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Janssens S, Deschodt M, Dejaeger M, Fagard K, Cerulus M, Cosyns H, Flamaing J, Herteleer M, Sermon A. From research to daily clinical practice: implementation of orthogeriatric co-management in the trauma ward. FRONTIERS IN HEALTH SERVICES 2023; 3:1249832. [PMID: 37711603 PMCID: PMC10498298 DOI: 10.3389/frhs.2023.1249832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023]
Abstract
Introduction Evidence strongly suggests that orthogeriatric co-management improves patient outcomes in frail older patients with a fracture, but evidence regarding how to implement this model of care in daily clinical practice is scarce. In this paper, we first describe the implementation process and selection of implementation strategies for an orthogeriatric co-management program in the traumatology ward of the University Hospitals Leuven in Belgium. Second, we report the results of a multi-method feasibility study. This study (1) measures the fidelity towards the program's core components, (2) quantifies the perceived feasibility and acceptability by the healthcare professionals, and (3) defines implementation determinants. Methods Implementation strategies were operationalized based on the Expert Recommendations for Implementing Change (ERIC) guidelines. In the feasibility study, fidelity towards the core components of the program was measured in a group of 15 patients aged 75 years and over by using electronic health records. Feasibility and acceptability as perceived by the involved healthcare professionals was measured using a 15-question survey with a 5-point Likert scale. Implementation determinants were mapped thematically based on seven focus group discussions and two semi-structured interviews by focusing on the healthcare professionals' experiences. Results We observed low fidelity towards completion of a screening questionnaire to map the premorbid situation (13%), but high fidelity towards the other program core components: multidimensional evaluation (100%), development of an individual care plan (100%), and systematic follow-up (80%). Of the 50 survey respondents, 94% accepted the program and 62% perceived it as feasible. Important implementation determinants were feasibility, awareness and familiarity, and improved communication between healthcare professionals that positively influenced program adherence. Conclusions Fidelity, acceptability, and feasibility of an orthogeriatric co-management program were high as a result of an iterative process of selecting implementation strategies with intensive stakeholder involvement from the beginning. Clinical trial registration [https://www.isrctn.com/ISRCTN20491828], International Standard Randomised Controlled Trial Number (ISRCTN) Registry: [ISRCTN20491828]. Registered on October 11, 2021.
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Affiliation(s)
- Sigrid Janssens
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
- Competence Centre of Nursing, University Hospitals Leuven, Leuven, Belgium
| | - Marian Dejaeger
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Katleen Fagard
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marie Cerulus
- Competence Centre of Nursing, University Hospitals Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Heidi Cosyns
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Michiel Herteleer
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Traumatology, University Hospitals Leuven, Leuven, Belgium
| | - An Sermon
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Traumatology, University Hospitals Leuven, Leuven, Belgium
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Karami B, Ostad-Taghizadeh A, Rashidian A, Tajvar M. Developing a Conceptual Framework for an Age-Friendly Health System: A Scoping Review. Int J Health Policy Manag 2023; 12:7342. [PMID: 37579375 PMCID: PMC10461896 DOI: 10.34172/ijhpm.2023.7342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/07/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Population aging is usually associated with increased health care needs. Developing an age-friendly health system with special features, structure, and functions to meet the special needs of older people and improving their health status and quality of life is essential. This study aimed to develop a conceptual framework for an age-friendly health system, which would offer a conceptual basis for providing the best possible care for older people in health system to let them experience a successful, healthy, and active aging. METHODS A scoping review was used to design the conceptual framework based on Arksey and O'Malley's model, including six stages, with the final stage of using expert's opinions to improve and validate the initial framework. The health system model of Van Olmen, was selected as the baseline model for this framework. Then, by reviewing the available evidence, the characteristics of an age-friendly health system were extracted and incorporated in the baseline mode. RESULTS Using the electronic searching, initially 12 316 documents were identified, of which 140 studies were selected and included in this review study. The relevant data were extracted from the 140 studies by two reviewers independently. Most studies were conducted in 2016-2020, and mostly were from United States (33.6%). To have an age-friendly health system, interventions and changes should be performed in functions, components and objectives of health systems. This system aims to provide evidence-based care through trained workforces and involves older people and their families in health policy-makings. Its consequences include better health acre for older people, with fewer healthcare-related harms, greater care satisfaction and increased use of cost-effective health services. CONCLUSION To meet the needs of older people, health systems should make interventions in their functions for better performance. In line with these changes, other parts of society should work in harmony and set the health of older people as a top priority to ensure they can have a successful aging.
