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O'Connor CMC, Poulos RG, Sharma A, Preti C, Reynolds NL, Rowlands AC, Flakelar K, Raguz A, Valpiani P, Faux SG, Boyer M, Close JCT, Gupta L, Poulos CJ. An Australian aged care home for people subject to homelessness: health, wellbeing and cost-benefit. BMC Geriatr 2023; 23:253. [PMID: 37106318 PMCID: PMC10139912 DOI: 10.1186/s12877-023-03920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Older people subject to homelessness face many challenges including poor health status, geriatric syndromes, and depression, coupled with barriers in accessing health and aged care services. Many are in need of formal aged care at a younger age than the general population, yet, in Australia, specialised aged-care services to support this vulnerable cohort are limited. METHODS This study was an evaluation of a new purpose-built aged care home for people with high care needs and who are homeless or at risk of homelessness. Over the first 12 months post-admission, the study examined: (1) changes in residents' physical, mental, psychological and social health, and (2) the costs incurred by the study cohort, including any cost benefit derived. RESULTS Thirty-five residents enrolled in the study between March 2020 - April 2021. At admission, almost half of residents were within the range for dementia, the majority were frail, at high risk for falls, and had scores indicative of depression. Over time, linear mixed-effect models showed significant improvement in personal wellbeing scores, with clinically significant improvements in overall health related quality of life. Levels of physical functional independence, frailty, and global cognition were stable, but cognitive functional ability declined over time. Comparison of 12 month pre- and post- admission cost utility data for a smaller cohort (n = 13) for whom complete data were available, suggested an average per resident saving of approximately AU$32,000, while the QALY indicators remained stable post-admission. CONCLUSION While this was a small study with no control group, these preliminary positive outcomes add to the growing body of evidence that supports the need for dedicated services to support older people subject to homelessness.
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Affiliation(s)
- Claire M C O'Connor
- Centre for Positive Ageing, HammondCare, Sydney, Australia.
- School of Population Health, University of New South Wales, Sydney, Australia.
- School of Psychology, University of New South Wales, Sydney, Australia.
- Neuroscience Research Australia, Sydney, Australia.
| | - Roslyn G Poulos
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Anurag Sharma
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Costanza Preti
- Centre for Positive Ageing, HammondCare, Sydney, Australia
| | | | | | - Kyall Flakelar
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Angela Raguz
- Centre for Positive Ageing, HammondCare, Sydney, Australia
| | | | - Steven G Faux
- Departments of Rehabilitation Medicine and Pain Medicine, St Vincent's Hospital, Sydney, Australia
| | | | - Jacqueline C T Close
- Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Leena Gupta
- Sydney Local Health District, Sydney, Australia
| | - Christopher J Poulos
- Centre for Positive Ageing, HammondCare, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
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Takase M. Falls as the result of interplay between nurses, patient and the environment: Using text-mining to uncover how and why falls happen. Int J Nurs Sci 2022; 10:30-37. [PMID: 36860705 PMCID: PMC9969063 DOI: 10.1016/j.ijnss.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives This study aimed to explore, from the perspectives of nurses, how patients, the environment, and the practice of nurses interact with each other to contribute to patient falls. Methods A retrospective review of incident reports on patient falls, registered by nurses between 2016 and 2020, was conducted. The incident reports were retrieved from the database set up for the project of the Japan Council for Quality Health Care. The text descriptions of the "background of falls" were extracted verbatim, and analyzed by using a text-mining approach. Results A total of 4,176 incident reports on patient falls were analyzed. Of these falls, 79.0% were unwitnessed by nurses, and 8.7% occurred during direct nursing care. Document clustering identified 16 clusters. Four clusters were related to patients, such as the decline in their physiological/cognitive function, a loss of balance, and their use of hypnotic and psychotropic agents. Three clusters were related to nurses, and these included a lack of situation awareness, reliance on patient families, and insufficient implementation of the nursing process. Six clusters were concerned with patients and nurses, including the unproductive use of a bed alarm and call bells, the use of inappropriate footwear, the problematic use of walking aids and bedrails, and insufficient understanding of patients' activities of daily living. One cluster, chair-related falls, involved both patient and environmental factors. Finally, two clusters involved patient, nurse, and environmental factors, and these falls occurred when patients were bathing/showering or using a bedside commode. Conclusions Falls were caused by a dynamic interplay between patients, nurses, and the environment. Since many of the patient factors are difficult to modify in a short time, the focus has to be placed on nursing and environmental factors to reduce falls. In particular, improving nurses' situation awareness is of foremost importance, as it influences their decisions and actions to prevent falls.
