David Challis

‘Not knowing where I am doesn't mean I don't know what I like’: cognitive impairment and quality of life responses in elderly people

To elucidate the extent to which elderly people with cognitive impairment are able to answer questions about their quality of life.

A new version of the Geriatric Depression Scale for nursing and residential home populations: The Geriatric Depression Scale (Residential) (GDS-12R)

The objective was to develop a new short-form Geriatric Depression Scale (GDS-12R) suitable for older people living in nursing and residential care settings, including those persons with significant cognitive impairment. A total of 308 newly admitted residents of 30 nursing and residential homes in northwest England were interviewed using the Geriatric Depression Scale (GDS-15), the Mini-Mental State Examination, and the Affect Balance Scale (ABS). A 12-item version of the GDS was shown to have greater internal reliability than the 15-item version, because of the context-dependent nature of the deleted items. There was close agreement between the GDS-12R items and another indicator of depressed mood (a single item from the ABS). Furthermore, moderate to high levels of cognitive impairment did not affect the performance of the new version of the scale. The GDS-12R provides researchers and clinicians with a brief, easy-to-administer depression scale that is relevant to residential and nursing home populations.

Assessing the Role of Increasing Choice in English Social Care Services

This article aims to explore the concept of choice in public service policy in England, illustrated through findings of the Individual Budgets (IB) evaluation. The evaluation tested the impact of IBs as a mechanism to increase choice of access to and commissioning of social care services around the individual through a randomised trial and explored the experiences and perspectives of key groups through a large set of interviews. The article presents a re-examination of these interview data, using three ‘antagonisms of choice’ proposed in the literature – choice and power relations, choice and equity, and choice and the public nature of decisions – as organising themes. The randomised trial found that IB holders perceived they had more control over their lives and appreciated the extra choice over use of services, albeit with variations by user group. However, problems of power relations, equity and the constraints implied by the public nature of decision-making were complicating and limiting factors in producing the benefits envisaged. The focus on choice in policy, especially as implemented by IBs, emphasises an individualistic approach. The findings suggest that addressing broader issues relating to power, equity and an understanding of the public nature of choice will be of value in realising more of the benefits of the policy.

Care management arrangements for older people in England: key areas of variation in a national study

Care management has become a key component in the development of community-based care in many countries, and this paper examines the different care management arrangements for older peoples services that are now emerging. It has been United Kingdom government policy since 1989 that the providers of social services develop care management systems, as confirmed in the White Paper, Modernising Social Services. The paper opens with the background to the policy changes and a discussion of the role of care management in the British social care system. Secondly, evidence from the early phases of care management development is examined; and thirdly, the evidence from a major national study of care management arrangements for older people on the patterns of variation on key dimensions is considered.

Care staff working with people with dementia: Training, knowledge and confidence

The complexity and diversity of the needs of older people in care homes presents challenges to those responsible for caring for residents, in particular nursing and care assistant staff providing the majority of direct care. This study examines the degree of knowledge and confidence of these staff in caring for people with dementia and seeks to identify factors which can contribute to greater confidence. It reveals that although staff knowledge of dementia is reasonable, confidence in dealing with related situations is lower. Results also suggest that training can positively influence staff confidence in dealing with behaviour associated with the condition, recognizing that it is one of many factors influencing performance as a paid carer. These findings are discussed in terms of the quality of care provided to residents with dementia, the forms such training might take and the importance of a work environment which facilitates on-the-job training.

Assessment approaches for older people receiving social care: Content and coverage

Assessment was identified as one of the ‘cornerstones’ of community care. This study presents findings from the first nationally representative analysis of assessment documents used by social services agencies in the UK.