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Affiliation(s)
- Badrye Karami
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ostad-Taghizadeh
- Department of Disaster & Emergency Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tajvar
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Garre-Fivelsdal TE, Gjertsen JE, Dybvik E, Bakken MS. A standardized clinical pathway for hip fracture patients is associated with reduced mortality: data from the Norwegian Hip Fracture Register. Eur Geriatr Med 2023:10.1007/s41999-023-00788-9. [PMID: 37100980 DOI: 10.1007/s41999-023-00788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE A standardized clinical pathway is recommended for hip fracture patients. We aimed to survey standardization of treatment in Norwegian hospitals and to investigate whether this affected 30-day mortality and quality of life after hip fracture surgery. METHODS Based on the national guidelines for interdisciplinary treatment of hip fractures, nine criteria for a standardized clinical pathway were identified. A questionnaire was sent to all Norwegian hospitals treating hip fractures in 2020 to survey compliance with these criteria. A standardized clinical pathway was defined as a minimum of eight criteria fulfilled. Thirty-day mortality for patients treated in hospitals with and without a standardized clinical pathway was compared using data in the Norwegian Hip Fracture Register (NHFR). RESULTS 29 out of 43 hospitals (67%) answered the questionnaire. Of these, 20 hospitals (69%) had a standardized clinical pathway. Compared to these hospitals, there was a significantly higher 30-day mortality in hospitals without a standardized clinical pathway in the period 2016-2020 (HR 1.13, 95% CI 1.04-1.23; p = 0.005). 4 months postoperatively, patients treated in hospitals with a standardized clinical pathway and patients treated in hospitals without a standardized clinical pathway reported an EQ-5D index score of 0.58 and 0.57 respectively (p = 0.038). Significantly more patients treated in hospitals with a standardized clinical pathway were 4 months postoperatively able to perform usual activities (29% vs 27%) and self-care (55% vs 52%) compared to hospitals without a standardized clinical pathway. CONCLUSION A standardized clinical pathway for hip fracture patients was associated with reduced 30-day mortality, but no clinically important difference in quality of life compared to a non-standardized clinical pathway.
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Affiliation(s)
| | - Jan-Erik Gjertsen
- The Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Eva Dybvik
- The Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
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Fagard K, Deschodt M, Geyskens L, Willems S, Boland B, Wolthuis A, Flamaing J. Geriatric care for surgical patients: results and reflections from a cross-sectional survey in acute Belgian hospitals. Eur Geriatr Med 2023; 14:239-249. [PMID: 36690884 PMCID: PMC9870777 DOI: 10.1007/s41999-023-00748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE To explore geriatric care for surgical patients in Belgian hospitals and geriatricians' reflections on current practice. METHODS A web-based survey was developed based on literature review and local expertise, and was pretested with 4 participants. In June 2021, the 27-question survey was sent to 91 heads of geriatrics departments. Descriptive statistics and thematic analysis were performed. RESULTS Fifty-four surveys were completed, corresponding to a response rate of 59%. Preoperative geriatric risk screening is performed in 25 hospitals and systematically followed by geriatric assessment in 17 hospitals. During the perioperative hospitalisation, 91% of geriatric teams provide non-medical and 82% provide medical advice. To a lesser extent, they provide geriatric protocols, geriatric education and training, and attend multidisciplinary team meetings. Overall, time allocation of geriatric teams goes mainly to postoperative evaluations and interventions, rather than to preoperative assessment and care planning. Most surgical patients are hospitalised on surgical wards, with reactive (73%) or proactive (46%) geriatric consultation. In 36 hospitals, surgical patients are also admitted on geriatric wards, predominantly orthopaedic/trauma, abdominal and vascular surgery. Ninety-eight per cent of geriatricians feel that more geriatric input for surgical patients is needed. The most common reported barriers to further implement geriatric-surgical services are shortage of geriatricians and geriatric nurses, and unadjusted legislation and financing. CONCLUSION Geriatric care for surgical patients in Belgian hospitals is mainly reactive, although geriatricians favour more proactive services. The main opportunities and challenges for improvement are to resolve staff shortages in the geriatric work field and to update legislation and financing.
