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Wintz D, Schaffer KB, Hites JJ, Wybourn C, Bui EH, Langness S, Hamel M, Wright K, Frey JR. GIFTS: Geriatric Intensive Functional Therapy Sessions-for the older trauma patient. J Trauma Acute Care Surg 2024; 97:197-204. [PMID: 38051122 DOI: 10.1097/ta.0000000000004224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Considering resources for comprehensive geriatric care, it would be beneficial for geriatric trauma patients (GTPs) and medical patients to be comanaged in one program focusing on ancillary therapeutics (AT): physical therapy, occupational therapy, speech language pathology, respiratory therapy, and sleep wake hygiene. This pilot study describes outcomes of GTPs in a hospital-wide program focused on geriatric-specific AT. METHODS Geriatric trauma patients and geriatric patients were screened by program coordinator for enrollment at one Level II trauma center from August 2021 to December 2022. Enrolled patients (EPs) were admitted to trauma or medicine floors and received repetitive AT with attention to sleep wake hygiene throughout hospitalization and compared with similar nonenrolled patients (NEPs). Excluded patients had any of the following: indication of geriatric syndrome with a fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) score of 5, no frailty with a FRAIL score of 0, comfort focused plans, or arrived from skilled care. Retrospective chart review of demographics and outcomes was completed for both EPs and NEPs. RESULTS A total of 224 EPs (28 trauma [TR]) were compared with 574 NEPs (148 TR). Enrolled patients showed shorter length of stay (mean, 3.8 vs. 6.1; p = 0.0001), less delirium (3.1% vs. 9.6%, p = 0.00222), less time to ambulation (13 hours vs. 39 hours, p = 0.0005), and higher likelihood to discharge home (56% vs. 27%, p < 0.0001) as compared with NEPs. The median FRAIL score was 3 for both groups. Enrolled medical patients ambulated the soonest at 11 average hours, compared with 23 hours for enrolled trauma patients and 39 hours for NEPs. There were zero delirium events among enrolled trauma patients; 25% was found among nonenrolled trauma patients ( p = 0.00288). CONCLUSION Despite a small trauma cohort, results support feasibility to include GTPs in hospital-wide programs with geriatric-specific AT. Mobility and cognitive strategies may improve opportunities to avoid delirium, decrease length of stay, and influence more frequent disposition to home. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Diane Wintz
- From the Sharp HealthCare, Sharp Memorial Hospital Trauma and Acute Care Surgery, San Diego, California
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Mohr M, Büttner M, Deuster O, Heckmann J, Huwer F, Krämer I, Lippold C, Siegrist B, Singer S, Veith M, Zinke A, Hardt R. E-Health-based, trans-sectoral, geriatric health service - Geriatric Network (GerNe). Sci Rep 2024; 14:17326. [PMID: 39068175 PMCID: PMC11283534 DOI: 10.1038/s41598-024-67624-3] [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: 12/05/2023] [Accepted: 07/15/2024] [Indexed: 07/30/2024] Open
Abstract
Currently, exchange of information between the geriatric clinic and the attending general practitioner (GP) occurs primarily through the doctor's letter after discharging from the clinic. The aim of our study was to reduce readmissions of multimorbid, geriatric patients to the clinic by establishing a new form of care via an electronic case file (ECF) and a consultation service (CS). The discharging geriatric clinic filled out an online ECF. The patient's GP should document quarterly follow-ups in the ECF. The case file was monitored by the discharging clinic due to a consultation service. The primary efficacy endpoint was the rehospitalization rate within one year. The hospitalization rate for patients managed in the project was 83.1/100 person years (PY), while the control group from insurance data had a rate of 69.0/100 PY. The primary endpoint did not show a statistically significant difference (p = 0.15). A total of 195 contacts were documented via CS for 171 participants, mostly initiated by the clinics. The clinical queries primarily concerned drug therapy. The Covid pandemic had an overall impact on hospitalizations. There are many approaches to reducing hospital readmissions after discharge of older patients. Supporting the transition from inpatient to outpatient care by different professional groups or care systems has been shown to have a positive effect. Furthermore, the utilisation of an ECF can also be beneficial in this regard.
