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The current policy emphasis in adult social care in England is on promoting independence, preventing or delaying the need for more intensive support and the provision of personalised services. However, there is little evidence available on how social workers (SWs) identify and meet the complex needs of older service users in practice. In this article, we present findings from a study of innovative social work practice with older adults in England (2018–2019). We present five case studies of social care and integrated services in which SWs are integral team members. Twenty-one individuals participated in interviews; this included service managers and practitioners with social work backgrounds, and other professionals, including nurses and occupational therapists. Specific practices contributing to innovative service delivery included: the strong demonstration of social work values influencing the practice of multidisciplinary teams; positive risk management; importance of timing and ensuring continuity of relationships; and, the proactive application of legal knowledge to promote older people’s rights. While some of these features can be seen as returning to the ‘heart’ of social work, we argue that they are promising in forging new paths for social work with older people that turn away from more managerialist- and procedurally driven approaches.

Copyright 2020, The Authors..Social work in the UK and US had similar origins with a historical focus on both community-based work, similar to Jane Addams’ settlement house, and individual casework/care management aligned with Mary Richmond’s approach to care (Gollins et al., 2016). The visit by Jane Addams in the 1880s to Toynbee Hall, a settlement house founded in London in 1884 to assist the poor through providing opportunities that would lead to social reform, is often cited as a key inspiration for the inception of social work in the US (Addams, 1910). In Addam’s description, there was an early recognition of a need to balance focus on youth and older people and to create intergenerational capacity in strengths. That interest remains present today and, with burgeoning numbers of people growing older globally (WHO, 2018), countries have responded in varying ways to this challenge to prepare for the future. Often this is driven by a need to reconcile competing agendas. The move to personalisation and personal budgets under recent UK Governments was an attempt to shift control of care to individual choices, a strengths view, but at the same time, those budgets were being reduced in line with Government austerity measures. This polcy and practice environment has shaped the conceptualisation of and approaches to strength-based practice for older people in the UK in ways that are different from the US. This chapter will provide background on the UK policy and practice context for strengths-based approaches and on the work of G-8—a group of gerontological social work academics who advocate for strengthening practice, education and research in work with older people. It looks specifically at a strengths approach to assessment and care planning and at older people’s perspectives on strengths. It concludes with examples of strengths-based practice from research into innovative services employing this approach with older people.

(2016). The Quiet Power of Indicators: Measuring Governance, Corruption and the Rule of Law Edited by Sally Engle Merry, Kevin E Davis and Benedict Kingsbury. Australian Journal of Human Rights: Vol. 22, Human rights, interdisciplinarity and the time of utopia, pp. 201-204.

Over the last twenty years, successive welfare policies have undermined gerontological social work as a specialist area of social work practice. The UK's ageing population offers an opportunity for gerontological social work to rebuild itself. Increasing numbers of older people with long-term conditions, significant growth in the population of family carers and enhanced community-based living for people with long-term needs combine to reposition social work as—potentially—playing a crucial role in the achievement of key policy goals. The particular skill and knowledge set of social workers uniquely equips them to manage the intersection of issues that currently challenge health and welfare services: complex needs, risk, transitions, end of life, carer stress and frailty. That older service users value the approach, input and expertise of social workers and that social workers have greater capacity to deliver sustainable support are also relevant. For gerontological social work to have a future, not only is it required to reclaim its specialist role, but it must re-establish its commitment to social justice, invest in building an evidence base of effectiveness and embed ageing-related teaching in the social work curriculum.

The specialist knowledge and skills of health and social care practitioners working with older people are often unacknowledged. This paper examines an important aspect of specialist knowledge, the understandings of ageing and old age that underpin practice in a society where negative assumptions about old age and older people are widespread. These understandings were explored through analysis of data from 30 interviews with health and social care practitioners working with older people at risk of falling. The interviews centred on a case vignette and the analysis presented here focuses on respondents' perceptions of the scenario and of the reluctance of its subject, a 79-year-old woman, to seek help after a fall. The findings suggest that practitioners' understandings of older people are grounded in practice and personal experience, with little evidence of the use of theoretical or research-based knowledge of ageing and old age. This suggests that the potential for formal knowledge of ageing to support reflective and empowering practice with older people has yet to be fully exploited. The paper concludes with a discussion of the relevance to interprofessional practice of gerontological theory and research and suggestions for further research.

