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Article ; Online: Time to rethink generational justice.

Lloyd-Sherlock, Peter

2020 Volume 397, Issue 10268, Page(s) 21–22

Language	English
Publishing date	2020-12-10
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(20)32547-2
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Article: Age discrimination, the right to life, and COVID-19 vaccination in countries with limited resources.

Lloyd-Sherlock, Peter / Guntupalli, Aravinda / Sempé, Lucas

The Journal of social issues

2022

Abstract: This paper seeks to develop and apply a simple yardstick based on remaining life expectancy to assess whether specific health policies unfairly discriminate against people on the basis of their age. This reveals that the COVID-19 vaccine prioritization ... ...

Abstract	This paper seeks to develop and apply a simple yardstick based on remaining life expectancy to assess whether specific health policies unfairly discriminate against people on the basis of their age. This reveals that the COVID-19 vaccine prioritization policies of several countries have discriminated against older people. Conversely, the exclusion of older people from COVID-19 vaccine testing is shown to be non-discriminatory, as is some degree of age prioritization for limited acute COVID-19 care. Age discrimination in vaccine prioritization is shown to be embedded in wider ageist attitudes in health policy, which give the lives of older people a lower social value than the lives of people at younger ages.
Language	English
Publishing date	2022-09-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2023973-7
ISSN	1540-4560 ; 0022-4537
ISSN (online)	1540-4560
ISSN	0022-4537
DOI	10.1111/josi.12561
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Article ; Online: The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people.

Lloyd-Sherlock, Peter / Giacomin, Karla / Sempé, Lucas

BMC health services research

2022 Volume 22, Issue 1, Page(s) 176

Abstract: Background: Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC - Older Person's Care Program). This paper examines two ...

Abstract	Background: Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC - Older Person's Care Program). This paper examines two potential associations between inclusion in PMC on types of outpatient health service utilization by dependent older people. The first is that being in PMC is associated with a higher frequency of outpatient visits for physical rehabilitation. The second is that being in PMC is associated with a higher frequency of planned versus unplanned outpatient visits. Methods: We apply a quasi-experimental design to a unique set of health administrative data recording visits to outpatient health services. We focus on comparisons of the universe of visits, transformed to ratios of planned/unplanned visits and rehabilitation/other reasons for visiting the outpatient service. First, we preprocess our sample through different matching techniques such as 'coarsened exact matching' (CEM), 'nearest neighbor' based on logit scores (NN), 'optimal pair' (OP) and 'optimal full' (OF) methods. Second, we estimate marginal effects of being in PMC on our outcomes of interest. We use Poisson regressions controlling for individual and community factors and use robust standard errors. Our results are presented as the comparative incidence ratio of PMC on rehabilitation and planned visits. Results: We find significant positive incidence rates for belonging to PMC for both outcomes of interest under all matching specifications. Poisson models using CEM shows a higher incidence rate for planned visits in comparison to unplanned visits, 1.3 (95% CI 1.1-1.4), by PMC patients compared to the non-PMC controls, and a higher proportion of visits for rehabilitation, 3.4 (95% CI 1.7-6.8). Similar positive results are found across other matching methods and models. Conclusions: Our analysis reveals significant positive associations between older people included in PMC and a matched set of controls for a greater ratio of making outpatient visits that were planned, rather than unplanned. We find similar associations for the proportion of visits made for rehabilitation, as opposed to other reasons. These findings indicate that PMC influences some elements of outpatient health service utilization by dependent older people.
MeSH term(s)	Aged ; Ambulatory Care ; Brazil/epidemiology ; Delivery of Health Care, Integrated ; Humans ; Incidence ; Patient Acceptance of Health Care
Language	English
Publishing date	2022-02-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-07552-y
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Article ; Online: Ageism in Indonesia's national covid-19 vaccination programme.

Lloyd-Sherlock, Peter / Muljono, Paramita / Ebrahim, Shah

BMJ (Clinical research ed.)

2021 Volume 372, Page(s) n299

MeSH term(s)	Ageism ; COVID-19/prevention & control ; COVID-19 Vaccines ; Health Services Accessibility/organization & administration ; Humans ; Indonesia ; Mass Vaccination/organization & administration
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2021-02-02
Publishing country	England
Document type	Letter
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.n299
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Article ; Online: Addressing pressures on health services in Belo Horizonte, Brazil through community-based care for poor older people: a qualitative study.

Lloyd-Sherlock, Peter / Fialho de Carvalho, Poliana / Giacomin, Karla / Sempé, Lucas

Lancet regional health. Americas

2023 Volume 27, Page(s) 100619

Abstract: Background: In low and middle-income countries, there is growing interest in managing pressures on health services through community interventions for older people. Evidence on the effects of such interventions is scarce. We draw on qualitative data to ... ...

