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Background Developing age-friendly communities is a significant global policy issue. The WHO (2007) age-friendly cities and communities initiative has had a significant influence on the development of Ireland's Age-Friendly Programme. With research on such programmes still at an early stage, this paper critically examines the utilisation of the WHO age-friendly planning framework in an Irish context. It explores older adults' experience of living in two towns in an 'age-friendly' county and, in parallel, examines stakeholders' perspectives on the development of the county's age-friendly programme. This multi-perspectival approach facilitates an assessment of how the age-friendly county programme addresses older residents' needs, and illustrates how the WHO conceptual and planning framework has worked in an Irish context. Methods The paper reports on a study which employed a mixed-method, qualitative case-study research design, using a constructivist grounded theory approach to explore the lived experience of older adults, and a case-study framework for the stakeholder perspective. Results The research identifies salient social and cultural dimensions of the day-to-day lived experience of older people which, although they impact on the age-friendliness of the places in which they live, are neglected in the WHO framework. It also identifies a unique combination of economic, political, cultural, and organisational factors which have impacted on age-friendly programme development in Ireland. Conclusion In critically analysing use of the WHO age-friendly model, the paper suggests ways in which the model can be modified to better accommodate the diverse experience of older adults not only in Ireland, but also in other geographic and cultural contexts. [ABSTRACT FROM AUTHOR]

Background Day care is an important service for some people with dementia and their carers. In Ireland, day care services for people with dementia are delivered by a mix of dementia specific day-care centres and generic centres that cater for people with dementia to various degrees. In this paper we map the geographic variation in the supply of day care services for people with dementia relative to potential need. Methods Using a national HSE survey of day care centres, we estimate the current supply of day care services for people with dementia in both generic and dementia specific centres by combining a number of qualitative and quantitative measures. To identify the variation in supply, we map day care provision at local and regional levels to the number of people with dementia in the area. To consider geographic accessibility, we map and analyse the population living outside the catchment area of the day care centres. Results There is significant variation across the country in the existing capacity of day care centres to cater for people with dementia. The number of places per 100 persons with dementia varies from 9 to 16 across the Community Health Organisation areas. We show that 20 per cent of people with dementia are not living within a 15km radius of a day care centre that caters for people with dementia. Conclusion Day care has a place in the menu of service for people with dementia living in the community. As the number of people with dementia grows, investment in day care centres needs to be targeted to areas of greatest need. In many parts of the country, the current day care centres have limited capacity to provide a service for people with dementia that live in their catchment area. There is considerable geographical inequity in day care provision for people with dementia across the country. [ABSTRACT FROM AUTHOR]

Background The continuing evolution of adult safeguarding legislation, policy and practice in relation to the abuse of vulnerable adults reflects a growing awareness of the nature and extent of such abuse in Ireland. The Adult Safeguarding Bill, 2017 represents a progressive step in safeguarding older people and vulnerable adults. The intention of the Bill is to put in place additional protections for adults, in particular, for those who may be unable to protect themselves, such as older people or those lacking capacity. Part 3 provides for mandatory reporting by specified/named persons/professionals. This paper sets out to critically analyse the concept of mandatory reporting within adult safeguarding using international comparators as case studies. Methods A rapid realist review of adult safeguarding reporting typologies and systems in five key jurisdictions: Australia, Canada, England, Northern Ireland and Scotland, were explored to answer the question: ' what works, for whom and in what circumstances ?' [1] Results Jurisdictions differ as to who the mandated reporters are, the scope and powers of mandatory reporting, and the types of abuse subject to reporting. Of significance is that the debate on mandatory reporting has increasingly focused on institutional settings, rather than more broadly across services. Key concepts identified are those of protection, empowerment and proportionality. Adult safeguarding legislation must therefore ensure that interventionist and compulsory measures to protect do not excessively restrict the rights of the individual. Conclusion Mandatory reporting may offer professionals increased powers to prevent and reduce the abuse of adults and older people, but this could also change the dynamic of relationships within families, and between families and professionals. Ultimately, the success of any legal approach will rest with professional judgment in balancing autonomy with protection. [ABSTRACT FROM AUTHOR]

Background Family carers provide thousands of hours of unpaid work every year, a third of whom are men, however this group are generally under-represented in research. Comparative studies have shown that male carers experience their caring role differently to female counterparts. Social concepts related to masculinity can help to explain help-seeking behaviours of male carers, as well as their attitudes to accessing outside support. Compared to women carers, men have lower rates of uptake of formal support services. This aim of this review, therefore, was to examine accounts of male carers' experiences and perceptions of receiving formal support. Methods The study followed a meta-ethnography process starting with a systematic literature search of five electronic databases. The methodological quality of the included studies was evaluated using the McMaster checklist. Using NVivo 12 software, primary qualitative data was analysed and key themes were identified. Results were synthesised using Noblit and Hare's (1988) process of meta-ethnography, retaining direct quotes from the studies. Results Eighteen studies were included in the final paper. Three main themes were identified: 1) asserting control over the caring role 2) desire to excel in caring role and 3) coping without formal support. Conclusion For the most part, male carers expressed a desire to be competent in their caring role. Perceived loss of control within the caring relationship was a key factor when men had low trust and dissatisfaction with services. Support services that were collaborative, education-based and gender-sensitive were favoured by the men. To engage more male carers, service providers should acknowledge men's experience and capabilities as well as their wish to stay involved in decision-making around care for their family member. For men over the age of 85 male family carers outnumber females in Ireland (CSO 2016). It is important to understand male carers' experience to develop more inclusive supports and consequently increase service uptake. [ABSTRACT FROM AUTHOR]