We have synthesized triple helix forming oligonucleotides (TFOs) that target a psoralen (pso) interstrand crosslink to a specific chromosomal site in mammalian cells. Mutagenesis of the targeted crosslinks results in base substitutions and deletions. Identification of the gene products involved in mutation formation is important for developing practical applications of pso-TFOs, and may be informative about the metabolism of other interstrand crosslinks. We have studied mutagenesis of a pso-TFO genomic crosslink in repair proficient and deficient cells. Deficiencies in non homologous end joining and mismatch repair do not influence mutation patterns. In contrast, the frequency of base substitutions is dependent on the activity of ERCC1/XPF and polymerase zeta, but independent of other nucleotide excision repair (NER) or transcription coupled repair (TCR) genes. In NER/TCR deficient cells the frequency of deletions rises, indicating that in wild-type cells NER/TCR functions divert pso-TFO crosslinks from processes that result in deletions. We conclude that targeted pso-TFO crosslinks can enter genetically distinct mutational routes that resolve to base substitutions or deletions.

A recent review of the literature on the learning and teaching of communication skills revealed that little attention has been paid to the appropriateness of communication skills training for the contemporary social work environment. Current approaches to skills teaching in social work education emphasise the development of empathy within the context of a ‘helping relationship’. The disparity between this model of social work and contemporary expectations, that social workers seek to understand and categorise individuals primarily through bureaucratic procedures, causes confusion and difficulty for students. As social work educators we face an ethical dilemma. Should we teach students to communicate in a way that conforms to the priorities and pressures of current practice? Or should we retain the focus on inter‐personal skills and on engaging with the worlds of service users? In this paper we examine the disparity between social work as conceived within communication skills training and as practised in t...

Objectives To assess whether the new contractual arrangements of first-wave Personal Medical Services (PMS) practices in England improved their quality of care, compared with changes in care provided in a control sample of General Medical Services (GMS) practices. Methods Controlled ‘before’ (at or near 1 April 1998) and ‘after’ (at or near 31 March 2001) quantitative observational study in a sample of 23 PMS and 23 GMS practices. Quantitative data focused on access, chronic disease management, mental health care, primary care of older people, costs and patient evaluation using the General Practice Assessment Survey. Case studies were also undertaken in all PMS pilots, involving interviews with general practitioners, nurses, practice managers and Health Authority and Primary Care Group/Trust managers, documentation review, and analysis of site-specific data. Results There were improvements in quality of care in PMS sites in all areas of care evaluated, but improvements in care over and above those found in GMS sites (the ‘PMS effect') were only statistically significant for angina care (P =0.05) and elderly care (P =0.04). Teamwork, shared culture, clear objectives and leadership were important catalysts for quality improvement in PMS sites. Improvements in PMS practices came at additional financial cost. There were concurrent improvements in GMS practices. No PMS site succeeded in meeting its aims without successfully introducing effective leadership and management, and changing relationships within the practice (e.g. equalising power between nurses and doctors). Conclusions Small but steady improvements were observed in English primary care. PMS contracts facilitated quality improvements in specific areas over and above these broad improvements (the ‘PMS effect') during the study period. New contractual arrangements for health care can be used to improve quality of care. However, the mechanisms that resulted in quality gains, while facilitated by the new contractual arrangements, were not specific or unique to the PMS experiment. Factors such as effective management, clear objectives and flexible professional relationships within practices are likely to be important in determining whether new contractual arrangements result in improved outcomes. The context within which care and services are provided is as important for quality innovations as specific contractual arrangements.

Effective gene targeting reagents would have widespread utility for genomic manipulation including transgenic cell and animal construction and for gene therapy. They would also be useful in basic research as probes of chromatin structure, and as tools for studying the repair and mutagenesis of targeted DNA damage. We are developing triple helix-forming oligonucleotides (TFOs) for gene targeting in living mammalian cells. Challenges to TFO bioactivity include the impediments to the biochemistry of triplex formation presented by the physiological environment and the charge repulsion between the duplex and the third strand. In addition, there are biological constraints to target access imposed by mammalian chromatin structure. Here we describe the oligonucleotide modification format that appears to support biological activity of TFOs. In addition we show that manipulation of the cell biology, specifically the cell cycle, has a dramatic influence on TFO bioactivity.

