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Evaluation of an Innovation in the Continuing Care of Very Frail Elderly People

Published online by Cambridge University Press:  14 November 2008

John Bond ,
Senga Bond ,
Cam Donaldson ,
Barbara Gregson  and
Ann Atkinson
John Bond
Affiliation:
Health Care Research Unit, The University, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK.
Senga Bond
Affiliation:
Health Care Research Unit, The University, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK.
Cam Donaldson
Affiliation:
Department of Public Health, A27 Fisher Road, University of Sydney, NSW 2006, Australia.
Barbara Gregson
Affiliation:
Health Care Research Unit, The University, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK.
Ann Atkinson
Affiliation:
Policy Services Unit, Newcastle City Council, Civic Centre, Newcastle upon Tyne NE1 8QN, UK.
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Abstract

This paper describes the theoretical and methodological perspectives adopted by a multidisciplinary research group undertaking a government-funded evaluation of a United Kingdom innovation in the continuing care of elderly people. In 1983 three experimental National Health Service (NHS) nursing homes were set up to care for patients usually cared for in NHS geriatric hospitals. Drawing on different approaches to the evaluation of health-care innovations, this paper delineates an evaluation model which identifies four types of variables: structure, process, intermediate outcome and final outcome. The relationship of this model to the design of an evaluation comprising seven complementary research activities is described, emphasising the need for multiple perspectives and multiple methods in policy-oriented health-care evaluations.

Type
Research Article
Information
Ageing & Society , Volume 9 , Issue 4 , December 1989 , pp. 347 - 381
Copyright
Copyright © Cambridge University Press 1989

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References

NOTES

1 Wicks, M. and Rossiter, C.Crises or Challenge? Family Care, Social Policy and Elderly People. Study Commission on the Family, London, 1980Google Scholar; Parker, G.With Due Care and Attention. A Review of Research on Informal Care. Family Policy Studies Centre, London, 1985Google Scholar; Anderson, R.The unremitting burden on carers. British Medical Journal, 294 (1987), 73–74.CrossRefGoogle ScholarPubMed

2 Thomson, D.Workhouse to nursing home: residential care of elderly people in England since 1840. Ageing and Society, 3 (1983), 41–69.CrossRefGoogle Scholar

3 Isaacs, B. and Neville, Y.The Management of Need in Old People. Scottish Home and Health Department Studies No. 34. Scottish Home and Health Department, Edinburgh, 1975.Google Scholar

4 Brocklehurst, J. C.Geriatric Care in Advanced Societies. MTP, Lancaster, 1975CrossRefGoogle Scholar; Hall, M. R. P. ‘Geriatric medicine today’, in Wells, N. and Freer, C. (eds), The Ageing Population. Burden or Challenge? Macmillan Press, London, 1988.Google ScholarPubMed

5 Andrews, K. and Brocklehurst, J.British Geriatric Medicine in the 1980s. King Edward's Hospital Fund, London, 1987Google Scholar; Lewis, R. and Wattis, J.Continuing care of old people – a medical viewpoint. Ageing and Society, 8 (1988), 189–209.CrossRefGoogle Scholar

6 Maguire, P. A., Taylor, I. C. and Stout, R. W.Elderly patients in acute medical wards: factors predicting length of stay in hospital. British Medical Journal, 292 (1986), 1251–1253.CrossRefGoogle ScholarPubMed

7 Lewis, and Wattis, , op. cit.Google Scholar

8 Evers, H. K.The creation of patient careers in geriatric wards: aspects of policy and practice. Social Science and Medicine, 15A (1981), 581–588.Google Scholar

9 Kitson, A. L. Steps toward the Identification and Development of Nursing's Therapeutic Function in the Care of the Hospitalised Elderly. Unpublished Ph.D. thesis, the New University of Ulster, 1984.Google Scholar

10 Norton, D., McLaren, R. and Exton Smith, A. N.An Investigation of Geriatric Nursing Problems in Hospital. Churchill Livingstone, Edinburgh, 1962.Google Scholar

