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Visser FCW, van Eersel MEA, Hempenius L, Verwey NA, Band C, van der Bol JM, Boudestein K, van Dijk SC, Gobbens R, van der Hooft CS, Kamper AM, Ruiter R, Sipers W, Spoelstra BNA, Stoffels J, Stolwijk-Woudstra DJ, van Stralen KJ, van Strien AM, Wijngaarden MA, Winters M, Strijkert F, van Munster BC. Recognition of cognitive dysfunction in hospitalised older patients: a flash mob study. BMC Geriatr 2024; 24:66. [PMID: 38229025 DOI: 10.1186/s12877-023-04588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND It is important that healthcare professionals recognise cognitive dysfunction in hospitalised older patients in order to address associated care needs, such as enhanced involvement of relatives and extra cognitive and functional support. However, studies analysing medical records suggest that healthcare professionals have low awareness of cognitive dysfunction in hospitalised older patients. In this study, we investigated the prevalence of cognitive dysfunction in hospitalised older patients, the percentage of patients in which cognitive dysfunction was recognised by healthcare professionals, and which variables were associated with recognition. METHODS A multicentre, nationwide, cross-sectional observational study was conducted on a single day using a flash mob study design in thirteen university and general hospitals in the Netherlands. Cognitive function was assessed in hospitalised patients aged ≥ 65 years old, who were admitted to medical and surgical wards. A Mini-Cog score of < 3 out of 5 indicated cognitive dysfunction. The attending nurses and physicians were asked whether they suspected cognitive dysfunction in their patient. Variables associated with recognition of cognitive dysfunction were assessed using multilevel and multivariable logistic regression analyses. RESULTS 347 of 757 enrolled patients (46%) showed cognitive dysfunction. Cognitive dysfunction was recognised by attending nurses in 137 of 323 patients (42%) and by physicians in 156 patients (48%). In 135 patients (42%), cognitive dysfunction was not recognised by either the attending nurse or physician. Recognition of cognitive dysfunction was better at a lower Mini-Cog score, with the best recognition in patients with the lowest scores. Patients with a Mini-Cog score < 3 were best recognised in the geriatric department (69% by nurses and 72% by physicians). CONCLUSION Cognitive dysfunction is common in hospitalised older patients and is poorly recognised by healthcare professionals. This study highlights the need to improve recognition of cognitive dysfunction in hospitalised older patients, particularly in individuals with less apparent cognitive dysfunction. The high proportion of older patients with cognitive dysfunction suggests that it may be beneficial to provide care tailored to cognitive dysfunction for all hospitalised older patients.
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Affiliation(s)
- Fleur C W Visser
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands.
| | - Marlise E A van Eersel
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
| | - Liesbeth Hempenius
- Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Nicolaas A Verwey
- Neurology and Geriatric Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Caterina Band
- Spaarne Gasthuis Hospital, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | | | - Kris Boudestein
- Department of Geriatric Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Suzanne C van Dijk
- Department of Geriatric Medicine, Franciscus Gasthuis and Vlietland, Schiedam, The Netherlands
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | | | - Adriaan M Kamper
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Walther Sipers
- Department of Geriatric Medicine, Zuyderland Medical Center Sittard-Geleen, Heerlen-Sittard-Geleen, The Netherlands
| | - Birgit N A Spoelstra
- Department of Geriatric Medicine, Meander Medisch Centrum, Amersfoort, The Netherlands
| | - Josephine Stoffels
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Aging & Later Life, Amsterdam, The Netherlands
| | | | | | - Astrid M van Strien
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marjolein A Wijngaarden
- Leiden University Medical Center, Internal Medicine, Section Geriatrics, Leiden, The Netherlands
| | - Marian Winters
- Departments of Internal Medicine and Geriatrics, Isala Hospital, Zwolle, The Netherlands
| | - Fijanne Strijkert
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
| | - Barbara C van Munster
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
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Kinsey D, Febrey S, Briscoe S, Kneale D, Thompson Coon J, Carrieri D, Lovegrove C, McGrath J, Hemsley A, Melendez-Torres GJ, Shaw L, Nunns M. Impact of interventions to improve recovery of older adults following planned hospital admission on quality-of-life following discharge: linked-evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-164. [PMID: 38140881 DOI: 10.3310/ghty5117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Objectives To understand the impact of multicomponent interventions to improve recovery of older adults following planned hospital treatment, we conducted two systematic reviews, one of quantitative and one of qualitative evidence, and an overarching synthesis. These aimed to: • understand the effect of multicomponent interventions which aim to enhance recovery and/or reduce length of stay on patient-reported outcomes and health and social care utilisation • understand the experiences