1
|
Hendlmeier I, Bickel H, Heßler-Kaufmann JB, Schäufele M. Care challenges in older general hospital patients : Impact of cognitive impairment and other patient-related factors. Z Gerontol Geriatr 2019; 52:212-221. [PMID: 31628613 PMCID: PMC6821661 DOI: 10.1007/s00391-019-01628-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Older general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment). METHODS A cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients' cognitive status. RESULTS Care challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations. CONCLUSION The findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.
Collapse
Affiliation(s)
- Ingrid Hendlmeier
- Faculty of Social Sciences, Hochschule Mannheim, University of Applied Sciences, Mannheim, Germany.
| | - Horst Bickel
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Johannes Baltasar Heßler-Kaufmann
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Martina Schäufele
- Faculty of Social Sciences, Hochschule Mannheim, University of Applied Sciences, Mannheim, Germany
| |
Collapse
|
2
|
Huenefeld D, Rodde S, Bureick G, Elkeles B, Hasebrook J. Improving Treatment of Elderly Patients by Interprofessional Education in a Quality Network of Geriatric Medicine: Protocol for Evaluating an Educational Initiative. JMIR Res Protoc 2019; 8:e11067. [PMID: 31066716 PMCID: PMC6524453 DOI: 10.2196/11067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/28/2018] [Accepted: 03/24/2019] [Indexed: 01/17/2023] Open
Abstract
Background All statistics on the development of demand for care for multimorbid elderly patients highlight the acute pressure to act to adequately respond to the expected increase in geriatric patient population in the next 15 years. Against this background, great importance must be attached to the improvement of cross-occupational group and cross-sector treatment of these patients. In addition, many professionals in the health care sector often have little knowledge about the special treatment and care needs of the elderly. Objective The Quality Network of Geriatric Medicine in north-west Germany is the body responsible for the project; with its member organizations, it provides care for over 400,000 inpatients and is thus one of the largest associations for geriatrics in Germany. The Quality Network conducts binding evaluated qualification measures for staff involved in the treatment and care of multimorbid elderly patients. The training offers are especially intended for staff who have not yet been trained in working with elderly patients. This approach is intended to improve the expertise of various occupational groups on different hierarchy levels, to include patients and their family members in the evaluation process, and to initiate changes within the organizations. Methods Various instruments are used in the evaluation of qualification measures: besides written surveys and questionnaires, structured work groups (consensus groups) and interviews are conducted. The evaluation starts before the qualification measures to determine the starting point and then continues during the measure and after its completion. This allows major findings to be integrated directly into the ongoing qualification program. At least 100 trainings on geriatric topics, 80 consensus groups, and 120 patients (and family members) are going to be included in the study. Results The evaluation of the educational initiative is funded by the State of Northrhine-Westfalia (Germany; LZG TG 71 001 / 2015 and LZG TG 71 002 / 2015). The results of the study will be published after review and approval by the state authorities – presumably by the end of 2019. The before and after comparison of the treatment-related outcomes at the beginning and near the completion of the educational initiative gives insights into how transfer-oriented education can improve the treatment of elderly patients across sector lines for inpatients as well as outpatients. The evaluation of the implementation of educational content in day-to-day work and occupational groups is to facilitate recommendations about economically sensible use of educational resources and about further adjustments to the training content. Conclusions The evaluation develops the foundation for targeted and needs-oriented qualification measures as well as transfer in cross-sector, multiprofessional networks. Instruments and results will be published and provided to other health care networks and institutions. The Quality Network will implement the results of the evaluation process in its member institutions. International Registered Report Identifier (IRRID) DERR1-10.2196/11067
Collapse
Affiliation(s)
- Daisy Huenefeld
- Board of the Foundation, St Franziskus Foundation, Muenster, Germany
| | - Sibyll Rodde
- zeb.healthcare, zeb.rolfes.schierenbeck.associates, Muenster, Germany
| | | | | | | |
Collapse
|
3
|
Hendlmeier I, Bickel H, Hessler JB, Weber J, Junge MN, Leonhardt S, Schäufele M. [Dementia friendly care services in general hospitals : Representative results of the general hospital study (GHoSt)]. Z Gerontol Geriatr 2017; 51:509-516. [PMID: 29110137 DOI: 10.1007/s00391-017-1339-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mostly model projects report on special care services and procedures for general hospital patients with cognitive impairment. The objective of this study was to determine the frequency of special care services and procedures in general hospitals on the basis of a representative cross-sectional study. METHODS From a list of all general hospitals in southern Germany we randomly selected a specified number of hospitals und somatic wards. The hospitals were visited and all older patients on the selected wards on that day were included in the study. Information about care services and their utilization was collected with standardized instruments. RESULTS A total of 33 general hospitals and 172 wards participated in the study. The patient sample included 1469 persons over 65 (mean age 78.6 years) and 40% of the patients showed cognitive impairments. The staff reported that the most frequent measures for patients with cognitive impairments concerned patients with wandering behavior (63.1%), efforts to involve the patients' relatives to help with their daily care (60.1%), conducting nonintrusive interviews to identify cognitive impairments (59.9%), allocation to other rooms (58%) and visual aids for place orientation of patients (50.6%). In accordance with earlier studies our results show that other dementia friendly services implemented in pilot projects were rare. The existing special services for patients with cognitive impairment were rarely used by the patients or their relatives. DISCUSSION The results demonstrate the urgent need to improve special care services and routines for identification of elderly patients with cognitive impairment and risk of delirium in general hospitals.
