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Mc Ardle R, Taylor L, Cavadino A, Rochester L, Del Din S, Kerse N. Characterizing Walking Behaviors in Aged Residential Care Using Accelerometry, With Comparison Across Care Levels, Cognitive Status, and Physical Function: Cross-Sectional Study. JMIR Aging 2024; 7:e53020. [PMID: 38842168 PMCID: PMC11185191 DOI: 10.2196/53020] [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: 09/22/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 06/07/2024] Open
Abstract
Background Walking is important for maintaining physical and mental well-being in aged residential care (ARC). Walking behaviors are not well characterized in ARC due to inconsistencies in assessment methods and metrics as well as limited research regarding the impact of care environment, cognition, or physical function on these behaviors. It is recommended that walking behaviors in ARC are assessed using validated digital methods that can capture low volumes of walking activity. Objective This study aims to characterize and compare accelerometry-derived walking behaviors in ARC residents across different care levels, cognitive abilities, and physical capacities. Methods A total of 306 ARC residents were recruited from the Staying UpRight randomized controlled trial from 3 care levels: rest home (n=164), hospital (n=117), and dementia care (n=25). Participants' cognitive status was classified as mild (n=87), moderate (n=128), or severe impairment (n=61); physical function was classified as high-moderate (n=74) and low-very low (n=222) using the Montreal Cognitive Assessment and the Short Physical Performance Battery cutoff scores, respectively. To assess walking, participants wore an accelerometer (Axivity AX3; dimensions: 23×32.5×7.6 mm; weight: 11 g; sampling rate: 100 Hz; range: ±8 g; and memory: 512 MB) on their lower back for 7 days. Outcomes included volume (ie, daily time spent walking, steps, and bouts), pattern (ie, mean walking bout duration and alpha), and variability (of bout length) of walking. Analysis of covariance was used to assess differences in walking behaviors between groups categorized by level of care, cognition, or physical function while controlling for age and sex. Tukey honest significant difference tests for multiple comparisons were used to determine where significant differences occurred. The effect sizes of group differences were calculated using Hedges g (0.2-0.4: small, 0.5-0.7: medium, and 0.8: large). Results Dementia care residents showed greater volumes of walking (P<.001; Hedges g=1.0-2.0), with longer (P<.001; Hedges g=0.7-0.8), more variable (P=.008 vs hospital; P<.001 vs rest home; Hedges g=0.6-0.9) bouts compared to other care levels with a lower alpha score (vs hospital: P<.001; Hedges g=0.9, vs rest home: P=.004; Hedges g=0.8). Residents with severe cognitive impairment took longer (P<.001; Hedges g=0.5-0.6), more variable (P<.001; Hedges g=0.4-0.6) bouts, compared to those with mild and moderate cognitive impairment. Residents with low-very low physical function had lower walking volumes (total walk time and bouts per day: P<.001; steps per day: P=.005; Hedges g=0.4-0.5) and higher variability (P=.04; Hedges g=0.2) compared to those with high-moderate capacity. Conclusions ARC residents across different levels of care, cognition, and physical function demonstrate different walking behaviors. However, ARC residents often present with varying levels of both cognitive and physical abilities, reflecting their complex multimorbid nature, which should be considered in further work. This work has demonstrated the importance of considering a nuanced framework of digital outcomes relating to volume, pattern, and variability of walking behaviors among ARC residents.
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Affiliation(s)
- Ríona Mc Ardle
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
- National Institute for Health and Care Research Biomedical Research Centre, Newcastle University and the Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Lynne Taylor
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
- National Institute for Health and Care Research Biomedical Research Centre, Newcastle University and the Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom
- The Newcastle Upon Tyne Hospitals National Health Institute Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Silvia Del Din
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
- National Institute for Health and Care Research Biomedical Research Centre, Newcastle University and the Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Ngaire Kerse
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Brotherhood K, Searle B, Spiers GF, Caiado C, Hanratty B. Variations in older people's emergency care use by social care setting: a systematic review of international evidence. Br Med Bull 2024; 149:32-44. [PMID: 38112600 PMCID: PMC10938536 DOI: 10.1093/bmb/ldad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/16/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Older adults' use of social care and their healthcare utilization are closely related. Residents of care homes access emergency care more often than the wider older population; however, less is known about emergency care use across other social care settings. SOURCES OF DATA A systematic review was conducted, searching six electronic databases between January 2012 and February 2022. AREAS OF AGREEMENT Older people access emergency care from a variety of community settings. AREAS OF CONTROVERSY Differences in study design contributed to high variation observed between studies. GROWING POINTS Although data were limited, findings suggest that emergency hospital attendance is lowest from nursing homes and highest from assisted living facilities, whilst emergency admissions varied little by social care setting. AREAS TIMELY FOR DEVELOPING RESEARCH There is a paucity of published research on emergency hospital use from social care settings, particularly home care and assisted living facilities. More attention is needed on this area, with standardized definitions to enable comparisons between studies.
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Affiliation(s)
- Kelly Brotherhood
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
| | - Ben Searle
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
| | - Gemma Frances Spiers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
| | - Camila Caiado
- Department of Mathematical Sciences, Mathematical Sciences & Computer Science Building, Durham University, Upper Mountjoy Campus, Stockton Road, Durham, DH1 3LE, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
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Irvine L, Burton J, Ali M, Booth J, Desborough J, Logan P, Moniz-Cook E, Surr C, Wright D, Goodman C. Data resource profile: the virtual international care homes trials archive (VICHTA). Int J Popul Data Sci 2024; 8:2161. [PMID: 38425721 PMCID: PMC10902812 DOI: 10.23889/ijpds.v8i6.2161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Introduction Randomised controlled trials (RCTs) conducted in care home settings address a range of health conditions impacting older people, but often include a common core of data about residents and the care home environment. These data can be used to inform service provision, but accessing these data can be challenging. Methods The Virtual International Care Home Trials Archive (VICHTA) collates care home RCTs conducted since 2010, with >100 participants, across multiple conditions, with documented eligibility criteria, initially identified from a scoping review. A Steering Committee comprising contributing trialists oversees proposed uses of fully anonymised data. We characterised available demography and outcomes to inform potential analyses. Data are accessible via application to the Virtual Trials Archives, through a secure online analysis platform. Trial recruitment is ongoing and future expansion will include international studies. Results The first phase of VICHTA includes data from six UK RCTs, with individual participant data (IPD) on 5,674 residents across 308 care homes. IPD include age, sex, dementia status, length of stay, quality of life, clinical outcome measures, medications, resource use, and care home characteristics, such as funding, case mix, and occupancy. Follow-up ranges between four and sixteen months. Conclusions VICHTA collates and makes accessible data on a complex and under-represented research population for novel analyses, and to inform design of future studies. Planned expansion to international care home RCTs will facilitate a wider range of research questions. Interested collaborators can submit trial data or request data at http://www.virtualtrialsarchives.org.
