Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens By…

Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens

By…

Nink PussayapibulQuality of Life ResearcherDepartment of SociologyCity University London

13 January 2006

Presentation to Thailand’s Ministry of Public Health

2

Presentation Outline

Introduction Project Background Policy Context

Project Overview Research Aims, Research Questions and Methodology Achievement to Date and Challenges

Preliminary Results Quantitative Arm - Wave 1: Main Survey (Summer 2004) Next Steps

Discussion

3

Project Background

CamdenCouncil

CamdenPrimary

CareTrust

CityUniversity

Partnership Approach

Quality of Life Research Studentship

Advisory Panel

4

Project Background (Cont’ d)

Involvement of Older Citizens

2. Quality of Life

Panel12 Older people 8 Councillors

8 Voluntary Organisations

Representatives

1. Older People

Reference Group

770 Older people

Quality of Life Partners

Annual Report to Council Executive

5

Policy Context

Quality of Life Strategy for Camden’s Older Citizens

To be the vehicle to deliver on the targets set out in the Community Strategy that relate to older people, and

To progress and deliver the National Service Framework for Older People – NSF Standard 8

6

Research Aims

To evaluate the impact of the implementation of th

e Quality of Life Strategy on Camden’s older citize

ns’ perception of feeling independent, having choi

ce and control and a sense of well-being

7

Research Questions

1. How is older people’s perception of quality of life changing

over time?

2. What impact are services having on older people’s quality of

life over time?

3. How is the implementation of the Quality of Life Strategy

affecting older people’s perception on their quality of life?

How much of this is as a result of the strategy?

8

Research Methodology

Quantitative Arm

A Panel Survey Various dimensions of social

circumstances The needs satisfaction model

(CASP-19) Take-up of services and

satisfaction rates Comparability with other relevant

data sources

Qualitative Arm

Gathering Stories from Older People

In-depth interviews with selected members of Quality of Life Panel

In-depth interviews with the selected sample; targeted to set up contrast groups based on the first wave of the quantitative survey

9

Capacity building Initial data

collection Pre-pilot planning Draft questionnaire

design

Literature review Questionnaire design Pre-pilot testing Application to Consultation Board at

Camden Council Identification of potential fieldwork agencies

Pilot testing Appointment of fieldw

ork agency Analysis of results fro

m the pilot testing Sample design Final revision of posta

l questionnaire

The first main survey Qualitative interviews Preliminary analysis Literature review (Cont’d)

Follow-up survey Follow-up qualitative

interviews

Final analysis Literature review (Cont’d) Write-up

Year 1Oct–Dec

’03(3m)

Year 2 Year 3Jan–Apr

’04(4m)

July ’04 – May ‘05(11m)

Jun – Dec ‘05(7m)

Jan – Sep ‘06(9m)

May-June ’04

(2m)

TimetableAchievement-to-date

10

Achievement-to-DateQuality of Life Survey

Pre-pilot (2004) Three focus groups – to develop questions Two additional groups – to test the draft questionnaire

Pilot test (2004) 100 people selected from Older People Reference Group (postal) 70% response rate achieved

Wave 1 of main survey (Summer 2004) 1,500 people selected from Accessible Transport database (postal) Boost sample through the Mobile Library scheme to target housebound people 40% response rate achieved Preliminary report completed and used to further develop the Community Strategy

Wave 2 of main survey (Summer 2005) 446 people who agreed to be re-contacted from the wave one (postal) 65% response rate achieved Jan 2006

11

Achievement-to-Date (Cont’d)Gathering Stories from Older Selected Citizens

Five in-depth interviews (May 2004) Selected members of the Quality of Life Panel Interviews conducted before they attended the first panel meeting Qualitative report completed and used to further develop the Community Strategy

Follow up in-depth interviews (Nov 2005) To gather people’s experiences as the Quality of Life panellists. To gather their views on being active in local community.

Targeted interviews (Dec 2005) Sixteen targeted in-depth interviews with a sub-sample of respondents from the first

wave of the quantitative survey. These were targeted in order to draw out contrasts based on their use of services and quality of life scores.

The targeted interviews seek to deepen our understanding on how the services under the Quality of Life Strategy make a difference to older people’s lives. The intention is to complement the questionnaire survey and provide a more comprehensive picture of older people’s lives.

Jan 2006

12

Challenges Secure funding to complete PhD

Limited knowledge in the field

Balance expectations/workloads between sponsor and academic demands

Research design to meet objectives while being practical

Manage project and gain support by working with various parties – eg. network, ask for flavour, subcontract etc.