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Affiliation(s)
- Katleen Fagard
- Department of Geriatric Medicine, University Hospitals Leuven, Dienst Geriatrie UZ Leuven, Herestraat 49, Box 7003 35, 3000, Leuven, Belgium.
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Competence Centre of Nursing, University Hospitals Leuven, Leuven, Belgium
| | - Lisa Geyskens
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Sarah Willems
- Department of Geriatric Medicine, University Hospitals Leuven, Dienst Geriatrie UZ Leuven, Herestraat 49, Box 7003 35, 3000, Leuven, Belgium
| | - Benoît Boland
- Department of Geriatric Medicine, University Hospital Saint-Luc, Brussels, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Dienst Geriatrie UZ Leuven, Herestraat 49, Box 7003 35, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Jeuris A, Van Grootven B, Geyskens L, Milisen K, Flamaing J, Deschodt M. Identifying vulnerable older adults at risk for functional decline in cardiac care wards: time to shift the paradigm. Acta Clin Belg 2023; 78:44-50. [PMID: 35076355 DOI: 10.1080/17843286.2022.2031374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine whether routine screening with the Flemish version of the Triage Risk Screening Tool (fTRST) is a valid approach to determine which patients on cardiac care wards are at risk for inhospital functional decline and would benefit from geriatric expertise consultation. METHODS A secondary data-analysis of the G-COACH before-cohort, describing patient profiles and routine care processes, in 189 older adults on two cardiac care wards in the University Hospitals Leuven between September 2016 and June 2017. Inhospital functional decline was defined as an increase of at least one point on the Katz Index of Activities of Daily Living or death between hospital admission and discharge. RESULTS Nine in 10 patients had at least one geriatric syndrome and one-third developed functional decline. Based on the fTRST proposed cut-off of ≥2, 156 (82.5%) patients were at risk for functional decline (sensitivity of 95.2%, specificity of 23.8%, negative predictive value of 90.9% and Area Under the Curve of 0.60). Of the 156 'at risk' patients, 43 (27.6%) received a consultation by the geriatric consultation team after a median of four hospitalization days. A positive fTRST was not significantly related to geriatric consultations (x2 = 0.57; p = 0.45). CONCLUSION The fTRST has a low discriminative value in identifying older cardiology patients at risk for functional decline. Given the high prevalence of geriatric syndromes, we propose a new paradigm were all older adults on cardiac care wards undergo a needs assessment upon hospital admission.
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Affiliation(s)
- Anthony Jeuris
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Geriatric Medicine, Jessa Hospital, Hasselt, Belgium
| | - Bastiaan Van Grootven
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lisa Geyskens
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mieke Deschodt
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Competence Center of Nursing, University Hospitals Leuven, Leuven, Belgium
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Zisberg A, Lickiewicz J, Rogozinski A, Hahn S, Mabire C, Gentizon J, Malinowska-Lipień I, Bilgin H, Tulek Z, Pedersen MM, Andersen O, Mayer H, Schönfelder B, Gillis K, Gilmartin MJ, Squires A. Adapting the Geriatric Institutional Assessment Profile for different countries and languages: A multi-language translation and content validation study. Int J Nurs Stud 2022; 134:104283. [DOI: 10.1016/j.ijnurstu.2022.104283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/05/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022]
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Jones HT, Barber TJ. How do geriatricians feel about managing older people living with HIV? A scoping review. Eur Geriatr Med 2022; 13:987-997. [PMID: 35397097 PMCID: PMC9378329 DOI: 10.1007/s41999-022-00642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
