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Specialist social workers with a budget for domiciliary care and other social-care interventions can be effective to support disabled adults and older adults with complex care needs

Gridley K, Brooks J, Glendinning C. Good practice in social care for disabled adults and older people with severe and complex needs: Evidence from a scoping review Health and Social Care in the Community. 2013; 22(3): 234-248.

Review question

      What is the best way to deliver social care for disabled adults and older adults with severe and complex needs?


      The number of older adults with dementia and multiple chronic conditions is increasing worldwide.

      Meanwhile, technological advances enable those with complex or severe health problems to be supported at home rather than in long-term care settings. These developments present new challenges for social-care services and require new responses and skills.

      This scoping review examined the research evidence to identify best practices in social care for disabled adults and older adults with severe and complex needs.

How the review was done

      25 databases were searched for literature published between January 1997 and February 2011 on best practices in social-care services in the United Kingdom.

      86 papers were selected for inclusion, from which 29 studies were identified and included in the scoping review.

      This scoping review was funded by the National Institute for Health Research School for Social Care Research in the United Kingdom. The authors declared no conflicts of interest.

What the researchers found

      35 papers advocated person‐centered support for people with complex needs, but no well‐supported evaluation evidence pointed to any optimal approach to delivering this.

      The strongest evaluation indicated that the following social-care interventions are effective: 1) multidisciplinary specialist team for young adults; 2) intensive case management for older adults with advanced dementia; 3) a specialist social worker with a budget for domiciliary care working with psychogeriatric patients that are hospitalized (psychogeriatrics is a branch of psychiatry concerned with behavioral and emotional disorders among older adults); and 4) interprofessional training for community mental health professionals.

      One study found that older adults who were provided with case management experienced significantly greater reduction in care needs compared to those given standard care after six months.

      Caregivers of older adults in the case-management group also reported significantly greater reductions in caregiver burden and total caregiving input at 12 months.

      Costs of health and social care were found to be significantly higher for those in the case-management group, though long-term costs are estimated to be reduced in the long run due to reduced admission to residential care.


      This scoping review highlights evidence supporting multiple interventions to provide social-care interventions to disabled adults and older adults with severe and complex needs. However, there is a need for more rigorous evaluation of models and approaches to support these vulnerable populations.


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