Abstract	Background: In low and middle-income countries, there is growing interest in managing pressures on health services through community interventions for older people. Evidence on the effects of such interventions is scarce. We draw on qualitative data to examine these effects for a specific scheme, Methods: Building on quantitative findings reported elsewhere, we use qualitative data to develop and test theories of change. These include data from 50 meetings with policymakers, managers and staff in 30 health centres and social assistance posts. Data collection was embedded in key informant interaction and knowledge coproduction. Data include participant and non-participant observation, focus groups and semi-structured interviews with key informants, as well as older people and carers from seven families. Findings: The data reveal three theories of change. Theory 1 is PMC maintains older people's health which reduces their need for inpatient or outpatient care. We find strong evidence to support this, through effects on use of medication, chronic disease management and risk prevention. Theory 2 is PMC promotes timely intervention by anticipating health problems, thus reducing demand for emergency and acute care. We find some evidence for this, but it was limited by limited availability of timely treatment or referral beyond PMC. Theory 3 is PMC facilitates hospital discharge. We find limited evidence for this, reflecting a lack of formal liaison between PMC and hospitals. Interpretation: Schemes like PMC have potential to reduce pressures on health service utilisation by older people, if they are well articulated with wider health services. Funding: Medical Research Council, Newton Fund and Brazilian Council of State Funding Agencies.
Language	English
Publishing date	2023-10-28
Publishing country	England
Document type	Journal Article
ISSN	2667-193X
ISSN (online)	2667-193X
DOI	10.1016/j.lana.2023.100619
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Article ; Online: The relationship of perceived discrimination in healthcare and future falls among community-dwelling older persons from an English longitudinal cohort.

Sandoval Garrido, Felipe Alfonso / Bolt, Timothy / Taniguchi, Yuta / Lloyd-Sherlock, Peter

F1000Research

2023 Volume 12, Page(s) 1134

Abstract: Background: The objective of this study is to examine the relation between the perceived discrimination suffered by older adults aged 60 and over during a healthcare encounter and its effects on the likelihood of falling 4 and 8 years later.: Methods!# ...

Abstract	Background: The objective of this study is to examine the relation between the perceived discrimination suffered by older adults aged 60 and over during a healthcare encounter and its effects on the likelihood of falling 4 and 8 years later. Methods: To identify discrimination, we used the English Longitudinal Study of Ageing (ELSA) data collected in 2010-2011 (wave 5) that asked respondents about feeling discriminated against by doctors or at hospitals in the past year. Falls were assessed by the question: "Have you fallen down in the last two years?" in subsequent waves. We performed longitudinal analyses using the 2014-2015 (wave 7) and 2018-2019 (wave 9) follow-ups. Multivariable logistic regression was used to estimate the odds ratios of falling. Results: At baseline, 707 (15.1%) of all respondents experienced healthcare discrimination. Those suffering from discrimination in health care had 64% higher chances of falling 4 years later (odds ratio: 1.637, 95% confidence interval: 1.131-2.368) compared to those who did not, adjusting for age, sex, marital status, wealth, ethnicity, education levels, self-perceived health, depressive symptoms, and difficulties with basic and/or instrumental activities of daily living (ADL/IADL) and difficulties with walking. After 8 years, the effect was not statistically significant. Older age was the only significant detrimental factor at both 4 and 8 years. Conclusions: Understanding discrimination in health care is important to enable safe and welcoming environments for the timely future use of services. These results remind us of the physical risk and the complex panorama of bio-psychosocial determinants involved in tackling discrimination over time.
MeSH term(s)	Humans ; Middle Aged ; Aged ; Aged, 80 and over ; Independent Living/psychology ; Activities of Daily Living/psychology ; Longitudinal Studies ; Perceived Discrimination ; Delivery of Health Care
Language	English
Publishing date	2023-09-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2699932-8
ISSN	2046-1402 ; 2046-1402
ISSN (online)	2046-1402
ISSN	2046-1402
DOI	10.12688/f1000research.140302.1
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Article ; Online: COVID-19 and inter-generational solidarity.

Sherlock, Peter Lloyd

Lancet (London, England)

2022 Volume 399, Issue 10337, Page(s) 1775

MeSH term(s)	COVID-19 ; Humans ; Intergenerational Relations ; SARS-CoV-2
Language	English
Publishing date	2022-05-06
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(22)00365-8
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Article ; Online: The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people

Peter Lloyd-Sherlock / Karla Giacomin / Lucas Sempé

BMC Health Services Research, Vol 22, Iss 1, Pp 1-

2022 Volume 11

Abstract: Abstract Background Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC – Older Person’s Care Program). This paper ... ...

