Age and ageing最新文献

Barriers and facilitators to implementation of mental capacity legislation in care homes for older adults in the United Kingdom: a mixed-methods systematic review 英国老年人护理院实施精神能力立法的障碍和促进因素：一项混合方法的系统评价

IF 6.7 2区医学

Age and ageing Pub Date : 2025-05-15 DOI: 10.1093/ageing/afaf119

Louis Stokes, Michelle Maden, Nefyn Williams, Nina Jacob, Sion Scott, Victoria Shepherd, Cara Gates, Liz Jones, Sandra Barker, Marie-Clare Hunter, Grahame Smith, Hayley Prout, Mishel Ingle, Ffion Curtis, Ruaraidh Hill, Alys Wyn Griffiths

{"title":"Barriers and facilitators to implementation of mental capacity legislation in care homes for older adults in the United Kingdom: a mixed-methods systematic review","authors":"Louis Stokes, Michelle Maden, Nefyn Williams, Nina Jacob, Sion Scott, Victoria Shepherd, Cara Gates, Liz Jones, Sandra Barker, Marie-Clare Hunter, Grahame Smith, Hayley Prout, Mishel Ingle, Ffion Curtis, Ruaraidh Hill, Alys Wyn Griffiths","doi":"10.1093/ageing/afaf119","DOIUrl":"https://doi.org/10.1093/ageing/afaf119","url":null,"abstract":"Objective Mental Capacity legislation defines when a person lacks capacity and subsequently supports individuals to make as many decisions as possible for themselves. Whilst frameworks exist, care home staff often feel unsupported with insufficient knowledge and training. This review aimed to understand barriers and facilitators of implementing mental capacity legislation in care homes for older adults in the United Kingdom. Methods A systematic review was conducted and 3041 potentially relevant studies identified, with 13 studies eligible for inclusion. 11 focused on the Mental Capacity Act (2005) and two on the Adults with Incapacity (Scotland) Act 2000. Barriers and/or facilitators were extracted and subsequently mapped to the Capability, Opportunity and Motivation model and Theoretical Domains Framework. Results Barriers included poor access to training, low staff confidence and a lack of understanding about using legislation in context. Conversely, staff reported in-person training using real-life examples, robust organisational policies and processes and respecting person-centred care were key facilitators. Sense-checking conversations were conducted with care home staff (n = 18) to interpret findings in the context of current practice. Conclusions This review presents complex and multi-faceted barriers preventing the implementation of mental capacity legislation in care homes for older adults. Whilst care home staff have now started to appreciate the importance of such legislation, insufficient time, resources and an inability to track staff knowledge prevents effective implementation of the law. Future research should explore how staff are trained about legislation and identify best practices.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"33 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Communication strategies for delivering personalised dementia care and support: a mixed-methods systematic review and narrative synthesis 提供个性化痴呆症护理和支持的沟通策略：混合方法的系统回顾和叙述综合

IF 6.7 2区医学

Age and ageing Pub Date : 2025-05-15 DOI: 10.1093/ageing/afaf120

Astrid Maria Sunjaya, Tamar Schreiber, Kumud Kantilal, Nathan Davies, Sarah Griffiths

{"title":"Communication strategies for delivering personalised dementia care and support: a mixed-methods systematic review and narrative synthesis","authors":"Astrid Maria Sunjaya, Tamar Schreiber, Kumud Kantilal, Nathan Davies, Sarah Griffiths","doi":"10.1093/ageing/afaf120","DOIUrl":"https://doi.org/10.1093/ageing/afaf120","url":null,"abstract":"Background Given the significant burden and rising prevalence of dementia, it is essential that personalised care is available to people with dementia (PWD) and their family carers. This involves tailoring support to meet individuals’ unique needs and preferences. Effective communication is fundamental to delivering such care, yet dementia impacts communication, posing challenges in meeting individuals’ needs. Aim To understand key communication strategies used by healthcare professionals (HCPs) in delivering personalised dementia care. Methods A systematic search across MEDLINE, EMBASE, EMCare, PsycINFO, CINAHL, Scopus, and Web of Science was conducted (April 2024) without limits on care setting, country or publication date. We identified studies examining communication strategies, barriers, and facilitators for delivering personalised care for PWD and their carers. Study quality was assessed using Joanna Briggs Institute critical appraisal tools and the Mixed Methods Appraisal Tool. Using codebook thematic analysis, a narrative synthesis of findings was developed. Results and Conclusion The review included 33 studies, encompassing qualitative, quantitative and mixed-methods research conducted in hospitals, care homes and community settings. Most studies originate from high-income countries and care homes, limiting generalisability. Three themes on communication strategies for delivering personalised dementia care were developed: understanding the person, their family and their care context; communication techniques (verbal, nonverbal and use of external aids); and support for the workforce. The review underscores the importance of combining practical, emotional and relational approaches while highlighting current gaps, such as the need for better workforce support and more research in primary care and culturally diverse contexts.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"48 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost-effectiveness of adopting a postoperative delirium risk prediction tool with nonpharmacological delirium prevention interventions for surgical patients 手术患者采用术后谵妄风险预测工具与非药物性谵妄预防干预的成本-效果