Aim To identify what evidence exists regarding how geriatricians feel about managing older people living with HIV. Findings Currently whilst geriatricians are willing to contribute to the care of older people living with HIV, they lack the experience and training to take a prominent role. Message Incorporating education about HIV care into geriatric medicine curricula and the formation of quality clinical practice guidelines is required to prepare geriatricians to help participate in the care of older people living with HIV. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00642-4. Purpose The proportion of people living with HIV being older adults is increasing and due to high rates of multimorbidity and frailty within this group geriatricians are well placed to contribute to their care. However, little is known about how geriatricians feel about this new opportunity. Methods A scoping review was performed following the Arksey & O’Malley’s methodological framework with nine databases searched in December 2021 for studies reporting the experiences or views of geriatricians on caring for people living with HIV. Study inclusion was not limited by language or year of publication. Narrative reviews were excluded. Two reviewers independently performed the extraction using predetermined criteria. A descriptive analysis of extracted information was performed. Results Six publications reporting four studies, all conducted in the USA, were identified. The current barriers to geriatricians being involved in the care of older people living with HIV are: their current experience in managing people living with HIV, their knowledge of HIV, specific issues related to older people living with HIV and screening for HIV in older people as well as their attitudes to people living with HIV and experience of managing older LGBTQ + people. Conclusion Prior to geriatricians being routinely involved in the care of older people living with HIV further research outside of the USA is required. Geriatricians will also require specific training which should be incorporated into geriatric medicine training curricula as well as the creation of learning tools and quality clinical practice guidelines ideally created in collaboration with HIV organisations. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00642-4.
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Affiliation(s)
- Howell T Jones
- Ian Charleson Day Centre, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London, NW3 2QG, UK.
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK.
| | - Tristan J Barber
- Ian Charleson Day Centre, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London, NW3 2QG, UK
- Institute for Global Health, UCL, London, UK
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Geyskens L, Jeuris A, Deschodt M, Van Grootven B, Gielen E, Flamaing J. Patient-related risk factors for in-hospital functional decline in older adults: A systematic review and meta-analysis. Age Ageing 2022; 51:6527380. [PMID: 35165688 DOI: 10.1093/ageing/afac007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Functional decline (FD) is a common and serious problem among hospitalised older adults. OBJECTIVE This systematic review and meta-analysis aims to identify patient-related risk factors for in-hospital FD in older adults. METHODS Previous reviews on this topic (1970-2007) and the databases PubMed, Embase, and CINAHL (January 2007-December 2020) were searched. Reference lists of included articles were screened. Studies investigating patient-related risk factors for FD from (pre)admission to discharge in older adults admitted to an acute geriatric or internal medical unit were included. Study quality was assessed using the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using random-effects models. The quality of evidence was assessed using GRADE. RESULTS Twenty-nine studies met the inclusion criteria. Statistically significant risk factors were living in a nursing home (OR, 2.42; 95% CI, 1.29-4.52), impairment in instrumental activities of daily living (OR, 2.08; 95% CI, 1.51-2.86), history of falls (OR, 1.71; 95% CI, 1.00-2.92), cognitive impairment (OR, 1.83; 95% CI, 1.56-2.14), dementia (OR, 1.71; 95% CI, 1.23-2.38), delirium (OR, 2.34; 95% CI, 1.88-2.93), (risk of) malnutrition (OR, 1.76; 95% CI, 1.03-3.03), hypoalbuminemia (OR, 1.79; 95% CI, 1.36-2.36), comorbidity (OR, 1.09; 95% CI, 1.03-1.16), and the presence of pressure ulcers (OR, 3.33; 95% CI, 1.82-6.09). The narrative synthesis suggested prehospital FD, needing assistance with walking, and low body mass index as additional risk factors. CONCLUSIONS Several patient-related risk factors for in-hospital FD were identified that can be used at hospital admission to identify older patients at risk of FD.
