team on undertaking this large-scale user involvement project were ascertained via a day-long seminar which was tape recorded and transcribed. LEARNING: While many espouse the principle of 'service user involvement' in research, there is a need to move beyond the rhetoric of participation and any blanket assumptions about what it means to be an 'older researcher', a 'service user researcher' or indeed, a 'professional researcher'. This means ensuring that within any given team (user-controlled or collaborative) there are clear lines of accountability and equal opportunities for individual appraisal, support, and personal or professional development. Such considerations are key to working with 'older researchers' and encouraging diversity in the research workforce more generally.
Abstract: At first glance, commissioning mental health may look like a heart-sink project, but it need not be. In fact, the opposite may be true. This report argues that consistent application of a long-term strategy, which allows the accumulation of small changes across agencies and disciplines, is likely to be the key to success. It sets out the issues that need to be addressed, the pitfalls to avoid, and examines a series of objectives for commissioners.
Abstract: This article aims to show that community nurses are well placed to recognize the early symptoms of dementia. It identifies the three main ways in which community nurses can assess changes in cognition, and how the community nurse can work with the GP and other family members to provide a seamless service to this vulnerable group. Special focus is given to the sensitivity with which nurses can guide the older person through the stages of recognition and diagnosis of the condition and subsequent after-care.
Abstract: Since July 2004, employers of social care staff working with vulnerable adults in England and Wales have been required to refer workers dismissed for misconduct that harmed vulnerable adults or placed them at risk of harm, to the Protection of Vulnerable Adults (POVA) list. Employers are also required to check the list before employing people to work with vulnerable adults. The Department of Health commissioned the authors to analyse the first 100 referrals to the POVA list. Key findings include the over-representation of males and care home staff in the sample of referrals, compared with national figures on care figures and the tendency for male staff to be involved in more physical types of misconduct. These findings are discussed in the light of the literature on workforce regulation and suggestions are made for the implementation of the Bichard Inquiry recommendations. While it is argued that the list is a positive development, it is also stressed that more general measures to improve the quality of services may be at least as important a means of protecting vulnerable adults. Furthermore, the article argues for public debate on the proper balance between the rights of staff and the protection of vulnerable people.
Abstract: This article reviews the practice and policy based literature on person-centred planning in learning disability services in England. Its aim is to identify the implications for the workforce in practice.The analysis found that implementation is often described as partial or slow and characterizes reasons for this at a number of levels, including the slow pace of change in service culture and power relations, immutable funding structures, services' inflexible infrastructures, high levels of staff turnover and lack of training, inexperience among service management, inadequate staff supervision, and ambiguity among some stakeholders. Little substantial critique exists of the model itself. Analysis of the literature further reveals that the implementation of person-centred planning in practice is assisted by policy encouragement, service development and investment, favourable case reports and personal accounts, practitioner enthusiasm and positive evaluations. This article explores these to consider what facilitates the adoption of new elements of practice.
Abstract: This paper draws on the findings of a review of regulation of professionally qualified teachers, social workers and other staff in social care. It charts the process of developing and implementing both professional and wider workforce regulation in England, focusing on the implications for generic and integrated working and the development of cross-professional procedures for the protection of vulnerable adults and children from abuse. There are many uncertainties about how best to develop workforce regulation especially when integrated working is a policy goal. In light of the paucity of evidence of outcomes and benefits for improved practice and the protection of the public, there is a need for research to address this complex arena.
Abstract: This article reports briefly on the first UK prevalence study (undertaken in 2006-7) of the abuse and neglect of older people living in the community. Older people living in the community who reported mistreatment and neglect (2.6 per cent) equate to about 227,000 of the population aged 66 years and over. If figures are broadened to include neighbours and acquaintances, prevalence increases from 2.6 per cent to 4.0 per cent. This article identifies risk factors of loneliness, depression and poor quality of life. It suggests that nurses have a key role in day-to-day clinical practice in enabling older people to report abuse and neglect.
Abstract: This article explores volunteering with older people through a study of the literature, mainly from the UK. The discussion is grouped around five themes: organization, support, sustainability, stereotypes and boundaries. The article discusses nurses' roles in working with volunteers and volunteer coordinators. It notes that older people are often volunteers themselves. A number of areas for future research are outlined.
Abstract: The Mental Capacity Act (MCA) 2005 will be implemented in England and Wales in 2007 and have consequences for dietitians who work with people who may lack capacity to make specific decisions. This paper will explore issues arising from the introduction of the Act and considers the implications for dietitians involved in the delivery of clinical care, using enteral feeding as an illustrative example. If patients lack capacity to make specific decisions, dietitians will be required to record if, how and why they reached a decision, how they are involved in the decision making process and need to be able to justify their actions in relation to those decisions. This paper discusses the importance of dietitians' involvement in best interests decision making and considers the implications of decision making where people have drawn up a Lasting Power of Attorney. The role of such advance decisions is discussed and consideration is given to the potential compatibility of perspectives between the patient and family that may give rise to disputes. Dietitians may be well placed within multidisciplinary team working to ensure patients and their carers are part of the decision making process through effective communication and support for patients. Dietitians in England and Wales must consider the implications of the MCA upon their clinical practice and others outside these jurisdictions may like to reflect on the relevance of such developments in their own contexts.
