Managing loneliness: a qualitative study of older people's views.

Engaging with older people who self-identify as lonely may help professionals in mental health and other services understand how they deal with loneliness. The evidence-base for effective interventions to address loneliness is inconclusive. This study aimed to explore how community-dwelling lonely older people in England manage their experiences of loneliness. Twenty eight community-dwelling older people identifying as lonely, based on responses to two loneliness measures (self-report and a standardised instrument), participated in in-depth interviews between 2013 and 2014. Fifteen lived alone. Thematic analysis of transcribed interviews was conducted by a multidisciplinary team including older people.Participants drew on a range of strategies to ameliorate their distress which had been developed over their lives and shaped according to individual coping styles and contexts. Strategies included physical engagement with the world beyond their home, using technologies, planning, and engagement with purpose in an 'outside world', and acceptance, endurance, revealing and hiding, positive attitude and motivation, and distraction within an 'inside world'. Strategies of interests and hobbies, comparative thinking, religion and spirituality and use of alcohol straddled both the inside and outside worlds. Participants conveyed a personal responsibility for managing feelings of loneliness rather than relying on others. This study includes the experiences of those living with loneliness whilst also living with other people. When developing policy and practice responses to loneliness it is important to listen attentively to the views of those who may not be engaging with services designed for 'the lonely' and to consider their own strategies for managing it.

User involvement in the development of a health promotion technology for older people: findings from the SWISH project.

Successive English government policies about older people's health and well-being aim to improve health and quality of life by promoting independence. Improving access to information and services that can improve health and well-being and reduce health risks is central to the modernisation of health and social care. Most recently, tailored and person-centred approaches with a strong emphasis on promoting health and well-being are central to policy, including the proposals for 'Life Checks' and the recent emphasis on commissioning 'community well-being'. We carried out a qualitative study to identify the key aspects of social situations that affect health and well-being, from the perspectives of older people and professionals, to enrich and expand an existing health risk appraisal tool so that it could be used for self-assessment of health and social well-being. This tool, Health Risk Appraisal in Older people (HRAO), has been evaluated in different European settings, including English general practice. Focus groups were recruited from general practice, older people's forums, social care and voluntary organisations in two London boroughs where the HRAO tool had previously been tested. The social factors determining health that were prioritised by older people and service providers and recommended for inclusion in the health risk appraisal tool were recent life events, housing and garden maintenance, transport, both public and private, financial management, career status & needs, the local environment and social networks and social isolation. This study has identified key social determinants of health that could usefully be added to 'Life Checks' for older people and that could also inform the commissioning of community well-being. Modified with the addition of social domains, the HRAO technology could be a suitable tool to achieve current policy objectives.

Health risk appraisal for older people in general practice using an expert system: a pilot study.

The prevention of disability in later life is a major challenge facing industrialised societies. Primary care practitioners are well positioned to maintain and promote health in older people, but the British experience of population-wide preventive interventions has been disappointing. Health risk appraisal (HRA), an emergent information-technology-based approach from the USA, has the potential for fulfilling some of the objectives of the National Service Framework for Older People. Information technology and expert systems allow the perspectives of older people on their health and health risk behaviours to be collated, analysed and converted into tailored health promotion advice without adding to the workload of primary care practitioners. The present paper describes a preliminary study of the portability of HRA to British settings. Cultural adaptation and feasibility testing of a comprehensive health risk assessment questionnaire was carried out in a single group practice with 12,500 patients, in which 58% of the registered population aged 65 years and over participated in the study. Eight out of 10 respondents at all ages found the questionnaire easy or very easy to understand and complete, although more than one-third had or would have liked assistance. More than half felt that the length of the questionnaire was about right, and one respondent in 10 disliked some questions. Of those who completed the questionnaire and received tailored, written health promotion advice, 39% provided feedback on this with comments that can be used for increasing the acceptability of tailored advice. These findings have informed a wider exploratory study in general practice.

Depression and the response of residential homes to physical health needs.

OBJECTIVE: To investigate the response of residential homes to four specific health problems of residents and the relationship between the quality of this response and the prevalence of depression. DESIGN AND SAMPLE: Post hoc analysis of data collected for a cross-sectional survey of homes chosen to represent "excellent" and "standard" care; resident sample sufficient to detect difference between 20% and 40% depression prevalence between two groups of homes (90% power, 5% significance). Three hundred and nine residents were assessed. SETTING: Seventeen residential homes in different areas of England. METHODS: Data were collected about aspects of the care provided, including quality rating of care plans. Standard instruments were used to collect resident data by direct and informant interviews, including assessments of dementia, depression, dependency, medication and specific health problems. RESULTS: Seventy-nine per cent of the sample were suffering from dementia; 40% of 194 residents who could be assessed for depression were depressed. Of residents assessed by research nurses, 72% had problems with mobility, 67% with stability, 40% with hearing and 46% with vision. Quality of response to these problems was variable. In a combined assessment of care plan quality and key worker awareness, 7% of homes' responses to these four problems in residents were rated as good. Seventeen per cent of depressed residents were so identified by their key workers. Good interventions by key workers were associated with less depression in residents. DISCUSSION: The response of home staff and community health professionals to physical health needs in residential homes is variable and should be improved. This study suggests that improving this aspect of care provision might reduce depression and thus improve quality of life.

Care homes. Home truths.

Proposed joint inspectorates of care homes open the way for health input into residential care. An investigation into quality-of-care measures concluded that health professionals should be included in inspectorate teams, particularly in view of the increasing dependency of residents. No association was shown between cost and quality, but higher costs were associated with short-term car provision. When costing residential care, the impact on community and primary healthcare services may need to be taken into account.