IF 6.7 2区医学

Age and ageing Pub Date : 2025-05-13 DOI: 10.1093/ageing/afaf122

Nicholas Graves, Sönke Böttger, Martin Zozmann, Maja Franziska, Reto Stocker

{"title":"Cost-effectiveness of adopting a postoperative delirium risk prediction tool with nonpharmacological delirium prevention interventions for surgical patients","authors":"Nicholas Graves, Sönke Böttger, Martin Zozmann, Maja Franziska, Reto Stocker","doi":"10.1093/ageing/afaf122","DOIUrl":"https://doi.org/10.1093/ageing/afaf122","url":null,"abstract":"Background Postoperative delirium (POD) arises among older surgical patients. Screening followed by prevention efforts are recommended. A risk prediction tool called PIPRA plus has been developed, yet its performance and whether adoption into health services is cost-effective are unknown. Objective To estimate the expected change to ‘total costs’ and ‘health benefits’ measured by quality adjusted life years (QALYs) from a decision to adopt PIPRA plus for screening purpose to find at-risk individuals who are then offered nonpharmacological interventions to reduce risks of POD. Design Cost-effectiveness modelling study that draws on a range of relevant data sources. Setting Swiss healthcare system. Subjects Surgical inpatients aged 60 or older, excluding cardiac and intracranial surgeries. Methods A decision tree model was used to capture the events likely to impact on cost and health outcomes. Information was harvested from a prospective before–after study done in Switzerland and augmented with other data. Probabilistic sensitivity analysis was undertaken to reveal the probability that adoption was cost-effective against a stated maximum willingness to pay threshold for decision-making in Switzerland. Results Patients in both phases of the study were similar. Costs were lower by 2898 CHF (SD 1050) per patient with the adoption of the risk screening tool and there was a modest gain to health benefits of 0.01 QALY (SD 0.026). There was a 99.7% probability that adoption would be cost-saving and 91% probability that adoption would be cost-effective. Conclusions We provide early-stage evidence that a decision to adopt the risk screening tool and offer risk-reducing interventions could be cost-effective.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"39 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How do early geriatric intervention and time to surgery influence each other in the management of proximal hip fractures? 在髋近端骨折的治疗中，早期老年干预和手术时间是如何相互影响的？

IF 6.7 2区医学

Age and ageing Pub Date : 2025-05-12 DOI: 10.1093/ageing/afaf116

Baptiste Boukebous, Fei Gao, David Biau

{"title":"How do early geriatric intervention and time to surgery influence each other in the management of proximal hip fractures?","authors":"Baptiste Boukebous, Fei Gao, David Biau","doi":"10.1093/ageing/afaf116","DOIUrl":"https://doi.org/10.1093/ageing/afaf116","url":null,"abstract":"Introduction Time to surgery (TTS) increases mortality risk in old patients with proximal femur fractures (PFFs). Orthogeriatric care pathways reduce mortality and length of stay, but the interaction between TTS and geriatric intervention remains unclear. Objective To identify organisational variables—including geriatric intervention—that are predictive of 90-day mortality and explore their interactions with TTS. Materials and Methods This retrospective study included 7756 PFFs aged over 60 who underwent surgery between 2005 and 2017. Organisational factors influencing 90-day mortality (main outcome) were identified in an administrative database using log-rank tests. Variables such as a mobile geriatric team (MGT) intervening in the emergency department were screened. Selected variables were included in a Cox model alongside TTS and the AtoG score, a validated multidimensional prognostic tool (from 0 no comorbidity to ≥5). Statistical interactions between TTS and organisational variables were calculated. Results MGT was one of the rare organisational variables with a protective effect: hazard ratio (HR) = 0.81, CI 95% [0.68–0.98], P = 0.03. MGT’s strongest effect was for TTS up to 1 day (HR = 0.70, CI95% [0.53–0.92], P = 0.01) and then decreased beyond 2 days (HR = 0.97, CI95% [0.73–1.3], P = 0.08). In patients with an AtoG score ≤ 2, MGT was the strongest parameter: HR = 0.76, CI95% [0.60–0.93], P = 0.03, while the HR for TTS was 1.01 CI 95% [0.99; 1.02], P = 0.15. In patients with an AtoG&gt;2, there was a synergic interaction between MGT and reduced TTS (P = 0.05). Conclusion Geriatric intervention modulated the effect of TTS on 90-day mortality up to a TTS of 2 days. MGT had a positive impact on both vulnerable and earthier patients.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"7 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143940269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Validation of the standard assessment of global everyday activities (SAGEA) scale for dementia diagnosis 全球日常活动标准评估（SAGEA）量表用于痴呆诊断的验证

