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BMC Geriatrics Jul 2019The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care system in the United... (Review)
Review
Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF).
BACKGROUND
The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care system in the United Kingdom. Addressing these unmet needs is becoming one of the urgent public health priorities. In order to develop effective solutions to address some of these needs, it is important first to understand the care and support needs of older people.
METHODS
A scoping review was conducted, using the Arksey and O'Malley original and enhanced framework, to understand the care and support needs of older people, focusing on those living at home with chronic conditions in the UK. The search was conducted using five electronic data bases, grey literature and reference list checks. The WHO International Classification of Functioning, Disability and Health (ICF) framework was used to analyse and categorise the literature findings.
RESULTS
Forty studies were included in the final analysis- 32 from academic literature and 8 from grey literature. The review highlighted that older adults faced a range of physical, social and psychological challenges due to living with chronic conditions and required care and support in three main areas: 1) social activities and relationships; 2) psychological health; and 3) activities related to mobility, self-care and domestic life. The review also highlighted that many older people demonstrated a desire to cope with their illness and maintain independence, however, environmental factors interfered with these efforts including: 1) lack of professional advice on self-care strategies; 2) poor communication and coordination of services; and 3) lack of information on services such as care pathways. A gap in the knowledge was also identified about the care and support needs of two groups within the older population: 1) older workers; and 2) older carers.
CONCLUSIONS
The review highlighted that older people living with chronic conditions have unmet care needs related to their physical and psychological health, social life, as well as the environment in which they live and interact. Findings of this review also emphasized the importance of developing care models and support services based around the needs of older people.
Topics: Aged; Aged, 80 and over; Caregivers; Chronic Disease; Disabled Persons; Health Services Needs and Demand; Health Status; Humans; International Classification of Functioning, Disability and Health; Mental Health; United Kingdom; World Health Organization
PubMed: 31331279
DOI: 10.1186/s12877-019-1189-9 -
Wound Repair and Regeneration :... 2009ABSTRACT In the United States, chronic wounds affect 6.5 million patients. An estimated excess of US$25 billion is spent annually on treatment of chronic wounds and the...
ABSTRACT In the United States, chronic wounds affect 6.5 million patients. An estimated excess of US$25 billion is spent annually on treatment of chronic wounds and the burden is rapidly growing due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide. The annual wound care products market is projected to reach $15.3 billion by 2010. Chronic wounds are rarely seen in individuals who are otherwise healthy. In fact, chronic wound patients frequently suffer from "highly branded" diseases such as diabetes and obesity. This seems to have overshadowed the significance of wounds per se as a major health problem. For example, NIH's Research Portfolio Online Reporting Tool (RePORT; http://report.nih.gov/), directed at providing access to estimates of funding for various disease conditions does list several rare diseases but does not list wounds. Forty million inpatient surgical procedures were performed in the United States in 2000, followed closely by 31.5 million outpatient surgeries. The need for post-surgical wound care is sharply on the rise. Emergency wound care in an acute setting has major significance not only in a war setting but also in homeland preparedness against natural disasters as well as against terrorism attacks. An additional burden of wound healing is the problem of skin scarring, a $12 billion annual market. The immense economic and social impact of wounds in our society calls for allocation of a higher level of attention and resources to understand biological mechanisms underlying cutaneous wound complications.
