There are stark inequalities in how different people experience later life. While some of us enjoy the benefits of longer lives, others may experience later life as a time of profound challenge. The causes of such inequalities are complex, inter-related, and challenging to address.
The Centre for Ageing Better commissioned a review of the evidence on the nature of inequalities in later life (published here), with a focus on six key areas: subjective wellbeing; physical and mental health; life expectancy and healthy life expectancy; financial security; social connections; and home and living environment.
The review presents and summarises the most recent published evidence on inequalities in later life in England. It is the collaborative work of teams from the Institute of Health & Society and Institute for Ageing at Newcastle University and the International Longevity Centre-UK (ILC-UK).
Research by the Centre for Ageing Better shows that people will have vastly different experiences of later life (Ipsos MORI 2015). This review broadens our understanding of the nature of inequalities in later life in England across a range of outcomes that contribute to a good later life. While there is strong evidence that poverty and disadvantage play a central role in inequalities in later life, there is much more to learn about how inequalities in later life are experienced by
and the factors affecting inequalities among BME groups, the LGBT community, people with disabilities, people with informal caring responsibilities, and the oldest old.
In this podcast mini-series, you will hear emotional accounts directly from caregivers who share their experiences, interviews with their healthcare professionals to understand the support that’s currently available, alongside major carer charities and leading experts who describe the vital importance of the caregiver in today’s healthcare system.
The Themed Review on NIHR evidence related to older people living with frailty in hospitals is now live on the Dissemination Centre website.
Comprehensive Care features 33 published and 20 ongoing studies concerning the concept of ‘frailty’ in older people. It brings together NIHR research on what can be done to identify and manage the needs of this group of people and avoid potential problems.
Reported by the National Health Executive (29 November 2018): The government is expected to conclude whether it is clinically appropriate to define specific nurse-to-patient ratios across different activities in the new year, health minister Philip Dunne has revealed. Speaking at a Health Select Committee inquiry yesterday, the minister said there has been a “big focus” on increasing the level of nurse staffing in hospitals since the Francis Report, something which he believes the government has had “some success” with.
“We have various strands of work being done now to look at whether or not it would be clinically appropriate to specify specific ratios of nurses to patients across different activities,” he argued. “At this point, those studies are concluding and we don’t have the output for that, but we will do at some point in the new year.”
Speaking as part of an investigation into the nursing workforce, Dunne also admitted that at present, there is no defined dataset that clearly quantifies what the staff vacancy level is across the NHS, although his department is reportedly working to change that.
“[Vacancies] are something we’re looking at and have some concerns about, because there isn’t an acknowledged dataset at this point which gives clarity about the actual vacancies are opposed to the proxies that people are using,” explained the health minister.
“The proxy that is most frequently used is the number of NHS job adverts, which gives rise to a number but is not particularly useful because you may have job adverts running in perpetuity because trusts know they have a turnover of staff. It doesn’t necessarily give you an accurate figure at any point in time. The advert may be for a number of jobs, too.”
The latest information the government has, he said, suggested there were around 36,000 clinical posts left unfilled by a substantive member of staff, but of these, 33,000 nursing and midwifery spots were covered by bank and agency staff. Therefore, the widely reported vacancy figure of almost 40,000 posts “doesn’t take into account the shifts which are filled by a large number of bank and agency staff.”
What works, for whom and in what circumstances - insights from the Optimal Study The powerpoint files supporting presentations at the BGS Autumn 2017 meeting will be published if and when authority has been obtained from presenters to publish. They will be published in secured pdf format and will be added to gradually, as permission is given to post onto the website. (updated 4 December 2017)
Wilco Achterberg: Innovation and emerging practice in elderly care medicine in the Netherlands
Anita Astle: Training a care home workforce fit for purposes, perspectives from a care home manager
Sharon Blackburn: What people living in care homes need from healthcare providers
Louise Butler: Haelo and Salford Care Homes
Iain Carpenter: The International Resident Assessment Instrument
Jo Hockley: The teaching/research-based care home - can it be a reality?
William Roberts: Enhanced health in care homes: progress and learning
Jos M G A Schols: Long-term (institutional) care in the Netherlands and the role of elderly care physicians; the story so far
Reported in Ageing Better (28 November 2017): A new report published today finds that making small changes to older people’s homes, such as installing handrails, ramps and level-access showers, alongside carrying out simple home repairs, could play a significant role in relieving pressure on the NHS and social care and reduce costs by millions of pounds each year.