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Affiliation(s)
- Michael Mohr
- Geriatric Department, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Matthias Büttner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Oliver Deuster
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Frank Huwer
- BARMER Rheinland-Pfalz/Saarland, Mainz, Germany
| | - Irene Krämer
- Pharmacy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Bettina Siegrist
- Pharmacy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marina Veith
- Geriatric Department, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ariane Zinke
- St. Marien- und St. Annastifts Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Roland Hardt
- Geriatric Department, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Dai ZH, Xu L, Yang Y, He XN, Chen K. Effects of integrated management on surgical outcomes and mental health of patients following endoscopic submucosal dissection. World J Clin Cases 2024; 12:4034-4040. [PMID: 39015912 PMCID: PMC11235559 DOI: 10.12998/wjcc.v12.i20.4034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/30/2024] [Accepted: 05/20/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a less invasive local treatment for diseases throughout the gastrointestinal tract. AIM To develop an integrated management protocol and analyze its effects on surgical outcomes and mental health of patients after ESD. METHODS The study population consisted of patients undergoing ESD before implementation of integrated management and those undergoing ESD by the same pool of surgeons after implementation of integrated management. RESULTS The management group exhibited shortened fasting time and length of hospital stay compared to the control group (P < 0.05). The management group exhibited a higher incidence rate of postoperative complications than the control group (3 cases vs 11 cases; P = 0.043). The management group exhibited a lower uncertainty score for disease knowledge compared to the control group 12 h after surgery (P < 0.05). The management group gave more scores on the domains of patient familiarity to the responsible nurses, professional skills of responsible nurses, and general evaluation compared to the control group. The management group had a higher total score of patient satisfaction towards the responsible nurses in term of health care than the control group (P < 0.01). The management group exhibited lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores compared to the control group 12 h after surgery (P < 0.01). CONCLUSION The study demonstrates that integrated management could improve surgical outcomes and mental health of patients undergoing ESD.
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Affiliation(s)
- Zhu-Hua Dai
- Department of Gastroenterology, Ningbo Yinzhou No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
| | - Lu Xu
- Department of Gastroenterology, Ningbo Yinzhou No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
| | - Yu Yang
- Department of Gastroenterology, Ningbo Yinzhou No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
| | - Xu-Ni He
- Department of Gastroenterology, Ningbo Yinzhou No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
| | - Ke Chen
- Department of Gastroenterology, Ningbo Yinzhou No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
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Albarqi MN. Assessing the Impact of Multidisciplinary Collaboration on Quality of Life in Older Patients Receiving Primary Care: Cross Sectional Study. Healthcare (Basel) 2024; 12:1258. [PMID: 38998793 PMCID: PMC11240966 DOI: 10.3390/healthcare12131258] [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: 05/11/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
The growing aging population presents unique challenges in maintaining their quality of life (QoL), which encompasses physical, psychological, and social wellbeing. This study aimed to assess the impact of multidisciplinary collaboration on QoL among older patients receiving primary care. A cross-sectional study was conducted involving a purposive sampling of 200 participants aged 60 years and above from Primary Healthcare Centers in Al-Ahsa, Saudi Arabia, between March and May 2024. Data were collected using standardized tools: SF-36 for health-related QoL, Multidisciplinary Collaboration Evaluation Tool (MCET), and Lubben Social Network Scale (LSNS). Multivariate regression analyses were performed to examine the associations between multidisciplinary collaboration, social support, and QoL outcomes. Multidisciplinary collaboration exhibited a significant positive association with improvements in physical functioning (β = 2.35, p < 0.001), mental health (β = 3.01, p < 0.001), and general health perceptions (β = 2.12, p < 0.001). Key drivers of effective collaboration included effective communication (β = 0.48, p < 0.001), coordination (β = 0.42, p < 0.001), and patient involvement (β = 0.40, p < 0.001). Social support, particularly from friends (β = 0.33, p < 0.001) and family (β = 0.28, p < 0.001), was also a robust predictor of better QoL. Younger age, female gender, married status, and absence of chronic conditions were associated with greater QoL improvements from multidisciplinary care. Multidisciplinary collaboration and social support networks significantly enhance QoL among older primary care patients. Healthcare systems should prioritize developing collaborative care models, fostering interdisciplinary teamwork, and integrating strategies to promote social connectedness for the aging population.