Topics: Chronic Disease; Health Care Costs; Health Services Needs and Demand; Humans; Skin Ulcer; Wound Healing
PubMed: 19903300
DOI: 10.1111/j.1524-475X.2009.00543.x -
The British Journal of General Practice... Oct 2019
Topics: Adaptation, Psychological; Adolescent; Caregivers; Child; Health Services Needs and Demand; Humans; Psychosocial Support Systems; Resilience, Psychological
PubMed: 31558528
DOI: 10.3399/bjgp19X705809 -
American Journal of Men's Health Jan 2014
Topics: Family Practice; Health Services Needs and Demand; Health Status; Humans; Male; Men's Health; Patient-Centered Care; Primary Health Care
PubMed: 24319072
DOI: 10.1177/1557988313513458 -
Journal of Epidemiology Feb 2017Confounding is a major concern in epidemiology. Despite its significance, the different notions of confounding have not been fully appreciated in the literature, leading... (Review)
Review
Confounding is a major concern in epidemiology. Despite its significance, the different notions of confounding have not been fully appreciated in the literature, leading to confusion of causal concepts in epidemiology. In this article, we aim to highlight the importance of differentiating between the subtly different notions of confounding from the perspective of counterfactual reasoning. By using a simple example, we illustrate the significance of considering the distribution of response types to distinguish causation from association, highlighting that confounding depends not only on the population chosen as the target of inference, but also on the notions of confounding in distribution and confounding in measure. This point has been relatively underappreciated, partly because some literature on the concept of confounding has only used the exposed and unexposed groups as the target populations, while it would be helpful to use the total population as the target population. Moreover, to clarify a further distinction between confounding "in expectation" and "realized" confounding, we illustrate the usefulness of examining the distribution of exposure status in the target population. To grasp the explicit distinction between confounding in expectation and realized confounding, we need to understand the mechanism that generates exposure events, not the product of that mechanism. Finally, we graphically illustrate this point, highlighting the usefulness of directed acyclic graphs in examining the presence of confounding in distribution, in the notion of confounding in expectation.
Topics: Bias; Computer Graphics; Confounding Factors, Epidemiologic; Epidemiologic Methods; Health Services Needs and Demand; Humans
PubMed: 28142011
DOI: 10.1016/j.je.2016.09.003 -
Statistics in Medicine Feb 2021Randomized trials are considered the gold standard for estimating causal effects. Trial findings are often used to inform policy and programming efforts, yet their... (Randomized Controlled Trial)
Randomized Controlled Trial
Randomized trials are considered the gold standard for estimating causal effects. Trial findings are often used to inform policy and programming efforts, yet their results may not generalize well to a relevant target population due to potential differences in effect moderators between the trial and population. Statistical methods have been developed to improve generalizability by combining trials and population data, and weighting the trial to resemble the population on baseline covariates. Large-scale surveys in fields such as health and education with complex survey designs are a logical source for population data; however, there is currently no best practice for incorporating survey weights when generalizing trial findings to a complex survey. We propose and investigate ways to incorporate survey weights in this context. We examine the performance of our proposed estimator through simulations in comparison to estimators that ignore the complex survey design. We then apply the methods to generalize findings from two trials-a lifestyle intervention for blood pressure reduction and a web-based intervention to treat substance use disorders-to their respective target populations using population data from complex surveys. The work highlights the importance in properly accounting for the complex survey design when generalizing trial findings to a population represented by a complex survey sample.
Topics: Causality; Health Services Needs and Demand; Humans; Substance-Related Disorders; Surveys and Questionnaires
PubMed: 33241607
DOI: 10.1002/sim.8822 -
Journal of General Internal Medicine Mar 2018The United States is facing a significant demographic transition, with about 10,000 baby boomers turning age 65 each day. At the same time, the nation is experiencing a... (Review)
Review
The United States is facing a significant demographic transition, with about 10,000 baby boomers turning age 65 each day. At the same time, the nation is experiencing a similarly striking transition in hospital capacity, as the supply of hospital beds has declined in recent decades. The juxtaposition of population aging and hospital capacity portends a potentially widening divergence between supply and demand for hospital care. We provide a closer look at current hospital capacity and a rethinking of the future role of hospital beds in meeting the needs of an aging population.
Topics: Age Factors; Aged; Aged, 80 and over; Aging; Female; Forecasting; Health Services Needs and Demand; Hospital Bed Capacity; Humans; Male; Middle Aged; Population Growth; United States
PubMed: 29273896
DOI: 10.1007/s11606-017-4257-x -
International Journal of Environmental... Feb 2021This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and...
This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and complexity of care, and discharge preparation. It describes the diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation that contribute to adopting a given work conception and/or method for nursing care delivery. Later, the concepts underlying the several methods-management theories and theoretical nursing concepts-are presented, with reference to relevant authors. The process of analysis and selection of the method is explained, highlighting the importance of diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation. The importance of various elements is highlighted, such as structural aspects, nature of care, target population, resources, and philosophy of the institution, which may condition the adoption of a method. The importance of care conceptualization is also underlined. The work methods are presented with a description of the key characteristics, advantages, and disadvantages of the task-oriented method (functional nursing) and patient-centered methods: individual, team nursing, and primary nursing. A critical and comparative analysis of the methods is then performed, alluding to the combination of person-centered methods.