Communication to various audiences – eg. policy makers, partners, older citizens and academia etc.

Time constraints within limited budget

13

Questionnaire Structure

A. Your recent life event (only wave 2)B. Your feelings about home and the neighbourhoodC. Your friends and familyD. Your feelings about your lifeE. Your healthF. Your life in CamdenG. Getting out and aboutH. Work and retirementI. About yourself (only wave 1)

14

Quality of Life

Control

Autonomy

Self-realisation

Pleasure

Quality of Life Measure: CASP-19

15

CASP-19 (Cont’d)

CONTROL My age prevents me from doing the

things I would like to I feel that what happens to me is out

of my control I feel free to plan for the future I feel left out of things

AUTONOMY I can do the things that I want to do Family responsibilities prevent me

from doing what I want to do I feel that I can please myself what I

can do My health stops me from doing the

things I want to do Shortage of money stops me from

doing the things that I want to do

PLEASURE I look forward to each day I feel that my life has meaning I enjoy the things that I do I enjoy being in the company of others On, balance, I look back on my life

with a sense of happiness

SELF- REALIZATION I feel full of energy these days I choose to do things that I have never

done before I feel satisfied with the way my life

has turned out I feel that life is full of opportunities I feel that the future looks good for me

16

Wave 1: Preliminary FindingsSample Characteristics

Age Group

13%

26%32%29%

10%

26%

40%

24%

0%

20%

40%

60%

80%

100%

60-64 65-74 75-84 85 and over

Ethnicity

2%3%4%

90%

Chinese/Others

2%

Black/Black British

4%

Asian/Asian British

5%

White/White-mixed

89%

0%

20%

40%

60%

80%

100%

Sample

Census 2001Average age= 72 years old

17

Wave 1: Preliminary FindingsAge – Profile and Mean CASP 19

Mean Scores for Quality of Life(CASP-19)

42

3438

0

20

40

60

60-69 70-79 80 and over

Mea

n

Age Group

25% 26%

50%

0%

10%

20%

30%

40%

50%

60-69 70-79 80 and over

18

Wave 1: Preliminary FindingsEthnicity – Profile and Mean CASP 19


Chinese/Others

36

White/Whitemixed

40

Black/BB35

Asian/AB

34

0

20

40

60

Mea

n

Ethnicity

Chinese/Others

2%

Asian/Asian British

4%

Black/BlackBritish

3%

White/White-mixed90%

0%

20%

40%

60%

80%

100%

19

Wave 1: Preliminary FindingsGender – Profile and Mean CASP 19


40 38

0

20

40

60

Males Females

Mea

n

Gender

56%

44%

0%

20%

40%

60%

80%

100%

Males Females

20

Wave 1: Preliminary FindingsSelf-assessed Health – Profile and Mean CASP 19


46

3037

0

20

40

60

Excellent/Good Fair Not good/Poor

Mea

n

Self-assessed Health

30% 29%42%

0%

20%

40%

60%

80%

100%

Excellent/Good Fair Not good/Poor

21

Wave 1: Preliminary FindingsLongstanding Illness – Profile and Mean CASP 19


3644

0

20

40

60

Yes NoM

ean

Longstanding Illness

33%

67%

0%

20%

40%

60%

80%

100%

Yes No

22

Wave 1: Preliminary FindingsIncome Adequacy – Profile and Mean CASP 19


43

3740

0

20

40

60

More thenenough

Just aboutenough

Less thanenough

Mea

n

Income Adequacy

53%

25%22%

0%

20%

40%

60%

80%

100%

More thenenough

Just aboutenough

Less thanenough

23

Wave 1: Preliminary FindingsInformation Satisfaction Level – Profile

Information Satisfaction Level

8%

37%

10%

45%

0%

20%

40%

60%

80%

100%

Satisfied Neithersatisfied nordissatisfied

Dissatisfied Not sure

Info:277

of out 620 people

24

Service Satisfaction Level

9%

30%

9%

52%

0%

20%

40%

60%

80%

100%



Wave 1: Preliminary FindingsService & Staff Satisfaction Level – Profile

Service:312

of out 602 people

Staff Satisfaction Level

10%

34%

7%

49%

0%

20%

40%

60%

80%

100%



Staff:293

of out 594people

25

Wave 1: Preliminary FindingsService Usage

Category Services Number of people who USE

ABOVE average ( ) quality of life

scores(Mean CASP-19)*

Housing Careline 69 xHome adaptation 53 xWarmth for All 51 xSheltered housing service 40 xHandy Person 31 xCare and Repair 27 x

