Cognitive impairment, disruptive behaviors, and home care utilization

Enabling older people with mental health needs to engage with community social care: A scoping review to inform a theory of change

Despite apparent need, many older people with cognitive impairment and/or mental health needs do not fully engage with social care. This can manifest in different ways, including passive or aggressive attempts to avoid or repel care workers. However, little is known about how to support such individuals in their own homes and deliver effective care. Against this background, we undertook a scoping review with a view to developing a preliminary theory of change suggesting how care might be modified to engage this client group. The most recent search was conducted on 21/04/21. Papers were included if they (i) focused on older people (65+) living at home with social care needs and (ii) described difficulties/problems with the provision/receipt of social care associated with individuals' mental health needs. Twenty-six citations were identified through electronic database searches and reference screening, and the results were charted according to key theory of change concepts (long-term outcomes, preconditions, interventions, rationale and assumptions). All the included papers were related to people with dementia. Four subgroups of papers were identified. The first highlights those external conditions that make it more likely an intervention will be successful; the second describes specific interventions to engage older people who by virtue of their mental health needs have not engaged with social care; the third explores what services can be done to increase service uptake by older people with mental health needs and their caregivers more generally; and the fourth details theoretical approaches to explaining the behaviour of people with dementia. Each provides information that could be used to inform care delivery and the development of interventions to improve engagement with health and social care for these individuals. The study concludes that different framing of engagement difficulties, such as that offered through positioning theory, may assist in future service design.

Spilling over Strain between Elders and Their Caregivers in Hong Kong

According to the dialectical model, the well-being of the older care recipient, the informal caregiver, and the professional care provider mutually affect each other. Particularly, the caregiver's strain can affect the care recipient's well-being both positively and negatively. Moreover, the task-specific model suggests that as social workers are responsible for maintaining elders' well-being, the workers' strain would be particularly influential on the elders' well-being. To clarify these dialectic relationships, the present study surveyed the three parties involved in home help or home care services in Hong Kong over two successive waves using a panel design. This study reveals the significant negative effect the professional care provider's earlier strain has on the elder's later well-being. Moreover, the social worker's earlier strain was particularly detrimental to the elder's later well-being. In contrast, the effect of the informal caregiver's earlier strain was not significant. Additionally, the elder's well-being had no significant impact on the strain of either the professional care provider or the informal caregiver. Findings of this study support the qualification of the dialectical model by the task-specific model to yield a model of channeled spillover. Accordingly, dialectical influence requires a channel to materialize the spillover effect.

Population-based home care services in breast cancer: utilization and costs

OBJECTIVE

To determine utilization and costs of home care services (hcs) for individuals with a diagnosis of breast cancer (bc).

METHODS

Incident cases of invasive bc in women were extracted from the Ontario Cancer Registry (2005-2009) and linked with other Ontario health care administrative databases. Control patients were selected from the population of women never diagnosed with any type of cancer. The types and proportions of hcs used were determined and stratified by disease stage. Attributable home care utilization and costs for bc patients were determined. Factors associated with hcs costs were assessed using regression analysis.

RESULTS

Among the 39,656 bc and 198,280 control patients identified (median age: 61.6 years for both), 75.4% of bc patients used hcs (62.1% stage i; 85.7% stage ii; 94.6% stage iii; 79.1% stage iv) compared with 14.6% of control patients. The number of hcs used per patient-year were significantly higher for the bc patients than for the control patients (14.97 vs. 6.13, p < 0.01), resulting in higher costs per patient-year ($1,210 vs. $325; $885 attributable cost to bc, p < 0.01). The number of hcs utilized and the associated costs increased as the bc stage increased. In contrast, hcs costs decreased as income increased and as previous health care exposure decreased.

INTERPRETATION

Patients with bc used twice as many hcs, resulting in costs that were almost 4 times those observed in a matched control group. Less than an additional $1000 per bc patient per year were spent on hcs utilization in the study population.

Caregiving Networks in Later Life: Does Cognitive Status Make a Difference?

This study examines the caregiving networks of older adults, with particular emphasis on differences according to cognitive status (n = 303). Individuals with cognitive impairment were significantly more likely than those who were cognitively intact to receive assistance with personal care, linking with the outside world, and mobility. The types of network were generally similar for care receivers with cognitive impairment and those who were cognitively intact, although the percentage of networks comprised solely of the identified caregiver varied depending on the tasks. Coresidence of the caregiver and care receiver was more important than the care receiver's cognitive status for exclusive care by the identified caregiver. Having more ADL/IADL limitations was associated with a reliance on a network of the identified caregiver, in conjunction with other caregivers in several task areas. The findings highlight the complexity of sources of help in later life and the need for future research to consider the caregiving network as a whole.

Beliefs and practices regarding Alzheimer's disease and related dementias among Filipino home care workers in Israel

BACKGROUND

In the past few decades, foreign home care to frail older adults has become a common alternative to family care in many developed countries. Whereas Alzheimer's disease and related dementias (ADRD) are common conditions in this population of frail older adults, little is known about the beliefs of foreign home care workers about ADRD or about their practices.