11 Evers, , op. cit.Google Scholar

12 Kitson, , op. cit.Google Scholar

13 Wells, T.Problems in Geriatric Nursing Care. A Study of Nurses' Problems in Care of Old People in Hospital. Churchill Livingstone, Edinburgh, 1980.Google Scholar

14 Brocklehurst, J. C. ‘Geriatric services and the day hospital’, in Brocklehurst, J. C. (ed.), Textbook of Geriatric Medicine and Gerontology, second edition. Churchill Livingstone, Edinburgh, 1978Google Scholar; Hodkinson, H. M.An Outline of Geriatrics. Academic Press, London, 1981.Google Scholar

15 Willcocks, D., Peace, S. and Kellaher, L.Private Lives in Public Places. Tavistock, London, 1987.Google Scholar

16 Larder, D., Day, P. and Klein, R.Institutional Care for the Elderly: the Geographical Distribution of the Public/Private Mix in England. Bath Social Policy Unit, University of Bath, 1986.Google Scholar

17 Laing, W.Laing's Review of Private Health Care. Laing & Buisson, London, 1988.Google Scholar

18 Larder, et al. , op. cit.Google Scholar

19 Lewis, and Wattis, , op. cit.Google Scholar

20 Goffman, E.Asylums. Essays on the Social Situation of Mental Patients and Other Inmates. Anchor, New York, 1961.Google Scholar

21 Townsend, P.The Last Refuge. A Survey of Residential Institutions and Homes for the Aged in England and Wales. Routledge & Kegan Paul, London, 1962.Google Scholar

22 Miller, E. J. and Gwynne, G. V.A Life Apart. A Pilot Study of Residential Institutions for the Physically Handicapped and the Young Chronic Sick. Tavistock Publications, London, 1972.Google Scholar

23 Baker, D. E. Attitudes of Nurses to the Care of the Elderly. Unpublished Ph.D. Thesis, University of Manchester, 1978Google Scholar; Evers, , op. cit.Google Scholar

24 Wolfensberger, W.Normalisation: One Principle of Normalisation in Human Services. Leonard Crainford, Toronto, 1972.Google Scholar

25 Department of Health and Social Security. Ageing in the United Kingdom. DHSS, London, 1982.Google Scholar

26 Department of Health and Social Security. The Experimental National Health Service Nursing Homes for Elderly People. An Outline. DHSS, London, 1983.Google Scholar

27 Cook, T. D. and Shadish, W. R.Program evaluation: the worldly science. Annual Review of Psychology, 37 (1986), 193–232.CrossRefGoogle Scholar

28 Report of the Royal College of Physicians. Medication for the elderly. Journal of the Royal College of Physicians of London, 18 (1984), 3–10.Google Scholar

29 Willcocks, A. J.The Creation of the National Health Service. A study of Pressure Groups and a Major Social Policy Decision. Routledge & Kegan Paul, 1967.Google Scholar

30 Evans, J. G. ‘Hospital care for the elderly’, in Shegog, R. F. A. (ed.), The Impending Crisis of Old Age: A Challenge to Ingenuity. Oxford University Press for the Nuffield Provincial Hospitals Trust, London, 1981, pp. 133–146.Google Scholar

31 Capewell, A. E., Primrose, W. R. and Maclntyre, C.Nursing dependency in registered nursing homes and long-term care geriatric wards in Edinburgh. British Medical Journal, 292 (1986), 1719–1721CrossRefGoogle ScholarPubMed; Bennett, J.Private nursing homes: contribution to long-stay care of the elderly in the Brighton Health District. British Medical Journal, 293 (1986), 867–870.CrossRefGoogle ScholarPubMed

32 Department of Health and Social Security, The Way Forward. HMSO, London, 1977Google Scholar; Department of Health and Social Security. A Happier Old Age. DHSS, London, 1978.Google Scholar

33 Department of Health and Social Security. Growing Older, Cmnd. 8173. HMSO, London, 1981Google Scholar; House of Commons Parliamentary Debate. Weekly Hansard, 1230. HMSO, London, 1982.Google Scholar

34 DHSS, 1983, op. cit. para. 1.3.Google Scholar

35 Ibid.

36 Weiss, C. H.Research for policy's sake: the enlightenment function of social research. Policy Analysis, 3 (1977), 531–545.Google Scholar