Learning Library 261Home Library/Mobile Library 55 xFree training and the use of computer service 40A Fair COPP 31 x

Exercise Specialist exercise classes for older people 44 x

* Mean quality of life score = 39

26

Wave 1: Preliminary FindingsService Usage

Category Services

Transportation Freedom PassTaxi-card xDial-a-ride xPlusBus xShop Mobility/Scooter loan

Finance Welfare benefit service or pension service x

Others Camden Age Concern xResource Centres/Day centres for older people xWell&Wise xCitizens Advice Bureau Housebound Service xGood Neighbour Schemes xOutreach service

Number of people who USE

4059342104

76

37322114148 x

* Mean quality of life score = 39

ABOVE average ( ) quality of life

scores(Mean CASP-19)*

27

Next Steps

Present results from wave 2 fieldwork to related parties

Analyse and compare results from wave 1 and 2, and in-depth interview

Write-up

28

References Blane, D., R. Wiggins, et al. (2002). "Inequalities in Quality of Life in Early Old Age."

ESRC Growing Older Programme Research Findings: 9.

(http://www.shef.ac.uk/uni/projects/gop/index.htm)

Camden's Promoting Independence Group (2002). Quality of Life Strategy for Camden's Older Citizens. London, London Borough of Camden: 28.

(http://www.camden.gov.uk/ccm/content/council-and-democracy/plans-and-policies/quality-of-life-strategy-for-older-citizens/quality-of-life-strategy-for-older-citizens.en)

Department of Health (2001). National Service Framework for Older People: Executive Summary. London, Department of Health: 32.

(http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4010161&chk=6GV5oj)

Hyde, M., Wiggins, R. D., Higgs, P. and Blane, D. (2003). "A Measure of Quality of Life in Early Old Age: the Theory, Development and Properties of a Needs Satisfaction Model (CASP-19)." Aging and Mental Health 7(3): 186-194.

29

Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens

Discussion

For further information, please contact: Nink Pussayapibul

[email protected]

30

BACK UP SLIDES

31

Questionnaire Development

Rationales Review of Questionnaires in the Field Pre-pilot: Focus Group Pilot Test

32

Explore various dimensions of social circumstances Adopt the needs satisfaction model (CASP 19) Understand take up of services and satisfaction level Ensure comparability with other relevant data sources Carefully include only key questions to encourage parti

cipation; Further information will be explored in the wave 2 (Summer 2005)

Start from general questions to specific questions Consider respondent friendly format eg. font size and

space etc.

Questionnaire design: Rationales

33

Questionnaire Structure – Wave 1

A. Your feelings about home and the neighbourhoodB. Your friends and familyC. Your feelings about your lifeD. Your healthE. Your life in CamdenF. Getting out and aboutG. Work and retirementH. About yourself

34

Review Questionnaires in the Field

Example:

Quality of Life in Early Old Age Quality of Life through Early Old Age English Longitudinal Study of Ageing (ELSA): Wave 1-

Health and lifestyles of people aged 50 and over British Household Panel Survey (BHPS): Wave 11 –

Ageing, Health and Retirement variable component Census 2001 Health Survey for England (HSE) Best Value Performance Indicator Survey (BVPI)

Step 1 – Questionnaire Development

35

Pre-pilot: Focus Group

Three groups conducted; two cold call and one in community setting - to develop questions and explore people circumstances 1st group – Cold call 8 people

2nd group – Cold call 5 people

3rd group – Volunteer 6 people from the Network Group

Two additional groups from selected resource centres, plus one recall (Network Group) - to test filing in the draft questionnaire


Questionnaire was too long, but comprehensive

Some wordings or questions were unclear

Front page should be more attractive (eg. color photos etc.), and use exciting words (eg. avoid the word “strategy” etc.)

Some people agreed that prize draw can help increase participation for the target group

Key Findings:

36

Pilot Test: 100 People Sampling frame

Older People Reference Group database

Criteria Census 2001; Profile of

Camden’s older citizens aged 60 and over

Age, gender, and ethnicity Sample size

100 people selected by purposive/quota sampling technique; over sampling non-white group

Response rate 70% achieved


Some questions had no response since they are not applicable to the respondents. Therefore, suggested to add “None of these” Or “Not sure” etc.

Question related to service provision was too long and looked complicate. Some people skipped it. Therefore, suggested to reduce it to one page by selecting only the services that are directly linked to the strategy.

Some statements were not clearly linked to the corresponding tick boxes.