Topics: Delivery of Health Care; Health Services Needs and Demand; Humans; Patient-Centered Care
PubMed: 33669955
DOI: 10.3390/ijerph18042088 -
BMJ Open Jul 2022This scoping review aimed to map the range of programmes in the literature to support children and youth with complex care needs and their families during transitions in... (Review)
Review
OBJECTIVE
This scoping review aimed to map the range of programmes in the literature to support children and youth with complex care needs and their families during transitions in care in the community.
DESIGN
A scoping review of the literature.
CONTEXT
This review included programmes that supported the transition in care to home and between settings in the community.
DATA SOURCES
We implemented our strategy to search five databases: (1) PubMed; (2) CINAHL; (3) ERIC; (4) PyscINFO and (5) Social Work Abstracts. The search was last implemented on 29 April 2021.
STUDY SELECTION
Our search results were imported into Covidence Systematic Review Software. First, two reviewers assessed titles and abstracts against our eligibility criteria. Relevant articles were then retrieved in full and reviewed by two reviewers for inclusion. Disagreements were resolved by a third reviewer.
DATA EXTRACTION
Relevant data were extracted related to population, concept, context, methods and key findings pertinent to our review objective.
RESULTS
A total of 2482 records were identified. After our two-stage screening process, a total of 27 articles were included for analysis. Articles ranged in the type of transitions being supported and target population. The most common transition reported was the hospital-to-home transition. Intervention components primarily consisted of care coordination using a teams-based approach. The most reported barriers and enablers to implementing these transition care programmes were related to physical opportunities.
LIMITATIONS
Included articles were limited to English and French.
CONCLUSIONS
This review identified important gaps within the literature, as well as areas for future consideration to ensure the effective development and implementation of programmes to support children and youth with complex care needs during transitions in care.
Topics: Adolescent; Child; Health Services Needs and Demand; Humans
PubMed: 35803631
DOI: 10.1136/bmjopen-2021-056799 -
BMJ Global Health Sep 2021People who are distinct from the dominant ethnic group within a country can experience a variety of barriers to accessing eyecare services. We conducted a scoping review... (Review)
Review
PURPOSE
People who are distinct from the dominant ethnic group within a country can experience a variety of barriers to accessing eyecare services. We conducted a scoping review to map published interventions aimed at improving access to eyecare for non-Indigenous, non-dominant ethnic groups residing in high-income countries.
METHODS
We searched MEDLINE, Embase and Global Health for studies that described an intervention to promote access to eyecare for the target population. Two authors independently screened titles and abstracts followed by review of the full text of potentially relevant sources. For included studies, data extraction was carried out independently by two authors. Findings were summarised using a combination of descriptive statistics and thematic analysis.
RESULTS
We screened 5220 titles/abstracts, of which 82 reports describing 67 studies met the inclusion criteria. Most studies were conducted in the USA (90%), attempted to improve access for Black (48%) or Latinx (28%) communities at-risk for diabetic retinopathy (42%) and glaucoma (18%). Only 30% included the target population in the design of the intervention; those that did tended to be larger, collaborative initiatives, which addressed both patient and provider components of access. Forty-eight studies (72%) evaluated whether an intervention changed an outcome measure. Among these, attendance at a follow-up eye examination after screening was the most common (n=20/48, 42%), and directly supporting patients to overcome barriers to attendance was reported as the most effective approach. Building relationships between patients and providers, running coordinated, longitudinal initiatives and supporting reduction of root causes for inequity (education and economic) were key themes highlighted for success.
CONCLUSION
Although research evaluating interventions for non-dominant, non-Indigenous ethnic groups exist, key gaps remain. In particular, the paucity of relevant studies outside the USA needs to be addressed, and target communities need to be involved in the design and implementation of interventions more frequently.
Topics: Delivery of Health Care; Developed Countries; Ethnicity; Health Services Needs and Demand; Humans; Income
PubMed: 34493531
DOI: 10.1136/bmjgh-2021-006188