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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.
• 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.
• 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.
• 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.