Formal and informal care for community‐dwelling frail elderly people over time: A comparison of integrated and usual care in the Netherlands

ObjectivesTo analyse the process and impact of confronting multidisciplinary teams (MTs) in primary care with the experiences of frail older patients through mirror meetings (MMs), with the aim of supporting teams to organize care in a more patient‐oriented way.MethodsProcess and impact analyses were performed using a mixed‐method approach. MMs were held with 14 frail older patients and four MTs comprising 23 health‐care professionals (HCPs) in primary care in the Netherlands.ResultsMirror meetings were feasible for frail older people living at home, although their recruitment was time‐consuming. Interaction between the patients was scarce, but they valued the opportunity to share their stories. HCPs preferred MMs overwritten reports about patient experiences. An impact analysis revealed four dominant professional areas for improvement: improve alignment with patient goals, improved communication with patients both orally and in writing, developing new pathways to connect with informal caregivers and an increased understanding that most HCPs are relative strangers to their patients.ConclusionsMirror meetings are a relatively simple and promising method for exploring the ways in which frail older patients experience care.Practice implicationsGiven the right conditions, MMs could result in valuable processes to enable MTs to improve their working methods.

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“…Many studies have elaborated on the importance of involving ICs for frail older people . Our study endorses these findings.…”

Section: Discussionsupporting

confidence: 87%

Mirror meetings with frail older people and multidisciplinary primary care teams: Process and impact analysis

Grol

Molleman

Schers

2019

Health Expectations

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“…It is clear from our study and the wider literature (Fratiglioni, Wang, Ericsson, Maytan, & Winblad, ; Hawkley & Cacioppo, ; Poot, Caljouw, Waard, Wind, & Gussekloo, ; Rico‐Uribe et al, ) that there is a direct link between social network structure and health. Janse et al () demonstrate that as time progresses, the role of informal carers in providing instrumental care tends to diminish and be transferred to more formal carers. In fostering trusting relationships with their patients, and considering them within their overall social environment, the CWT is altering these supportive networks in a way that enables people to become more resilient to health stressors.…”

Section: Discussionmentioning

confidence: 99%

Community care for severely frail older people: Developing explanations of how, why and for whom it works

Lhussier

Dalkin

Hetherington

2018

Int J Older People Nursing

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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 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 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 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 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 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.

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“…All nurses worked for the same home care organisation. Informal carers were defined as family members (partners or children), close friends or neighbours who provide non-professional, voluntary care (Janse, Huijsman, Looman, & Fabbricotti, 2018).…”

Section: Design and Participantsmentioning

confidence: 99%

Trust in older persons: A quantitative analysis of alignment in triads of older persons, informal carers and home care nurses

Doekhie

Strating

Buljac-Samardžić

et al. 2019

Health Soc Care Community

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Self‐management by older persons could be influenced by the level of trust found in triads of informal carers, formal care providers and care recipient, the older person. Little research has been done on care providers’ trust in older persons. This study aims to explore the level of trust that informal carers and home care nurses have in older persons, the extent of alignment in triads and the relationship between trust in older persons and self‐management. We conducted a cross‐sectional survey study in the Netherlands, sampling 133 older persons, 64 informal carers and 72 nurses, which resulted in 39 triads. Alignment level was analysed through Intraclass Correlation Coefficient 1 scores and absolute and mean difference scores. Correlation analysis and one‐way analysis of variance measured the relationship between trust and self‐management. The results show that triads contain both alignment and misalignment. Misalignment occurs mostly when informal carers and nurses have little trust in the older person while this person views their own behaviour towards their caregivers positively. Care providers’ trust levels relate significantly to their perception of the person's ability to self‐manage, but not to the person's self‐rated ability. This could be explained by care providers not communicating their intrinsic trust in the older person to them. Trust building could be enhanced by organising discussions of mutual expectations of trust and both formal and informal care providers could benefit from compassionate assessment training, to learn how to openly express their trust in the older person.

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Formal and informal care for community‐dwelling frail elderly people over time: A comparison of integrated and usual care in the Netherlands

Cited by 11 publications

References 45 publications

Mirror meetings with frail older people and multidisciplinary primary care teams: Process and impact analysis

Mirror meetings with frail older people and multidisciplinary primary care teams: Process and impact analysis

Community care for severely frail older people: Developing explanations of how, why and for whom it works

Trust in older persons: A quantitative analysis of alignment in triads of older persons, informal carers and home care nurses

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