37 Cook, and Shadish, , op. cit.Google Scholar

38 Graham, J.The experimental National Health Service nursing homes. Age and Ageing, 12 (1983), 273–274.CrossRefGoogle Scholar

39 Yin, R. K.Studying phenomenon and context across sites. American Behavioral Scientist, 26 (1982), 84–100.CrossRefGoogle Scholar

40 Yin, R. K.Case Study Research. Design and Methods. Sage, London, 1984.Google Scholar

41 Donabedian, A.The Definition of Quality and Approaches to its Assessment. Health Administration Press, Ann Arbor, Michigan, 1980.Google Scholar

42 Ibid. p. 81.

43 Davies, B. and Knapp, M.Old People's Homes and the Production of Welfare. Routledge & Kegan Paul, London, 1981.Google Scholar

44 Department of Health and Social Security. Health and Personal Social Services Statistics for England, 1987 edition. HMSO, London, 1987.Google Scholar

45 Brocklehurst, J. C. and Andrews, K.Nurse staffing in geriatric wards. Nursing Times Occasional Paper, 83 (1987), 48–51.Google ScholarPubMed

46 Brocklehurst, , 1978, op. cit.Google Scholar; Hodkinson, , op. cit.Google Scholar

47 Department of Health and Social Security, Mix and Match. A Review of Nursing Skill Mix. DHSS, London, 1986Google Scholar; Brocklehurst, and Andrews, , op. cit.Google Scholar; Reid, N.Nursing Hours Per Patient Day – A Study of Geriatric Wards in Northern Ireland. University of Ulster, 1987.Google Scholar

48 Rhys-Hearn, C.Staffing geriatric wards: Trials of a package. Nursing Times Occasional Paper, 75 (1979), 45–48, 52.Google Scholar

49 Norwich, H. S.A study of nursing care in geriatric hospitals. Nursing Times, 76 (1980), 292–295.Google ScholarPubMed

50 Savage, B., Widdowson, T. and Wright, T. ‘Improving the care of the elderly’, in Towell, D. and Harris, C. (eds), Innovations in Patient Care: An Action Research Study of Change in a Psychiatric Hospital. Groom Helm, London, 1979.Google Scholar

51 Ball, J. and Oreschnick, R.Balanced formulae. Senior Nurse, 5 (1987), 30–32.Google Scholar

52 Lemke, S. and Moos, R. H.Quality of residential settings for elderly adults. Journal of Gerontology, 41 (1986), 268–276.CrossRefGoogle ScholarPubMed

53 Willcocks, et al. , op. cit.Google Scholar

54 Ibid.

55 Garibaldi, R. A., Brodine, R. N. and Matsumiya, R. N.Infections among patients in nursing homes. New England Journal of Medicine, 305 (1981), 731–735.CrossRefGoogle ScholarPubMed

56 Stryker, R.How to Reduce Employee Turnover in Nursing Homes and Other Health Organisations. G. C. Thomas, Springfield, Illinois, 1981.Google Scholar

57 Andrews, K. and Brocklehurst, J.Provision of remedial therapists in geriatric medicine. British Medical Journal, 289 (1984), 661.CrossRefGoogle ScholarPubMed

58 Baker, , op. cit.Google Scholar

59 Fielding, P.Attitudes Revisited: An Examination of Student Nurses' Attitudes Towards Old People in Hospital. Royal College of Nursing, London, 1986.Google Scholar

60 United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Project 2000: A Neva Preparation for Practice. UKCC, London, 1986.Google Scholar

61 Wells, , op. cit.Google Scholar

62 Fielding, , op. cit.Google Scholar

63 Kitson, , op. cit.Google Scholar

64 Evers, , op. cit.Google Scholar

65 Lawton, M. P., Environment and Ageing. Brooks/Cole, Co. Monterey, Cal., 1980, p. 14.Google Scholar

66 Willcocks, et al. , op. cit.Google Scholar

67 Lawton, M. P.Institutions for the aged: theory, content and methods for research. Gerontologist, 10 (1970), 305–312.CrossRefGoogle ScholarPubMed

