Problems in the delivery of medical care to the frail elderly in
the community

Craig, Gillian

doi:10.1108/02689239510086515

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…14(pp10) In the United Kingdom, the need for community geriatricians was recognized in 1995 but there was little support for the idea at that time. 15…”

Section: Care In the Community Mattersmentioning

confidence: 99%

Palliative Care in Overdrive: Patients in Danger

Craig

2008

Am J Hosp Palliat Care

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8 It describes the Liverpool Care Pathway (LCP), a regime that is being promoted throughout the United Kingdom for the care of people dying of malignant or nonmalignant disease in hospitals, care homes for the elderly, private residences, and hospices. The aims are to improve the care of the dying in the community and reduce emergency admissions to overburdened hospitals. The LCP employs traditional palliative care regimes, advocates the use of syringe drivers and powerful medication according to hospice practice, and virtually ignores the hydration debate. This approach is likely to become an integral part of the National Health Service (NHS) End of Life Care Programme unless wiser council prevails. Changing Gear 2006 includes a table apparently taken from a publication by the National Institute for Health and Clinical Excellence (NICE), whose representatives consider it "best practice" to make decisions "to discontinue inappropriate interventions, including blood tests, intravenous fluids, and observation of vital signs in the last hours and days of life." 9 The National Institute for Health and Clinical Excellence is an organization with a nasty habit of prohibiting the use of various treatments in the NHS on the basis of a cost/benefit analysis. This may suit politicians and economists, but it raises ethical, medical, and legal dangers that must not be ignored. Lo and Rubenfeld 10 have stressed that palliative sedation must be carefully distinguished from euthanasia. If correctly used, it can be justified as a last resort if certain criteria are met, namely that intolerable symptoms cannot be relieved in any other way, the patient is at the point of death, and the intention is to relieve symptoms, not shorten life. 10 The LCP is unlikely to fulfill the Lo and Rubenfeld criteria in all cases, for it could well make death under palliative sedation the norm rather than a last resort. If that happens, we will be only a From Medical Ethics Alliance (UK), United Kingdom.

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“…14(pp10) In the United Kingdom, the need for community geriatricians was recognized in 1995 but there was little support for the idea at that time. 15…”

Section: Care In the Community Mattersmentioning

confidence: 99%

Palliative Care in Overdrive: Patients in Danger

Craig

2008

Am J Hosp Palliat Care

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“…Over the years, many authors have addressed issues concerning networks for integrated care delivery (e.g. Brown et al, 1992;Craig, 1995;Hardy et al, 1992;Kickert and Van Vught, 1995;Lyne and Williams, 1995; Mur-Veeman and Neale, 1997;Ovretveit, 1993;Walston et al, 1996;Wolstenholme et al, 1989). Among the issues are fragmentation of power, its dimensions, causes, problems and challenges for co-operation between organisations.…”

Section: Theory Of Behaviour Controlmentioning

confidence: 99%

Integrated care management: applying control theory to networks

Raak

Paulus²,

Merode³

et al. 1999

Journal of Management in Medicine

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Delivery of integrated care by interorganizational networks attracts much attention in Europe. Such care is required to meet the demands of multi-problem patients. Many efforts are made to establish networks. Often, established networks do not deliver integrated care. Managers must understand the background of this problem, in order to deal with it. The issue addressed here concerns behaviour control in networks of autonomous care-providing organizations. So far, publications have focused on behaviour control in single organisations. Based on empirical data we argue that, due to an essential distinction between networks and single organizations, behaviour control in the former should be approached differently. In addition, we discuss the implications of our findings for the management of integrated care delivery.

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“…As in other countries, long-stay geriatric wards in New Zealand have been closed, and their frail elderly occupants have been discharged to residential facilities. The medical care of these residents becomes the responsibility of the GP in charge of that facility, adding to GPs already heavy burden (Craig, 1995;Kavanagh & Knapp, 1998). This is particularly true of the Kapiti Coast, where there are a high number of residential facilities.…”

Section: Access To General Practitionersmentioning

confidence: 99%

A Descriptive Research Study on Factors that Impact Upon the Quality of Life of Elderly Women with Comorbid Chronic Illnesses; Three Women's Perspectives

Lowe¹

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<p>Background: Women live longer than men and are more likely to live alone; this makes dealing with chronic illnesses more of a challenge for older women. Therefore, an understanding of what living with chronic illness is like for these women is essential in ensuring health professionals can meet their health needs. Aim of Research: The aim of this research study is to explore factors that older women living with comorbid chronic illnesses identify as key to maintaining or improving their quality of life. Design: This study uses a qualitative approach, with a descriptive methodology. Face-to-face: interviews were conducted with three women over the age of 80 who had been diagnosed with more than one chronic illness. These interviews were audiotaped, and the data analysed using thematic analysis. Findings: What emerged from this analysis of older women was the need for them to create meaning in their life, which is further explicated through three main themes: (1) coping with changing health, (2) the impact of family, and (3) attitude. Attitude to life and having a positive outlook were all factors these participants expressed as being essential to maintaining their quality of life. Conclusion: The quality of life of these participants is enhanced by the ability of these women to create meaning in their life. They do this by integrating their wealth of past experience into their present, reflecting back on their lives, but still gaining enjoyment from the here and now. Understanding of how chronic illness impacts, and is managed, by these women leads health care professionals to a greater understanding of being older and living with comorbid chronic illness. The findings of this research may assist nurses working alongside older people to focus on the making of meaning,which may facilitate these people to retain a sense of autonomy and control over their life.</p>

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Problems in the delivery of medical care to the frail elderly in the community

Cited by 4 publications

References 8 publications

Palliative Care in Overdrive: Patients in Danger

Palliative Care in Overdrive: Patients in Danger

Integrated care management: applying control theory to networks

A Descriptive Research Study on Factors that Impact Upon the Quality of Life of Elderly Women with Comorbid Chronic Illnesses; Three Women's Perspectives

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