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Ambagtsheer RC, Leach MJ, O'Brien LM, Tyndall J, Wardle J, Beilby J. Multidisciplinary, multicomponent interventions to reduce frailty among older persons in residents of residential care facilities: a scoping review. Syst Rev 2024; 13:154. [PMID: 38858798 PMCID: PMC11163739 DOI: 10.1186/s13643-024-02576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Frailty reduction and reversal have been addressed successfully among older populations within community settings. However, these findings may not be applicable to residential care settings, largely due to the complex and multidimensional nature of the condition. Relatively, few attempts at frailty prevention exist in residential settings. This review aims to identify and describe best practice models of care for addressing frailty among older populations in residential care settings. This research also sets out to explore the impact of multidisciplinary health service delivery models on health outcomes such as mortality, hospitalisations, quality of life, falls and frailty. METHODS A scoping review of the literature was conducted to address the project objectives. Reference lists of included studies, bibliographic databases and the grey literature were systematically searched for literature reporting multidisciplinary, multidimensional models of care for frailty. RESULTS The scoping review found no interventions that met the inclusion criteria. Of the 704 articles screened, 664 were excluded as not relevant. Forty articles were fully assessed, and while no eligible studies were found, relevant data were extracted from 10 near-eligible studies that reported single disciplines or single dimensions rather than a model of care. The physical, nutritional, medicinal, social and cognitive aspects of the near eligible studies have been discussed as playing a key role in frailty reduction or prevention care models. CONCLUSION This review has identified a paucity of interventions for addressing and reducing frailty in residential care settings. High-quality studies investigating novel models of care for addressing frailty in residential care facilities are required to address this knowledge gap. Similarly, there is a need to develop and validate appropriate screening and assessment tools for frailty in residential care populations. Health service providers and policy-makers should also increase their awareness of frailty as a dynamic and reversible condition. While age is a non-modifiable predictor of frailty, addressing modifiable factors through comprehensive care models may help manage and prevent the physical, social and financial impacts of frailty in the ageing population.
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Affiliation(s)
| | - M J Leach
- Faculty of Health, National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - L M O'Brien
- Torrens University Australia, Adelaide, SA, 5000, Australia.
| | - J Tyndall
- Torrens University Australia, Adelaide, SA, 5000, Australia
| | - J Wardle
- Faculty of Health, National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - J Beilby
- Torrens University Australia, Adelaide, SA, 5000, Australia
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de Seze J, Dive D, Ayrignac X, Castelnovo G, Payet M, Rayah A, Gobbi C, Vermersch P, Zecca C. Narrative Review on the Use of Cladribine Tablets as Exit Therapy for Stable Elderly Patients with Multiple Sclerosis. Neurol Ther 2024; 13:519-533. [PMID: 38587749 PMCID: PMC11136913 DOI: 10.1007/s40120-024-00603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
The number of ageing people with relapsing multiple sclerosis (RMS) is increasing. The efficacy of disease-modifying therapies (DMTs) for RMS declines with age. Also, older persons with MS may be more susceptible to infections, hospitalisations and malignancy. Aging people with MS have higher rates of comorbidities versus aged-matched controls, increasing the individual risk of disability. We review the therapeutic properties of cladribine tablets (CladT) in ageing people with RMS, with regard to their utility for allowing these individuals to cease continuous administration of a DMT (i.e. to act as an "exit therapy"). CladT is thought to be an immune reconstitution therapy, in that two short courses of oral treatment 1 year apart provide suppression of MS disease activity in responders that far outlasts the duration of treatment and post-treatment reductions in lymphocyte counts. Post hoc analyses, long-term follow-up of populations with RMS in randomised trials, and real-world evidence suggest that the efficacy of CladT is probably independent of age, although more data in the elderly are still needed. No clear adverse signals for lymphopenia or other adverse safety signals have emerged with increasing age, although immunosenescence in the setting of age-related "inflammaging" may predispose elderly patients to a higher risk of infections. Updating vaccination status is recommended, especially against pneumococci and herpes zoster for older patients, to minimise the risk of these infections. CladT may be a useful alternative treatment for ageing people with MS who often bear a burden of multiple comorbidities and polypharmacy and who are more exposed to the adverse effects of continuous immunosuppressive therapy.
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Affiliation(s)
- Jerome de Seze
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France.