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Affiliation(s)
- Lisa Irvine
- Centre for Research in Public health and Community Care, University of Hertfordshire, UK
- NIHR Applied Research Collaboration East of England, UK
| | - Jenni Burton
- School of Cardiovascular & Metabolic Health, College of Medicine, Veterinary & Life Sciences, University of Glasgow
| | - Myzoon Ali
- School of Cardiovascular & Metabolic Health, College of Medicine, Veterinary & Life Sciences, University of Glasgow
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK
| | - Jo Booth
- Research Centre for Health (ReaCH), Glasgow Caledonian University, UK
| | | | - Pip Logan
- Centre for Rehabilitation and Ageing Research, University of Nottingham, UK
| | | | - Claire Surr
- Centre for Dementia Research, School of Health, Leeds Beckett University, UK
| | - David Wright
- School of Healthcare, University of Leicester, Leicester, UK
| | - Claire Goodman
- Centre for Research in Public health and Community Care, University of Hertfordshire, UK
- NIHR Applied Research Collaboration East of England, UK
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Nordin S, Elf M, McKee K. Development and initial validation of the staff perception of residential care environments (SPORE) instrument. Int J Older People Nurs 2024; 19:e12596. [PMID: 38073273 DOI: 10.1111/opn.12596] [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: 05/08/2023] [Revised: 11/05/2023] [Accepted: 11/30/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The impact of the physical environment on healthcare staff well-being and work performance is well recognised, yet there is a lack of instruments assessing environmental features from the perspective of staff working in residential care facilities (RCFs) for older people. OBJECTIVES To develop and provide initial validation of the instrument Staff Perceptions Of Residential care facility Environments (SPORE). DESIGN An instrument development and psychometric evaluation study. METHODS Based on material from a British project, items were translated and adapted for Swedish residential care facilities as SPORE. Care staff (N = 200), recruited from 20 Swedish RCFs, completed a questionnaire-based survey containing the SPORE instrument and two other instruments selected as suitable for use in the validation. In addition, an environmental assessment instrument was used for further validation. Analyses were performed at individual (staff) level and home (RCF) level. RESULTS The SPORE subscales demonstrated good internal consistency reliability and were moderately to strongly correlated at the individual level with the subscales of measures of person-centred care, and strongly correlated with the same measures at the home level. The SPORE subscales were also highly correlated with the total score of the instrument used to assess the quality of the physical environment. CONCLUSION The initial validation indicates that the SPORE instrument is promising for measuring care staff perceptions of environmental features in care facilities for older people. SPORE can be a valuable instrument for use in research and in practice to evaluate the environment as part of working towards high-quality care. IMPLICATIONS FOR PRACTICE The design of the physical environment within RCFs can affect the staff's health and work performance. The instrument is useful for evaluating the environment and informing decisions about design solutions that support staff in their important work.
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Affiliation(s)
- Susanna Nordin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Kevin McKee
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Devi R, Martin GP, Banerjee J, Gladman JR, Dening T, Barat A, Gordon AL. Sustaining interventions in care homes initiated by quality improvement projects: a qualitative study. BMJ Qual Saf 2023; 32:665-675. [PMID: 35318273 PMCID: PMC10646854 DOI: 10.1136/bmjqs-2021-014345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Inadequate and varied quality of care in care homes has led to a proliferation of quality improvement (QI) projects. This study examined the sustainability of interventions initiated by such projects. METHOD This qualitative study explored the sustainability of seven interventions initiated by three QI projects between 2016 and 2018 in UK care homes and explored the perceived influences to the sustainability of interventions. QI projects were followed up in 2019. Staff leading QI projects (n=9) and care home (n=21, from 13 care homes) and healthcare (n=2) staff took part in semi-structured interviews. Interventions were classified as sustained if the intervention was continued at the point of the study. Thematic analysis of interview data was performed, drawing on the Consolidated Framework for Sustainability (CFS), a 40-construct model of sustainability of interventions. RESULTS Three interventions were sustained and four interventions were not. Seven themes described perceptions around what influenced sustainability: monitoring outcomes and regular check-in; access to replacement intervention materials; staff willingness to dedicate time and effort towards interventions; continuity of staff and thorough handover/inductions in place for new staff; ongoing communication and awareness raising; perceived effectiveness; and addressing care home priorities. All study themes fell within 18 of the 40 CFS constructs. DISCUSSION Our findings resonate with the CFS and are also consistent with implementation theories, suggesting sustainability is best addressed during implementation rather than treated as a separate process which follows implementation. Commissioning and funding QI projects should address these considerations early on, during implementation.
