Alex Hall

The ability to manage money is vital for independent living, especially for older people who must navigate major financial decisions about retirement income, benefits, housing, and care (Price, 201...

The ability to manage money is essential for independent functioning but highly sensitive to cognitive decline. Managing money involves more than deploying skills rationally; it is influenced by a range of emotional and psychosocial factors. There is relatively little knowledge about how older adults, families and care professionals working with older people navigate and experience potential challenges of declining mental capacity to manage money. This article draws on a UK-based study involving 13 older people and/or family members and 28 social sector professionals, and their experiences of supporting older people with cognitive decline to manage money, triangulated with public information resources from major national organisations across the health, care, consumer and charity sectors. It focuses on the emotive and personal nature of cognitive decline and money management. Declining mental capacity to manage money can strike at the core of people’s sense of who they are, leading to strong tensions and difficulties in discussing support. Support to manage money is often framed in discussions as ‘there if we need it’; this can be reassuring for people, but may be challenged if there are subsequent disagreements and changes in perspectives about the detail and timing of support. These nuances are not well reflected in public information resources, which largely emphasise administrative procedure. Financial organisations may lack empathy that declining mental capacity to manage money is extremely challenging. The article highlights a greater need for recognition of the emotional and psychosocial complexities presented by declining mental capacity to manage money in later life.

As the numbers of displaced persons across the world grows, research methodologies need to develop to be able to understand these lived experiences in context. This paper draws on key learning points from a project which worked with older women who have applied for asylum in the UK, and specifically in England - a cohort often overlooked by research and practice - to understand their experiences of ageing in this country. Our aim is to provide unique insights into the design and methodological elements of conducting research with older women who seek asylum or are refugees. More specifically, we discuss and explore methodological innovations with oral history approaches to meaningfully and sensitively account for experiences and potential futures of healthy ageing. Our findings focus on three key methodological learning points: from the personal to the universal (study design); participatory oral history (data collection); and oral history for future change (outcomes). To close, we discuss the implications of our research findings and the limitations and strengths of this original project which used a novel application of the methodology, “Oral Histories and Futures”.

How quality of care in homecare for older people is understood is important, because it influences how quality in homecare is delivered, improved, regulated and measured. We conducted a scoping review to summarise the meanings of homecare quality for key stakeholders and identify measures of homecare quality. We searched four databases (CINAHL, PsycINFO, ASSIA and Social Care Online) for peer-reviewed literature from high-income countries, and websites of major UK organisations for grey literature, published between 2016 and 2023. Articles were included if they reported views of any stakeholder on quality of care in the context of homecare for older people (aged 65 and above). Data were summarised using a qualitative content analysis approach to identify key dimensions of quality. Overall, 93 articles from 16 countries were included. Research focussed on understanding the views of four groups: older people, family carers, care workers and service providers. Homecare quality is understood as a multi-dimensional concept. We identified four dimensions: (1) relationships and continuity of care; (2) bespoke care; (3) organisational and structural aspects of care; and (4) understanding of quality as a measurable construct. Notable gaps in the literature include a lack of evidence on how older people form and articulate their preferences for homecare; a lack of consensus on care quality measurement; and a lack of focus on optimal models of care provision within existing budgets. Many crucial perspectives were absent, including owners of homecare organisations, inspectors and assessors involved in regulation of homecare services, and the legal or advocacy professions. There is a wealth of evidence about how homecare quality for older people is understood. These understandings are largely consistent across different constituencies and countries. It is less clear how this shared vision of high quality homecare might be realised within existing systems.

Background: Infection prevention and control (IPC) is vital in care homes as it can reduce morbidity and mortality by 30%. Ensuring good IPC practice is a perennial challenge in the varied and complex context of care homes. Behavior change interventions delivered via digital technology may be effective in improving IPC among care home staff. Objective: This study aimed to evaluate how an evidence-based, digital behavior change intervention called Germ Defence can be rapidly adapted to meet the needs of care homes. Methods: This study applied the person-based approach, which emphasizes iterative approaches to optimizing interventions via individual user feedback. Phase 1 involved initial edits to the website by the research team to create Germ Defence for Care Homes (GDCH) version 1. Phase 2 consisted of stakeholder consultation on GDCH version 1 followed by edits to create GDCH version 2. The formal research (phases 3 and 4) involved individual think-aloud interviews with 21 staff members from management, care, and ancillary positions in 4 care homes providing real-time feedback as they worked through GDCH. Edits were made to create GDCH version 3 between phases 3 and 4. During the development of GDCH versions 2 and 3, it became clear that the intervention would need more fundamental changes beyond the pragmatic, incremental changes that would be possible within the scope of this study. Analysis was completed via a rapid, qualitative descriptive approach to develop a high-level summary of key findings from the interview data. Results: There were mixed results about the attractiveness of GDCH and its suitability to the care home context. Participants felt that the images needed to be aligned much more closely with the meaning of adjacent text. Many participants felt that they would not have time to read a text-based website, and some suggested that more engaging content, including audio and video, may be preferable. Most participants felt that the overall concept of Germ Defence was clearly relevant to their context. Some felt that it might be a useful introduction for new staff members or a refresher for current staff, but others felt that it did not add anything to their existing IPC training. There were mixed opinions about the level of detail provided in the information offered by the site. While the goal-setting behavior change mechanism may have potential, the findings suggested that it may be unsuitable for care homes and more work is needed to refine it. Conclusions: Much more work needs to be done to make Germ Defence more engaging, accessible, and relevant to the care home workforce. Our study highlights the challenges of rapidly adapting an existing intervention to a new context. Future research in this area will require a pragmatic methodological approach with a focus on implementation.

