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In recent years dignity in care has become a priority and the focus of a number of government reports and policy initiatives (DH 2003, 2007; SCIE 2006; Healthcare Commission, 2007). The National Service Framework for Older People (DH 2001) and its follow up document, (DH 2006a) emphasised the pivotal position of maintaining and improving care for older people. However, despite considerable political support, there continues to be a problem in health and social care related to preserving the dignity of older people (Levenson, 2007). Generalised policy statements appear to have little effect on actual practice and care unless they are operational, supported by guidelines for practice and actively monitored.\ud There has been an increase in studies of dignity in health care over the past few years (Chochinov et al., 2002a, Woolhead et al., 2006) particularly focusing on the ways in which dignity is defined and what it means to people. There have, however, been far fewer studies on the relationship between dignity and personal care particularly when that care involves sensitive issues, of which continence care is a prime example. This report provides the initial analysis of emerging themes and findings from the first phase of a qualitative study of privacy and dignity in continence care for older people.

This report provides an account of the methods and findings of Phase 2 of the Privacy and Dignity in Continence Care for Older People study funded by the Royal College of Physicians and the British Geriatrics Society.\ud The overall objectives of this two year project were to:\ud • Identify and validate person-centred attributes of dignity in relation to continence;\ud • Develop reflective guidelines for dignified care;\ud • Produce recommendations for best practice.

These guidelines are based on the findings from the project ‘Privacy and Dignity in Continence Care for Older People’, funded and supported by the Royal College of Physicians and British Geriatrics Society. The aim of this two year project was to develop a set of guidelines that can help caregivers in a variety of health and social care settings reflect on their practice with respect to maintaining privacy and dignity in continence care. Other dignity guidelines and toolkits have been developed, but not with the focus specifically on continence. The rationale for this is that, however good the care, people with continence problems in an institutional setting have a high chance of suffering loss of dignity because they need help with very intimate care, and this can have a long term effect on self-esteem and self-respect.

Chez les personnes âgées, l’hospitalisation est en général un moment-clef. Pour quelles raisons les généralistes hospitalisent-ils leurs patients ? Est-ce dans un contexte d’urgence ? Quelques données issues d’une enquête en Belgique.

Une enquête réalisée dans deux cercles de médecins généralistes belges francophones s’est intéressée aux motifs d’institutionnalisation des personnes âgées de plus de 75 ans par leur généraliste. L’implication du médecin généraliste dans la décision est très fréquente.

In recent years dignity in care has become a priority and the focus of a number of government reports and policy initiatives. (DH 2003, 2007), (SCIE 2006). The National Service Framework for older people (DH 2001) and its follow up document, (DH 2006a) for example stated that maintaining dignity was pivotal in improving care for older people. However, despite this political support, there continue to be problems in health and social care settings related to preserving the dignity of older people (Levenson 2007). There is a risk therefore that generalised policy statements have little effect on actual practice and care unless they are operational, and supported by detailed guidelines for practice.\ud \ud Alongside policy, there has also been an increase in studies of dignity in health care (Chochinov et al,2002a), (Woolhead et al 2006) particularly focusing on the ways in which dignity is defined and what it means to people. There have, however, been far fewer on the relationship between dignity and personal care particularly when care involves sensitive issues such as incontinence. This report provides an initial analysis of emerging themes and findings from Phase 1 of the study of privacy and dignity in continence care for older people funded by the Royal College of Physicians and the British Geriatrics Society.\ud The overall objectives of this two year project are to:\ud i. develop reflective standards/guidelines for dignified care, \ud ii. produce recommendations for best practice,\ud iii. provide advice with regard to changing practice in the clinical setting.

This report features in-depth analyses of three health promotion interventions amongst older adults that have taken place in the UK during the last ten years (and much longer in one case). All three projects have been assessed as demonstrating high levels of effectiveness in achieving specific results with regard to the public health of their targeted local older people. The three interventions vary quite dramatically in both the nature and goals of the intervention as well as the means of evaluation, yet all possess a number of discernable characteristics which are crucial to their success in promoting the health of older people. Such facets may be taken to represent key components of what comprises ‘best practice’ in health promotion amongst older people. These features will be elucidated implicitly throughout this report before being clarified more explicitly in its concluding discussions.

It starts with a short discussion of the nature of multimedia profiling, then discusses the development of multimedia profiling within Kingsgate Resource Centre and with KOVE and considers why Acting Up successfully developed in these contexts and not in others. It concludes with a discussion of the outputs of profiling and their impacts.

Background: Public involvement in research on sensitive subjects, such as death and dying, can help to ensure\ud that questions are framed to reflect the interests of their peers, develop a shared understanding of issues raised,\ud and moderate the often unequal power relationship between researcher and participant. This paper describes the\ud contribution and impact of older members of a Public Involvement in Research group (PIRg) to a study on living\ud and dying in care homes.\ud Methods: A longitudinal study, with a mixed method approach, its aims were to capture key experiences, events\ud and change over one year, of older people resident in participating care homes in the East of England. Residents\ud were interviewed up to three times and their case notes were reviewed four times over the year. Interviews were\ud semi structured, and recorded. Four members of a Public Involvement in Research group (PIRg) contributed to\ud preliminary discussions about the research and three were involved with many of the subsequent stages of the\ud research process including the facilitation of discussion groups with residents.\ud Results: There were three areas where the involvement of the Public Involvement in Research group (PIRg)\ud positively influenced the study process. These were recruitment, governance and safeguarding, and in collaboration\ud with the residents in the care homes, the discussion and interpretation of emergent findings. PIRg members were\ud of similar age to the residents and their involvement provided different and often more reflective insights of the\ud significance of the findings for the participants. There were examples where decision making about the range of\ud PIRg participation was not always negotiable, and this raised issues about power relationships within the team.\ud Nevertheless, PIRg members expressed personal benefit and satisfaction through participating in the research and a\ud commitment to continue to support research with this older age group.\ud Conclusions: The contribution of the PIRg supported a successful recruitment process that exceeded response\ud rates of other studies in care homes. It safeguarded residents during the conduct of research on a sensitive topic\ud and helped in validating the interview data gathered by the researchers through the discussion groups facilitated\ud by the PIRg. There were power differentials that persisted and affected PIRg participation. The study has showed\ud the value of developing job descriptions and a more formal means of setting out respective expectations. Future\ud research may wish to elicit the views of focal participants in such studies about the mediation of research by\ud public involvement in research.