Sarah Burch

The Huntingdon Day Hospital Trial: secondary outcome measures

Objective: To compare day hospital to day centre rehabilitation using scales to measure mobility, activities of daily living and quality of life. Design: Single blind randomized controlled trial with home assessments at baseline (twice), six weeks and three months. Setting: Mainly rural health district. Day hospital and social services day centres in market towns. Interventions: Day hospital treatment or day centre rehabilitation by a physiotherapist and two health support workers. Main outcome measures: World Health Organization mobility scale scored with and without aid, Nottingham Extended Activities of Daily Living Scale and Nottingham Health Profile. Subjects: One hundred and five physically disabled older patients living at home referred for day hospital rehabilitation or maintenance before discharge from hospital (66) or referred as outpatients (39). Results: At three months there were no statistically significant differences between rehabilitation at day hospital and day centre for any of the outcome measurements. However, there were significant improvements between baseline and three months for the following subscales [mean change per six-week period (95% confidence interval)]: WHO mobility subscale (with aid) – 0.67 (–0.99,–0.35); Nottingham Health Profile mobility subscale –10 (–15.5,–4.5) Nottingham extended ADL mobility subscale +3.08 (1.78,4.37); Nottingham extended ADL leisure subscale +1.66 (0.96,2.36). Conclusion: There were no differences between day hospital and day centre in the outcomes measured. Day rehabilitation appeared to improve functional ability and mobility and scales reflecting these domains deserve further evaluation as outcome measures in this patient group. However, no improvement in quality of life was observed.

Who are the young people who are not in education, employment or training? An application of the risk factors to a rural area in the UK

Young people who are not in education, employment or training (NEET) are a focus of government attention in the UK. For social service professionals the mechanisms underpinning the individual experience of NEET are critical to designing effective interventions. International comparisons point to similar experiences at the level of the individual family. This article examines the factors that may contribute to a young person becoming NEET and applies these to the demographics of a rural area in England. Poor educational attainment and low socio-economic status are key factors, with the mental well-being of young people as a proposed underpinning mechanism.

Evaluating Health Interventions for Older People

In recent years there has been a growing emphasis on evidencebased medicine and measuring outcomes of health care. The evaluation of health interventions for older people has increasingly relied upon the use of standardized assessment instruments, which are seen as providing detailed, holistic and patient-centred information. This article argues that such an approach has several drawbacks which may have serious implications for the evaluation and provision of health care. Standardized assessment instruments ignore the social dimensions of interviewing, decontextualize scores and contain an implicitly individualistic biomedical ideology of health. These factors undermine the effective evaluation of interventions. This is particularly significant when health care is purchased on the basis of delivering demonstrable gains. Provision for older people may be under threat if methods of evaluating its efficacy are inadequate.

True technology-enabled mental health care: trust, agency and ageing

Technology and ageing is a subject which attracts intense interest. In part, this is undoubtedly due to the search for a solution which will help manage the scale, costs and predicted impact of demographic change (1). However, it arguably also reflects a fascination with imagining futures, both in personal and social terms.

Dementia buddying as a vehicle for person-centred care? The performance of a volunteer-led pilot on two hospital wards:

Objectives To understand and explain whether a dementia buddies pilot introduced into two adjacent mental health hospital wards in England was achieving its aim of enhancing person-centred care. Methods The research used a cultural lens to evaluate the dementia buddies pilot. It comprised 20 in-depth semi-structured interviews with staff, volunteers and carers in the two wards where the pilot was introduced. Results The pilot’s ability to deliver positive outcomes depended on its compatibility with the culture of the ward and it performed better in the ward where a person-centred culture of care already existed. In this ward, the pilot became a catalyst for improved experience among patients, carers and staff, whereas in the second ward, the pilot faced resistance from staff and achieved less. Conclusions This finding underlines the benefit of focusing on workplace culture to understand the performance of volunteer-led initiatives. It also shows that existing ward culture is a determining factor in the capacity for dementia buddy schemes to act as vehicles for culture change.

The Use of Internet-Enabled Cognitive Behavioral Therapy in the Treatment of Depression and Anxiety amongst Older People

This article reports on the experience of internet-enabled cognitive behavioural therapy (IECBT) for older people diagnosed with depression and anxiety. IECBT involves synchronous real-time communication between the therapist and patient via instant messaging and has been found to be effective in the treatment of patients over eighteen diagnosed with depression. While younger populations are an obvious focus for studies into the potential of internet-based therapies, older people’s experience of such therapies can be overlooked due to assumptions about their relatively lower rates of internet use. However, rapid increases in this generation’s levels of internet access make this an important avenue of enquiry. In addition, such therapies may offer a route to address the underdiagnosis and undertreatment of depression and anxiety among older people. Once older people are diagnosed, evidence suggests that they tend to prefer psychological therapies, and these can be effective in this age group. This article therefore builds on the positive findings about IECBT as a treatment option in general by, for the first time, analysing quantitative data relating to older people’s use of this form of therapy. It analyses secondary data on patient characteristics, take-up of treatment, and treatment outcomes, finding that older men are over-represented among IECBT patients and that rates of self-referral are higher in this age group.