Understanding the care and support needs of older people

By Dr. Simon Brownsell, Research Fellow, Barnsley Hospital, Barnsley, England
Contact: simon.brownsell@bhnft.nhs.uk

Many are aware that our societies are ageing. Over the coming years we face challenging times as we seek improved, user centred, services at reduced overall spending. Telecare proponents have suggested that these challenges can be met through telecare. However, the evidence to support this argument is not always robust and the Institute of Public Policy Research has commented that without clearer evidence it will be difficult to target resources wisely and justify the large amounts of public money being spent on Information Technology (Bend 2004).

There are numerous examples where telecare appears to be beneficial, but if these examples were rolled out as local or national services, would the benefits be observed by a large number of people? Could financial savings be made at the local or national level? Indeed, does telecare even address the important issues of combating the reasons why older people need increasing levels of care and support? If telecare only supports secondary issues and key issues are not addressed, then a move up ‘the care ladder’, perhaps to residential or nursing care, will still take place and the investment in telecare may not actually provide significant tangible benefits (despite reports of user satisfaction and so forth in telecare trials).

In order to address these questions we began by discovering the main reasons why older people need increasing levels of care and support. This was supplemented by an analysis of service delivery options (including telecare).

Identifying the reasons for increasing levels of care and support

A literature review of the reasons why older people need increasing levels of care and support, i.e. why people commence home care, increase their care hours, move to some form of residential or nursing care, and so on was conducted. In total, 102 trigger factors were identified in relation to these needs. However, there appeared to be no ranking of these factors in terms of their relative priority with respect to each other.

A stakeholder event was therefore held with participants from a range of relevant agencies including housing, health, social care, voluntary services and carers. Participants were first asked to highlight what they considered the main reasons were as to why older people needed increasing levels of care and support. A prioritisation process was initiated, and a total of 36 trigger factors for increased levels of care and support were identified as being in the top 3 bands of importance (as reported elsewhere, in Brownsell et al 2005).

Quantifying the role of service delivery options

Having identified the main reasons why older people need increasing levels of care and support, we then sought to discover how service delivery could impact upon the identified trigger factors. Three service delivery categories were considered, namely:

• Formal care services - Regular and ongoing intervention by health, care and support services.
• Current assistive technology provision - Technologies that do not necessarily function without formal care services, but where the main support is in the form of assistive technology, i.e. hand rail, zimmer frame, communication aid and so on.
• Telecare - Technologies that do not necessarily function without formal care services, but the main support is through remote telecare monitoring and response.

Results and discussion

The analysis revealed that of the 36 key reasons identified as to why older people need increasing levels of care and support, formal care services could be offered to provide support in 80% of cases. Assistive technologies could be deployed in 58% of cases and telecare in 66%.

The analysis highlights that user assessment and choice is an important consideration. For example, ‘occurrence of falls’ was one of the factors, and all three service delivery categories could be utilised depending on individual circumstances. For other factors such as, ‘presence of chronic disease’ formal services or telecare would both be possibilities. However, a cautionary note must be made, often older people will experience more than one of the key trigger factors and if complete solutions cannot be offered for these multiple factors, a move up ‘the care ladder’ is still likely to occur. Analysis of the 36 factors highlights the breadth of services required within 4 domains, namely:

Domain	Number of Key Factors
Dwelling	3
Social aspects	8
Physical aspects	12
Health	13

Comprehensive and user centred approaches are therefore required in meeting need and telecare must work in combination with formal and other support services if holistic packages of care and support are to be provided for the benefit of older people in our ageing societies.

It is clear that this work quantifies and demonstrates, perhaps for the first time, that telecare has a significant role to play in addressing the main reasons why older people require increasing levels of care and support. At Barnsley hospital, we offer the health and care services you would expect from an NHS hospital, however we have also provided an assistive technology service for over 15 years. This review of the care and support needs of older people suggests that a greater integration of services is required and that the telecare research and evaluation conducted on site and elsewhere, should be integrated into full scale service delivery. However, it is obvious that such work should not be conducted in isolation and there is therefore a challenge to share learning between centres and organisations if we are to offer truly patient centred services for the benefit of all.

References

Bend J. (2004). “Public value and e-health.” Institute for Public Policy Research. http://www.ippr.org/research/files/team34/project143/Bend_PublicValueandeHealth_ippr.pdf

Brownsell S, Aldred H & Hawley M. (2005). “The role of assistive technology in addressing the care and support needs of older people.” The 5 th International conference of Gerontechnology. Nagoya Japan, May 24-27.

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