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Affiliation(s)
- Lisa Geyskens
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
| | - Anthony Jeuris
- Department of Geriatric Medicine, Jessa Hospital, Hasselt 3500, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
- Competence Center of Nursing, University Hospitals Leuven, Leuven 3000, Belgium
| | - Bastiaan Van Grootven
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
- Research Foundation Flanders, Brussels 1000, Belgium
| | - Evelien Gielen
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven 3000, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven 3000, Belgium
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Van Heghe A, Mordant G, Dupont J, Dejaeger M, Laurent MR, Gielen E. Effects of Orthogeriatric Care Models on Outcomes of Hip Fracture Patients: A Systematic Review and Meta-Analysis. Calcif Tissue Int 2022; 110:162-184. [PMID: 34591127 PMCID: PMC8784368 DOI: 10.1007/s00223-021-00913-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/06/2021] [Indexed: 10/24/2022]
Abstract
Orthogeriatrics is increasingly recommended in the care of hip fracture patients, although evidence for this model is conflicting or at least limited. Furthermore, there is no conclusive evidence on which model [geriatric medicine consultant service (GCS), geriatric medical ward with orthopedic surgeon consultant service (GW), integrated care model (ICM)] is superior. The review summarizes the effect of orthogeriatric care for hip fracture patients on length of stay (LOS), time to surgery (TTS), in-hospital mortality, 1-year mortality, 30-day readmission rate, functional outcome, complication rate, and cost. Two independent reviewers retrieved randomized controlled trials, controlled observational studies, and pre/post analyses. Random-effects meta-analysis was performed. Thirty-seven studies were included, totaling 37.294 patients. Orthogeriatric care significantly reduced LOS [mean difference (MD) - 1.55 days, 95% confidence interval (CI) (- 2.53; - 0.57)], but heterogeneity warrants caution in interpreting this finding. Orthogeriatrics also resulted in a 28% lower risk of in-hospital mortality [95%CI (0.56; 0.92)], a 14% lower risk of 1-year mortality [95%CI (0.76; 0.97)], and a 19% lower risk of delirium [95%CI (0.71; 0.92)]. No significant effect was observed on TTS and 30-day readmission rate. No consistent effect was found on functional outcome. Numerically lower numbers of complications were observed in orthogeriatric care, yet some complications occurred more frequently in GW and ICM. Limited data suggest orthogeriatrics is cost-effective. There is moderate quality evidence that orthogeriatrics reduces LOS, in-hospital mortality, 1-year mortality, and delirium of hip fracture patients and may reduce complications and cost, while the effect on functional outcome is inconsistent. There is currently insufficient evidence to recommend one or the other type of orthogeriatric care model.
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Affiliation(s)
| | - Gilles Mordant
- Institute of Statistics, Biostatistics and Actuarial Sciences, UCLouvain, Louvain-la-Neuve, Belgium
| | - Jolan Dupont
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Centre for Metabolic Bone Diseases, UZ Leuven, Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Marian Dejaeger
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Centre for Metabolic Bone Diseases, UZ Leuven, Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Michaël R Laurent
- Centre for Metabolic Bone Diseases, UZ Leuven, Leuven, Belgium
- Geriatrics Department, Imelda Hospital, Bonheiden, Belgium
| | - Evelien Gielen
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
- Centre for Metabolic Bone Diseases, UZ Leuven, Leuven, Belgium.
- Department of Geriatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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10
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Heeren P, Hendrikx A, Ceyssens J, Devriendt E, Deschodt M, Desruelles D, Flamaing J, Sabbe M, Milisen K. Structure and processes of emergency observation units with a geriatric focus: a scoping review. BMC Geriatr 2021; 21:95. [PMID: 33526029 PMCID: PMC7852183 DOI: 10.1186/s12877-021-02029-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/13/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs. METHODS The revised scoping methodology framework of Arksey and O'Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies. RESULTS Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients' medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies. CONCLUSION This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of 'observation medicine' and 'CGA' can ideally be merged and successfully implemented in clinical care.
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Affiliation(s)
- Pieter Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Research Foundation Flanders, Egmontstraat 5, 1000, Brussels, Belgium
| | - Annabelle Hendrikx
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium
| | - Janne Ceyssens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium
| | - Els Devriendt
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Faculty of Medicine and Life Sciences, Healthcare and Ethics, UHasselt, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Didier Desruelles
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Marc Sabbe
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, Emergency Medicine, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium.