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Affiliation(s)
- Reena Devi
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Nurturing Innovation in Care Home Excellence in Leeds (NICHE-Leeds), Leeds, UK
| | - Graham P Martin
- Department of Public Health and Primary Care, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Jaydip Banerjee
- Emergency Medicine, Leicester Royal Infirmary, Leicester, UK
| | - John Rf Gladman
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands, Nottingham, UK
| | - Tom Dening
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Atena Barat
- Centre for Primary Care, Wolfson Institute of Population Health Sciences, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adam Lee Gordon
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands, Nottingham, UK
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Flannagan J, Chudasama DY, Hope R, Collin SM, Bhattacharya A, Merrick R, Aziz NA, Hopkins S, Dabrera G, Lamagni T. Attribution of nosocomial seeding to long-term care facility COVID-19 outbreaks. Epidemiol Infect 2023; 151:e191. [PMID: 37876042 PMCID: PMC10728972 DOI: 10.1017/s0950268823001565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 10/26/2023] Open
Abstract
Residents of long-term care facilities (LTCFs) were disproportionately affected by the COVID-19 pandemic. We assessed the extent to which hospital-associated infections contributed to COVID-19 LTCF outbreaks in England. We matched addresses of cases between March 2020 and June 2021 to reference databases to identify LTCF residents. Linkage to health service records identified hospital-associated infections, with the number of days spent in hospital before positive specimen date used to classify these as definite or probable. Of 149,129 cases in LTCF residents during the study period, 3,748 (2.5%) were definite or probable hospital-associated and discharged to an LTCF. Overall, 431 (0.3%) were identified as index cases of potentially nosocomial-seeded outbreaks (2.7% (431/15,797) of all identified LTCF outbreaks). These outbreaks involved 4,521 resident cases and 1,335 deaths, representing 3.0% and 3.6% of all cases and deaths in LTCF residents, respectively. The proportion of outbreaks that were potentially nosocomial-seeded peaked in late June 2020, early December 2020, mid-January 2021, and mid-April 2021. Nosocomial seeding contributed to COVID-19 LTCF outbreaks but is unlikely to have accounted for a substantial proportion. The continued identification of such outbreaks after the implementation of preventative policies highlights the challenges of preventing their occurrence.
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Affiliation(s)
| | | | - Russell Hope
- United Kingdom Health Security Agency, London, UK
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Cho E, Min D, Heo SJ, Lee K, Kim H. Effects of registered nurses' staffing levels, work environment and education levels on nursing home residents' quality of life and nurse outcomes. J Clin Nurs 2023; 32:6494-6503. [PMID: 36932041 DOI: 10.1111/jocn.16689] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/23/2022] [Accepted: 02/20/2023] [Indexed: 03/19/2023]
Abstract
AIMS AND OBJECTIVES To examine the effects of registered nurse staffing levels, work environment and education levels on the residents' quality of life and nurses' job dissatisfaction, burnout and turnover intention. BACKGROUND Registered nurse staffing status and work environment are suboptimal in nursing homes worldwide. Nursing home care aims to maximise residents' quality of life. However, evidence on the impact of registered nurse staffing levels, work environment and education levels on the residents' quality of life and nurse outcomes in nursing homes is limited. DESIGN This is a cross-sectional observational study. METHODS A total of 513 residents and 117 registered nurses from 39 nursing homes in South Korea participated in surveys. The main measures included registered nurses' staffing levels, work environment, education levels, residents' quality of life, registered nurses' job dissatisfaction, burnout and turnover intention. We analysed data using the generalised estimating equations and reported the study using the STROBE checklist. RESULTS Overall, the residents' quality-of-life score was 13.7 ± 2.6 (out of 17). Residents in nursing homes with a higher number of registered nurses or with work environment evaluated as 'mixed' or 'better' (compared with 'poor') had a higher quality of life. Regarding nurse outcomes, 74.4% of the registered nurses were dissatisfied with their current jobs, 12.0% had burnout and 18.8% had a turnover intention. Registered nurses working in 'mixed' or 'better' work environment were less likely to have job dissatisfaction. Registered nurses' education levels did not have a statistically significant effect on the resident and nurse outcomes. CONCLUSIONS Registered nurse staffing levels and work environment should be considered important for improving residents' quality of life and nurses' job satisfaction. RELEVANCE TO CLINICAL PRACTICE Regulation and policy reforms are needed to increase the registered nurse staffing levels and to create a good work environment in nursing homes. PATIENT OR PUBLIC CONTRIBUTION Nursing home residents and registered nurses participated in the surveys of this study. Registered nurses facilitated resident recruitment by identifying and introducing the study to residents who were eligible for study participation. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Eunhee Cho
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, Korea
| | - Seok-Jae Heo
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Korea
| | - Kyoungeun Lee
- Department of Nursing, Tongmyong University, Busan, Korea
| | - Hyejin Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Kelly S, Cowan A, Akdur G, Irvine L, Peryer G, Welsh S, Rand S, Lang IA, Towers AM, Spilsbury K, Killett A, Gordon AL, Hanratty B, Jones L, Meyer J, Goodman C, Burton JK. Outcome measures from international older adult care home intervention research: a scoping review. Age Ageing 2023; 52:afad069. [PMID: 37192505 PMCID: PMC10187991 DOI: 10.1093/ageing/afad069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Care homes are increasingly important settings for intervention research to enhance evidence-informed care. For such research to demonstrate effectiveness, it is essential that measures are appropriate for the population, setting and practice contexts. OBJECTIVE To identify care home intervention studies and describe the resident outcome measures used. DESIGN Scoping review. METHODS We reviewed international care home research published from 2015 to August 2022. We searched MEDLINE, EMBASE, CINAHL and ASSIA. We included any intervention study conducted in a care home, reporting resident outcomes. We extracted resident outcome measures, organised these using the domains of an adapted framework and described their use. RESULTS From 7,330 records screened, we included 396 datasets reported in 436 publications. These included 12,167 care homes and 836,842 residents, with an average of 80 residents per study. The studies evaluated 859 unique resident outcomes 2,030 times using 732 outcome measures. Outcomes were evaluated between 1 and 112 times, with 75.1% of outcomes evaluated only once. Outcome measures were used 1-120 times, with 68.4% of measures used only once. Only 14 measures were used ≥20 times. Functional status, mood & behaviour and medications were the commonest outcome domains assessed. More than half of outcomes were assessed using scales, with a fifth using existing records or administrative data. CONCLUSIONS There is significant heterogeneity in the choice and assessment of outcomes for intervention research in care homes. There is an urgent need to develop a consensus on useful and sensitive tools for care homes, working with residents, families and friends and staff.