Collapse
Affiliation(s)
- Ingrid Hendlmeier
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland.
| | - Horst Bickel
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Klinikum rechts der Isar, München, Deutschland
| | - Johannes Baltasar Hessler
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Klinikum rechts der Isar, München, Deutschland
| | - Joshua Weber
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland.,Hochschule für Soziale Arbeit Olten, Fachhochschule Nordschweiz, Olten, Schweiz
| | - Magdalena Nora Junge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Klinikum rechts der Isar, München, Deutschland
| | - Sarah Leonhardt
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland
| | - Martina Schäufele
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland.
| |
Collapse
|
4
|
Kratz T, Heinrich M, Schlauß E, Diefenbacher A. Preventing postoperative delirium. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 112:289-96. [PMID: 26008890 DOI: 10.3238/arztebl.2015.0289] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Delirium is a common complication in elderly hospitalized patients. It prolongs the length of hospital stay, raises costs, increases the workload of the nursing staff, and may necessitate transfer of the patient to a nursing home. The risk of postoperative delirium is particularly high in elderly patients with pre-existing cognitive deficits. METHODS In an open study, we systematically assessed the frequency of postoperative delirium in patients over age 70 on two surgical wards of a general hospital. In a six-month "prevalence phase," from March to August 2011, we counted the number of patients with postoperative delirium, but did not initiate any intervention. Thereafter, in a ten-month "intervention phase" from September 2011 to June 2012, a nurse with special training in the management of delirium carried out an intervention involving component measures of the Hospital Elder Life Program (HELP) on one of the two wards, with the aim of preventing postoperative delirium. The patients on the other ward served as a control group. RESULTS In the prevalence phase, 20.2% of all patients developed postoperative delirium (95% confidence interval [CI], 14.6-26.4). In the intervention phase, postoperative delirium arose in 20.8% (95% CI, 11.3-32.1) of the patients on the ward with no specific interventions, but in only 4.9% (95% CI, 0.0-11.5) of those on the ward where the intervention was carried out. The difference was presumably due to the measures initiated by the specially trained nurse, including validation, improvement of sleep, cognitive activation, early mobilization, improved sensory stimulation, and improved nutritional and fluid intake. Important predictors of postoperative delirium included a low score on the Mini-Mental State Examination, advanced age, and preoperative infection. CONCLUSION The frequency of postoperative delirium in elderly patients with cognitive deficits can be lowered with nursing measures carried out by a specially trained nurse, close postoperative supervision, and cognitive activation.
Collapse
Affiliation(s)
- Torsten Kratz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus "Königin Elisabeth" Herzberge, Berlin
| | | | | | | |
Collapse
|
5
|
Kratz T, Diefenbacher A. [Acute and long-term cognitive consequences of treatment on intensive care units]. DER NERVENARZT 2016; 87:246-52. [PMID: 26910259 DOI: 10.1007/s00115-016-0078-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Following treatment on the intensive care unit (ICU) patients often suffer from acute and long-term cognitive deficits. This is true for patients of all age groups but especially for elderly patients who have undergone surgery and develop postoperative delirium (POD) or postoperative cognitive decline (POCD). Both are associated with severe limitations in the quality of life and long-term outcome. OBJECTIVE Which acute and long-term cognitive effects develop in ICU survivors and how do they influence the outcome? How can POD and POCD be differentiated? METHOD A selective literature search was carried out. RESULTS Following surgery POCD can develop within days to weeks, may persist for weeks or months and can lead to problems in attentiveness even under conditions of inconspicuous consciousness. Remission is possible but may take up to more than 12 months. The POD is a phenomenon characterized by disturbances of consciousness and problems in attention, beginning acutely hours and days postoperatively, can persist for days to weeks and remission can be expected within a few days. While POD often has an organic cause, such as an infection, the pathogenesis of POCD has not been sufficiently elucidated. DISCUSSION Both POD and particularly POCD can lead to a deterioration of cognition following ICU treatment. As efficient treatment still has to be developed preventive methods, such as preoperative screening for risk factors, thorough planning of operative and anesthetic techniques and compensation of risk factors as well as providing assistance to patients, e. g. by a trained nurse should be implemented in the clinical routine more often than is presently the case.