| | - Dominique Dive
- Department of Neurology, Liège University Hospital, Liège, Belgium
| | - Xavier Ayrignac
- Department of Neurology, University of Montpellier, INM, INSERM, Montpellier University Hospital, Montpellier, France
| | - Giovanni Castelnovo
- Department of Neurology, Nîmes University Hospital, Hopital Caremeau, Nîmes, France
| | - Marianne Payet
- Merck Santé S.A.S., an Affiliate of Merck KGaA, Lyon, France
| | - Amel Rayah
- Merck Santé S.A.S., an Affiliate of Merck KGaA, Lyon, France
| | - Claudio Gobbi
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Patrick Vermersch
- University of Lille, INSERM U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Chiara Zecca
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
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Basile I, Consolo L, Colombo S, Rusconi D, Rampichini F, Lusignani M. Technology to Support Older Adults in Home Palliative Care: A Scoping Review. Am J Hosp Palliat Care 2024; 41:673-690. [PMID: 37473720 PMCID: PMC11032634 DOI: 10.1177/10499091231189502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Today, many older adults use health technologies, approach their final days with laptops, smartphones, and tablets. Telepalliative care is a service that remotely delivers palliative care through videoconferencing, telephonic communication, or remote symptom monitoring. The service meets the needs of patients who want to die at home and reducing unnecessary hospitalizations. The objective of this study is to map the literature on the use of technology by the terminally ill older adult population being cared for at home, to identify which technology systems are in use, to determine how technology can change communication between palliative care professionals and patients, and to explore the strengths or weaknesses patients perceive regarding the use of technology. METHODS We conducted a scoping review following the methodology of Arksey and O'Malley. A literature search was conducted in the MEDLINE, Embase, Web of Science, SCOPUS, PsycINFO, CINAHL, Ilisi and Google Scholar databases. RESULTS Fourteen eligible papers identified various tools available in clinical practice and found that most older adults are comfortable and satisfied using them. Despite being physically distanced from clinicians, patients felt cared for even though eye contact was lacking. Being unfamiliar with technology emerged as a barrier to telepalliative care in addition to difficulties caused by screen size and internet connection problems. CONCLUSIONS Older adults in palliative care at home perceive technology as a means of receiving efficient care. However, future research is needed to investigate what they look for in a technological tool and to develop more suitable technologies for them. CLINICAL TRIAL REGISTRATION The protocol of this study has been published in the Open Science Framework (OSF) preregistrations at https://osf.io/acv7q to enhance replicability and transparency and reduce any publication or reporting bias.
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Affiliation(s)
- Ilaria Basile
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, IRCCS, National Cancer Institute Milan, Milan, Italy
| | - Letteria Consolo
- Bachelor School of Nursing, IRCCS, National Cancer Institute, Milan Italy
| | - Stella Colombo
- Intensive Care Unit, IRCCS, National Cancer Institute, Milan, Italy
| | - Daniele Rusconi
- Urology Unit, IRCCS, National Cancer Institute, Milan, Italy
| | - Flavia Rampichini
- Central Medical and Surgical Pole Library, University of Milan, Milan, Italy
| | - Maura Lusignani
- Associate Professor, Department of Biomedical Sciences for Health, Milan, Italy
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Torres-Perez AC, Ramos-Lopez WA, Covarrubias-Gómez A, Sánchez-Roman S, Quiroz-Friedman P, Alcocer-Castillejos N, Milke-García MDP, Carrillo-Soto M, Morales-Alfaro A, Chávarri-Guerra Y, Soto-Perez-de-Celis E. Supportive care needs among older Mexican adults with metastatic cancer. J Geriatr Oncol 2024; 15:101796. [PMID: 38761773 DOI: 10.1016/j.jgo.2024.101796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/18/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Supportive care needs may vary according to age. The purpose of this research is to describe and compare supportive care needs between older adults with metastatic cancer (age ≥ 65 years) and their younger counterparts. MATERIALS AND METHODS We conducted a retrospective secondary analysis of a cohort of patients with newly diagnosed metastatic solid tumors. Supportive care needs were assessed at baseline and at a three-month follow-up. Patients were divided into two groups (aged ≥65/<65 years). Differences in clinical characteristics and supportive care needs were compared utilizing descriptive statistics. Multivariate logistic regression models were employed to identify patient characteristics associated with specific supportive care needs. RESULTS Between 2018 and 2022, 375 patients were enrolled. Median age was 66 years (interquartile range 19-94). At baseline, older adults had a higher number of supportive care needs (4.8 vs. 4.2, p = 0.01) and were at higher risk of malnutrition (75 vs. 65%, p = 0.05). Increasing age (odds ratio [OR] 1.02 (95% confidence interval [CI] 1.0-1.04, p = 0.03) and an estimated life expectancy <6 months (OR 3.0, 95%CI 1.5-6.1; p < 0.01) were associated with higher odds of malnutrition, while a higher educational level was associated with decreased odds (OR 0.68, 95%CI 0.5-0.8; p < 0.01). At three-month follow-up, older adults still had a higher number of supportive care needs (3.8 vs.2.6, p < 0.01) and were more likely to have fatigue (62 vs. 47%, p = 0.02). An estimated life expectancy of <6 months was associated with increased odds of fatigue (OR 3.0, 95%CI 1.5-6.3; p < 0.01). DISCUSSION Older adults reported significantly more supportive care needs, particularly risk of malnutrition and fatigue. This information can help in the creation of supportive care services tailored to the needs of older individuals.