68 Canter, D. and Canter, S. (eds), Designing for Therapeutic Environments: A Review of Research. Wiley, Chichester, 1979.Google Scholar

69 Rowles, G.The surveillance zone as meaningful space for the aged. Gerontologist, 21 (1981), 304–311.CrossRefGoogle ScholarPubMed

70 Kitson, , op. cit.Google Scholar

71 Wallis, D. and Cope, D. ‘Pay-off conditions for organisational change in the hospital service’, in Duncan, K. D., Gruneberg, M. M. and Wallis, D. (eds), Changes in Working Life. Wiley, London, 1980, pp. 459–480.Google Scholar

72 Baker, , op. cit.Google Scholar

73 Wade, B., Sawyer, L. and Bell, J.Dependency with Dignity, Occasional Papers on Social Administration, No. 68. Bedford Square Press, London, 1983.Google Scholar

74 Report of the Royal College of Physicians, op. cit.Google Scholar

75 Evers, , op. cit.Google Scholar

76 Miller, A.A study of the dependency of elderly patients in wards using different methods of nursing care. Age and Ageing, 14 (1985), 132–138.CrossRefGoogle ScholarPubMed

77 King, R. D. and Raynes, N. V.An operational measure of inmate management in residential institutions. Social Science and Medicine, 2 (1968), 41–53.CrossRefGoogle Scholar

78 Evans, G., Hughes, B., Wilkin, D. and Jolley, D.The Management of Mental and Physical Impairment in Non-Specialist Residential Homes for the Elderly, Research Report No. 4. Departments of Psychiatry and Community Medicine, University of Manchester, 1981Google Scholar; Wade, et al. , op. cit.Google Scholar; Booth, T.Home Truths. Old People's Homes and the Outcome of Care. Gower, Aldershot, 1985Google Scholar; Willcocks, et al. , op. cit.Google Scholar

79 Ibid. p. 121.

80 Wade, et al. , op. cit.Google Scholar

81 Goldberg, E. M. and Connelly, N.The Effectiveness of Social Care for the Elderly. Heinemann, London, 1982, pp. 272–273.Google Scholar

82 Dick, D.The institutional trap. Nursing Times, 81 (1985), 47–48.Google ScholarPubMed

83 Moos, R. H., Gauvain, M., Lemke, S., Max, W. and Mehren, B.Assessing the social environments of sheltered care settings. Gerontologist, 19 (1979), 74–82.CrossRefGoogle ScholarPubMed

84 Lemke, and Moos, , op. cit.Google Scholar

85 Pincus, A.The definition and measurement of the institutional environment in homes for the aged. Gerontologist, 8 (1968), 207–210CrossRefGoogle ScholarPubMed; Pincus, A. and Wood, V.Methodological issues in measuring the environment in institutions for the aged and its impact on residents. Ageing and Human Development, 1 (1970), 117–126.CrossRefGoogle Scholar

86 Sinclair, I.Hostels for Probationers. Home Office Research Studies No. 6. HMSO, London, 1971.Google Scholar

87 Cawson, P. and Perry, J.Environmental correlates of attitude among residential staff. British Journal of Criminology, 17 (1977), 141–156.CrossRefGoogle Scholar

88 Martin, D. N.Disruptive behaviour and staff attitudes at the St. Charles' youth treatment centre. Child Psychology and Psychiatry, 18 (1977), 1221–1228.CrossRefGoogle Scholar

89 Pembrey, S.The Ward Sister – Key to Nursing: A Study of the Organisation of Individualised Nursing. Royal College of Nursing, London, 1980Google Scholar; Runciman, P. J.Ward Sister at Work. Churchill Livingstone, Edinburgh, 1983.Google Scholar

90 Baker, , op. cit.Google Scholar

91 Lipman, A. and Slater, R.Status and spatial appropriation in eight homes for old people. Gerontologist, 17 (1977), 250–255.CrossRefGoogle ScholarPubMed

92 Finlay, O. E., Bayles, T. B., Rozan, C. and Milling, J.Effects of chair design, age and cognitive status on mobility. Age and Ageing, 12 (1983), 329–335.CrossRefGoogle ScholarPubMed