IF 6.7 2区医学

Age and ageing Pub Date : 2025-05-12 DOI: 10.1093/ageing/afaf115

Jolene Phelps, Dylan X Guan, Koon Teo, Martin O'Donnell, Salim Yusuf, Jackie Bosch, Zahinoor Ismail, Eric E Smith

{"title":"Validation of the standard assessment of global everyday activities (SAGEA) scale for dementia diagnosis","authors":"Jolene Phelps, Dylan X Guan, Koon Teo, Martin O'Donnell, Salim Yusuf, Jackie Bosch, Zahinoor Ismail, Eric E Smith","doi":"10.1093/ageing/afaf115","DOIUrl":"https://doi.org/10.1093/ageing/afaf115","url":null,"abstract":"Background Standardised questionnaires of cognitive symptoms and cognitive-related function can assist in diagnosing dementia. The Standardised Assessment of Global Everyday Activities (SAGEA) is a 15-item questionnaire, developed to measure functional status by capturing cognitive symptoms, basic and instrumental activities of daily living, participation in activites, and mobility. Objective The aim of this study was to validate the SAGEA as a tool for assessing cognitive dysfunction in dementia. Methods Participants with dementia, mild cognitive impairment (MCI) or subjective cognitive decline (SCD) were selected from the clinic-based Prospective Registry for Persons with Memory Symptoms (PROMPT), and cognitively asymptomatic, unimpaired controls were selected from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function and Caregiving in Ageing study. Results SAGEA scores correlated well with the Lawton-Brody scale for instrumental activities of daily living (r = −0.68, P &lt; 0.0001). SAGEA scores differed significantly across participant groups, highest for individuals with dementia (17.7 ± 8.59) followed by MCI (10.8 ± 9.10), SCD (8.07 ± 7.06) and controls (1.60 ± 2.07). The SAGEA classified dementia with an AUC of 0.97, sensitivity of 94.5% and specificity of 94.6% at a cut-off point of ≥6 points based on Youden’s index. A dementia diagnosis algorithm based on the SAGEA distinguished dementia from controls with a sensitivity of 68% and specificity of 100%. Conclusions This study supports the utility of the SAGEA as an adjunct to diagnosing dementia and a potentially useful screening tool.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"58 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143940270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prevalence of sarcopenia in middle-aged and older adults with cognitive impairment: a meta-analysis 认知障碍中老年患者肌肉减少症的患病率：一项荟萃分析

IF 6.7 2区医学

Age and ageing Pub Date : 2025-05-08 DOI: 10.1093/ageing/afaf114

Jia-You Ye, Li-Fang Chang, Ruey Chen, Hidayat Arifin, Chia-Hui Wang, Kai-Jo Chiang, Kondwani J Banda, Kuei-Ru Chou