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Hauer K, Ullrich P, Heldmann P, Bauknecht L, Hummel S, Abel B, Bauer JM, Lamb SE, Werner C. Psychometric Properties of the Proxy-Reported Life-Space Assessment in Institutionalized Settings (LSA-IS-Proxy) for Older Persons with and without Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083872. [PMID: 33917097 PMCID: PMC8067867 DOI: 10.3390/ijerph18083872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
(1) Background: Life-space mobility assessments for institutionalized settings are scarce and there is a lack of comprehensive validation and focus on persons with cognitive impairment (CI). This study aims to evaluate the psychometric properties of the Life-Space Assessment for Institutionalized Settings by proxy informants (LSA-IS-proxy) for institutionalized, older persons, with and without CI. (2) Methods: Concurrent validity against the self-reported version of the LSA-IS, construct validity with established construct variables, test-retest reliability, sensitivity to change during early multidisciplinary geriatric rehabilitation treatment, and feasibility (completion rate, floor/ceiling effects) of the LSA-IS-proxy, were assessed in 94 hospitalized geriatric patients (83.3 ± 6.1 years), with and without CI. (3) Results: The LSA-IS-proxy total score showed good-to-excellent agreement with the self-reported LSA-IS (Intraclass Correlations Coefficient, ICC3,1 = 0.77), predominantly expected small-to-high correlations with construct variables (r = 0.21–0.59), good test–retest reliability (ICC3,1 = 0.74), significant sensitivity to change over the treatment period (18.5 ± 7.9 days; p < 0.001, standardized response mean = 0.44), and excellent completion rates (100%) with no floor/ceiling effects. These results were predominantly confirmed for the sub-scores of the LSA-IS-proxy and were comparable between the sub-groups with different cognitive status. (4) Conclusions: The LSA-IS-proxy has proven to be feasible, valid, reliable, and sensitive to change in hospitalized, geriatric patients with and without CI.
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Affiliation(s)
- Klaus Hauer
- Agaplesion Bethanien Hospital Heidelberg/Geriatric Center at the Heidelberg University, and Center of Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany; (P.U.); (B.A.); (J.M.B.); (C.W.)
- Correspondence: ; Tel.: +49-6221-319-1532
| | - Phoebe Ullrich
- Agaplesion Bethanien Hospital Heidelberg/Geriatric Center at the Heidelberg University, and Center of Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany; (P.U.); (B.A.); (J.M.B.); (C.W.)
| | - Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, 69115 Heidelberg, Germany;
| | - Laura Bauknecht
- Medical Faculty, Heidelberg University, 69120 Heidelberg, Germany; (L.B.); (S.H.)
| | - Saskia Hummel
- Medical Faculty, Heidelberg University, 69120 Heidelberg, Germany; (L.B.); (S.H.)
| | - Bastian Abel
- Agaplesion Bethanien Hospital Heidelberg/Geriatric Center at the Heidelberg University, and Center of Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany; (P.U.); (B.A.); (J.M.B.); (C.W.)
| | - Juergen M. Bauer
- Agaplesion Bethanien Hospital Heidelberg/Geriatric Center at the Heidelberg University, and Center of Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany; (P.U.); (B.A.); (J.M.B.); (C.W.)
| | - Sarah E. Lamb
- Institute of Health Research, University of Exeter, South Cloisters, St. Luke’s Campus, Exeter EX1 2LU, UK;
| | - Christian Werner
- Agaplesion Bethanien Hospital Heidelberg/Geriatric Center at the Heidelberg University, and Center of Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany; (P.U.); (B.A.); (J.M.B.); (C.W.)
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Jakobsson E, Nygård L, Kottorp A, Olsson CB, Malinowsky C. The use of everyday technology; a comparison of older persons with cognitive impairments’ self-reports and their proxies’ reports. Br J Occup Ther 2020. [DOI: 10.1177/0308022620954117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Older persons with cognitive impairment have often been disregarded in providing information on their own perceptions. This study explored the number of relevant everyday technologies and the ability to use everyday technologies as perceived by persons with cognitive impairment in comparison with their proxies’ estimates using the Short Everyday Technology Use Questionnaire. Method In this cross-sectional study, persons with cognitive impairment ( n = 21) and their proxies ( n = 21) were interviewed on separate occasions with the Short Everyday Technology Use Questionnaire, which measures the number of relevant everyday technologies and the ability to use everyday technologies. The data were analysed with t-tests, z-comparisons, and Fisher’s exact test. The level of significance was set at p < 0.05. Results At the group level, no significant differences were found between persons with cognitive impairments’ perceptions and their proxies’ estimates regarding the number of relevant everyday technologies or the ability to use everyday technologies. On the individual level, significant differences were found in the ability measures within four out of the 21 dyads. Conclusion The persons with cognitive impairment and their proxies verified each other’s responses, providing evidence that persons with cognitive impairment should be the primary source for information about their own everyday technology use.
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Affiliation(s)
- Elin Jakobsson
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Louise Nygård
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | | | - Camilla Malinowsky
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Buitenweg JIV, Van De Ven RM, Ridderinkhof KR, Murre JMJ. Does cognitive flexibility training enhance subjective mental functioning in healthy older adults? AGING NEUROPSYCHOLOGY AND COGNITION 2018; 26:688-710. [DOI: 10.1080/13825585.2018.1519106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - K. Richard Ridderinkhof
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap M. J. Murre
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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