Rebekah Luff

Measuring unmet need for social care amongst older people

Recent spending cuts in the area of adult social care raise policy concerns about the proportion of older people whose need for social care is not being met. Such concerns are emphasised in the context of population ageing and other demographic changes. For example, the increasing proportion of the population aged 75 and over places greater pressure on formal and informal systems of care and support provision, while changes in the living arrangements of older people may affect the supply of informal care within the household. This article explores the concept of ‘unmet need’ for support in relation to specific Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), using data on the receipt of support (informal, formal state or formal paid) from the General Household Survey, the English Longitudinal Study of Ageing and the British Household Panel Survey. The results show that different kinds of need tend to be supported by particular sources of care, and that there is a significant level of ‘unmet need’ for certain activities.

AN ACTIGRAPHIC STUDY COMPARING COMMUNITY DWELLING POOR SLEEPERS WITH NON-DEMENTED CARE HOME RESIDENTS

Sleep disturbances are a common problem among institutionalized older people. Studies have shown that this population experiences prolonged sleep latency, increased fragmentation and wake after sleep onset, more disturbed circadian rhythms, and night-day reversal. However, studies have not examined the extent to which this is because of individual factors known to influence sleep (such as age) or because of the institutional environment. This article compares actigraphic data collected for 14 days from 122 non-demented institutional care residents (across ten care facilities) with 52 community dwelling poor sleepers >65 yrs of age. Four dependent variables were analyzed: (i) “interdaily stability” (IS); (ii) “intradaily variability” (IV); (iii) relative amplitude (RA) of the activity rhythm; and (iv) mean 24 h activity level. Data were analyzed using a fixed-effect, single-level model (using MLwiN). This model enables comparisons between community and institutional care groups to be made while conditioning out possible “individual” effects of “age,” “sex,” “level of dependency,” “level of incontinence care,” and “number of regular daily/prescribed medications.” After controlling for the effects of a range of individual level factors, and after controlling for unequal variance across groups (heteroscedascity), there was little difference between community dwelling older adults and institutional care residents in IS score, suggesting that the stability of day-to-day patterns (such as bed get-up, lunch times, etc.) is similar within these two resident groups. However, institutional care residents experienced more fragmented rest/wake patterns (having significantly higher IV scores and significantly lower mean activity values). Our findings strongly suggest that the institutional care environment itself has a negative association with older peoples rest/wake patterns; although, longitudinal studies are required to fully understand any causal relationships. (Author correspondence: r.meadows@surrey.ac.uk)

The teaching and learning of social research methods: developments in pedagogical knowledge

Social research methods have been taught in a systematic and widespread way within Western academia for much of the past century. With increasing demands facing the social research community – whether from funders, universities, or the public – building and sustaining the methodological capacity to navigate challenging and unfamiliar empirical terrain is becoming ever more important. Yet despite this, to date the teaching and learning of research methods has occupied a comparatively marginal position within broader methodological discussions in the social sciences. In this special issue on developments of pedagogical knowledge in social research methods, established researchers from a range of social science disciplines, international contexts, and methodological orientations engage with questions of how research methods are taught and learnt.

Using system dynamics to model the social care system: simulation modeling as the catalyst in linking demography to care delivery

This paper describes a system dynamics model for social care, developed in collaboration with a local authority in England, as part of the UK Engineering and Physical Sciences Research Council Care Life Cycle project based at the University of Southampton. The model was populated with data from a wide range of sources, local and national. We present some illustrative results, and discuss the process of model development and the challenges around data collection. We also discuss the benefits derived from co-developing such a model with practitioner users and as part of a multi-disciplinary team involving demographers and social statisticians.

How do we measure unmet need for social care in later life

Studies addressing multiple morbid conditions in elderlypopulations usually focus on disease and physiological indicatorsrelevant for the medical care system. Few studies include bothmedical and fu ...The UK’s population is ageing, and understanding the dynamics of living arrangements in later life and the implications for the provision and funding of appropriate housing and long-term care is critical given the current economic climate which can have an adverse impact on state support for older people. This paper investigates the dynamics of living arrangements amongst people aged 65 years old and over between 1991 and 2008, focussing on the two key housing and care pathways in later life: moving into sheltered accommodation and moving into residential care. The empirical research examines the rates of moving into sheltered accommodation and institutional care and investigates the determinants and probabilities of these transitions in the UK. The paper employs all 18 waves of the British Household Panel Survey data (1991-2008) and uses a discrete-time logistic regression model in order to model the probability of entering sheltered accommodation and residential care. After reading this poster, participants will be able to associate specific factors with each of the two transitions in later life. For example age, health and marital status are significant determinants of a move into residential care, while the move into sheltered accommodation is also associated with housing tenure and education. After reading this poster, participants will be able to discuss the prevalence of each the two kinds of transition at different stages of the latter part of the life course, and to understand the crucial implications for the design of social care provision for older people in the future.This pilot project aimed to try something different - rekindle positive memories of swimming in people with dementia who enjoyed swimming throughout their lives, and involve them in active swimming again using a swimming club intervention. Club members were recruited from two residential aged care facilities in Queensland, Australia (n=25 recruited, n=18 commenced, n=11 (median age=88.4, IQR=12.3; 1 male) completed the intervention). The 12 week program consisted of two, 45 minute sessions per week held at a municipal pool, using a trained instructor and assistants. Measures, taken at baseline, Week 6, Week 9 and post intervention included psychosocial and physical assessments such as the Revised Memory and Behavior Problems Checklist, Psychological Well-Being in Cognitively Impaired Persons, Seniors Physical Performance Battery and bioelectric impedance analysis. Stakeholder focus groups determined the barriers and facilitators for the club. Three outcomes have been achieved: 1) the development of a dementia specific, evidence-based, aquatic exercise program. This valuable resource will ensure that the benefits will be maximized with tailored exercises for strength, agility, flexibility, balance, relaxation and stress reduction, 2) improved quality of life for members, with statistically significant improvements in psychological wellbeing (χ2 =8.66, p<0.05), BPSD expression (χ2=16.91, p=0.001) and staff distress (χ2=16.86, p=0.001) and 3) an informative website with instructional video clips and a manual to assist others in implementing and maintaining a Watermemories Swimming Club. This pilot project has provided strong evidence that aquatic exercise can produce positive physical, psychosocial and behavioral outcomes for people with dementia.

A guide to research with care homes

Purpose – A growing older population with complex care needs, including dementia, are living in care homes. It is important to support researchers in conducting ethical and appropriate work in this complex research environment. The purpose of this paper is to discuss key issues in care homes research including examples of best practice. The intention is to inform researchers across disciplines, leading to more sensitive and meaningful care home research practice. Design/methodology/approach – Experienced care homes researchers were invited to provide methodological insights and details not already reported in their publications. These have been analysed, creating key themes and linked to project publications. Findings – The need for reflexivity was a key finding. In particular, researchers need to: appreciate that the work is complex; see participants as potential research partners; and consider how cognitive and physical frailty of residents, staffing pressures and the unique environments of care homes m...