{"title":"Prevalence of sarcopenia in middle-aged and older adults with cognitive impairment: a meta-analysis","authors":"Jia-You Ye, Li-Fang Chang, Ruey Chen, Hidayat Arifin, Chia-Hui Wang, Kai-Jo Chiang, Kondwani J Banda, Kuei-Ru Chou","doi":"10.1093/ageing/afaf114","DOIUrl":"https://doi.org/10.1093/ageing/afaf114","url":null,"abstract":"Background Cognitive impairment, dementia and sarcopenia significantly reduce the quality of life in middle-aged and older adults by impairing daily functioning, making cognitive decline a major concern for healthcare professionals. Objective To estimate the prevalence of sarcopenia and probable sarcopenia in middle-aged and older adults with cognitive impairment. Methods Six databases—Embase, Ovid MEDLINE, PubMed, CINAHL, Scopus and Web of Science was conducted through February 2025. Cohort and cross-sectional studies included, and a random-effects model was used for pooled prevalence analysis. Cognitive impairment is a decline in cognitive functions, including memory, attention and executive function, covering mild cognitive impairment and dementia. Sarcopenia is decreased skeletal muscle mass and function, assessed by muscle strength or physical performance. Results A total of 67 studies involving 23 532 participants revealed a pooled sarcopenia prevalence of 30.1% and a probable sarcopenia prevalence of 40.5%. Additionally, amongst adults aged 65 and older, the prevalence of sarcopenia was 32.7%. The prevalence of sarcopenia varied by setting: 25.3% in community-dwelling populations, 35.5% in hospitals and 41.5% in institutional settings. Moderating factors included age, female, body mass index, comorbidities and risk factors such as depression, diabetes, hypertension, malnutrition, osteoarthritis, alcohol consumption and smoking. Conclusions Approximately one-third of middle-aged and older adults with cognitive impairment demonstrate to have sarcopenia. Early detection and tailored interventions by public health professionals are crucial, particularly for individuals with mild cognitive impairment and dementia. Enhanced preventive strategies are essential to improving outcomes and reducing healthcare costs.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"68 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cancer and older people. A research collection and commentary on the theme 癌症和老年人。关于这一主题的研究文集和评论

IF 6.7 2区医学

Age and ageing Pub Date : 2025-05-05 DOI: 10.1093/ageing/afaf113

Shane O'Hanlon

{"title":"Cancer and older people. A research collection and commentary on the theme","authors":"Shane O'Hanlon","doi":"10.1093/ageing/afaf113","DOIUrl":"https://doi.org/10.1093/ageing/afaf113","url":null,"abstract":"Cancer disproportionately affects older adults, who account for the majority of diagnoses and deaths globally. However, research and clinical care often fail to adequately address their unique needs. This collection of studies in Age and Ageing highlights challenges and opportunities in geriatric oncology. The rising incidence of cancer in the older population, driven by demographic shifts and socioeconomic factors, underscores the need for targeted prevention and control strategies. Despite this, older adults remain underrepresented in clinical trials, with barriers including social isolation, healthcare professionals’ biases and a lack of dedicated studies. Frailty assessment is gaining ground as a key tool in geriatric oncology. Studies on frailty scores such as the Hospital Frailty Risk Score, and comprehensive geriatric assessment (CGA), show their ability to predict outcomes and guide interventions. CGA-based care has been shown to reduce treatment toxicity without compromising survival, yet its integration into routine practice remains limited. Treatment challenges are common, particularly with novel therapies like immune checkpoint inhibitors, which carry age-specific risks of adverse events. Tailored services are essential to address the diverse needs of older cancer patients. Research highlights the importance of improving communication around cancer screening for older adults and developing specialised care pathways for vulnerable populations, such as those with dementia. Continuity of care remains a significant challenge, requiring better coordination across healthcare providers. These findings emphasise the urgent need for age-attuned research, frailty-informed care models and tailored interventions to improve outcomes for older adults with cancer.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"115 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143910421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The use and effect of virtual reality as a non-pharmacological intervention for behavioural and psychological symptoms of dementia: a systematic review and meta-analysis. 虚拟现实作为痴呆行为和心理症状的非药物干预的使用和效果：系统回顾和荟萃分析

IF 6 2区医学

Age and ageing Pub Date : 2025-05-03 DOI: 10.1093/ageing/afaf117

Li-Chin Wang, Amy Montgomery, Peter Smerdely, Olivia Paulik, Cherie Barton, Elizabeth Halcomb, Heidi Hoi Ying Hui, Carolyn Pieri, Maria Rios Lopez, Judeil Teus, Gemma McErlean