of patients, carers and staff involved in the delivery of interventions • understand how different aspects of the content and delivery of interventions may influence patient outcomes. Review methods We searched bibliographic databases including MEDLINE ALL, Embase and the Health Management Information Consortium, CENTRAL, and Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database, conducted forward and backward citation searching and examined reference lists of topically similar qualitative reviews. Bibliographic database searches were completed in May/June 2021 and updated in April 2022. We sought primary research from high-income countries regarding hospital inpatients with a mean/median age of minimum 60 years, undergoing planned surgery. Patients experienced any multicomponent hospital-based intervention to reduce length of stay or improve recovery. Quantitative outcomes included length of stay and any patient-reported outcome or experience or service utilisation measure. Qualitative research focused on the experiences of patients, carers/family and staff of interventions received. Quality appraisal was undertaken using the Effective Public Health Practice Project Quality Assessment Tool or an adapted version of the Wallace checklist. We used random-effects meta-analysis to synthesise quantitative data where appropriate, meta-ethnography for qualitative studies and qualitative comparative analysis for the overarching synthesis. Results Quantitative review: Included 125 papers. Forty-nine studies met criteria for further synthesis. Enhanced recovery protocols resulted in improvements to length of stay, without detriment to other outcomes, with minimal improvement in patient-reported outcome measures for patients admitted for lower-limb or colorectal surgery. Qualitative review: Included 43 papers, 35 of which were prioritised for synthesis. We identified six themes: 'Home as preferred environment for recovery', 'Feeling safe', 'Individualisation of structured programme', 'Taking responsibility', 'Essential care at home' and 'Outcomes'. Overarching synthesis: Intervention components which trigger successful interventions represent individualised approaches that allow patients to understand their treatment, ask questions and build supportive relationships and strategies to help patients monitor their progress and challenge themselves through early mobilisation. Discussion Interventions to reduce hospital length of stay for older adults following planned surgery are effective, without detriment to other patient outcomes. Findings highlight the need to reconsider how to evaluate patient recovery from the perspective of the patient. Trials did not routinely evaluate patient mid- to long-term outcomes. Furthermore, when they did evaluate patient outcomes, reporting is often incomplete or conducted using a narrow range of patient-reported outcome measures or limited through asking the wrong people the wrong questions, with lack of longer-term evaluation. Findings from the qualitative and overarching synthesis will inform policy-making regarding commissioning and delivering services to support patients, carers and families before, during and after planned admission to hospital. Study registration This trial is registered as PROSPERO registration number CRD42021230620. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 130576) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 23. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Debbie Kinsey
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Samantha Febrey
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Simon Briscoe
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Jo Thompson Coon
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Daniele Carrieri
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Christopher Lovegrove
- School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - John McGrath
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Anthony Hemsley
- Department of Healthcare for Older People, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Liz Shaw
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Michael Nunns
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Griffin JM, Vanderboom CE, Gustavson A, Kaufman BG, Ingram C, Wild E, Dose AM, Mandrekar J, Holland DE. A Methodological Approach for Documenting Multi-Component Interventions Targeting Family Caregivers. J Appl Gerontol 2023; 42:487-492. [PMID: 36341961 PMCID: PMC9957899 DOI: 10.1177/07334648221137882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Managing the complex care needs of seriously ill patients transitioning from hospital to home can have detrimental effects on family caregivers (FCG). Multi-component interventions tailored to FCG needs are most effective at reducing caregiver burden, distress, and depression. However, gaps exist in determining best methods to assess, document, and analyze intervention components for FCGs. Common methods used to capture patient data during transitions in care may not be appropriate or allowed for FCG needs. As such, we present a methodological approach for electronically capturing, reporting, and analyzing multiple intervention components. This approach uses a standardized terminology and pathway for tailoring intervention components in real time while evaluating intervention effects across time. We use examples from a randomized controlled trial to illustrate the benefits of the current approach for analyzing the effectiveness of multi-component interventions in the context of caregiving research.
