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Welfare Reform on the Web (February 2008): Care of the elderly - overseas

Health informatics for older people: a review of ICT facilitated integrated care for older people

B.D. Loader, M. Hardey and L. Keeble

International Journal of Social Welfare, vol.17, 2008, p. 46-53

There are high expectations that information and communication technologies (ICTs) will improve professional integration and promote user-centred health and social care services for older people. This article reports findings from a review of internationally published sources which aimed to find examples of good practice and evidence to support these expectations. The review focused on evidence that could influence the implementation of the UK government's modernisation programme for services for older people, which emphasises the use of ICTs to facilitate information sharing and to foster person-centred care which empowers older people in their community. Findings suggest that these two objectives may be incompatible and that this is likely to produce expensive and ineffective health informatics outcomes.

It's a family affair: consumer advocacy for nursing-home residents in the United States

C.D. Phillips and others

Ageing and Society, vol. 28, 2008, p. 67-84

Nursing homes in the United States care for approximately 1.6 million people. Public funds pay for just over half of nursing home care, and the industry is dominated by large for-profit companies. In spite of an elaborate state and federal regulatory regime, the industry is riddled with poor practice. In order to improve standards nursing home consumer advocacy groups have grown up. These are voluntary organisations which operate through political pressure on state legislatures. This article describes how these organisations work based on the results of a postal survey of 47 active groups.

Living and dying with dementia: dialogues about palliative care

N. Small, K. Froggatt, and M. Downs

Oxford: OUP, 2007

Improvements in health care in the 21st century mean people are living longer, but with the paradox that chronic illness is increasingly prevalent. Dementia, a term used to describe various different brain disorders that involve a loss of brain function that is usually progressive and eventually severe, is a condition associated with an ageing population and is becoming increasingly common. Worldwide there are approximately 25 million people with dementia, expected to rise to 63 million by 2030, and 114 million by 2050. Inevitably, people living with dementia will die, but their needs at the end of life are not well known. This book describes what might be achieved if the values and best practice of both dementia care and palliative care are brought together, to achieve quality end of life care for this specific group of patients. It explores what is known about the experience of dying with dementia, using a narrative approach, and develops a model that draws together a 'person-centred' approach to care. The book examines the possibilities and the challenges faced when trying to improve quality of life for people with dementia, and presents examples of good practice from across the world.

Policy and practices relating to the active engagement of older people in the community: a comparison of Sweden and Australia

R. Leonard and S. Johansson

International Journal of Social Welfare, vol. 17, 2008, p. 37-45

This article compares policy and practices relating to the active engagement of older people in their communities in Sweden and Australia. It makes the assumption that the engagement of older people in their communities benefits both the community and the participants. Barriers and support for active engagement through paid work, formal voluntary work, political lobbying, social activism and participation in community events are compared.

Which advance directive matters? An analysis of end-of-life decisions made in nursing homes

J. Cohen-Mansfield and S. Lipson

Research on Aging, vol. 30, 2008, p. 74-92

The Patient Self-Determination Act in the United States requires nursing homes to maintain written policies and procedures regarding the patient's right to participate in decisions about his/her treatment. It includes the use of advance directives as a means to control medical care when an individual is incapacitated. This study examines the actual use by doctors of advance directives during decision-making processes in a nursing home. Results showed advance directives to be widespread but of limited use because they were generally not applicable to the situation at hand.

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