Background Currently, 1 in 10 people diagnosed with dementia in Ireland are aged under 65, this is termed "Younger Onset Dementia" (YOD). Though small in numbers these figures (4000 people) are increasing, and important differences exist between people diagnosed with (PwYOD) and those diagnosed with later onset dementia (LOD). As dementia is normally associated with advancing age, clinicians are not always on the alert for its diagnosis in younger people. Diagnosing YOD can be especially challenging since presentation may be atypical and there is a lack of clinical ownership in this area. Methods A structured literature review was conducted to identify optimum models of diagnostic processes and pathways for PwYOD. Two research questions were addressed: (i) what models for the diagnosis of PwYOD exist nationally and internationally, and what evidence supports these and (ii) what are the differences between diagnostic processes and pathways for PwYOD compared with PwLOD. A systematic search strategy was devised to identify all relevant scientific papers. Key databases were used, supplemented by grey literature searches. A narrative synthesis approach was undertaken to assess the literature identified. Results Pathways and processes to the diagnosis of YOD are unclear and complex and compared with LOD, diagnosis takes more time. PwYOD are more likely to have multiple referrals to different specialists, have their memory and cognitive complaints misattributed to other factors such as depression and experience longer delays in obtaining a diagnosis. Conclusion Few evidence-based best-practice models or guidelines for the diagnosis of YOD exist internationally. Increased awareness of the signs and symptoms of YOD among all healthcare professionals is necessary. There is a need for improved linkages to be developed between Geriatric Medicine, Neurology, Psychiatry, and Primary Care services and in certain instances for suspected cases of YOD to be referred to neurology-led memory clinics. [ABSTRACT FROM AUTHOR]

Background Home-care robots have been developed as one of the assistive technologies, and benefits and challenges of their use have been debated in many countries. Research teams in Japan, Finland and Ireland carried out a questionnaire to explore perceptions of potential users (older people, family caregivers, and health and social care professionals (HSCPs)) towards the use of home-care robots. As part of a larger tri-country comparative study, this paper reports preliminary findings from the data collected from the online survey of HSCPs in Ireland. Methods Questionnaire was developed iteratively among the research teams in three countries. Questions related to the use of advocates in deciding whether to use home-care robots, desirable functions in such robots, and perceptions of privacy protection. Based on networks of professional and advocacy groups, HSCPs were contacted and 123 respondents took part in the questionnaire, and 46 fully completed the questionnaire. Results Out of 46 respondents (44 female, 1 male and 1 did not wish to specify), 80% answered that they are open to the use of home-care robots. Safety monitoring and alert functions were considered to be most desirable in home-care robots. 76% of the respondents placed importance on the guarantee of entitlement to receiving human care, irrespective of the use of home-care robots. 30% answered that they have a negative impression of robots, to some extent. The overall majority (N=39, 85%) felt strongly that a decision as to whether to use home-care robots should be made by the user, and that the access to data collected in any form by robots requires extra care. Conclusion While there was generally a positive perception of the use of home-care robots among Irish HSCPs, cautious attitudes were evident in the areas of decision-making and privacy. This study was funded by the Pfizer Health Research Foundation. [ABSTRACT FROM AUTHOR]

Background A major focus on decision making capacity (as opposed to cognitive capacity and competence) legislation in many Western countries is the integration of a human rights approach focused on self-determination and autonomy. This paper examines modern day concepts of personhood and person centred care and presents Irish and United Kingdom legal commentaries which focus on health services' and society's approaches to risky decision making. Integrating human rights into decision making capacity legislation has been central in contemporary discourses on health and welfare. Methods A literature review was undertaken charting the emergence of personhood, person centred care and human rights. Case studies of influential legal commentaries in Ireland and the United Kingdom where decision-making capacity was addressed were mapped to person centred care principles. Results Findings point to a convergence of discourses of human rights in contemporary approaches to health and social care as well as the evolution of legislation to support person centredness in fostering safeguarding and promoting autonomy and self-determination. Specific legal commentaries point to the need of health and social care to be mindful of paternalism and to conceptualise the concept of 'risk' with a particular emphasis on the inclusion and defence of the voice of the older or vulnerable person. Conclusion The intrinsic worth of each human is articulated through an implicit and explicit vindication of their human rights. The emergence of the third generation of human rights has argued the value of self-determination and autonomy, articulated through robust national legislation on decision-making capacity based on the core principles of person centred care approaches. This move from paternalism is imperative and is imbued in contemporary legislation and legal commentaries, which has noted the need for revisions in health and social care case management perspectives. [ABSTRACT FROM AUTHOR]

Background and purpose: this paper examines the impact of demographic change from 2007 to 2021 on the total cost of stroke in Ireland and analyses potential impacts of expanded access to stroke unit care and thrombolytic therapy on stroke outcomes and costs.Methods: total costs of stroke are estimated for the projected number of stroke cases in 2021 in Ireland. Analysis also estimates the potential number of deaths or institutionalised cases averted among incident stroke cases in Ireland in 2007 at different rates of access to stroke unit care and thrombolytic therapy. Drawing on these results, total stroke costs in Ireland in 2007 are recalculated on the basis of the revised numbers of incident stroke patients estimated to survive stroke, and of the numbers estimated to reside at home rather than in a nursing home in the context of expanded access to stroke units or thrombolytic therapy.Results: future costs of stroke in Ireland are estimated to increase by 52–57% between 2007 and 2021 on the basis of demographic change. The projected increase in aggregate stroke costs for all incident cases in 1 year in Ireland due to the delivery of stroke unit care and thrombolytic therapy can be offset to some extent by reductions in nursing home and other post-acute costs. [ABSTRACT FROM PUBLISHER]