Ian Philp

Analysis and Design of the eSAP: An Integrated Health and Social Care Information System:

Health care information systems are becoming more and more computerized. A huge amount of health related information needs to be stored and analysed, and with the aid of computer systems this can be done faster and more efficiently. The Agent Oriented paradigm provides an alternative way of developing medical based systems. This article presents an initial exploration of the analysis and design of a multi-agent system to deliver the Single Assessment Process, an integrated health and social care information system for older people. The article concludes by making the following observations: Agent technology has the potential to support the development of medical and health and social care systems for older people. Nevertheless there are not many real-life agent based applications successfully applied in the health care sector. One of the main reasons is the limitation of the existing analysis and design methodologies. Thus, in order for the agent-technology to be widely accepted in the development of computer based medical information systems for older people (and in extent any medical system) it is necessary to develop a complete and mature analysis and design methodology to support the development of agent based medical systems.

Future directions for geriatric medicine : Geriatricians must move with their patients into the community

Less than 50 years ago the plight of sick older people in the United Kingdom was pitiful. Chronically sick old people were left to languish bedridden in the most miserable of circumstances. The specialty of geriatric medicine developed in the 1950s as a response to the particular health needs of frail older people.1 Timely response to crises, comprehensive assessment of needs, multidisciplinary management focused on reducing disability, and helping older people to remain at home while recognising the needs of family carers became the underlying principles. These elements have become accepted and implemented in many countries, with convincing evidence of effectiveness.2 Britain is still unique, however, in the extent to which geriatricians work in the acute hospital sector, and a major triumph of elderly care medicine has been the unquestioned access of acutely ill older people to district general hospitals. With these successes it is therefore surprising that geriatric medicine is now …

QUALITY OF CARE, QUALITY OF LIFE AND THE RELATIONSHIP BETWEEN THEM IN LONG‐TERM CARE INSTITUTIONS FOR THE ELDERLY

A stratified randomly selected sample of 28 of all elderly long‐term care institutions in the Southampton district was studied including private and local authority residential homes, private nursing homes and NHS geriatric and psychogeriatric wards. The manager was interviewed with a 57‐item quality of care questionnaire modified from the methodology of Willcockset al. (1987) covering aspects of regime and environment. To assess quality of life, 10% of residents were randomly selected for a series of structured quality of life interviews and Barthel Index determination. A life‐history approach was used to build rapport and increase the authenticity of resident responses. Systematic significant differences in quality of care and quality of life were found between sectors. The correlation coefficients between quality of care and morale and between quality of care and dependency were significant (r=0.526,p<0.01;r=0.508,p<0.01 respectively) although the correlation between morale and dependency (r=0.155,p=0.2) was insignificant. High‐quality care may be more difficult to provide in facilities for more disabled residents. This may affect their morale but the relationship between morale and dependency is complex.

New beginning for care for elderly people? : National framework could transform care for older people in England

Editor—Grimley Evans and Tallis criticise the national service framework for older people.1 I agree with them that the policy to reduce emergency admissions to hospital only among the over 75s is ageist. Application of the frameworks age discrimination standard means that this high level performance measure will have to be changed to an age standardised measure. The framework model for intermediate care services requires there to be comprehensive assessment, active rehabilitation, and medical leadership involving both hospital specialists and general practitioners. There will be no return to 1960s-style convalescence and other forms of marginalising older people. On research strategy, the national framework supports the recommendations of the research and development strategic review to establish a national research advisory network for older people and for a directed programme of research; this has already commissioned a £1.2m programme to evaluate intermediate care. On information provision, the framework will ensure scrutiny by patients and the public of all age based policies. It will also ensure the involvement of older people in patient forums, the local strategic partnerships, and the development of personal care plans that reflect individual needs, circumstances, and priorities. The single assessment process will not replace medical diagnoses and decision making but will ensure that a single patient record is built up over time and shared among healthcare and social-care professionals, to replace the current inefficient and fragmented records systems. Milestones for implementation of the falls standard are longer than those for some other parts of the framework as evidence is emerging about how best to organise this key component of services. Achieving organised services for the prevention and management of falls will be a great advance in the care of older people. An inclusive approach was used throughout the development of the national service framework. The success of the approach is one reason why the framework has been so well received; it provides a historic opportunity for transforming health and social care for older people in England.

Legislation offers protection

When good people argue in favour of age discrimination in the NHS it is time to despair, or to act, to protect the rights of older people.1 This was my rationale in advocating for legislation on age …