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Affiliation(s)
- Joan M. Griffin
- Professor of Health Services Research, Division of Health Care Delivery Research (HCDR) and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota,Corresponding and reprint request author: Joan M. Griffin, PhD, 200 1 Street SW, Rochester, MN 55905, , Phone: 507-538-1490, Fax: 507-284-1731
| | - Catherine E. Vanderboom
- Principal Health Services Analyst, Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | - Allison Gustavson
- Core Investigator, Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System and Assistant Professor, Department of Medicine, University of Minnesota
| | - Brystana G Kaufman
- Assistant Professor of Population Health Sciences, Duke University, Durham, North Carolina
| | - Cory Ingram
- Assistant Professor of Family Medicine and Palliative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ellen Wild
- Research Interventionist, Mayo Clinic, Rochester, Minnesota
| | - Ann Marie Dose
- Principal Health Services Analyst, Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | - Jay Mandrekar
- Professor, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Diane E. Holland
- Principal Health Services Analyst, Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
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Transitional care interventions for supporting frail older adults discharged from hospitals: An umbrella review. Geriatr Nurs 2023; 50:80-89. [PMID: 36669435 DOI: 10.1016/j.gerinurse.2022.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023]
Abstract
Transitional care interventions have been shown to assist frail older adults; however, their true efficacy remains inconclusive. This umbrella review aimed (1) to summarize the components of transitional care interventions in support of frail older adults discharged from hospitals to community-based facilities that may have impacted healthcare outcomes and (2) to synthesize the impacts of these interventions. Systematic reviews published between January 2018 and September 2022 were screened using seven electronic databases. The review protocol followed the Joanna Briggs Institute Reviewers' Manual and was registered in the PROSPERO. Nine relevant systematic reviews were assessed for their methodological quality. Four of the measured primary healthcare outcomes improved as a result of transitional care interventions. In particular, evidence indicates that high-intensity transitional care or transitional care lasting at least one month can improve healthcare outcomes in frail older adults. Additional funding research and practical guidelines are warranted.
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Wittenberg E, Bevan JL, Goldsmith JV. Assessing Family Caregiver Communication in Chronic Illness: Validation of the FCCT-CI. Am J Hosp Palliat Care 2022; 40:500-507. [PMID: 35653264 DOI: 10.1177/10499091221106694] [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: 11/16/2022] Open
Abstract
Background: Chronic illness care demands attention to the unique needs of family caregivers who support care at home, yet few tools exist for family caregiver assessment in the social domain of practice. Objectives: The Family Caregiver Communication Tool (FCCT) assesses caregiver communication as part of the family system and was originally developed for cancer caregivers. The aim of this study was to develop and psychometrically-validate a version of the FCCT for Chronic Illness (FCCT-CI). Methods: We revised the FCCT, including the generation of new items, and psychometrically tested it in 303 family caregivers recruited through Amazon Prime Panels. Item reduction through exploratory factor analysis was conducted, internal consistency was assessed using Cronbach's alpha, and concurrent validity was conducted to demonstrate correlation of the new scale with previously validated instruments. Results: A principal axis analysis with promax rotation initially revealed a five-factor structure of the 27 items initially tested, but, after statistical and theoretical reduction and refinement, a 10 item FCCT-CI emerged. Cronbach's alpha ranged from .74 to .86 for the FCCT-CI instrument. Concurrent validity was supported by bivariate correlation tests. Conclusions: The FCCT-CI is the first psychometrically tested scale designed to assess caregiver communication with chronically ill patients, family members, and palliative care providers about caregiving. The FCCT-CI scale includes but is not limited to cancer caregiving and palliative care contexts and has good reliability and validity. Palliative care providers can use this tool to assess, design, and test interventions to support family caregivers.
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Affiliation(s)
- Elaine Wittenberg
- Department of Communication Studies, 14669California State University, Los Angeles, CA, USA
| | - Jennifer L Bevan
- School of Communication, 6226Chapman University, Orange, CA, USA
| | - Joy V Goldsmith
- Communication and Film, 5415University of Memphis, Memphis, TN, USA
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