Objective. To examine the impact of an implementation program on adherence to a guideline for the management of acute gastroenteritis. Design. Using four retrospective audits over a 10-year period, the authors examined the change in practice and maintenance of that change following a targeted implementation program for the clinical guideline. Setting. Tertiary children's hospital in South Wales. Participants. 447 children aged less than 5 years, admitted to hospital with acute gastroenteritis, comprising four cross-sectional samples (106 in 1999, 153 in 2002, 99 in 2004, 89 in 2009). Main outcome measures. Age of child, hydration status, method of rehydration and duration of admission, for each audit, with an implementation strategy delivered after the second audit. Results. In 1999 and 2002, intravenous rehydration was used in 20% and 15% of cases, respectively. After the implementation program in 2004, compared to 1999, there was a significant decrease in the intravenous rehydration rate to 4% in 2004 (p

The idea of active ageing retains a broad appeal and has a global reach, particularly through the influence of the World Health Organisation (WHO). However, in practice it has been the subject of criticism. In this article, it is argued that the incorporation of active ageing into the policy agendas of the welfare systems for older people should be understood by reference to the perceived effects of demographic trends on demand for services. In the context of the British welfare system, the active ageing agenda has become inextricably linked with the broader policy agenda to reduce older people's call on public resources in order to manage the increasing proportions of older people in the British population. The implications of these developments for social work are significant.

BACKGROUND: Mortality rates for coronary heart disease are higher in blacks than in whites. OBJECTIVES: To examine differences between blacks and whites in the manifestation of symptoms of coronary heart disease and in delay in seeking treatment. METHODS: Patients were directly observed as they came to an emergency department with symptoms suggestive of coronary heart disease. The sample included 40 blacks and 191 whites with a final diagnosis of angina or acute myocardial infarction. RESULTS: After controlling for pertinent demographic and clinical characteristics, logistic regression analysis revealed that blacks were more likely than whites to have shortness of breath (odds ratio = 3.16; 95% CI = 1.49-6.71; P = .003) and left-sided chest pain (odds ratio = 2.55; 95% CI = 1.10-5.91; P =.03). Blacks delayed a mean of 26.8 hours (SD = 30.3; median = 11 hours), whereas whites delayed a mean of 24.4 hours (SD = 41.7; median = 5 hours) in seeking care. Mean delay time was not significantly different for blacks and whites; differences in median delay time were of borderline significance (P = .05). CONCLUSIONS: Blacks were more likely than whites to have shortness of breath and left-sided chest pain as the presenting symptoms of coronary heart disease. Differences in delay in seeking treatment were not significant, although blacks tended to delay longer than did whites. The relatively small number of blacks may account for the lack of observed racial differences in both initial symptoms and in delay in seeking treatment.

At the heart of needs-based assessment is an uneasy tension between agency-centred and user-centred objectives. Using case material from an ethnographic study of the process of assessment for older people, this paper looks at what happens when practitioners try to understand the needs of individual elders through a process dominated by agency agendas. By marginalizing the older person's insights, the risk of unwelcome or inappropriate intervention may increase. A user-centred approach, by contrast, requires information gathering and provision that is meaningful to the older person and sensitive to their efforts to analyse and manage their situation. These efforts are often revealed in narrative form as the person tells their story which, in an agency-centred assessment, is easily overlooked or even ignored.

Survivors' Poetry was established in 1991 by four major poets who had first‐hand experience of the mental health system. The current CEO of Survivors' Poetry, Simon Jenner, describes the national charity's main aim as promoting poetry and associated literary arts ‘by and for survivors of mental distress’ and to play a part in enabling recovery. There is an array of oppportunities available to publish new poetry and prose, attend workshops, perform at public readings, join the National Mentoring Scheme and a moderated online community of writers and artists.Even today, the overwhelming majority of staff, volunteer workers, advisors and trustees come from a survivor background. As such, Survivors' Poetry is in a unique position to support people who seek emotional and mental stability through imaginatively expressed language transformed from traumatic experiences. Survivors' Poetry actively supports and promotes the linguistic talent that many survivors bring from insight into their own circumstances and those of others.