A New Approach to Community Care for the Elderly

Organisations can absorb successfully only a few fundamental innovations within a short period of time. It is therefore important for the designers of innovations to ensure that they directly and substantially contribute to solving important problems, and for agencies to concentrate their innovative activity on those that do so contribute. The first aim of this paper is to analyse the policy context so as to clarify the nature of the problems that make innovation in the care of the elderly imperative and show how features of the Community Care Project contribute to their solution. The second aim is to provide some preliminary evidence of the success of the scheme. The analysis of data fpr seventy persons in the experimental and control groups shows that the experimental group fared better in a number of important ways; and that the gains appear to have been made at no extra cost to the social services department. Therefore, it is concluded, the adoption of the scheme may contribute to the technical progress needed in the provision of social service to the elderly with needs at or above the margin for residential care.

Activities of daily living and quality of life across different stages of dementia: a UK study

Objectives: People with dementia (PwD) require an increasing degree of assistance with activities of daily living (ADLs), and dependency may negatively impact on their well-being. However, it remains unclear which activities are impaired at each stage of dementia and to what extent this is associated with variations in quality of life (QoL) across the different stages, which were the two objectives of this study. Methods: The sample comprised 122 PwD, and their carers, either living at home or recently admitted to long-term care. Measures of cognition and QoL were completed by the PwD and proxy measures of psychopathology, depression, ADLs and QoL were recorded. Using frequency, correlation and multiple regression analysis, data were analysed for the number of ADL impairments across mild, moderate and severe dementia and for the factors impacting on QoL. Results: ADL performance deteriorates differently for individual activities, with some ADLs showing impairment in mild dementia, including dressing, whereas others only deteriorate later on, including feeding. This decline may be seen in the degree to which carers perceive ADLs to explain the QoL of the PwD, with more ADLs associated with QoL in severe dementia. Results of the regression analysis showed that total ADL performance however was only impacting on QoL in moderate dementia. Conclusion: Knowledge about performance deterioration in different ADLs has implications for designing interventions to address specific activities at different stages of the disease. Furthermore, findings suggest that different factors are important to consider when trying to improve or maintain QoL at different stages.

Older people's experiences of cash-for-care schemes: evidence from the English Individual Budget pilot projects

ABSTRACT Cash-for-care schemes offering cash payments in place of conventional social services are becoming commonplace in developed welfare states; however, there is little evidence about the impact of such schemes on older people. This paper reports on the impact and outcomes for older people of the recent English Individual Budget (IB) pilot projects (2005–07). It presents quantitative data on outcome measures from structured interviews with 263 older people who took part in a randomised controlled trial and findings from semi-structured interviews with 40 older people in receipt of IBs and with IB project leads in each of the 13 pilot sites. Older people spent their IBs predominantly on personal care, with little resources left for social or leisure activities; and had higher levels of psychological ill-health, lower levels of wellbeing, and worse self-perceived health than older people in receipt of conventional services. The qualitative interviews provide insights into these results. Potential advantages of IBs included increased choice and control, continuity of care worker, and the ability to reward some family carers. However, older people reported anxieties about the responsibility of organising their own support and managing their budget. For older people to benefit fully from cash-for-care schemes they need sufficient resources to purchase more than basic personal care; and access to help and advice in planning and managing their budget.

The use of assessment scales in Old Age Psychiatry Services in England and Northern Ireland

Implementation of the Single Assessment Process in the UK is designed to ensure that more standardized assessment procedures are in place across all areas and agencies, that practice improves and older peoples needs are comprehensively assessed. This study provides a unique picture of the range and prevalence of standardized scales used within Old Age Psychiatry Services in England and Northern Ireland, reported by 73% of old age psychiatrists. Most services (64%) used three or more standardized assessment scales (range 1–12). Sixty-two separate instruments were identified. The six most used measures were the Mini Mental State Examination (95%), the Geriatric Depression Scale (52%) and the Clock Drawing (50%), the Clifton Assessment Procedures for the elderly (26%), the Barthel Index (18%) and the Health of the Nation Outcome Scales (HoNOS) 65 + (18%). A number of factors were associated with greater use of certain standardized assessment scales. Shared documentation, along with other indicators of integration between health and social care were associated with greater use of standardized scales. The provision of a memory clinic was associated with greater use of neuropsychiatric scales and lower levels of use of cognitive scales. These results provide key material for shaping the provision of psychiatric services for older people