The report by the Centre for Ageing Better and the University of West of England, Bristol (UWE, Bristol) also shows that minor home aids and adaptations can greatly improve quality of life for people who are losing mobility. Studies show that people’s difficulties with ‘Activities of Daily Living’ can be reduced by 75% – these include washing, bathing, going to the toilet, dressing and eating. Home aids and adaptations can also increase people’s ability to perform everyday activities by 49%, and reduce depressive symptoms by 53%, the report shows.
Making these kinds of small changes to homes earlier, alongside repairs to homes, should be a greater priority for local services, and could help to avoid or delay use of NHS and social care, the Centre for Ageing Better argues. Its report includes new analysis from the BRE (Building Research Establishment) showing that, installing home adaptations and undertaking home repairs in order to reduce falls on stairs, can lead to savings of £1.62p for every £1 spent, and a payback period of less than eight months. Installing minor home adaptations and making improvements to housing can lead to overall savings of at least £500 million each year to the NHS and social care services in the UK through a 26% reduction in falls, which account for over four million hospital bed days each year in England alone.
The National Audit of Intermediate Care (NAIC) report, published in November by the NHS Benchmarking Network, covers organisational level data relating to the period 2016/17. Service user and patient reported experience data was collected between May and August 2017.
Some of the findings:
Effectiveness: “Evidence from the audit demonstrates that intermediate care works with more than 91% of service users either maintaining or improving their level of independence in undertaking activities of daily living, during their episode of care.”
Waiting times: “Average waiting times have slightly reduced in home based services to 5.8 days (referral to assessment) and 2.5 days (referral to commencement) in bed based services. Whilst the reduction is welcome, the averages are still higher than the two-day wait standard.”
And capacity: “It was calculated in NAIC 2012 that intermediate care capacity needed to approximately double to meet demand. Given the ageing population and the increase in emergency admissions, it is likely that demand has continued to rise over the last five years. However, as in previous iterations of the audit, there is no evidence to suggest the step change in investment and capacity needed to meet demand has been achieved in 2017. Total investment in intermediate care services is around £2.8 million per 100,000 weighted population.”
Reported by the BBC (18 November 2017): Ninety MPs have signed a letter calling on the prime minister to set up a cross-party convention on the future of the NHS and social care in England.
They say a non-partisan debate is needed to deliver a "sustainable settlement". The letter to Theresa May and Chancellor Philip Hammond said patients were being "failed" by the system. A government spokesperson said it was "committed" to making the sector sustainable.
The government had already provided an additional £2bn to social care over the next three years, the spokesperson added.
One-third of the MPs who have signed the letter are Conservative. They include Sarah Wollaston, chair of the health select committee, former education secretary Nicky Morgan and Andrew Mitchell, a minister under the last government.
Tories George Freeman, former policy adviser to Mrs May and Sir Nicholas Soames, are other signatories. Labour MPs to sign include Liz Kendall, Chuka Umunna, Hilary Benn, Frank Field and Caroline Flint. Among the Liberal Democrats to have signed are Sir Vince Cable, Sir Ed Davey, Tim Farron and Norman Lamb.
A similar initiative with a much smaller group of MPs, including Ms Wollaston and Mr Lamb, was launched earlier in the year. The heads of three commons select committees also demanded "swift" action. This resulted in a meeting with Downing Street officials.
The latest letter, now backed by a broader range of senior parliamentarians, said the general election had interrupted these plans.
"The need for action is greater now than ever," it said.
The Dunhill Medical Trust is pleased to announce the latest call for applications to its popular Research Project Grant Scheme
Applications are invited from academics and clinicians from all health professions (including allied health professionals) who wish to undertake a research proposal aimed at improving the understanding of the mechanisms of ageing, the treatment of age-related disease and frailty or identifying and developing new and effective ways to improve the lives of older people.
Applications should be made by the Principal Investigator - PI - (Lead Applicant), as the person responsible for the research. As part of the application process, the PI will be expected to demonstrate that he/she is based in a strong research environment with a suitable skill mix in the research team (with other members of the team being named as Co-Investigators). The Trust does not consider single applicant proposals.
Reported by NHS Improvement (17 October): An evidence-based framework to support and enable directors of nursing and medical directors to achieve ‘outstanding’ care standards for those living with dementia during their stay in hospital.
The framework consists of eight standards and draws on learning from organisations that have achieved an ‘outstanding’ rating from the Care Quality Commission, and integrates policy guidance and best practice with opinion from patients and carers. The latter was captured through existing resources, including Healthwatch UK (2017), Patient Voices, the Alzheimer’s Society and meeting people and their carers living with dementia.
Designed to be implemented using quality improvement methodology, embodying the principle of continual learning, We recommend it forms part of your quality improvement programme. The principles of the framework apply to all services and you should adapt it to meet your local population and workforce needs.
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