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Affiliation(s)
- Sarah Kelly
- Cambridge Public Health, University of Cambridge, East Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
- THIS Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge CB2 0AH, UK
| | - Andy Cowan
- Cambridge Public Health, University of Cambridge, East Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Gizdem Akdur
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK
| | - Lisa Irvine
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK
| | - Guy Peryer
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- NIHR Applied Research Collaboration, East of England, CB2 8AH, UK
| | - Silje Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - Stacey Rand
- Personal Social Services Research Unit, University of Kent, Cornwallis Central, Canterbury CT2 7NF, UK
| | - Iain A Lang
- Department of Health and Community Sciences, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK
- NIHR Applied Research Collaboration, South West Peninsula, EX1 2LU, UK
| | - Ann-Marie Towers
- Centre for Health Services Studies, Cornwallis Central, University of Kent, Canterbury CT2 7NF, UK
- NIHR Applied Research Collaboration, Kent Surrey and Sussex, BN3 7HZ, UK
| | - Karen Spilsbury
- School of Healthcare, University of Leeds, Baines Wing, Leeds LS2 9JT, UK
- NIHR Applied Research Collaboration, Yorkshire and Humber, BD9 6RJ, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- NIHR Applied Research Collaboration, East of England, CB2 8AH, UK
| | - Adam Lee Gordon
- Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3DT, UK
- NIHR Applied Research Collaboration, East Midlands, LE5 4PW, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle-upon-Tyne NE4 5PL, UK
- NIHR Applied Research Collaboration, North East and North Cumbria, NE3 3XT, UK
| | - Liz Jones
- National Care Forum, Friars House, Manor House Drive, Coventry CV1 2TE, UK
| | - Julienne Meyer
- National Care Forum, Friars House, Manor House Drive, Coventry CV1 2TE, UK
- City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK
- NIHR Applied Research Collaboration, East of England, CB2 8AH, UK
| | - Jennifer Kirsty Burton
- School of Cardiovascular and Metabolic Health, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
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Kristensen GS, Kjeldgaard AH, Søndergaard J, Andersen-Ranberg K, Pedersen AK, Mogensen CB. Associations between care home residents' characteristics and acute hospital admissions - a retrospective, register-based cross-sectional study. BMC Geriatr 2023; 23:234. [PMID: 37072701 PMCID: PMC10114422 DOI: 10.1186/s12877-023-03895-1] [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: 11/02/2022] [Accepted: 03/15/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Care home residents are frail, multi-morbid, and have an increased risk of experiencing acute hospitalisations and adverse events. This study contributes to the discussion on preventing acute admissions from care homes. We aim to describe the residents' health characteristics, survival after care home admission, contacts with the secondary health care system, patterns of admissions, and factors associated with acute hospital admissions. METHOD Data on all care home residents aged 65 + years living in Southern Jutland in 2018-2019 (n = 2601) was enriched with data from highly valid Danish national health registries to obtain information on characteristics and hospitalisations. Characteristics of care home residents were assessed by sex and age group. Factors associated with acute admissions were analysed using Cox Regression. RESULTS Most care home residents were women (65.6%). Male residents were younger at the time of care home admission (mean 80.6 vs. 83.7 years), had a higher prevalence of morbidities, and shorter survival after care home admission. The 1-year survival was 60.8% and 72.3% for males and females, respectively. Median survival was 17.9 months and 25.9 months for males and females, respectively. The mean rate of acute hospitalisations was 0.56 per resident-year. One in four (24.4%) care home residents were discharged from the hospital within 24 h. The same proportion was readmitted within 30 days of discharge (24.6%). Admission-related mortality was 10.9% in-hospital and 13.0% 30 days post-discharge. Male sex was associated with acute hospital admissions, as was a medical history of various cardiovascular diseases, cancer, chronic obstructive pulmonary disease, and osteoporosis. In contrast, a medical history of dementia was associated with fewer acute admissions. CONCLUSION This study highlights some of the major characteristics of care home residents and their acute hospitalisations and contributes to the ongoing discussion on improving or preventing acute admissions from care homes. TRIAL REGISTRATION Not relevant.
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Affiliation(s)
- Gitte Schultz Kristensen
- Emergency Department, Aabenraa Hospital, Department of Regional Health Research, Faculty of Health Science, University Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark.
| | | | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, Department of Public Health, Department of Regional Health Research, Faculty of Health Science, Clinical research Department, Aabenraa Hospital, University of Southern Denmark University Hospital of Southern Denmark, Odense, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, Faculty of Health Science, Emergency Department, Aabenraa Hospital, The University of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
| | - Christian Backer Mogensen
- Department of Regional Health Research, Faculty of Health Science, Emergency Department, Aabenraa Hospital, The University of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
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Barker RO, Atkin C, Hanratty B, Kingston A, Cooksley T, Gordon AL, Holland M, Knight T, Subbe CP, Lasserson DS. National Early Warning Scores Following Emergency Hospital Transfer: Implications for Care Home Residents. J Am Med Dir Assoc 2023; 24:653-656. [PMID: 36822235 DOI: 10.1016/j.jamda.2023.01.013] [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: 06/14/2022] [Revised: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Care home residents have high rates of hospital admission. The UK National Early Warning Score (NEWS2) standardizes the secondary care response to acute illness. However, the ability of NEWS2 to predict adverse health outcomes specifically for care home residents is unknown. This study explored the relationship between NEWS2 on admission to hospital and resident outcome 7 days later. DESIGN Repeated cross-sectional study. SETTING AND PARTICIPANTS Data on UK care home residents admitted to 160 hospitals in two 24-hour periods (2019 and 2020). METHOD Chi-squared and Kruskal-Wallis tests, and multinomial regression were used to explore the association between low (score ≤2), intermediate (3-4), high (5-6), and critically high (≥7) NEWS2 on admission and each of the following: discharge on day of admission, admission and discharge within 7 days, prolonged hospital admission (>7 days), and death. RESULTS From 665 resident admissions across 160 hospital sites, NEWS2 was low for 54%, intermediate for 18%, high for 13%, and critically high for 16%. The 7-day outcome was 10% same-day discharge, 47% admitted and subsequently discharged, 34% remained inpatients, and 8% died. There is a significant association between NEWS2 and these outcomes (P < .001). Compared with those with low NEWS2, residents with high and critically high NEWS2 had 3.6 and 9.5 times increased risk of prolonged hospitalization [relative risk ratio (RRR) 3.56; 95% CI 1.02-12.37; RRR 9.47; CI 2.20-40.67], respectively. The risk of death was approximately 14 times higher for residents with high NEWS2 (RRR 13.62; CI 3.17-58.49) and 54 times higher (RRR 53.50; CI 11.03-259.54) for critically high NEWS2. CONCLUSION AND IMPLICATIONS Higher NEWS2 measurements on admission are associated with an increased risk of hospitalization up to 7 days duration, prolonged admission, and mortality for care home residents. NEWS2 may have a role as an adjunct to acute care decision making for hospitalized residents.