Abstract: Evaluation of the impact of the National Service Framework for Older People (NSFOP) on the experiences and expectations of older people, 4 years into its 10 year programme.
Abstract: Overall, the number of people who kill themselves across all ages is falling but suicide rates among older people remain comparatively high. This article considers possible risk factors and suggests ways of reducing and containing potential harm. It also explores ways of responding when prevention of suicide fails.
Abstract: This article explores anxiety states among older people and how they may overlap with depression. It discusses prevalence, symptoms and treatment, and aims to help nurses to develop appropriate intervention strategies and to know when they should refer patients to other health practitioners.
Abstract: This article describes and discusses 27 interviews that explored perceptions of the effectiveness of advocacy services for people with learning disabilities in the UK. The views of stakeholders on the current position of advocacy services, how services are evaluated and recommendations for change are central themes in the analysis of the interviews. The discussion suggests that although evaluation of effectiveness is increasingly important in the light of policy change and funding constraints, it is not universally in place and available tools are considered to be inadequate for the task. The explanation of this may lie in the continuing debates over the meaning and purpose of evaluation and fears that it is one-dimensional. Future investment and commitment to advocacy schemes will need to address these issues.
Abstract: Increases in funding of advocacy schemes are leading to their general expansion in the UK. Little is known of how their activities are evaluated by funders. This article examines how local authorities evaluate the outcomes of advocacy schemes. It reports on and discusses the findings of a survey of local authorities. Respondents identified the types of support they provided to advocacy schemes and their requirements for service reports. Data are presented on the length of time that schemes have been funded, geographical variations and whether schemes are generalist or specialist. This analysis is set in the context of discussion with stakeholders. The authors conclude that monitoring and review systems are not well known or extensively used, that while user involvement in evaluation is seen as appropriate this is not well developed, but that advocacy services themselves are interested in contributing to processes of improvement and accountability.
Abstract: This article explores dementia and depression, the relationship between them and ways of distinguishing between them in older patients. It also suggests ways in which nurses can offer support to people affected by both conditions.
Abstract: Social work education in England underwent significant change in its move to degree status in 2003. It is hoped that the result will be increased professional standing for social workers, an improvement in the current widespread problems with recruitment, and assurance that all newly qualified social workers meet the National Occupational Standards for Social Work (Available from: http://www.topssengland.net/files/cd/). This change has pre-occupied social work educators and debate within the profession has concentrated on the practicalities and expectations of reform. This paper suggests that those working in nurse education may observe a number of similarities with its own earlier reforms and with current debates on whether nursing should move to an all-graduate profession. It then highlights three aspects of the new requirements for social work training: service user involvement, the place of research-minded practice, and the primacy of practice--that may be of interest and relevance to nursing colleagues.
Abstract: The developed world's population is aging, due to trends of increased life expectancies and decreased fertility rates. These trends are predicted to increase demand on long-term care services. At the same time, the long-term care workforce is in shortage in most of the developed world. Moreover, such shortages are expected to increase due to parallel socio-demographic factors. The increase in demand for longterm care, coupled with shortage in supply of care workers, has promoted some attention from policymakers. The current paper provides an international review of institutional arrangements for long-term care in different developed countries and in particular explores different strategies used or proposed to resolve the shortage in the long-term care workforce.
Abstract: Advocacy schemes have been established throughout the United Kingdom (UK) but their evaluation by funders is varied. This article reviews the literature in respect of models of evaluation of advocacy schemes for people with learning disability. It discusses the six main models and the issues that arise in evaluation. The advantages and disadvantages of each model are analysed. The article concludes that whilst fears exist about the potential for evaluation to infringe advocacy schemes' autonomy, funders need to undertake such a process for reasons of public accountability. Advocacy schemes may find it useful to consider which model of evaluation works best for them and will be appropriate and useful for their funders.
Abstract: This paper aims to explore the influences on employment related decision making in respect of nurses over 50 in the United Kingdom. It investigates the retirement and labour market relationship through the diverse experiences of older nurses and stakeholders in nursing.
Abstract: In common with the nursing workforces of the developed world, the NHS nursing workforce is ageing. Community nurses, in particular, tend to be older than their acute counterparts and this ageing could have a greater impact on this section of the workforce than on nurses in other sectors. This article reports on a study into the options, decisions and outcomes for nurses over the age of 50 years in the NHS. The study was funded by the Joseph Rowntree Foundation as part of a larger programme of work. Older nurses are a valuable part of the NHS workforce, being a repository of skill and wisdom. While this is generally recognized, and there are policies to support this, there is little recognition or action within the NHS. This study found that older nurses would like to see greater flexibility being shown towards them, in terms of their working hours and conditions of work, without harming their pension prospects. They would like to see return to practice courses and continuing professional development more geared towards their needs. Furthermore, they would like more information about their options. The article includes the experiences of some older nurses working in the community who remain, have left or have returned to the NHS.