{"title":"The use and effect of virtual reality as a non-pharmacological intervention for behavioural and psychological symptoms of dementia: a systematic review and meta-analysis.","authors":"Li-Chin Wang, Amy Montgomery, Peter Smerdely, Olivia Paulik, Cherie Barton, Elizabeth Halcomb, Heidi Hoi Ying Hui, Carolyn Pieri, Maria Rios Lopez, Judeil Teus, Gemma McErlean","doi":"10.1093/ageing/afaf117","DOIUrl":"https://doi.org/10.1093/ageing/afaf117","url":null,"abstract":"Background: Behavioural and psychological symptoms of dementia (BPSD) are complex neuropsychiatric symptoms that contribute to caregiver strain, increased rates of institutionalisation and reduced quality of life. Virtual reality (VR) has gained interest as a non-pharmacological approach to potentially reduce BPSD severity.Objective: This review sought to synthesise evidence on the effectiveness of VR in reducing BPSD severity, while exploring its acceptability, safety, and optimal dosage in dementia care.Methods: MEDLINE, EMBASE, CINAHL and SCOPUS were searched for randomised and quasi-experimental trials assessing VR's effect on BPSD. JBI critical appraisal checklists were used to assess methodological quality. Findings were presented narratively, with meta-analysis performed on a subset of BPSD symptoms where data were available.Results: Of the ten included studies, four found no significant change in overall BPSD. Mixed findings were observed for individual BPSD symptoms. Meta-analysis showed a significant reduction in depressive symptoms (mean diff -0.38, P= .026) and no reduction in agitation (mean diff 1.87, P = .2). Two studies reported reduced aggression and mixed findings were found for anxiety. Reduced apathy was observed in one study following each VR session and during the session in another. VR was generally well-accepted with few side effects reported.Conclusion: VR appears to be an acceptable non-pharmacological intervention for BPSD reduction. However, the limited available studies, methodological variations and quality issues suggest the need for future larger-scale research to confirm its efficacy and effectiveness.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 5","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Resident funding and care home quality: a retrospective observational analysis of the impact of the two-tier care system in England. 居民资金和护理院质量：英国双层护理系统影响的回顾性观察分析。

IF 6.7 2区医学

Age and ageing Pub Date : 2025-05-03 DOI: 10.1093/ageing/afaf100

Anders Bach-Mortensen,Benjamin Goodair,Michelle Degli Esposti,Christine Corlet Walker

{"title":"Resident funding and care home quality: a retrospective observational analysis of the impact of the two-tier care system in England.","authors":"Anders Bach-Mortensen,Benjamin Goodair,Michelle Degli Esposti,Christine Corlet Walker","doi":"10.1093/ageing/afaf100","DOIUrl":"https://doi.org/10.1093/ageing/afaf100","url":null,"abstract":"BACKGROUNDAdult social care in England operates in a two-tier system of self-funded and state-funded residents. It is unclear, however, whether resident funding source impacts care home quality.METHODSWe conducted a nationwide retrospective observational analysis of care homes in England (n = 28 239 Provider Information Return entries for 14 444 care homes, representing ~367 653 residents), 2021-23, to examine the relationship between resident funding (self- or state-funded) and care home quality (inspection ratings by the industry regulator). We linked data from the Care Quality Commission's Provider Information Return to inspection ratings, area deprivation, and care home and resident characteristics. We modelled a series of logistic regressions, incorporating interaction terms to investigate the interrelationships between ownership (for-profit, third sector, public) and area deprivation.FINDINGSCare homes with more self-funded residents were more likely to have better inspection ratings [odds ratio for each percentage of self-funded residents: 1.01, 95% confidence interval (CI) 1.008-1.012, P < .001]. The effect of self-funded residents on care quality was largest amongst for-profit homes and not statistically significant for third sector and public homes. For homes without self-funders, third sector and public providers were 14.0 (95% CI: 10.1-17.8, P < .001) and 6.9 (95% CI: 4.1-9.7, P < .001) percentage points more likely to be rated higher than for-profit homes.CONCLUSIONSThe quality of for-profit care homes is strongly influenced by the proportion of self-funded residents, whilst third and public sector homes provide consistent care regardless of resident funding source. This strongly impacts care equity for residents nationwide, as the concentration of self-funders is largely determined by area wealth.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"23 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Advancing frailty identification in UK primary care with eFI2: are we there yet? eFI2在英国初级保健中推进衰弱识别：我们做到了吗？

IF 6 2区医学

Age and ageing Pub Date : 2025-05-03 DOI: 10.1093/ageing/afaf111

Roman Romero-Ortuno, Victoria Louise Keevil

引用次数: 0