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Affiliation(s)
- Robert O Barker
- Population Health Sciences Institute, Newcastle University, Newcastle, UK; NIHR Applied Research Collaboration North East and North Cumbria, Newcastle, UK.
| | - Catherine Atkin
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle, UK; NIHR Applied Research Collaboration North East and North Cumbria, Newcastle, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Tim Cooksley
- Department of Acute Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Adam L Gordon
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK; NIHR Applied Research Collaboration-East Midlands, Nottingham, UK
| | - Mark Holland
- School of Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, Bolton, UK
| | - Thomas Knight
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham, UK; Department of Acute Medicine, Sandwell and West Birmingham NHS, Birmingham, UK
| | - Christian P Subbe
- School of Medical Sciences, Bangor University, Bangor, UK; Department of Acute Medicine, Ysbyty Gwynedd, Bangor, UK
| | - Daniel S Lasserson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK; Division of Acute General Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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11
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Sattar Z, Young-Murphy L, Craig L, Steven A, Wilson-Menzfeld G. Frailty nurse and GP-led models of care in care homes: the role of contextual factors impacting Enhanced health in care homes framework implementation. BMC Geriatr 2023; 23:69. [PMID: 36737688 PMCID: PMC9898931 DOI: 10.1186/s12877-023-03742-3] [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: 07/04/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Enhanced Health for Care homes (EHCH) framework is an innovative response to provide more proactive, preventative approaches to care for residents living in care homes. It involves co-producing a shared vision with primary care. As part of EHCH a UK clinical commissioning group supported GP's in two localities to implement their preferred delivery approach involving a new Frailty Nurse-led (FN-led) model in care homes alongside an existing General Practitioner-led (GP-led) model. This paper focuses on implementation of the new FN-led model. METHODS A qualitative study design was adopted. Forty-eight qualitative semi-structured interviews were undertaken across six care home sites in a Northern locality: three implementing the FN-led and three engaged in an existing GP-led model. Participants included residents, family members, care home managers, care staff, and health professionals working within the EHCH framework. RESULTS Two overarching themes were generated from data analysis: Unanticipated implementation issues and Unintended consequences. Unsuccessful attempts to recruit Frailty Nurses (FN) with enhanced clinical skills working at the desired level (UK NHS Band 7) led to an unanticipated evolution in the implementation process of the FN-led model towards 'training posts'. This prompted misaligned role expectations subsequently provoking unexpected temporary outcomes regarding role-based trust. The existing, well understood nature of the GP-led model may have further exacerbated these unintended consequences. CONCLUSION Within the broader remit of embedding EHCH frameworks, the implementation of new FN roles needed to evolve due to unforeseen recruitment issues. Wider contextual factors are not in the control of those developing new initiatives and cannot always be foreseen, highlighting how wider factors can force evolution of planned implementation processes with unintended consequences. However, the unintended consequences in this study highlight the need for careful consideration of information dissemination (content and timing) to key stakeholders, and the influence of existing ways of working.
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Affiliation(s)
- Zeibeda Sattar
- Department of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
| | - Lesley Young-Murphy
- Chief Operating Officer, North Tyneside Clinical Commissioning Group, Newcastle upon Tyne, UK
| | - Lynn Craig
- Head of Quality, Safety and Development, North Tyneside Clinical Commissioning Group, Newcastle upon Tyne, UK
| | - Alison Steven
- grid.42629.3b0000000121965555Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Gemma Wilson-Menzfeld
- grid.42629.3b0000000121965555Department, Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
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12
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Ross A, Anderson JE, Selveindran S, MacBride T, Bowie P, Sherriff A, Young L, Fioratou E, Roddy E, Edwards H, Dewar B, Macpherson LM. A qualitative study of organisational resilience in care homes in Scotland. PLoS One 2022; 17:e0279376. [PMID: 36538564 PMCID: PMC9767361 DOI: 10.1371/journal.pone.0279376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Providing care for the dependent older person is complex and there have been persistent concerns about care quality as well as a growing recognition of the need for systems approaches to improvement. The I-SCOPE (Improving Systems of Care for the Older person) project employed Resilient Healthcare (RHC) theory and the CARE (Concepts for Applying Resilience) Model to study how care organisations adapt to complexity in everyday work, with the aim of exploring how to support resilient performance. The project was an in-depth qualitative study across multiple sites over 24 months. There were: 68 hours of non-participant observation, shadowing care staff at work and starting broad before narrowing to observe care domains of interest; n = 33 recorded one-to-one interviews (32 care staff and one senior inspector); three focus groups (n = 19; two with inspectors and one multi-disciplinary group); and five round table discussions on emergent results at a final project workshop (n = 31). All interviews and discussion groups were recorded and transcribed verbatim. Resident and family interviews (n = 8) were facilitated through use of emotional touchpoints. Analysis using QSR NVivo 12.0 focused on a) capturing everyday work in terms of the interplay between demand and capacity, adaptations and intended and unintended outcomes and b) a higher-level thematic description (care planning and use of information; coordination of everyday care activity; providing person-centred care) which gives an overview of resilient performance and how it might be enhanced. This gives important new insight for improvement. Conclusions are that resilience can be supported through more efficient use of information, supporting flexible adaptation, coordination across care domains, design of the physical environment, and family involvement based on realistic conversations about quality of life.