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Affiliation(s)
- Ana Cristina Torres-Perez
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Wendy Alicia Ramos-Lopez
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Alfredo Covarrubias-Gómez
- Department of Palliative Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Sofía Sánchez-Roman
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Paulina Quiroz-Friedman
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Natasha Alcocer-Castillejos
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Del Pilar Milke-García
- Department of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Mónica Carrillo-Soto
- Department of Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Andrea Morales-Alfaro
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Yanin Chávarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Ushimaru Y, Nagano S, Kawabata R, Nishikawa K, Takeoka T, Kitagawa A, Ohara N, Tomihara H, Maeda S, Imasato M, Noura S, Miyamoto A. Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support. World J Surg Oncol 2024; 22:136. [PMID: 38778314 PMCID: PMC11112811 DOI: 10.1186/s12957-024-03421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND As the prevalence of gastric cancer rises in aging populations, managing surgical risks and comorbidities in elderly patients presents a unique challenge. The Comprehensive Preoperative Assessment and Support (CPAS) program, through comprehensive preoperative assessments, aims to mitigate surgical stress and improve outcomes by enhancing patient awareness and preparation. This study investigates the efficacy of a CPAS program, incorporating frailty and sarcopenia evaluations, to improve short-term outcomes in elderly gastric cancer patients. METHODS A retrospective analysis was conducted on 127 patients aged 75 or older who underwent surgery with CPAS between 2018 and August 2023, compared to 170 historical controls from 2012 to 2017. Propensity score matching balanced both groups based on age-adjusted Charlson Comorbidity Index and surgical details. The primary focus was on the impact of CPAS elements such as rehabilitation, nutrition, psychological support, oral frailty, and social support on short-term surgical outcomes. RESULTS Among 83 matched pairs, the CPAS group, despite 40.4% of patients in the CPAS group and 21.2% in the control group had an ASA-PS score of 3 or higher (P < 0.001), demonstrated significantly reduced blood loss (100 ml vs. 190 ml, P = 0.026) and lower incidence of serious complications (19.3% vs. 33.7%, P = 0.034), especially in infections and respiratory issues. Sarcopenia was identified in 38.6% of CPAS patients who received tailored support. Additionally, the median postoperative hospital stay was notably shorter in the CPAS group (10 days vs. 15 days, P < 0.001), with no in-hospital deaths. These results suggest that personalized preoperative care effectively mitigates operative stress and postoperative complications. CONCLUSION Implementing CPAS significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic.
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Affiliation(s)
- Yuki Ushimaru
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinnosuke Nagano
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Ryohei Kawabata
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan.
| | - Kazuhiro Nishikawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Tomohira Takeoka
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Akihiro Kitagawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Nobuyoshi Ohara
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Hideo Tomihara
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Sakae Maeda
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Mitsunobu Imasato
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Shingo Noura
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
| | - Atsushi Miyamoto
- Department of Gastroenterological Surgery, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, 593-8304, Japan
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Hogue LL, Kennelly M. The Ideal Neurogenic Bladder Management Team. Urol Clin North Am 2024; 51:297-303. [PMID: 38609201 DOI: 10.1016/j.ucl.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
This article discusses the ideal neurogenic bladder management team for patients who have neurogenic lower urinary tract dysfunction (NLUTD). It emphasizes the importance of a diverse team, including urologists, physiatrists, neurologist and others, working collaboratively to prevent complications and enhance patient outcomes. Owing to the unique nuances of the various neurologic conditions and patterns of NLUTD dysfunction, the roles of different specialists in the interdisciplinary team are outlined. This article describes 3 team models: multidisciplinary, interdisciplinary, and transdisciplinary, highlighting the benefits of collaborative approaches.
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Affiliation(s)
- LaTanya Lofton Hogue
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Atrium Health, Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC 28203, USA
| | - Michael Kennelly
- Department of Urology, Wake Forest School of Medicine, Atrium Health, Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC 28203, USA.