This article is available open access through the publisher’s website. Copyright @ 2013 The Authors. This article explores the readiness of gerontological social work in the UK for meeting the challenges of an ageing society by investigating the focus on work with older people in social work education and the scope of gerontological social work research. The discussion draws on findings from two exploratory studies: a survey of qualifying master's programmes in England and a survey of the content relating to older people over a six-year period in four leading UK social work journals. The evidence from master's programmes suggests widespread neglect of ageing in teaching content and practice learning. Social work journals present a more nuanced picture. Older people emerge within coverage of generic policy issues for adults, such as personalisation and safeguarding, and there is good evidence of the complexity of need in late life. However, there is little attention to effective social work interventions, with an increasingly diverse older population, or to the quality of gerontological social work education. The case is made for infusing content on older people throughout the social work curriculum, for extending practice learning opportunities in social work with older people and for increasing the volume and reporting of gerontological social work research. Brunel Institute for Ageing Studies

Although ambulatory electrocardiographic (ECG) monitors are increasingly being used to detect arrhythmias in outpatient and home care settings, little is known about patients' reactions to these devices and their ability to use them correctly. This study determined the feasibility of this type of monitoring. It provides clinicians a research-based approach to patient care and teaching in the home.

• Background Atrial fibrillation is the most common complication after cardiac surgery and a major cause of morbidity and increased cost of care.• Objectives To examine the incidence, timing, symptoms, and risk factors for atrial fibrillation after cardiac surgery.• Methods A total of 302 patients were continuously monitored for atrial fibrillation with standard hardwire and telemetry devices during hospitalization after coronary artery bypass graft and/or valve surgery and with wearable cardiac event recorders for 2 weeks after discharge from the hospital. After discharge, patients recorded and transmitted their rhythm by telephone daily and whenever they had symptoms suggestive of atrial fibrillation.• Results Of the 302 patients, 127 (42%) had atrial fibrillation; 41 had it after discharge, and for 10 it was their first episode. The first episode occurred at a mean of 2.9 days after surgery (SD, 3.1; range, day of surgery to 21 days after surgery). Although palpitations was the most common symptom (17%), most episodes of atrial fibrillation (69%) were not associated with symptoms. Independent predictors of atrial fibrillation were age 65 years or greater, history of intermittent atrial fibrillation, atrial pacing, male sex, white race, and not having hyperlipidemia. Independent predictors of atrial fibrillation after discharge from the hospital were having atrial fibrillation while hospitalized, valve surgery, and pulmonary hypertension.• Conclusions Atrial fibrillation is common after cardiac surgery and often occurs after discharge from the hospital and without accompanying symptoms. Outpatient monitoring may be warranted in patients with characteristics that place them at increased risk for atrial fibrillation.

diac monitoring may need to expand from the hospital to the home. We just completed a study in which we used intermittent loop recorders, a type of ambulatory electrocardiographic (ECG) device, to examine the incidence, timing, and symptoms of and risk factors for postoperative atrial fibrillation. In this article, we describe ambulatory ECG, discuss how we used this technique to monitor for atrial fibrillation after cardiac surgery, and present examples of 2 patients whose atrial fibrillation was detected by using ambulatory ECG.

This study explores gender differences in symptom presentation associated with coronary heart disease (CHD). In this prospective study, nurse data collectors directly observed 550 patients as they presented to the Emergency Department (ED) of Yale-New Haven Hospital. The final sample included 217 patients (41% women) diagnosed with CHD (acute coronary ischemia or myocardial infarction). Chest pain was the most frequently reported symptom in women (70%) and men (71%). Unadjusted analyses revealed that women were more likely than men to present with midback pain (odds ratio [OR] 9.61, 95% confidence interval [CI] 2.10 to 44.11, p = 0.001), nausea and/or vomiting (OR 2.29, 95% CI 1.19 to 4.42, p = 0.012), dyspnea (OR 1.82, 95% CI 1.05 to 3.16, p = 0.032), palpitations (OR 3.42, 95% CI 1.02 to 11.47, p = 0.036), and indigestion (OR 2.13, 95% CI 1.03 to 4.44, p = 0.040). After adjustment for age and diabetes, women were more likely to present with nausea and/or vomiting (OR 2.43, 95% CI 1.23 to 4.79, p = 0.011) and indigestion (OR 2.13, 95% CI 1.10 to 4.53, p = 0.048). Women (30%) and men (29%) were equally likely to present without chest pain, and dyspnea was the most common non-chest pain symptom. In the subgroup of patients without chest pain, unadjusted analyses revealed that women were more likely to report nausea and/or vomiting compared with men (OR 4.40, 95% CI 1.30 to 14.84, p = 0.013). Although we found some significant gender differences in non-chest pain symptoms, we conclude that there were more similarities than differences in symptoms in women and men presenting to the ED with symptoms suggestive of CHD who were later diagnosed with CHD.