93 Willcocks, et al. , op. cit.Google Scholar

94 Donabedian, , op. cit.Google Scholar

95 Kushlick, A. and Blundon, R.Proposals for Setting Up and Evaluation of an Experimental Service for the Elderly. Research Report No. 107. Health Care Evaluation Research Team.Google Scholar

96 Godlove, C., Richard, L. and Rodwell, G.Time for Action. An Observation Study of Elderly People in Four Different Care Environments. Joint Unit for Social Services Research, University of Sheffield, 1982.Google Scholar

97 McFadyen, M. ‘The measurement of engagement in the institutionalised elderly’, in Hanley, I. and Hodge, J. (eds), Psychological Approaches to the Care of the Elderly. Croom Helm, London, 1984, pp. 136–163.Google Scholar

98 Gupta, H.Can we de-institutionalise an institution? Concord, 13 (1979), 47–57.Google Scholar

99 Adams, J.A change of scene: I Ridge Hill, or home not a ward: features of the bungalow. Nursing Times, 75 (1979), 1659–1661.Google ScholarPubMed

100 Davies, and Knapp, , op. cit.Google Scholar

101 Elliott, J. R.Living in Hospital: The Social Needs of People in Long Term Care. King Edward's Hospital Fund, London, 1975.Google Scholar

102 Davies, A. D. M. and Snaith, P. A.Mealtime problems in a continuing care hospital for the elderly. Age and Ageing, 9 (1980), 100–105CrossRefGoogle Scholar; Davies, A. D. M. and Snaith, P. A.The social behaviour of geriatric patients at meal times: an observational and interventional study. Age and Ageing, 9 (1980), 93–99.CrossRefGoogle Scholar

103 Kay, D. W. K., Bergmann, K., Foster, E. and Garside, R. S.A 4-year follow-up of a random sample of old people originally seen in their homes. A physical, social and psychiatric enquiry. Proceedings of the IV Congress of Psychiatry, 150 (1966), 1668–1670.Google Scholar

104 Townsend, P. ‘On the likelihood of admission to an institution’, in Shanas, E. and Streib, G. F. (eds), Social Structure and the Family Generational Relations. Prentice-Hall Inc., New York, 1965, pp. 163–187.Google Scholar

105 Bourestom, N. and Tars, S.Alterations in life patterns following nursing home relocation. Gerontologist, 14 (1974), 506–510.CrossRefGoogle ScholarPubMed

106 MacDonald, A. J. D., Mann, A. H., Jenkins, R., Richard, L., Godlove, C. and Rodwell, G.An attempt to determine the impact of four types of care upon the elderly by the study of matched groups. Psychological Medicine, 12 (1982), 193–200.CrossRefGoogle Scholar

107 Wilkin, D.Conceptual problems in dependency research. Social Science and Medicine, 24 (1987), 867–873.CrossRefGoogle ScholarPubMed

108 Walker, A.Dependency and old age. Social Policy and Administration, 16 (1982), 115–135.CrossRefGoogle Scholar

109 Pattie, A. H., Gilleard, C. J. and Bell, J. H.The Relationship of the Intellectual and Behavioural Competence of the Elderly to their Present and Future Needs from the Community, Residential and Hospital Services. Department of Clinical Psychology, Clifton Hospital, York, 1979.Google Scholar

110 Miller, , op. cit.Google Scholar

111 Townsend, J. and Kimbell, A.Caring regimes in elderly persons' homes. Health and Social Service Journal, 11 10 (1975), p. 2286.Google Scholar

112 Booth, , op. cit.Google Scholar

113 Op. cit.

114 Mitchell, J. B.Patient outcomes in alternative long-term care settings. Medical Care, 16 (1978), 439–452.CrossRefGoogle ScholarPubMed

115 Chekryn, J. and Roos, L.Auditing the process of care in a new geriatric unit. Journal of the American Geriatric Society, 27 (1979), 62–72.CrossRefGoogle Scholar

116 Willcocks, et al. , op. cit.Google Scholar

117 Op. cit.

118 White, K.Nurse recruitment and retention in long-term care. Journal of Long-Term Care Administrators, 7 (1980), 25–36.Google Scholar