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Yoshida Y, Hirakawa Y, Hong YJ, Mamun MR, Shimizu H, Nakano Y, Yatsuya H. Factors influencing interprofessional collaboration in long-term care from a multidisciplinary perspective: a case study approach. Home Health Care Serv Q 2024:1-20. [PMID: 38521999 DOI: 10.1080/01621424.2024.2331452] [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: 03/25/2024]
Abstract
Systematic assessments of interprofessional collaboration barriers and enablers in long-term care settings are critical for delivering person-centered healthcare. However, research on factors influencing interprofessional collaboration in long-term care settings is limited. For this study, 65 healthcare professionals across multiple facilities experienced in long-term care in Japan participated in online focus group discussions and individual interviews to discuss cases. The qualitative data were analyzed using qualitative content analysis. Seven themes emerged: coordination, the need for care manager training, hierarchy among healthcare professionals, specialization but not the mind-set of overspecialization, casual conversations, electronic group communication tools, and excessive fear of personal information protection. These findings highlight the need to develop coordinator roles and for interprofessional education on the proper approach to personal information protection laws. Furthermore, daily casual conversations, the use of online platforms, and the prevention of patients being left behind due to overspecialization are required.
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Affiliation(s)
- Yuko Yoshida
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Department of Psychiatry, Daido Hospital, Kojunkai Social Medical Corporation, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Department of Health Research and Innovation, Aichi Comprehensive Health Science Center (Aichi Health Plaza), Chita-Gun, Japan
| | - Young Jae Hong
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Md Razib Mamun
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroko Shimizu
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoshihisa Nakano
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Fhon JRS, Alves N, dos Santos AP, Djinan ARFS, Laurenti AV, Lima EFC. Attitudes and perceptions about ageism among nursing students: a scoping review. Rev Lat Am Enfermagem 2024; 32:e4116. [PMID: 38511735 PMCID: PMC10959072 DOI: 10.1590/1518-8345.6851.4116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/12/2023] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE to map scientific knowledge on nursing students' attitudes and perceptions regarding ageism. METHOD scoping review according to the recommendations of the Joanna Briggs Institute. The study question was: What are scientific evidence available on the attitudes and perceptions of nursing students regarding ageism? The search was conducted in 12 databases using the Rayyan application and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The studies were selected by two reviewers using a data extraction tool. RESULTS of the 4,595 files, 46 that were published between 1984 and 2022 were selected, and the quantitative method was the most used. The most commonly used instrument was the Kogan's Attitudes Toward Old People Scale. Positive, negative, mixed, neutral, and inconclusive attitudes and perceptions were identified. CONCLUSION attitudes and perceptions about ageism are diverse and not conclusive. Future intervention studies are recommended to detect changes in the behavior of nursing students in the face of ageism. BACKGROUND (1) Attitudes and perceptions about ageism are diverse and not conclusive. BACKGROUND (2) Importance of discussing ageism in the training of nursing students. BACKGROUND (3) Intervention studies to identify paradigm shifts in nursing students.
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Affiliation(s)
| | - Natalia Alves
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
- Scholarship holder at the Programa Unificado de Bolsas da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Alice Regina Felipe Silva Djinan
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Anaclara Viggiano Laurenti
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
- Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Eveline Fontes Costa Lima
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
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Hsiao ML, Su CY, Loh CH, Kao SL. Effects of integrated care with case management and nutritional counselling for frail older adults with nutritional risk in the primary care setting. Fam Pract 2024:cmae011. [PMID: 38423070 DOI: 10.1093/fampra/cmae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The effects of integrated care with case management and nutritional counselling for frail patients with nutritional risk are unclear. OBJECTIVES To assess the impact of the integrated care model for frail patients with nutritional risk in the primary care setting. METHODS This was a retrospective observational study. We enrolled 100 prefrail or frail patients according to Clinical Frailty Scale (CFS) aged ≥ 60 years with nutritional risk from the geriatric clinic. We implemented the frailty intervention model, including integrated care with comprehensive geriatric assessments (CGA), case management, and nutritional counselling by the dietitian. We obtained measures of CGA components, physical performance, body mass index (BMI), and daily caloric intake before and after the 2-month care program. We used the Wilcoxon signed-rank test to analyse differences after the care program and applied multiple linear regression to determine the predictive factors for CFS improvement. RESULTS Among the 100 patients (mean age, 75.0 ± 7.2 years; females, 71.0%; frail patients, 26%), 93% improved their CFS status, and 91% achieved > 80% of recommended daily caloric intake after the care program. The Mini Nutritional Assessment Short-Form significantly improved after the program. BMI and daily caloric intake increased significantly after nutritional counselling. The post-test short physical performance battery (SPPB) significantly increased with a faster 4 m gait speed. Baseline poor CFS was a significant predictor for CFS improvement. CONCLUSIONS Integrated care with case management and nutritional counselling for prefrail and frail patients with nutritional risk in the primary care setting may improve physical performance and nutritional status.