Collapse
Affiliation(s)
- T Kratz
- Abt. für Psychiatrie, Psychotherapie und Psychosomatik, Evangelisches Krankenhaus Königin Elisabeth Herzberg gGmbH, Herzbergstr. 79, 10365, Berlin, Deutschland.
| | - A Diefenbacher
- Abt. für Psychiatrie, Psychotherapie und Psychosomatik, Evangelisches Krankenhaus Königin Elisabeth Herzberg gGmbH, Herzbergstr. 79, 10365, Berlin, Deutschland
| |
Collapse
|
6
|
Dreier A, Thyrian JR, Eichler T, Hoffmann W. Qualifications for nurses for the care of patients with dementia and support to their caregivers: A pilot evaluation of the dementia care management curriculum. NURSE EDUCATION TODAY 2016; 36:310-317. [PMID: 26277428 DOI: 10.1016/j.nedt.2015.07.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/15/2015] [Accepted: 07/24/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND A substantial increase of people with dementia (PwD) is predicted for the future. Nurses are taking over important tasks to support PwD, which requires a specialized qualification. OBJECTIVES The aim was to identify points for revision and to further improve the Dementia Care Manager (DCM) curriculum as a basis for probable qualification of nurses caring for PwD. DESIGN We conducted a summative evaluation study to revise the first version of the DCM curriculum. SETTING The study was conducted in the primary health care setting. PARTICIPANTS Nurses and lecturers of the first theoretical and practical implementation were involved. METHODS Questionnaire-based interviews with nurses and lecturers after every module during the theoretical qualification. Besides, nurses rated the curriculum after the end of the theoretical part and evaluated the DCM tasks and the usefulness of the curriculum contents after the practical phase in questionnaire-based interviews. Descriptive statistics were used for analysis. RESULTS A total of five nurses and 33 lecturers participated in the first theoretical and practical implementation of the DCM qualification. Generally, nurses and lecturers assessed the curriculum contents as "very important" or "important." In particular, the job-related issues, the variety of course topics and the close combination of theory and practice were highly valued. The practical implementation of the DCM was rated predominantly as "important" by nurses for the delivery of care for PwD. To optimize the theoretical DCM curriculum, participants suggested increasing the number of lessons for two of the modules (gerontopsychiatry, interdisciplinary case reviews). Furthermore, nurses preferred a longer practical phase, whereas some lecturers called for larger group sizes of participants. CONCLUSIONS The DCM qualification enhances nurses' competencies to care for PwD. The curriculum regards an interprofessional, cooperative team approach as the potential to improve health care supply for demented people and to better support their caregivers.
Collapse
Affiliation(s)
- Adina Dreier
- Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Neurodegenerative Diseases (DZNE), Ellernholzstr. 1-2, Greifswald 17487, Germany.
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Ellernholzstr. 1-2, Greifswald 17487, Germany.
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Ellernholzstr. 1-2, Greifswald 17487, Germany.
| | - Wolfgang Hoffmann
- Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Neurodegenerative Diseases (DZNE), Ellernholzstr. 1-2, Greifswald 17487, Germany.
| |
Collapse
|
7
|
Diefenbacher A. [Psyche and soma: what can the consultation-liaison psychiatrist contribute?]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2014; 29:54-62. [PMID: 25416207 DOI: 10.1007/s40211-014-0126-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/31/2014] [Indexed: 06/04/2023]
Abstract
In German speaking countries, during the last decades, we can see a growing, though albeit small, integration of psychiatry and psychosomatics into (somatic) medicine. This article outlines the importance of the growing number of elderly patients in medical care as a vantage point for c-l-psychiatrists to play a pro-active role in implementing adequate structures and processes for diagnostics and treatment of this patient group. It is argued that delirium (in dementia) can and should be regarded as a paradigm for a biopsychosocial disorder sui generis. In addition, aspects of the cl-psychiatrists role at two important interfaces of somatic and psychological medicine, i.e. primary care and emergency rooms, are highlighted. Finally, some information about the development of the professionalization of cl-psychiatry in Europe is given.
Collapse
Affiliation(s)
- Albert Diefenbacher
- Abt. für Psychiatrie, Psychotherapie und Psychosomatik, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Deutschland,
| |
Collapse
|