Objectives: There is no guidance to support the reporting of systematic reviews of mobile health (mhealth) apps (app reviews), so authors attempt to use/modify the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). There is a need for reporting guidance, building on PRISMA where appropriate, tailored to app reviews. The objectives were to describe the reporting quality of published mHealth app reviews, identify the need for, and develop potential candidate items for a reporting guideline. Materials and Methods: A scoping review following the Joanna Briggs Institute and Arksey and O’Malley approaches. App reviews were identified in January 2024 from SCOPUS, CINAHL, AMED, EMBASE, Medline, PsycINFO, ACM Digital Library, snowballing reference lists, and forward citation searches. Data were extracted into Excel and analyzed using descriptive statistics and content synthesis, using PRISMA items as a framework. Results: One hundred and seventy-one app reviews were identified, published from 2013 to 2024. Protocols were developed for 11% of the reviews, and only 52% reported the geographical location of the app markets. Few reported the duplicate removal process (12%), device and operating system used (30%), or made clear recommendations for the best-rated apps (18%). Nineteen PRISMA items were not reported by most (>85%) reviews, and 4 were modified by >30% of the reviews. Involvement of patient/public contributors (4%) or other stakeholders (11%) was infrequent. Overall, 34 candidate items and 10 subitems were identified to be considered for a new guideline. Discussion and Conclusion: App reviews were inconsistently reported, and many PRISMA items were not deemed relevant. Consensus work is needed to revise and prioritize the candidate items for a reporting guideline for systematic app reviews.

Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales—people of South Asian, Black African, and Caribbean backgrounds—in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services.

Introduction Informal caregivers are essential in supporting end-of-life patients at home but are often ill-prepared for the carer role. There is growing interest in the development of tools to assess caregiver support needs and a recognised need for a greater focus on addressing inequities in end-of-life care. We plan to undertake a scoping review of available literature to (1) identify and describe tools developed to assess the support needs of informal caregivers in end-of-life care; (2) report on any inequities and under-represented groups in tool development and use. Methods and analysis The review will conform to best practice methodological guidance (Joanna Briggs Institute) for scoping reviews. The search strategy will target published and unpublished studies using any methodology, which reports on developing or using tools or measures to assess informal carer support needs in end-of-life/palliative care settings. The following databases will be searched: MEDLINE, CINAHL, PsycINFO, Web of Science, ASSIA and Proquest. Both title/abstract screening and full-text assessment will be undertaken to ensure eligibility. Searches will be conducted between May and December 2024. We will extract data relating to (1) tools/measures identified, and outcome measures used to assess these; (2) participant characteristics. Extracted data will be tabulated with accompanying narrative description to address the review objectives. Data will be extracted and write-up will be completed between January and May 2025. Ethics and dissemination This scoping review will provide an overview of the tools developed to identify and assess informal caregiver support needs in palliative and end-of-life care. The identification of any inequities will increase awareness of potentially underserved groups and contexts within the current literature, highlighting how future research and resource can be more equitably focused and implemented in a way that does not further embed disparity. Findings will be made publicly available through the Open Science Framework and disseminated through a peer-reviewed publication. As a scoping review of available literature, this work does not require ethical approval.

BACKGROUND Infection prevention and control (IPC) is vital in care homes as it can reduce morbidity and mortality by 30%. Ensuring good IPC practice is a perennial challenge in the varied and complex context of care homes. Behavior change interventions delivered via digital technology may be effective in improving IPC among care home staff. OBJECTIVE This study aimed to evaluate how an evidence-based, digital behavior change intervention called Germ Defence can be rapidly adapted to meet the needs of care homes. METHODS This study applied the person-based approach, which emphasizes iterative approaches to optimizing interventions via individual user feedback. Phase 1 involved initial edits to the website by the research team to create Germ Defence for Care Homes (GDCH) version 1. Phase 2 consisted of stakeholder consultation on GDCH version 1 followed by edits to create GDCH version 2. The formal research (phases 3 and 4) involved individual think-aloud interviews with 21 staff members from management, care, and ancillary positions in 4 care homes providing real-time feedback as they worked through GDCH. Edits were made to create GDCH version 3 between phases 3 and 4. During the development of GDCH versions 2 and 3, it became clear that the intervention would need more fundamental changes beyond the pragmatic, incremental changes that would be possible within the scope of this study. Analysis was completed via a rapid, qualitative descriptive approach to develop a high-level summary of key findings from the interview data. RESULTS There were mixed results about the attractiveness of GDCH and its suitability to the care home context. Participants felt that the images needed to be aligned much more closely with the meaning of adjacent text. Many participants felt that they would not have time to read a text-based website, and some suggested that more engaging content, including audio and video, may be preferable. Most participants felt that the overall concept of Germ Defence was clearly relevant to their context. Some felt that it might be a useful introduction for new staff members or a refresher for current staff, but others felt that it did not add anything to their existing IPC training. There were mixed opinions about the level of detail provided in the information offered by the site. While the goal-setting behavior change mechanism may have potential, the findings suggested that it may be unsuitable for care homes and more work is needed to refine it. CONCLUSIONS Much more work needs to be done to make Germ Defence more engaging, accessible, and relevant to the care home workforce. Our study highlights the challenges of rapidly adapting an existing intervention to a new context. Future research in this area will require a pragmatic methodological approach with a focus on implementation.