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Affiliation(s)
- Mei-Lan Hsiao
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien 970, Taiwan
| | - Chen-Ying Su
- Department of Nutrition, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd., Hualien 970, Taiwan
| | - Ching-Hui Loh
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707 Sec. 3, Chung Yang Rd., Hualien 970, Taiwan
- Department of Family Medicine, College of Medicine, Tzu Chi University, No. 701, Sec. 3, Chung Yang Rd., Hualien 970, Taiwan
| | - Sheng-Lun Kao
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707 Sec. 3, Chung Yang Rd., Hualien 970, Taiwan
- Department of Family Medicine, College of Medicine, Tzu Chi University, No. 701, Sec. 3, Chung Yang Rd., Hualien 970, Taiwan
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Drew S, Fox F, Gregson CL, Gooberman-Hill R. Model of multidisciplinary teamwork in hip fracture care: a qualitative interview study. BMJ Open 2024; 14:e070050. [PMID: 38417961 PMCID: PMC10900388 DOI: 10.1136/bmjopen-2022-070050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES Hip fractures are common injuries in older age with high mortality requiring multidisciplinary clinical care. Despite guidance, there is considerable variation in hip fracture services and patient outcomes; furthermore, little is known about how successful multidisciplinary working can be enabled. This study aimed to characterise professionals' views about the core components of multidisciplinary teamwork in hip fracture care. DESIGN The study comprised qualitative interviews with healthcare professionals delivering hip fracture care. Interviews were audio recorded, transcribed and analysed abductively: material was coded inductively and grouped into higher level concepts informed by theories and frameworks relating to teamwork. SETTING Four hospitals in England. PARTICIPANTS Participants were 40 healthcare professionals including orthopaedic surgeons, orthogeriatricians, physiotherapists and service managers. RESULTS Results identified four components of successful multidisciplinary teamwork: (1) defined roles and responsibilities, (2) information transfer processes, (3) shared goals and (4) collaborative leadership. These were underpinned by a single concept: shared responsibility. Defined roles and responsibilities were promoted through formal care pathways, reinforced through induction and training with clear job plans outlining tasks. Information transfer processes facilitated timely information exchange to appropriate individuals. Well-defined common purpose was hindered by complex interdisciplinary professional relationships, particularly between orthogeriatric and orthopaedic staff, and encouraged through multidisciplinary team meetings and training. Clinical service leads were integral to bridging interdisciplinary boundaries. Mutual trust and respect were based on recognition of the value of different professional groups. Teamwork depended on formal clinical leads with facilitative and motivational roles, and on hospital leadership that created an environment supporting collaboration. Shared responsibility for patients was encouraged by joint orthopaedic and orthogeriatric care models. Staff shared responsibility by assisting colleagues when needed. CONCLUSIONS Shared responsibility across the multidisciplinary team is fundamental to delivery of hip fracture care. Findings will inform development of clinical practice recommendations and training to build teamworking competencies.
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Affiliation(s)
- Sarah Drew
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fiona Fox
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
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Ye P, Peng J, Jin Y, Duan L, Yao Y, Ivers R, Keay L, Tian M. Using a participatory design to develop an implementation framework for integrating falls prevention for older people within the Chinese primary health care system. BMC Geriatr 2024; 24:178. [PMID: 38383320 PMCID: PMC10882749 DOI: 10.1186/s12877-024-04754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/27/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Chinese National Essential Public Health Service Package (NEPHSP) has mandated primary health care providers to provide falls prevention for community-dwelling older people. But no implementation framework is available to guide better integration of falls prevention for older people within the primary health care system. METHODS This is a two-stage online participatory design study consisting of eight workshops with stakeholders from three purposively selected cities. First, two workshops were organised at each study site to jointly develop the framework prototype. Second, to refine, optimise and finalise the prototype via two workshops with all study participants. Data analysis and synthesis occurred concurrently with data collection, supported by Tencent Cloud Meeting software. RESULTS All participants confirmed that the integration of falls prevention for older people within the NEPHSP was weak and reached a consensus on five opportunities to better integrate falls prevention, including workforce training, community health promotion, health check-ups, health education and scheduled follow-up, during the delivery of NEPHSP. Three regional-tailored prototypes were then jointly developed and further synthesised into a generic implementation framework by researchers and end-users. Guided by this framework, 11 implementation strategies were co-developed under five themes. CONCLUSIONS The current integration of falls prevention in the NEPHSP is weak. Five opportunities for integrating falls prevention in the NEPHSP and a five-themed implementation framework with strategies are co-identified and developed, using a participatory design approach. These findings may also provide other regions or countries, facing similar challenges, with insights for promoting falls prevention for older people.