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Affiliation(s)
- Alastair Ross
- Glasgow Dental School, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Janet E. Anderson
- Department of Anaesthesiology and Perioperative Medicine, Monash University, Monash, Australia
| | - Santhani Selveindran
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Tamsin MacBride
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | - Paul Bowie
- NHS Education for Scotland, Inverness, United Kingdom
| | - Andrea Sherriff
- Glasgow Dental School, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Linda Young
- NHS Education for Scotland, Inverness, United Kingdom
| | - Evie Fioratou
- Centre for Undergraduate Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Edel Roddy
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | | | - Belinda Dewar
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | - Lorna M. Macpherson
- Glasgow Dental School, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
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13
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St Clair B, Jorgensen M, Nguyen A, Georgiou A. A Scoping Review of Adverse Incidents Research in Aged Care Homes: Learnings, Gaps, and Challenges. Gerontol Geriatr Med 2022; 8:23337214221144192. [PMID: 36568485 PMCID: PMC9772958 DOI: 10.1177/23337214221144192] [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: 09/23/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Adverse incidents are well studied within acute care settings, less so within aged care homes. The aim of this scoping review was to define the types of adverse incidents studied in aged care homes and highlight strengths, gaps, and challenges of this research. Methods: An expanded definition of adverse incidents including physical, social, and environmental impacts was used in a scoping review based on the PRISMA Extension for Scoping Reviews Checklist. MEDLINE, CINAHL, and EBSCOhost were searched for English language, peer-reviewed studies conducted in aged care home settings between 2000 and 2020. Forty six articles across 12 countries were identified, charted, and analyzed using descriptive statistics and narrative summary methods. Results: Quantitative studies (n = 42, 91%) dominated adverse incidents literature. The majority of studies focused on physical injuries (n = 29, 63%), with fewer examining personal/interpersonal (15%) and environmental factors (22%). Many studies did not describe the country's aged care system (n = 26, 56%). Only five studies (11%) included residents' voices. Discussion: This review highlights a need for greater focus on resident voices, qualitative research, and interpersonal/environmental perspectives in adverse event research in aged care homes. Addressing these gaps, future research may contribute to better understanding of adverse incidents within this setting.
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Affiliation(s)
- B. St Clair
- Macquarie University, Sydney, NSW, Australia,B. St Clair, Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia.
| | | | - A. Nguyen
- Macquarie University, Sydney, NSW, Australia,UNSW Sydney, NSW, Australia
| | - A. Georgiou
- Macquarie University, Sydney, NSW, Australia
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14
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Vardy ER, Lasserson D, Barker RO, Hanratty B. NEWS2 and the older person. Clin Med (Lond) 2022; 22:522-524. [PMID: 38589152 PMCID: PMC9761433 DOI: 10.7861/clinmed.2022-0426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The National Early Warning Score (NEWS), published in 2012, made no specific adjustments for older people. The updated NEWS2 (2017) incorporated new confusion as a category for consciousness. In this article, we consider the role of NEWS2 in detection of acute clinical deterioration in older people and how the score may be used to inform care, highlighting the additional aspects, such as care escalation decisions, that may ensue. We consider the evidence of NEWS and NEWS2 in assessment of the older person in different settings, including the potential benefits and limitations for care home residents. We suggest that NEWS2 may need adaptation for older people in future iterations, and that it should be used in conjunction with other clinical assessments, such as the Clinical Frailty Scale and the four 'A's test (4AT) for delirium.
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Affiliation(s)
- Emma Rlc Vardy
- Northern Care Alliance NHS Foundation Trust, Salford, UK and School of Health Sciences and NIHR Applied Research Collaboration Greater Manchester, Manchester, UK.
| | - Daniel Lasserson
- University of Warwick, Warwick, UK and clinical lead, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert O Barker
- Population Health Sciences Institute, Newcastle upon Tyne, UK and NIHR Applied Research Collaboration North East and North Cumbria, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle upon Tyne, UK and NIHR Applied Research Collaboration North East and North Cumbria, Newcastle upon Tyne, UK
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15
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Narsakka N, Suhonen R, Kielo-Viljamaa E, Stolt M. Physical, social, and symbolic environment related to physical activity of older individuals in long-term care: A mixed-method systematic review. Int J Nurs Stud 2022; 135:104350. [DOI: 10.1016/j.ijnurstu.2022.104350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 10/31/2022]
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16
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Harrad-Hyde F, Armstrong N, Williams CD. 'Weighing up risks': a model of care home staff decision-making about potential resident hospital transfers. Age Ageing 2022; 51:6649130. [PMID: 35871419 PMCID: PMC9308989 DOI: 10.1093/ageing/afac171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
Background care home staff play a crucial role in managing residents’ health and responding to deteriorations. When deciding whether to transfer a resident to hospital, a careful consideration of the potential benefits and risks is required. Previous studies have identified factors that influence staff decision-making, yet few have moved beyond description to produce a conceptual model of the decision-making process. Objectives to develop a conceptual model to describe care home staff’s decision-making when faced with a resident who potentially requires a transfer to the hospital. Methods data collection occurred in England between May 2018 and November 2019, consisting of 28 semi-structured interviews with 30 members of care home staff across six care home sites and 113 hours of ethnographic observations, documentary analysis and informal conversations (with staff, residents, visiting families, friends and healthcare professionals) at three of these sites. Results a conceptual model of care home staff’s decision-making is presented. Except in situations that staff perceived to be urgent enough to require an immediate transfer, resident transfers tended to occur following a series of escalations. Care home staff made complex decisions in which they sought to balance a number of potential benefits and risks to: residents; staff (as decision-makers); social relationships; care home organisations and wider health and social care services. Conclusions during transfer decisions, care home staff make complex decisions in which they weigh up several forms of risk. The model presented offers a theoretical basis for interventions to support deteriorating care home residents and the staff responsible for their care.
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Affiliation(s)
- Fawn Harrad-Hyde
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Natalie Armstrong
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Christopher D Williams
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
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17
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Foundation Level Barriers to the Widespread Adoption of Digital Solutions by Care Homes: Insights from Three Scottish Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127407. [PMID: 35742667 PMCID: PMC9223833 DOI: 10.3390/ijerph19127407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
Abstract
The care home sector has great potential to benefit from technological innovations and to be at the forefront of developing novel digital solutions to improve the experiences of care home residents, their families, and the staff caring for them. The COVID-19 pandemic exposed variability in digital capabilities and longstanding data challenges within the care home sector. Paradoxically, however, it also increased the use of digital tools and services to support residents and staff. There are, however, a number of barriers to sustained and widespread adoption of digital solutions by care homes. Here, the focus is on foundation-level barriers and the groundwork required to overcome them. Using data from three Scottish-based studies, foundation-level barriers to the adoption of digital tools and services faced by care homes are discussed. These main barriers are the need for robust basic internet connectivity; capabilities for digital data collection; access to data to inform and drive digital solutions; the need for trust in the use of resident data by commercial companies; and the danger that poorly coordinated strategies undermine efforts to build a care home data platform and the digital solutions it can support. Sustained and widespread adoption of digital solutions by care homes will require these foundation-level barriers to be addressed. Strong and stable data and digital foundations supported by sector-specific scaffolding are major prerequisites to the widespread adoption of digital solutions by care homes.