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Deschodt M, Jeuris A, Van Grootven B, Van Waerebeek E, Gantois E, Flamaing J, Velghe A. Adherence to recommendations of inpatient geriatric consultation teams: a multicenter observational study. Eur Geriatr Med 2021; 12:175-184. [PMID: 32978747 PMCID: PMC7900061 DOI: 10.1007/s41999-020-00397-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Inpatient geriatric consultation teams (IGCTs) provide recommendations for the care of older patients hospitalized on non-geriatric wards based on comprehensive geriatric assessment. The lack of adherence to their recommendations hinders the potential impact of IGCTs. We evaluated the adherence to IGCT recommendations and determined which team and recommendation characteristics are related to higher adherence rates. METHODS Multicenter observational study in older adults aged ≥ 75 years admitted to an acute non-geriatric ward. Demographic and adherence data were collected for 30 consecutive patients. A cross-sectional survey mapped team and organizational characteristics of the participating IGCTs. RESULTS Analyses were conducted in 278 patients (51.4% male, mean age 82.5 years, and median length of stay 10 days). There was a median number of 3 recommendations (range 1-13) per patient. The overall adherence rate was 69.7%. Recommendations related to 'social status' (82.4%) and 'functional status/mobility' (73.3%) were best adhered to. Recommendations related to 'medication' (53.2%) and 'nutritional status' (59.1%) were least adhered to. Adherence rates increased if recommendations were given to allied health professionals (OR = 6.37, 95% CI = 1.15-35.35) or by more experienced IGCTs (OR = 1.34, 95% CI = 1.04-1.72) and decreased when more recommendations were given (OR = 0.51, 95% CI = 0.33-0.80). CONCLUSION Adherence rate to IGCT recommendations increased if given to allied health professionals or by more experienced IGCTs and when fewer recommendations were given. Study replication in an international multicenter study with a larger number of centers and evaluating the quality of the recommendations is suggested.
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Affiliation(s)
- Mieke Deschodt
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium.
- Department of Public Health, Nursing Science, University of Basel, Basel, Switzerland.
| | | | - Bastiaan Van Grootven
- Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | | | - Evie Gantois
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
- Geriatrics Department, University Hospitals Leuven, Leuven, Belgium
| | - Anja Velghe
- Geriatrics Department, University Hospitals Ghent, Ghent, Belgium
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Start low, go slow, but look far: the case of geriatric medicine in Balkan countries. Eur Geriatr Med 2020; 11:869-878. [PMID: 32588380 DOI: 10.1007/s41999-020-00350-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To present an insight of the situation of geriatric medicine in Balkan countries, as it was presented in the context of the 2nd pre-congress seminar of the 16th European Geriatric Medicine Society (EuGMS) Congress Athens 2021. METHODS Representatives from 8 Balkan countries (Albania, Croatia, Greece, Republic of North Macedonia, Romania, Serbia, Slovenia, Turkey) answered 3 questions to reflect the state of geriatric medicine in their country: education on geriatrics; systems/methods for assessment of functional status and frailty; pre-operative risk assessment. An open discussion followed. RESULTS Undergraduate education in geriatric medicine seems underestimated in medical faculties of Balkan countries, whereas a high heterogeneity is observed at a post-graduate level. Only a few Balkan countries have geriatric medicine as a recognized medical specialty or subspecialty. Functional status and frailty are only sporadically assessed, and pre-operative risk assessment is very rarely performed with a geriatric focus. Scarcity of expertise and structures relevant to geriatric medicine seems to be common. Developing a training curriculum and geriatrics-related structures are two interconnected aspects. Cooperation among physicians and multidisciplinary teams are essential for the practice of geriatric medicine. A functional geriatric network is eventually necessary and ambulatory geriatric expertise is probably a feasible and clinically relevant starting point. Providing pragmatic solutions to the pressing challenges in variable clinical settings, supplementing and working in harmony with existing components of each health system, is probably the most convincing strategy to gain political support in developing geriatric medicine. CONCLUSION Balkan countries share common experiences and challenges in developing geriatrics. Whilst the principles of geriatric medicine are perhaps universal, proposed solutions should be adapted to each country's specific circumstances. Cooperation of the Balkan countries could promote in each the development of geriatric medicine. EuGMS is willing to foster relevant actions.
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Impact of geriatric co-management programmes on outcomes in older surgical patients: update of recent evidence. Curr Opin Anaesthesiol 2020; 33:114-121. [DOI: 10.1097/aco.0000000000000815] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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