Abstract: Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing.
Abstract: The concept of ethnicity remains attractive and meaningful to service developers and professionals, although research suggests that this disguises other facets of identity and difference. An epidemiological perspective on the relationship between ethnicity and dementia supports the idea that ethnicity (defined as particular shared cultural characteristics) is not likely to influence unduly the emergence of dementia in individuals. Cultural factors may protect against dementia, impeding its recognition and influencing its course and these deserve further investigation. Ethnicity is a general concept that subsumes and conceals the impact of migration, education, health beliefs and socio-economic status on health, and therefore is problematic. Empirical research on dementia and ethnicity reveals that intra-ethnic group variation is greater than inter-ethnic group variation; supporting the view that ethnicity as a category may not have great explanatory power and may foster a category fallacy. However, the experiences of people with dementia and their carers show that the important issues for service providers to consider are language, religious belief and observance, cultural practices (including food and personal care practices) and social support and coping mechanisms. In this position paper we argue that these issues are applicable to all individuals with dementia, independent of apparent ethnicity, and that promotion of cultural competence in service provision should not be relegated to an ethnic minority agenda. The task for health and social care providers is therefore to recognise the diversity of users and to increase access to appropriate quality mainstream person-centred services, rather than to develop segregated or specialized services.
Abstract: In the context of increasing interest in how rurality affects health services and nursing practice in the UK, this paper reports and discusses data from a survey of older people living in three English villages. The survey found that village populations differed widely, that there were changes in the proportions of older people in the villages over time, and that close social networks existed for some but not all. The paper concludes that health care practitioners should avoid stereotypes of village life. In their increasing emphasis on health promotion and active ageing among older people, nurses may find data collected by the voluntary sector to be a useful resource. Working in partnership with groups to achieve a deep understanding of local contexts may assist nursing practitioners when building up pictures of older patients' health-related needs and views.
Abstract: In 1981, June Huntington published a study of social work and general practice which rapidly became influential. In it she offered a sociological analysis of these two occupations to explain the difficulties and conflicts which had arisen between them and to predict the future course of their relationship. In this paper we revisit Huntington's propositions and assess the extent to which her predictions have been realised in the UK context. We adopt her perspective of the two organisational cultures of general practice and social work to consider her claims, particularly with respect to developments in social work. We then outline her depiction of the likely evolution of interprofessional relationships over the past two decades, considering the generalisability of experiments in collaboration, conflict with the medical profession, tensions within social work itself, and the sense of 'crisis' in relationships between professions. To promote debate with colleagues in different disciplines, this paper ends with a series of questions about the likely impact of care trust formation on social work.
Abstract: People with dementia encounter problems in eating and these have been reported in various studies. Many of these studies focus on individual difficulties and neglect the social, environmental and cultural aspects of meals and eating. Studies often centre on the problems of providing food instead of the experience of those receiving food. Less is known of the perspectives of family carers and residential or domiciliary care staff than of nurses' perceptions. Only recently are the perspectives of family carers and people with dementia joining nurses' discussions.
Abstract: Eating and drinking difficulties are common in people with dementia and yet some health staff are inclined to neglect this important area of care. This article explores how, combined with the skills of nurses, the experiences of those caring for relatives with dementia can help potential problems to be avoided.
Abstract: Advances in clinical and technical areas, combined with developments in community support services, have enabled people to receive enteral tube feeding at home in the UK. Research has focused on clinical and technical aspects, and people's experiences have largely been explored through the audit of after-care services. The research reported in the present paper consisted of a qualitative study in which a small number of people under going enteral tube feeding at home and their carers were interviewed. The study took place in one area of northern England. The interviews explored aspects of daily life, focusing on decision-making and adaptation, and revealed positive feelings about the process of tube feeding, as well as areas of difficulty and concern. Opportunities to improve practice and services are identified from these accounts.
Abstract: Early recognition of dementia is a key policy objective designed to maximize the efficacy of treatment and to provide timely and appropriate support before crisis occurs. The impact of early recognition of dementia is under-researched in primary care nursing.
Abstract: This brief review comes at a time when there is interest in grandparents as sources of help and support for younger generations, both for their own families and also in the wider intergenerational community (Box 1). 'Special' populations of grandparents are being identified as playing major roles in childcare but these may have high health needs. Being a grandparent is generally a positive role for older people and for some may be satisfying and enjoyable and endure over many decades.
Abstract: To investigate the options, decisions and outcomes for nurses aged over 50 in terms of remaining in, retiring from, or returning to, work in the NHS.
Abstract: The present article explores professional attitudes to family members supporting an older person newly diagnosed with dementia. It draws on professional perspectives derived from a series of 24 multidisciplinary workshops held in the UK, analysed using a typology developed by Twigg in 1989. The primary care workers' understanding of carers' needs and circumstances fitted best with Twigg's models of carers as resources and co-workers, but showed limited awareness of carers' responses and attitudes to caring. It is argued that professional assumptions about family members' roles when dementia is recently recognised among older people expand definitions of carers, but still confirm their instrumental role.