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18
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De Mello-Sampayo F. Spatial and Temporal Analysis of COVID-19 in the Elderly Living in Residential Care Homes in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105921. [PMID: 35627458 PMCID: PMC9140434 DOI: 10.3390/ijerph19105921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 01/27/2023]
Abstract
Background: The goal of this study is to identify geographic areas for priority actions in order to control COVID-19 among the elderly living in Residential Care Homes (RCH). We also describe the evolution of COVID-19 in RHC throughout the 278 municipalities of continental Portugal between March and December 2020. Methods: A spatial population analysis of positive COVID-19 cases reported by the Portuguese National Health Service (NHS) among the elderly living in RCH. The data are for COVID-19 testing, symptomatic status, comorbidities, and income level by municipalities. COVID-19 measures at the municipality level are the proportion of positive cases of elderly living in RCH, positive cases per elderly living in RCH, symptomatic to asymptomatic ratio, and the share of comorbidities cases. Spatial analysis used the Kernel density estimation (KDE), space-time statistic Scan, and geographic weighted regression (GWR) to detect and analyze clusters of infected elderly. Results: Between 3 March and 31 December 2020, the high-risk primary cluster was located in the regions of Braganca, Guarda, Vila Real, and Viseu, in the Northwest of Portugal (relative risk = 3.67), between 30 September and 13 December 2020. The priority geographic areas for attention and intervention for elderly living in care homes are the regions in the Northeast of Portugal, and around the large cities, Lisbon and Porto, which had high risk clusters. The relative risk of infection was spatially not stationary and generally positively affected by both comorbidities and low-income. Conclusion: The regions with a population with high comorbidities and low income are a priority for action in order to control COVID-19 in the elderly living in RCH. The results suggest improving both income and health levels in the southwest of Portugal, in the environs of large cities, such as Lisbon and Porto, and in the northwest of Portugal to mitigate the spread of COVID-19.
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Affiliation(s)
- Felipa De Mello-Sampayo
- Business Research Unit (BRU-IUL), Lisbon University Institute (ISCTE-IUL), 1649-026 Lisbon, Portugal
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19
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Krutikov M, Stirrup O, Nacer-Laidi H, Azmi B, Fuller C, Tut G, Palmer T, Shrotri M, Irwin-Singer A, Baynton V, Hayward A, Moss P, Copas A, Shallcross L. Outcomes of SARS-CoV-2 omicron infection in residents of long-term care facilities in England (VIVALDI): a prospective, cohort study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e347-e355. [PMID: 35531432 PMCID: PMC9067940 DOI: 10.1016/s2666-7568(22)00093-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background The SARS-CoV-2 omicron variant (B.1.1.529) is highly transmissible, but disease severity appears to be reduced compared with previous variants such as alpha and delta. We investigated the risk of severe outcomes following infection in residents of long-term care facilities. Methods We did a prospective cohort study in residents of long-term care facilities in England who were tested regularly for SARS-CoV-2 between Sept 1, 2021, and Feb 1, 2022, and who were participants of the VIVALDI study. Residents were eligible for inclusion if they had a positive PCR or lateral flow device test during the study period, which could be linked to a National Health Service (NHS) number, enabling linkage to hospital admissions and mortality datasets. PCR or lateral flow device test results were linked to national hospital admission and mortality records using the NHS-number-based pseudo-identifier. We compared the risk of hospital admission (within 14 days following a positive SARS-CoV-2 test) or death (within 28 days) in residents who had tested positive for SARS-CoV-2 in the period shortly before omicron emerged (delta-dominant) and in the omicron-dominant period, adjusting for age, sex, primary vaccine course, past infection, and booster vaccination. Variants were confirmed by sequencing or spike-gene status in a subset of samples. Results 795 233 tests were done in 333 long-term care facilities, of which 159 084 (20·0%) could not be linked to a pseudo-identifier and 138 012 (17·4%) were done in residents. Eight residents had two episodes of infection (>28 days apart) and in these cases the second episode was excluded from the analysis. 2264 residents in 259 long-term care facilities (median age 84·5 years, IQR 77·9-90·0) were diagnosed with SARS-CoV-2, of whom 253 (11·2%) had a previous infection and 1468 (64·8%) had received a booster vaccination. About a third of participants were male. Risk of hospital admissions was markedly lower in the 1864 residents infected in the omicron-period (4·51%, 95% CI 3·65-5·55) than in the 400 residents infected in the pre-omicron period (10·50%, 7·87-13·94), as was risk of death (5·48% [4·52-6·64] vs 10·75% [8·09-14·22]). Adjusted hazard ratios (aHR) also indicated a reduction in hospital admissions (0·64, 95% CI 0·41-1·00; p=0·051) and mortality (aHR 0·68, 0·44-1·04; p=0·076) in the omicron versus the pre-omicron period. Findings were similar in residents with a confirmed variant. Interpretation Observed reduced severity of the omicron variant compared with previous variants suggests that the wave of omicron infections is unlikely to lead to a major surge in severe disease in long-term care facility populations with high levels of vaccine coverage or natural immunity. Continued surveillance in this vulnerable population is important to protect residents from infection and monitor the public health effect of emerging variants. Funding UK Department of Health and Social Care.