Abstract	Abstract Background Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC – Older Person’s Care Program). This paper examines two potential associations between inclusion in PMC on types of outpatient health service utilization by dependent older people. The first is that being in PMC is associated with a higher frequency of outpatient visits for physical rehabilitation. The second is that being in PMC is associated with a higher frequency of planned versus unplanned outpatient visits. Methods We apply a quasi-experimental design to a unique set of health administrative data recording visits to outpatient health services. We focus on comparisons of the universe of visits, transformed to ratios of planned/unplanned visits and rehabilitation/other reasons for visiting the outpatient service. First, we preprocess our sample through different matching techniques such as ‘coarsened exact matching’ (CEM), ‘nearest neighbor’ based on logit scores (NN), ‘optimal pair’ (OP) and ‘optimal full’ (OF) methods. Second, we estimate marginal effects of being in PMC on our outcomes of interest. We use Poisson regressions controlling for individual and community factors and use robust standard errors. Our results are presented as the comparative incidence ratio of PMC on rehabilitation and planned visits. Results We find significant positive incidence rates for belonging to PMC for both outcomes of interest under all matching specifications. Poisson models using CEM shows a higher incidence rate for planned visits in comparison to unplanned visits, 1.3 (95% CI 1.1–1.4), by PMC patients compared to the non-PMC controls, and a higher proportion of visits for rehabilitation, 3.4 (95% CI 1.7–6.8). Similar positive results are found across other matching methods and models. Conclusions Our analysis reveals significant positive associations between older people included in PMC and a matched set of controls ...
Keywords	older people ; rehabilitation ; planned visits ; health policy in Brazil ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A critical review of intervention and policy effects on the health of older people in sub-Saharan Africa.

Lloyd-Sherlock, Peter / Amoakoh-Coleman, Mary

Social science & medicine (1982)

2020 Volume 250, Page(s) 112887

Abstract: This paper provides a critical review of publications containing information about specific health effects on older adults of interventions and policies in sub-Saharan Africa. Interventions and policies fell into the following categories: testing or ... ...

Abstract	This paper provides a critical review of publications containing information about specific health effects on older adults of interventions and policies in sub-Saharan Africa. Interventions and policies fell into the following categories: testing or treating HIV, the provision of pensions, screening for non-communicable diseases (NCDs), health service financing and interventions related to visual conditions. The review finds that the relevant literature is very limited relative to the size of older populations in the region. Conditions of particular relevance to older adults, such as NCDs, are under-represented and most studies treat older people as a single category, typically including all adults aged 50 and over. The paper concludes that evidence about the health effects of interventions and policies on the region's rapidly growing older populations remains minimal, and that this both reflects and reinforces a bias against older people in health policy.
Language	English
Publishing date	2020-02-27
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	4766-1
ISSN	1873-5347 ; 0037-7856 ; 0277-9536
ISSN (online)	1873-5347
ISSN	0037-7856 ; 0277-9536
DOI	10.1016/j.socscimed.2020.112887
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Article ; Online: Addressing pressures on health services in Belo Horizonte, Brazil through community-based care for poor older people

Peter Lloyd-Sherlock / Poliana Fialho de Carvalho / Karla Giacomin / Lucas Sempé

The Lancet Regional Health. Americas, Vol 27, Iss , Pp 100619- (2023)

a qualitative studyResearch in context

2023

Abstract: Summary: Background: In low and middle-income countries, there is growing interest in managing pressures on health services through community interventions for older people. Evidence on the effects of such interventions is scarce. We draw on qualitative ... ...

Abstract	Summary: Background: In low and middle-income countries, there is growing interest in managing pressures on health services through community interventions for older people. Evidence on the effects of such interventions is scarce. We draw on qualitative data to examine these effects for a specific scheme, Programa Maior Cuidado (PMC) in the Brazilian city of Belo Horizonte. Methods: Building on quantitative findings reported elsewhere, we use qualitative data to develop and test theories of change. These include data from 50 meetings with policymakers, managers and staff in 30 health centres and social assistance posts. Data collection was embedded in key informant interaction and knowledge coproduction. Data include participant and non-participant observation, focus groups and semi-structured interviews with key informants, as well as older people and carers from seven families. Findings: The data reveal three theories of change. Theory 1 is PMC maintains older people’s health which reduces their need for inpatient or outpatient care. We find strong evidence to support this, through effects on use of medication, chronic disease management and risk prevention. Theory 2 is PMC promotes timely intervention by anticipating health problems, thus reducing demand for emergency and acute care. We find some evidence for this, but it was limited by limited availability of timely treatment or referral beyond PMC. Theory 3 is PMC facilitates hospital discharge. We find limited evidence for this, reflecting a lack of formal liaison between PMC and hospitals. Interpretation: Schemes like PMC have potential to reduce pressures on health service utilisation by older people, if they are well articulated with wider health services. Funding: Medical Research Council, Newton Fund and Brazilian Council of State Funding Agencies.
Keywords	Older people ; Primary health care ; Long-term care ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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