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Title: Impact of day care services on older people with long term conditions
Author: Lunt, Catherine A.
ISNI:       0000 0004 7658 4831
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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Background: Day care services support older people with multiple long term conditions (LTC) within the community to age in place. This salient topic is given little attention by researchers. Day care services models are complex and outcomes for service users unknown. In the UK, in response to wider policy reforms local authority models have been outsourced to a range of organisations, including Charitable and Voluntary services. This thesis aims to understand the models of day care provided in the community and the subsequent outcomes for users and their families. Methods: This is an exploratory study comparing outcomes for users across five different service types: firstly comparing day care provided by Paid staff services, Voluntary services and Blended services (provided by staff and volunteers) and secondly comparing services provided in urban and rural areas, with a particular focus on health inequalities. Mixed Methodology was used. Observations using focussed ethnography and semi structured qualitative interviews with staff and volunteers provided a greater understanding of the type of provision. Quantitative measures were used at 3 time points over 12 weeks of attendance with clients new to day care to assess outcomes using tools for health status and loneliness. Findings: Data was collected from nine day care centres across seven services. 94 clients and 16 carers attending day care were recruited. 36 semi structured interviews were undertaken with clients, carers, staff and volunteers at the services. At baseline there were no differences across services types in the numbers of long term conditions reported by service types but there were significant differences between rural and urban services (rural mean LTC 5.2, urban mean LTC 4.2, p0.04). A larger proportion of clients attending Blended and volunteer led services reported a reduction in loneliness. When adjusted for other baseline variables in logistic regression model, likelihood of reduction in loneliness was increased in Blended (OR=2.28) and Voluntary (OR=2.16) services compared to Paid staff service. People using Blended and Voluntary services reported better or same health outcomes across most EQ5D3L domains than Paid services. Observations and interview data suggests that the differences in outcomes at Blended and Voluntary services may be due to the delivery of activities promoting self-worth and facilitating links to the wider community. Conclusion: This thesis concludes that day care provides vital support for frail older people living at home and their volunteers can deliver effective support with favourable outcomes. It is suggested that activities that promote self-worth and provide links to the community may facilitate positive health outcomes and reduce loneliness. Preparation of such activities can be implemented with minimum resources, providing cost effective interventions for providers to deliver.
Supervisor: Lloyd-Williams, Mari ; Dowrick, Christoper Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral