Community care for severely frail older people: Developing explanations of how, why and for whom it works.
care coordinator
home care
integrated services
realist evaluation
severe frailty
vulnerable adults
wellness
Journal
International journal of older people nursing
ISSN: 1748-3743
Titre abrégé: Int J Older People Nurs
Pays: England
ID NLM: 101267281
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
26
03
2018
revised:
15
10
2018
accepted:
19
11
2018
pubmed:
29
12
2018
medline:
18
12
2019
entrez:
29
12
2018
Statut:
ppublish
Résumé
A Community Wellness Team was implemented in North East England in 2014, in line with national policy directives to support frail older people in the community. The service provides a comprehensive and integrated care package, which aims to reduce avoidable admissions, inappropriate service use and enable patients to stay at home. A realist design combining a review of the literature and primary data collection from service providers and patients was used to develop programme theories explaining the links between the Team interventions and expected outcomes. Five programme theories were developed, detailing: trust development and relationship building; risk minimisation in the home environment; advice on self-management; referral to preventative services; and coordination of services. The programme theories explain the role and impact of the Community Wellness Team. These programme theories are interrelated and impact one another; a hypothesised progression of programme theories indicating how the Community Wellness Team "works" is discussed. Of particular importance was the comprehensive initial assessment, which leads to the alteration of the social and physical environment within which older people live. Severely frail older people present cases that are complex socially, medically, financially and environmentally. In order to meet these needs, the Team coordinators are adopting a complex and flexible person-centred approach. This study paves the way for further research into the care networks surrounding severely frail older people living in the community, and how they can most effectively be implemented.
Sections du résumé
BACKGROUND
BACKGROUND
A Community Wellness Team was implemented in North East England in 2014, in line with national policy directives to support frail older people in the community. The service provides a comprehensive and integrated care package, which aims to reduce avoidable admissions, inappropriate service use and enable patients to stay at home.
DESIGN
METHODS
A realist design combining a review of the literature and primary data collection from service providers and patients was used to develop programme theories explaining the links between the Team interventions and expected outcomes.
RESULTS
RESULTS
Five programme theories were developed, detailing: trust development and relationship building; risk minimisation in the home environment; advice on self-management; referral to preventative services; and coordination of services.
DISCUSSION
CONCLUSIONS
The programme theories explain the role and impact of the Community Wellness Team. These programme theories are interrelated and impact one another; a hypothesised progression of programme theories indicating how the Community Wellness Team "works" is discussed. Of particular importance was the comprehensive initial assessment, which leads to the alteration of the social and physical environment within which older people live.
CONCLUSION
CONCLUSIONS
Severely frail older people present cases that are complex socially, medically, financially and environmentally. In order to meet these needs, the Team coordinators are adopting a complex and flexible person-centred approach.
IMPLICATIONS FOR PRACTICE
CONCLUSIONS
This study paves the way for further research into the care networks surrounding severely frail older people living in the community, and how they can most effectively be implemented.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e12217Subventions
Organisme : Cancer Research UK
Pays : United Kingdom
Organisme : Medical Research Council
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/K02325X/1
Pays : United Kingdom
Informations de copyright
© 2018 John Wiley & Sons Ltd.