119 Op. cit.

120 Op. cit. p. 275.

121 Evans, J. G.Prevention of age-associated loss of autonomy: epidemiological approaches. Journal of Chronic Diseases, 37 (1984), 353–363.CrossRefGoogle Scholar

122 Goldfarb, A. I.Predicting mortality in the institutionalised aged. Archives of General Psychiatry, 21 (1969), 172–176CrossRefGoogle Scholar; Whitehead, A. and Hunt, A.Elderly psychiatric patients: 5-year prospective study. Psychological Medicine, 12 (1982), 149–157.CrossRefGoogle Scholar

123 Christie, A. B.Changing patterns in mental illness in the elderly. British Journal of Psychiatry, 140 (1982), 154–159CrossRefGoogle ScholarPubMed; Blessed, G. and Wilson, D.The contemporary natural history of mental disorder in old age. British Journal of Psychiatry, 141 (1982), 59–67.CrossRefGoogle ScholarPubMed

124 Smith, R. G. and Lowther, C. P.Follow-up study of 200 admissions to a residential home. Age and Ageing, 5 (1976), 176–180.CrossRefGoogle Scholar

125 Op. cit.

126 Brauer, E., Mackeprang, B. and Bentzon, M. W.Prognosis of survival in a geriatric population. Scandinavian Journal of Social Medicine, 6 (1978), 17–24CrossRefGoogle Scholar; Donaldson, L. J. and Jagger, C.Survival and functional capacity: three year follow up of an elderly population in hospitals and homes. Journal of Epidemiology and Community Health, 37 (1983), 176–179CrossRefGoogle ScholarPubMed; Hodkinson, H. M. and Hodkinson, I.Death and discharge from a geriatric department. Age and Ageing, 9 (1980), 220–228.CrossRefGoogle ScholarPubMed

127 Neugarten, B. L., Havighurst, R. J. and Tobin, S. S.The measurement of life satisfaction. Journal of Gerontology, 16 (1961), 134–143.CrossRefGoogle ScholarPubMed

128 Ibid.

129 Luker, K. A.Measuring life satisfaction in an elderly female population. Journal of Advanced Nursing, 4 (1979), 503–511.CrossRefGoogle Scholar

130 Bradburn, N. M.The Structure of Psychological Well-being. Aldine, Chicago, Ill., 1969.Google Scholar

131 Lawton, M. P. ‘The dimensions of morale’, in Kent, D. P. (ed.), Research Planning and Action for the Elderly. Behavioural Publications, New YorkGoogle Scholar; Lawton, M. P.The PGC morale scale: A revision. Journal of Gerontology, 30 (1975), 85–89.CrossRefGoogle ScholarPubMed

132 Op. cit.

133 Ibid. p. 103.

134 Williams, A.Economics of coronary artery by-pass grafting. British Medical Journal, 291 (1985), 326–329.CrossRefGoogle Scholar

135 Donaldson, C. R., Atkinson, A., Bond, J. and Wright, K.QALYs and long-term care for elderly people in the UK: scales of assessment of quality of life. Age and Ageing, 17 (1988), 379–387.CrossRefGoogle ScholarPubMed

136 Cronbach, L. J.Designing Evaluations of Educational and Social Programs. Jossey-Bass, London, 1982.Google Scholar

137 Bond, J. ‘Evaluation of long-stay accommodation for elderly people’, in Bromley, D. B. (ed.), Gerontology: Social and Behavioural Perspectives. Croom Helm, London, pp. 88–101Google Scholar; Bond, J., Atkinson, A., Bond, S., Donaldson, C., Gregson, B. A. and Hally, M. R.Evaluation of Long-stay Accommodation for Elderly People: First Interim Report, Volume I, Protocol and Progress Report. Health Care Research Unit, University of Newcastle upon Tyne, 1986.Google Scholar

138 Bond, J. and Bond, S.Sociology and Health Care. An Introduction for Nurses and other Health Care Professions. Churchill Livingstone, Edinburgh, 1986.Google Scholar

139 Cronbach, , op. cit.Google Scholar

140 Weiss, , op. cit.Google Scholar