Some instructions were not clearly underlined. Some respondents misunderstood when reading quickly.

Key Findings:

37

Pilot Test: Expert Review Step 3 – Questionnaire Development (Cont’d)

Key Findings: The pilot questionnaire were also distributed to related parties to seek their expert suggestions to improve its quality Advisory Panel Implementation

team Selected professional

researchers

Overall, it was not feasible to cut number of pages from 12 to 8 pages since too many key questions would be eliminated.

Questions that can be found in other Camden surveys were deleted eg. housing conditions etc.

Questions that are more personal should be moved towards the end.

Health related questions should be adopted from the Quality of Life in Early Old Age since they have been well tested.

Some questions were reworded to be easier to understand and avoid start the sentence with negative meaning.

Some choices were revised to be more comprehensive.

Overall format were revised to make it look more friendly and easier to catch the key points eg. section heading or instruction etc.

38

Project Background

Partnership Approach

CamdenCouncil

CamdenPCT

CityUniversity

Quality of Life Research Studentship PhD registration and allowance Fieldwork

Advisory Panel Contribute to the evaluating strategy and help shape the

project’s direction Consist of Department of Health, Audit Commission, Age

Concern Camden, Better Government for Older People, University College London, Imperial College, London School of Hygiene and Tropical Medicine, and Ipsos UK.

Involvement of Older CitizensOlder People Reference Group 770 older people who have volunteered to give their opinions on issues affecting older people in

Camden Quality of Life Panel 12 older people, 8 councillors and 8 representatives from organisations working with older

people, who respond to issues raised by older people in a proactive way

[Note for presentation]

39

Wave 1: Preliminary FindingsMean Scores for Quality of Life Domains

Mean Scores for Quality of Life Domains

Range 0-57

Range 0-12

Range 0-15

Range 0-15

Range 0-15

39

7

10

9

13

0 10 20 30 40 50 60

CASP-19

Control

Autonomy

Self-realisation

Pleasure

Scores

Sample

Score range

40

Wave 1: Preliminary FindingsSocial Network >> Close Relationship – Profile and Mean CASP 19


31

46

3540

0

20

40

60

Many Some One/Two None

Mea

n

Close Relationship

9%

36%31%

24%

0%

20%

40%

60%

80%

100%

Many Some One/Two None

41

Wave 1: Preliminary FindingsSocial Network >> Family and Friends – Profile and Mean CASP 19


3742

0

20

40

60

Below/Equal average Above average

Mea

n

Family and Friends

56%44%

0%

20%

40%

60%

80%

100%

Below/Equalaverage

Above average

Score Range : 0-14Average: 10

42

Wave 1: Preliminary FindingsSocial Network >> Frequency of Contact – Profile and Mean CASP 19


3542

0

20

40

60

Below/Equal average Above average

Mea

n

Frequency of Contact

59%

41%

0%

20%

40%

60%

80%

100%

Below/Equalaverage

Above average

Score Range : 0-16Average: 13

43

Wave 1: Preliminary FindingsHome Ownership – Profile and Mean CASP 19

Home Ownership

59%

41%

0%

20%

40%

60%

80%

100%

Owned/Sharedownership

Rented/Rent free


4236

0

20

40

60

Owned/Sharedownership

Rented/Rent free

Mea

n

44

Wave 1: Preliminary FindingsLiving Alone or Not – Profile and Mean CASP 19

Living Alone or Not

58%

42%

0%

20%

40%

60%

80%

100%

Live as couple/withfriend/famliy

Live alone


4138

0

20

40

60

Live as couple/withfriend/family

Live alone

Mea

n

45

Wave 1: Preliminary FindingsAccess to Car – Profile and Mean CASP 19

Access to Car

62%

38%

0%

20%

40%

60%

80%

100%

Yes No


4237

0

20

40

60

Yes No

Mea

n

46

Wave 1: Preliminary FindingsFeelings about the Neighbourhood >> Like to Live in Current Neighbourhood – Profile and Mean CASP 19

Like to Live in Current Neighbourhood

8%(52 people)

92%(624 people)

0%

20%

40%

60%

80%

100%

Yes No


4033

0

20

40

60

Yes NoM

ean

Total of 676 people

47

Wave 1: Preliminary FindingsFeelings about the Neighbourhood >> Moving Preference – Profile and Mean CASP 19

Moving Preference

13%(89 people)

8%(54 people)

79%(536 people)

