V. Abrahamson

Perceptions of heatwave risks to health: interview-based study of older people in London and Norwich, UK

BACKGROUND Most projections of climate change suggest an increased frequency of heatwaves in England over coming decades; older people are at particular risk. This could result in substantial mortality and morbidity. OBJECTIVE To determine elderly peoples knowledge and perceptions of heat-related risks to health, and of protective behaviours. METHODS Semi-structured interviews: 73 men and women, 72-94 years, living in their own homes in London and Norwich, UK. RESULTS Few respondents considered themselves either old or at risk from the effects of heat, even though many had some form of relevant chronic illness; they did recognize that some medical conditions might increase risks in others. Most reported that they had taken appropriate steps to reduce the effects of heat. Some respondents considered it appropriate for the government to take responsibility for protecting vulnerable people, but many thought state intervention was unnecessary, intrusive and unlikely to be effective. Respondents were more positive about the value of appropriately disseminated advice and solutions by communities themselves. CONCLUSION The Heatwave Plan should consider giving greater emphasis to a population-based information strategy, using innovative information dissemination methods to increase awareness of vulnerability to heat among the elderly and to ensure clarity about behaviour modification measures.

Health and social care responses to the Department of Health Heatwave Plan

BACKGROUND The increasing risk of heatwaves in England poses a particular threat to the health of elderly people. A National Heatwave Plan has been produced to ensure that adaptation plans are established. The objective was to explore the perceptions of frontline statutory and voluntary sector staff on the feasibility of implementing the Heatwave Plan for elderly people in the community. METHODS Semi-structured interviews and focus groups with 109 health, social care and voluntary staff from three London Boroughs. RESULTS Few frontline staff were aware of the Plan. Most respondents did not perceive heatwaves to be a sufficiently frequent event to require prioritization within their routine summer workloads. They highlighted the complexities associated with defining vulnerability and identifying vulnerable individuals as well as barriers to implementation of the Plan. Respondents suggested a multi-faceted approach to interventions including a public health campaign, community engagement and increasing the responsiveness of statutory services. CONCLUSION The issues highlighted could hinder effective implementation of the Heatwave Plan. Ensuring continuity of care so that timely information can be recorded and disseminated may address the problems associated with shifting vulnerability. Best practice with respect to inter-sectoral collaboration should be identified and innovative multi-faceted interventions should be designed and evaluated.

Do occupational therapists feel equipped to deal with the adult legacy of childhood sexual abuse

Research findings are consistent in showing a strong, specific and coherent association between childhood sexual abuse (CSA) and long-term psychiatric problems. Occupational therapists working in mental health services must therefore have contact with survivors of abuse, yet the literature reveals a paucity of research on their role. Semi-structured interviews were conducted with nine occupational therapists to explore their knowledge and practice concerning this issue. All respondents considered that awareness of CSA was pertinent to their profession and should be taught during education and training. None of them had received teaching in this area. Most respondents thought that it was not their role to deal with CSA in depth. However, the context in which they worked provided an opportunity for initial disclosure which might not happen elsewhere and needed to be handled skilfully. Occupational therapy techniques, including creative methods, link in well with other approaches, especially counselling, in treating the long-term effects of CSA. Continuing educational requirements and the role of occupational therapy with this client group need to be addressed by the profession.

Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community: a qualitative study

Abstract Purpose: To explore the experiences of individuals who have had a severe traumatic brain injury (TBI) and their carers in the first month post-discharge from in-patient rehabilitation into living in the community. Method: Using a qualitative approach underpinned by critical realism, we explored the narratives of 10 patients and nine carers using semi-structured interviews approximately one month post-discharge. Thematic analysis was carried out independently by two researchers. Results: Firstly, perceptions of support were mixed but many patients and carers felt unsupported in the inpatient phase, during transitions between units and when preparing for discharge. Secondly, they struggled to accept a new reality of changed abilities, loss of roles and loss of autonomy. Thirdly, early experiences post-discharge exacerbated fears for the future. Conclusions: Most patients and carers struggled to identify a cohesive plan that supported their transition to living in the community. Access to services required much persistence on the part of carers and tended to be short-term, and therefore did not meet their long-term needs. We propose the need for a case manager to be involved at an early stage of their rehabilitation and act as a key point for information and access to on-going rehabilitation and other support services. Implications for Rehabilitation Traumatic Brain Injury (TBI) is a major cause of long-term disability. It can affect all areas of daily life and significantly reduce quality of life for both patient and carer. Professionals appear to underestimate the change in abilities and impact on daily life once patients return home. Community services maintain a short-term focus, whereas patients and carers want to look further ahead – this dissonance adds to anxiety. The study’s findings on service fragmentation indicate an urgent need for better integration within health services and across health, social care and voluntary sectors. A link person/case manager who oversees the patient journey from admission onwards would help improve integrated care and ensure the patient, and carer, are at the center of service provision.