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Affiliation(s)
- Maria Krutikov
- Institute of Health Informatics, University College London, London, UK
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | | | - Borscha Azmi
- Institute of Health Informatics, University College London, London, UK
| | - Chris Fuller
- Institute of Health Informatics, University College London, London, UK
| | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Tom Palmer
- Institute for Global Health, University College London, London, UK
| | - Madhumita Shrotri
- Institute of Health Informatics, University College London, London, UK
| | | | | | - Andrew Hayward
- UCL Institute of Epidemiology & Health Care, University College London, London, UK
- Health Data Research UK, London, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
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20
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Burton JK, Wolters AT, Towers AM, Jones L, Meyer J, Gordon AL, Irvine L, Hanratty B, Spilsbury K, Peryer G, Rand S, Killett A, Akdur G, Allan S, Biswas P, Goodman C. Developing a minimum data set for older adult care homes in the UK: exploring the concept and defining early core principles. THE LANCET. HEALTHY LONGEVITY 2022; 3:e186-e193. [PMID: 35282598 PMCID: PMC8901193 DOI: 10.1016/s2666-7568(22)00010-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Reforms to social care in response to the COVID-19 pandemic, in the UK and internationally, place data at the heart of proposed innovations and solutions. The principles are not well established of what constitutes core, or minimum, data to support care home residents. Often, what is included privileges data on resident health over day-to-day care priorities and quality of life. This Personal View argues for evidence-based principles on which to base the development of a UK minimum data set (MDS) for care homes. Co-produced work involving care home staff and older people working with stakeholders is required to define and agree the format, content, structure, and operationalisation of the MDS. Implementation decisions will determine the success of the MDS, affecting aspects including data quality, completeness, and usability. Care home staff who collect the data need to benefit from the MDS and see value in their contribution, and residents must derive benefit from data collection and synthesis.
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Affiliation(s)
- Jennifer Kirsty Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK,Correspondence to: Dr Jennifer Kirsty Burton, Institute of Cardiovascular and Medical Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | | | - Ann-Marie Towers
- Centre for Health Services Studies, Cornwallis Central, University of Kent, Canterbury, UK,NIHR Applied Research Collaboration Kent Surrey and Sussex, UK
| | | | - Julienne Meyer
- National Care Forum, Coventry, UK,School of Health Sciences, Division of Nursing, City University of London, London, UK
| | - Adam Lee Gordon
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Derby Medical School, Royal Derby Hospital, Derby, UK,NIHR Applied Research Collaboration East Midlands, UK
| | - Lisa Irvine
- Centre for Research in Public health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK,NIHR Applied Research Collaboration North East and North Cumbria, UK
| | - Karen Spilsbury
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK,NIHR Applied Research Collaboration Yorkshire and Humber, UK
| | - Guy Peryer
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK,NIHR Applied Research Collaboration East of England, UK
| | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), Cornwallis Central, University of Kent, Canterbury, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK,NIHR Applied Research Collaboration East of England, UK
| | - Gizdem Akdur
- Centre for Research in Public health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Stephen Allan
- Personal Social Services Research Unit (PSSRU), Cornwallis Central, University of Kent, Canterbury, UK
| | - Priti Biswas
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Claire Goodman
- Centre for Research in Public health and Community Care, University of Hertfordshire, Hatfield, UK,NIHR Applied Research Collaboration East of England, UK
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Devi R, Gordon A, Dening T. Enhancing the Quality of Care in Long-Term Care Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031409. [PMID: 35162431 PMCID: PMC8834779 DOI: 10.3390/ijerph19031409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Reena Devi
- School of Healthcare, University of Leeds, Leeds LS2 9JT, UK
- Nurturing Innovation in Care Home Excellence in Leeds (NICHE-Leeds), Leeds, UK
- Correspondence:
| | - Adam Gordon
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (A.G.); (T.D.)
- National Institute of Health Research (NIHR) Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
| | - Tom Dening
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (A.G.); (T.D.)
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22
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Gordon AL, Bennett C, Goodman C, Achterberg WP. Making progress: but a way to go-the age and ageing care-home collection. Age Ageing 2022; 51:6399884. [PMID: 34661617 DOI: 10.1093/ageing/afab213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
Care homes enable people with advanced physical and cognitive impairment to live well with 24-h support from staff. They are a feature of care systems in most countries. They have proved pivotal to the coronavirus disease 2019 (COVID-19) response. We searched Age and Ageing for care-home articles published since 2015. From these we collated 42 into the Age and Ageing care-home collection. This collection draws together important papers that show how Age and Ageing is helping to shape and grow care-home research. The collection outlines the technical issues that researchers face by grouping together important feasibility trials conducted in the sector. It looks at the challenges of measuring quality of life and working with routine data in care homes. It brings together observational studies considering loneliness, functional dependency, stroke outcomes, prescribing and acute deterioration. Health services research in care homes is represented by two studies that demonstrate realist evaluation as a way to make sense of service innovations. Papers are included that consider: non-pharmacological strategies for residents with dementia, end-of-life care, sexuality and intimacy and the care-home workforce. Given the importance of the COVID-19 pandemic in care homes, all of the care home COVID-19 papers published in Age and Ageing to date are included. Finally, a group of papers that present innovative approaches to research in care homes, each of which give voice to residents and/or staff, are collated and presented as a way of moving towards a more resident and care home centred research agenda.
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Affiliation(s)
- Adam L Gordon
- Unit of Injury, Inflammation and Recovery, School of Medicine, University of Nottingham, Nottingham UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
| | - Chloe Bennett
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
- NIHR Applied Research Collaboration East of England (ARC EoE), Cambridge, UK
| | - Wilco P Achterberg
- The Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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23
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Szczepura AK, Wild D, Kneafsey R. Adult social care in England: revive the role of gerontological nurse specialist. BMJ 2021; 375:n2567. [PMID: 34686500 DOI: 10.1136/bmj.n2567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ala K Szczepura
- Centre for Intelligent Healthcare, Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Deidre Wild
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Rosie Kneafsey
- Centre for Healthcare Research, Institute for Health and Wellbeing, Coventry University
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24
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Burton JK, Walker MF. Supporting stroke survivors living in care homes: challenges and opportunities for practice development and research. Age Ageing 2021; 50:1901-1903. [PMID: 34473829 PMCID: PMC8581371 DOI: 10.1093/ageing/afab180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 07/10/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Marion F Walker
- School of Medicine, University of Nottingham, Nottingham, England
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