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Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.

Introduction: The home of an older person can impact on their physical and mental health. Social housing (rental housing provided on a subsidised basis to people who cannot afford housing from their own resources) for older people in Ireland includes standard design dwellings, and purpose-built “sheltered housing” where residents have access to additional supports on site. It was important that older people’s views on the relative merits of both models of social housing were ascertained, to aid future housing and social care planning in Ireland.Theory/Methods: A mixed-methods research design, using quantitative and qualitative methodologies, was employed. A survey was performed of tenants (aged ≥60) of a large, not-for-profit, Irish housing association, living in standard (representative sample; n=413) or sheltered social housing (census survey; n=415). Assistance was provided to complete surveys by telephone if required. Six focus-groups were conducted, three each with standard and sheltered scheme tenants, in Cork, Dublin, and Longford, to explore themes further.Results: Overall, 380 surveys were returned (46.0% response rate, standard housing; 48.4%, sheltered). Thirty-one people, aged 60-96, participated in focus groups. Tenants in standard houses reported more disability/illnesses, worried more about the future (especially the risk of falls), felt less safe at home, and were more lonely. However, few wanted to move. Residential care was negatively viewed and most were unaware of sheltered housing schemes. Conversely, older people in sheltered housing were more satisfied with the physical design of their home and reported more positive outcomes than older people in standard housing, including improved quality of life following a move to sheltered accommodation. Perceived safety and security, social contact (neighbours and staff), and on-site support were highly regarded.Discussion: Older people had poor knowledge about housing and support options, and felt a move to alternative accommodation would be stressful, but those who had made the move were very satisfied. For all older people, facilitation of pet ownership, bathroom adaptations and safe outdoor spaces (for social contact in a neutral space) were important aspects of a “good” house.Conclusions: Sheltered housing, in which multiple homes are provided within one complex with onsite support, provides significant benefits for social integration and well-being, but does require a move from the person’s home, which was negatively considered by those in standard social housing.Lessons learned: Future social housing designs should be flexible, i.e. adaptable to the needs of the tenants over time to allow “ageing in place”, and should offer a range of house layout options, to allow tenants to choose a home most suitable to their personal lifestyle / support needs. Older people need information to inform housing choices, and support when considering a change of abode.Limitations: This research was performed with older people in a single (although national) social housing scheme.Suggestions for future research: A key objective of future research should be to ascertain whether sheltered housing can facilitate ageing-in-place and whether it mitigates the need to move into residential care, and a cost analysis of this.

Objective: Our home can have a major impact on our physical and mental health; this is particularly true for older people who may spend more time at home. Older people in social (i.e., public) housing are particularly vulnerable. Housing options for older people in social housing include standard design dwellings or specially designed “sheltered housing.” The most suitable housing model should be identified, with older people consulted in this process. Method: Survey of older people (aged ≥60) living in standard or sheltered social housing. Data were analyzed using descriptive and inferential statistics in SPSS Version 22. Results: Overall, 380 surveys were returned (response rate = 47.2%). All older people had similar housing needs. Those in sheltered housing were more satisfied with the physical home design and reported more positive outcomes. Older people in standard housing were less likely to have necessary adaptations to facilitate aging-in-place. Discussion: Older people in standard housing reported more disability/illnesses, are worried about the future, and felt less safe at home. However, few wanted to move, and very few viewed sheltered housing as an alternative, suggesting limited knowledge about their housing options. Future social housing designs should be flexible, that is, adaptable to the needs of the tenants over time.

There is an increasing focus on promoting person-centred systems across continuing care settings, emphasizing the need to enhance the quality of life of older adults. Life story books (LSB) can provide a holistic view of older adults, promote relationship-centred care and enhance person-centred care. The process of developing LSB involve collecting and recording aspects of a person's life both past and present. The purpose of this study was to engage residents in developing life story books in a nursing home setting and then to explore the narratives and documented life story books with residents and their families. A qualitative descriptive exploratory design was utilized for the study. Five residents and three family carers participated. Focus groups were tape recorded and thematically analyzed and a review of the LSB was conducted. The central themes from the data analysis related to the social construction of people's lives, social roles and religious values, relationships and loss, and sense of self.

Self-neglect is a significant international public health issue. Estimates suggest that there may be over one million cases per year in the United States. Aging populations will put more people at risk of self-neglect. This chapter presents background literature, self-neglect definitions and policy context, risk factors, and a brief overview of research on perspectives of self-neglect from both clients and community health and social care professionals. A case study is presented from the perspective of an individual and is used to explore ethical issues therein. A person-centered assessment within a multidisciplinary team approach is required for building a therapeutic relationship with clients. Capacity is a central issue in the management of responses to self-neglect. Ethical considerations of importance for community health and social care professionals include beneficence and nonmaleficence, autonomy and capacity, and respect for people's rights and dignity. A model of ethical justification is presented to explain dilemmas, challenges, and actions. Competence of professionals, multidisciplinary team working, informed consent, privacy, confidentiality, and best interest are also critical considerations. Effective decision making by an interdisciplinary team of professionals needs to be person-centered and give due consideration to the best interest of self-neglecting clients. The purpose of this chapter is to provide an in-depth discussion and examination of ethical issues and challenges relating to self-neglecting clients.

Self-neglect is characterised by an inability to meet one's own basic needs and can be intentional or unintentional. Ageing populations, chronic illness, disability and poverty place individuals at risk for self-neglect. Self-neglect accounted for one-fifth of referrals received by the Elder Abuse Services (EAS) in 2008 in Ireland. Self-neglect (SN) can occur across the lifespan and is a serious public health issue and a social problem that is difficult to detect and diagnose. This article reports findings from a qualitative exploratory study, which explored the views and experience of a purposeful sample of seven Senior Case Workers (SCWs), working in Elder Abuse Services (EAS) on SN in Ireland. Individual interviews were tape recorded, transcribed and thematically analysed. Four major themes emerged from the findings: self-neglect as an entity, assessment, interventions and ethical challenges. SCWs are challenged and frustrated by this complex multidimensional phenomenon. Furthermore, poor operational definitions of 'exceptional circumstances' and 'self-neglect' can lead to diversity in choosing and responding to self-neglect. Suggestions are made about ways in which practice, policy and research can be developed.

This paper reports on the development, delivery, content and student evaluation of a comprehensive elder abuse and self-neglect workshop for public health nursing and social work students.The workshop provided an interdisciplinary shared learning experience for the students to prepare them for their critical role in safeguarding vulnerable adults. The aim of the workshop was to increase knowledge, awareness and understanding of roles and responsibilities and critical practice problems in the prevention and management of elder abuse and self-neglect. The shared learning approach provided clarity on roles and responsibility, valuing and respecting the contribution of each team member. The importance of building communication and trust with team members and clients was seen as critical. Through case studies and group discussion, assessment and practice skills were developed and awareness heightened on the complexity of the critical practice problems and ethical issues.

Research spanning 30 years has highlighted discharge planning as a complex area of practice. Discharge co-ordinators are part of the support provided to improve the patient's journey from acute to community settings. The aim of this study was to explore and describe the role of discharge co-ordinators in a healthcare setting. Using an exploratory descriptive research design a convenience sample of discharge co-ordinator nurses (n=6) across a variety of acute care settings in the Republic of Ireland, were interviewed. Thematic analysis revealed that the role of the discharge co-ordinators was multifaceted and a number of factors affected their role. Recommendations for practice include improved discharge planning processes and education.

Older people tend to be stereotyped as a uniform group with total disregard for individuality (National Co and will enable the older person to be seen as an individual in the context of their past and present life (Clarke et al 2003).