METHODS

A mixed-methods design was conducted in 2006-2007 in Israel. The study included a survey of beliefs about ADRD completed by 184 Filipino home care workers and qualitative interviews with 29 Filipino home care workers.

RESULTS

On seven of the 14 belief items, more than 30% of the workers were in discordance with scientific view about ADRD. Those workers who were not informed about the care recipient's medical conditions were more likely to report beliefs that were inconsistent with current scientific knowledge. In qualitative interviews, Filipino home care workers reported using intuitively behavioral techniques when caring for older adults with ADRD.

CONCLUSIONS

Despite the fact that some of the workers' beliefs are inconsistent with current scientific view, their actual intuitive practices are consistent with the scientific paradigm. Specific emphasis has to be placed on encouraging workers' intuitive approach to ADRD and providing workers with ample information about the medical conditions and needs of the care recipient.

Costs and determinants of privately financed home-based health care in Ontario, Canada

The Canadian context in which home-based healthcare services are delivered is characterised by limited resources and escalating healthcare costs. As a result, a financing shift has occurred, whereby care recipients receive a mixture of publicly and privately financed home-based services. Although ensuring that care recipients receive efficient and equitable care is crucial, a limited understanding of the economic outcomes and determinants of privately financed services exists. The purposes of this study were (i) to determine costs incurred by families and the healthcare system; (ii) to assess the determinants of privately financed home-based care; and (iii) to identify whether public and private expenditures are complements or substitutes. Two hundred and fifty-eight short-term clients (<90 days of service utilisation) and 256 continuing care clients (>90 days of utilisation) were recruited from six regions across the province of Ontario, Canada, from November 2003 to August 2004. Participants were interviewed by telephone once a week for 4 weeks and asked to provide information about time and monetary costs of care, activities of daily living (ADL), and chronic conditions. The mean total cost of care for a 4-week period was $7670.67 (in 2004 Canadian dollars), with the overwhelming majority of these costs (75%) associated with private expenditures. Higher age, ADL impairment, being female, and a having four or more chronic conditions predicted higher private expenditures. While private and public expenditures were complementary, private expenditures were somewhat inelastic to changes in public expenditures. A 10% increase in public expenditures was associated with a 6% increase in private expenditures. A greater appreciation of the financing of home-based care is necessary for practitioners, health managers and policy decision-makers to ensure that critical issues such as inequalities in access to care and financial burden on care recipients and families are addressed.

Mental illness and use of home care nationally in the U.S. Department of Veterans Affairs

OBJECTIVE

To determine whether patients with mental health diagnoses are more likely to utilize home-based primary care (HBPC), and to identify characteristics associated with HBPC admission among elderly and nonelderly veterans, specifically.

METHODS

Patients receiving treatment during fiscal year (FY) 2003 and having no evidence of home care utilization during FY2002 were followed through FY2005 using administrative claims data of the Veterans Health Administration of the U.S. Department of Veterans Affairs (VA). Participants were 4,411,677 VA patients with no prior HBPC use. Cox proportional hazard models were developed to identify correlates of HBPC use.

RESULTS

Of VA patients with no prior use of HBPC, 24.2% received a mental health diagnosis, of whom 1.5% eventually used HBPC. Two in five new HBPC admissions were diagnosed with mental illness. Patients diagnosed with dementia were 66% more likely to be admitted. Patients diagnosed with nonschizophrenia psychoses (hazard ratio [HR]: 1.30), miscellaneous affective disorders (HR: 1.22), and schizophrenia (HR: 1.21) had the next highest probabilities. Risk of admission was highest for > or = 3 outpatient medical visits (HR: 2.61), followed by any inpatient medical/surgical days (HR: 1.79) or outpatient mental health visits (HR: 1.30). Elderly patients with any inpatient mental health days were less likely to be admitted; younger patients with nursing home use, community residential care, and mental health intensive care management were more likely to be admitted.

CONCLUSION

Given that mental illness is independently associated with the likelihood of admission, it is critical that providers develop the skills and resources necessary to meet the psychiatric needs of home care recipients.

Correlates of physical health of informal caregivers: a meta-analysis

Effects of caregiving on physical health have received less theoretical and empirical attention than effects on psychological health. This meta-analysis integrates results from 176 studies on correlates of caregiver physical health. Caregiver depressive symptoms had stronger associations with physical health than did objective stressors. Higher levels of care recipient behavior problems were more consistently related to poor caregiver health than were care receiver impairment and intensity of caregiving. Higher age, lower socioeconomic status, and lower levels of informal support were related to poorer health. Predictors of physical health are not identical to predictors of psychological health. Associations of caregiving stressors with health were stronger among older samples, dementia caregivers, and men. In sum, negative effects of caregiving on physical health are most likely to be found in psychologically distressed caregivers facing dementia-related stressors.