Editorial
Article Type: Editorial From: Quality in Ageing and Older Adults, Volume 12, Issue 4
Planning for the community care of older adults leaving hospital will always be a fraught and complex process. Older patients are particularly vulnerable and fearful at such times and staff have to deal with multiple inter-agency negotiations. While flexibility is in order, there is often little available time and many formal procedural issues to take account of. I have long been in favour of pragmatic checklists to assist in ensuring that all the elements of complex processes are addressed and to help offer some peace of mind to both staff and patients. William Spence here reports on the first, observational stage of an action research project which applies just such an assessment tool and looks at how staff view its value. Although this represents just the first stage in a necessarily lengthy action research project, there are grounds for optimism as far as staff views are concerned – they clearly see the benefits of a reliable assessment scale and are happy to make use of it.
This paper and the following one by David Walton, Michael Fullerton and Seraphim Patel demonstrate the importance of the collaborative development of assessment scales. They report on a pilot study of joint user outcome measures for older adults with mental health problems and their carers. Outcome measures are crucial to measuring the impact of services on people’s lives and are central to the new NHS and Adult Social Care Outcome Frameworks. They advocate such developments in order to supplement existing clinical outcome measures(such as HONOS65+) with holistic measures of the impact of services on the lives of patients. Once again they need to be easy to administer, cover the range of health and social care outcomes and meet both health and social care outcome requirements. More “holistic” measures should enable joint services to develop more systematic collection of outcome and effectiveness data.
While procedural improvements are vital to the practical considerations of caring for older people, neglect of their emotional and psychological needs is all too frequent. Hence, the importance of the study by Randall Smith, Julia Johnson and Sheena Rolph into the role that keeping pets might play in improving care. Interconnected factors such as improvements in physical exercise, physical and mental health and increased social interaction are all related to the effects of pet-keeping. While the presence of animals apparently helps the transition into residential care, when residents are unable to bring their own pet into care with them the separation from that “loved one” can bring a further sense of loss, adding to the sensed loss of independence. Indeed, some residents gain a real notion of enhanced responsibility and of contributing to the life of the care community by looking after any communal pets.
Consideration does have to be given to the potential disadvantages of the presence of animals in institutionalized care settings – cleanliness,infection risk and so on. But these concerns appear to be considerably outweighed by the benefits of “pet-facilitated therapy”. Although it may be a challenge to animal lovers to discover that “robotic pet therapy”appears equally rewarding – and poses less cleaning issues!
I wanted to include the interesting reflective commentary from Daniel Briggs in this issue of Quality in Ageing and Older Adults since, despite his admitted naivety for this work, his observations highlight the sorts of challenges typically confronted by researchers in this field and commissioners,policy makers and managers need to be made more aware of them. As he says,sometimes it is best to come as an outsider to a field to be able to ask the“innocent” questions that undermine procedural complacency. All too often the internal politics and social dynamics of the situation prevent those who can do something from engaging with the issues at the level that will really make a difference. All too often researchers’ dependency on cultivating favourable relationships with commissioners militates against full and transparent reporting. It can be beneficial to the research “truth”not to be even aware that there are toes being trod on. As Daniel illustrates sometimes that may be the only way to help the helpers.
Even before the economic downturn and corresponding cuts in government funding, social researchers have displayed a growing eagerness to exploit the world wide web to increase sample size and access some previously “hard to reach” groups. Hence, we read with interest this paper by Clive Mitchell,Gareth Morgan and John Gallacher to seek older people’s views of service delivery via an internet survey. My personal concern that the motives for internet surveys have been primarily economic has been assuaged by this study which has shown that older people are as ready as any other sector of the population to respond to a call for web-based evaluations and that the resulting sample could be as methodologically sound as more conventional survey approaches. In fact much more could be done to understand older people’s use of information technology and the internet and the assumption that older people are shy of new technologies might be challenged by a generation that has aged alongside massive technological change in forms of communication.
In similar vein much more research is needed to understand older people’s use of alcohol in the context of changing social, cultural and economic circumstances. Drinking may be related to the experience of ageing and this may vary across a range of social categories and situations. Lizzie Ward, Marian Barnes and Beatrice Gahagan attempt to fill the gaps in our knowledge about older people’s drinking behaviour by a reporting on a participatory research study exploring the circumstances in which older people drink and the meaning of alcohol in their lives. Participatory methodologies are well suited to research with older people and, in particular, in approaching the “use”of alcohol as not necessarily an “abuse”. By this means it becomes problematised only from the participants’ perspective and offers insights for professional support which are well evidenced. The authors’ list of recommendations for practice here may be seen as particularly helpful for a range of professionals working with and for older people.
Ron Iphofen
