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Care for Elderly People in the European Community

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Abstract

All EEC countries are faced with an ageing population, which means an increase of people in some way handicapped in everyday activities. A comparison of the solutions adopted by several EEC countries in the sectors of housing, home care services, residential and nursing homes shows that a real medico-social policy has been worked out only in Denmark and the Netherlands. In France and the United Kingdom, public authorities have certainly defined policies which lay claim to providing overall coverage but they have not provided corresponding resources. In Germany and in Italy there is no clearly defined policy. Here we discuss the various factors which may account for these differences.

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Background By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov). Selection Criteria Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality. The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication. There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues. Authors' Conclusions There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.
Article
The absence of old age as a specific social group in some cultures raises the question of ageing as a cultural construction. In this paper we will consider only problems of cultural ageing in industrial Western society and especially in some OECD countries. There, demographic changes have been characterised by ageing of populations, visible since the fifties, by feminization of later life and modifications of social network. Ageing of population including the oldest generations have made definitions of later life more politicized and have gone together with new attitudes towards ageing and elderly people giving rise to different patterns of ageism. Examination of incomes, health status, social support of the elderly shows that until today there have been persistent inequalities related to age, gender and social class in terms of resources, access to informal and formal care and value accorded to later life. These inequalities are due to differences in status and resources of elderly and trajectories of ageing, always conditioned by social locations: position in labour market and in domestic division of labour with resulting social relations. The differences vary also between countries according to their welfare regime and their social policy. In the future, the proportion of those over 65 of age and among them of those ever 80 will be greater raises the questions of health status of the oldest generations, income distribution among generations and genders, of access to informal and formal care and adequacy of the later for the frail elderly. To cope with those issues ageing and later life should be considered in a life-span perspective. Better sharing of jobs and of economic wealth, development of meaningful activities other than work may be solutions to answer to the questions addressed by an ageing population and the problems of later life.
Article
In the early 1960s, old age in France was replaced by the notion of "troisième âge," a new definition stressing the possibility of pursuing social and leisure activities and greater independence. Old age itself was postponed to a later age, and acquired a purely negative image and one confused with that of incurable illness. As a result, a living-at-home policy was elaborated, and also a program of adapting institutions to the problems of those now defined as being in the "quatrième âge." This dual-faceted medicosocial policy was originally intended to be comprehensive and coordinated. Analysis of the structural characteristics of the care providers and of the agencies responsible for organization and financing of services shows fragmentation at the levels of service delivery and policy development. This prevents the coordination of service provision, gives rise to a mismatch between people and provision, and leads to a lack of coherent regulation and of adequate financing, in particular with regard to domiciliary care and social services. External factors, such as scarcity of funds related to the economic crisis, reinforce system dysfunctions.
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