0%

20%

40%

60%

80%

100%

Stay here Prefer tomove

Do not know


403637

0

20

40

60

Stay here Prefer tomove

Do notknow

Mea

n

Total of 679 people

48

Wave 1: Preliminary FindingsInformation Satisfaction Level – Profile and Mean CASP 19

Information Satisfaction Level

8%

37%

10%

45%

0%

20%

40%

60%

80%

100%




3741

3539

0

20

40

60



Mea

n

Info:277

of out 620 people

49

Service Satisfaction Level

9%

30%

9%

52%

0%

20%

40%

60%

80%

100%



Wave 1: Preliminary FindingsService Satisfaction Level – Profile and Mean CASP 19


3740

3340

0

20

40

60



Mea

n

Service:312

of out 602 people

50

Staff Satisfaction Level

10%

34%

7%

49%

0%

20%

40%

60%

80%

100%



Wave 1: Preliminary FindingsStaff Satisfaction Level – Profile and Mean CASP 19


373933

41

0

20

40

60



Mea

n

Staff:293

of out 594people

51

National Service Framework for Older People (NSF-OP)

Published in March 2001

The health-driven framework sets eight new national standards of care for all older people

The standards will ensure investment is used wisely to improve quality of care and services for older people

Look to new models of care and service that emphasise prevention and rehabilitation

The Standard Eight - “To promote healthy living and an active life in later years”. It identifies that the health and well-being of older people is promoted through a co-ordinated programme of action led by the NHS with support from councils

52

National Service Framework for Older People (NSF-OP) – (Cont’d) Standard One: Rooting out age discrimination

NHS services will be provided, regardless of age, on the basis of clinical need alone. Social Care services will not use age in their eligibility criteria or policies, to restrict access to available services.

Standard Two: Person-centred careNHS and social care services treat older people as individuals and enable them to make choices about their own care. This is achieved through the single assessment process, integrated commissioning arrangements and integrated provision of services, including community equipment and continence services.

Standard Three: Intermediate careOlder people will have access to a new range of intermediate care services at home or in designated care settings to promote their independence by providing enhanced services from the NHS and councils to prevent unnecessary hospital admission and effective rehabilitation services to enable early discharge from hospital and to prevent premature or unnecessary admission to long-term residential care.

Standard Four: General hospital careOlder people's care in hospital is delivered through appropriate specialist care and by hospital staff who have the right set of skills to meet their needs.

Standard Five: StrokeThe NHS will take action to prevent strokes, working in partnership with other agencies where appropriate.People who are thought to have had a stroke have access to diagnostic services, are treated appropriately by a specialist stroke service, and subsequently, with their carers, participate in a multidisciplinary programme of secondary prevention and rehabilitation.

Standard Six: FallsThe NHS, working in partnership with councils, takes action to prevent falls and reduce resultant fractures or other injuries in their populations of older people.Older people who have fallen receive effective treatment and rehabilitation and, with their carers, receive advice on prevention through a specialised falls service.

Standard Seven: Mental health in older peopleOlder people who have mental health problems have access to integrated mental health services, provided by the NHS and councils to ensure effective diagnosis, treatment and support, for them and for their carers.

Standard Eight: Promoting an active healthy life in older ageThe health and well-being of older people is promoted through a co-ordinated programme of action led by the NHS with support from councils.

53

Camden Community Strategy Published in June 2001

A multi-agency project between Camden Council, the Health Authority, the Police, Voluntary Action Camden, London Central Learning and Skills Council, and University College London (UCL)

The key areas for change that aim to improve the quality of life of Camden citizens include:

a place with stronger communities

a safer place

a healthier place

an economically successful place

an attractive and environmentally-friendly place

a place with excellent services

54

Camden Quality of Life Strategy Integrated strategies for older people aimed at promoting good health and quality of life, and to prevent or

delay frailty and disability

Demonstrate how agencies will work together and with older people to promote and provide healthy living activities, sustain people’s independence and promote positive views of ageing

Eight objectives guide the implementation of the strategy:

To promote the principles of active engagement

To make older people aware of a range of opportunities and activities that facilitate health and well-being.

To ensure older people have equal access to both statutory and non-statutory services.

To ensure older people have access to a range of services that can help to maximise their income, help them claim appropriate benefits and deal with any other advice needs they may have around financial issues.

To ensure older people feel safe and secure in their homes and in the community.

To promote a positive approach to the experience of ageing through older people working together and with others

To challenge assumptions about ageing by promoting links and activities across generations

To prepare generations for the opportunities and challenges of later year

Documents

Evaluation of the London Borough of Camden's Quality of Life Strategy for Older Citizens By…