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Affiliation(s)
- Pengpeng Ye
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Junyi Peng
- School of Public Health, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Ye Jin
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Leilei Duan
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yao Yao
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Rebecca Ivers
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Lisa Keay
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150081, China.
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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Khalil MIM, Elnakeeb M, Hassanin HI, Sorour DM. Knowledge, familiarity, and impact of the COVID-19 pandemic on barriers to seeking mental health services among older people: a cross-sectional study. Psychogeriatrics 2024; 24:3-15. [PMID: 37908168 DOI: 10.1111/psyg.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/28/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023]
Abstract
AIM The COVID-19 pandemic caused drastic changes in older people's daily activities with a negative impact on their mental health, yet older people are less likely to seek mental health services. This study aims to explore the relationship between knowledge of and familiarity with mental health services, along with the impact of the COVID-19 pandemic, and barriers to seeking mental health services among older people. METHODS A descriptive cross-sectional study was conducted with a convenience sample of 352 older people, recruited among community-dwelling adults who attended randomly selected postal offices and pension outlets. Three tools were used: a structured interview schedule for sociodemographic and clinical characteristics of older people, the revised version of the Knowledge and Familiarity of Mental Health Services Scale (KFFMHS-R), and the Barriers to Mental Health Services Scale Revised (BMHSS-R). RESULTS All participants reported experiencing mental health distress during the COVID-19 pandemic. Intrinsic barriers had a higher mean score than extrinsic barriers, and 27.4% of the variance of overall barriers to seeking mental health could be explained through regression analysis by familiarity, knowledge of mental health services, and age. Overall barriers explained 24.4% of the variance of older people's perceived distress as an impact of the COVID-19 pandemic (F = 22.160, P < 0.001). CONCLUSIONS Knowledge of mental health services was the most significant predictor of barriers to seeking mental health services during the COVID-19 pandemic. Higher barriers predicted higher distress as an impact of the COVID-19 pandemic. The results of the study suggest the need for a multidisciplinary mental health team for older people.
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Affiliation(s)
| | - Mayar Elnakeeb
- Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Hany Ibrahim Hassanin
- Geriatric Medicine and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dina Metwally Sorour
- Gerontological Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Al-Daken L, Lazarus ER, Al Sabei SD, Alharrasi M, Al Qadire M. Perception of Nursing Students About Effective Clinical Teaching Environments: A Multi-Country Study. SAGE Open Nurs 2024; 10:23779608241233146. [PMID: 38510754 PMCID: PMC10953109 DOI: 10.1177/23779608241233146] [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: 03/18/2023] [Revised: 12/10/2023] [Accepted: 01/26/2024] [Indexed: 03/22/2024] Open
Abstract
Background The transition of nursing education from traditional methods to more advanced approaches is crucial for adequately preparing students to deliver competent care in tertiary care centers. Moreover, clinical faculty in nursing plays a key role in guiding nursing students through their clinical training in various healthcare settings. Purpose This study aims to describe the perceptions of undergraduate nursing students regarding the effectiveness of the learning environment and clinical teaching in clinical areas across various countries. Methods The study, conducted using a descriptive, cross-sectional research design, gathered data from 215 nursing students using the Clinical Learning Environment Inventory and Clinical Teaching Effectiveness Instrument. Data analysis included frequencies, percentages, mean, standard deviation, t-tests, analysis of variance, and correlation assessments to comprehend the impact of clinical teaching and learning environments. Results Nursing students' perceptions of the clinical learning environment produced mean scores between 2.03 and 3.38 on a scale from 1 to 4, resulting in an overall mean score of 2.72 across 42 items. This indicates a general satisfaction with their clinical learning experiences. Regarding effective clinical teaching, the mean student responses varied from 3.02 to 3.40 out of a possible 5 points, with a total mean of 3.22. The study revealed notable correlations in the context of effective clinical teaching, particularly with demographic variables and the clinical learning environment. Specifically, a significant correlation with age (r = .177, p = .009) and the clinical learning environment (r = .572, p < .001) was identified. Conclusion The study concludes that students expressed overall satisfaction with their clinical learning experiences. They recognized the importance of participating in clinical training, fulfilling clinical responsibilities for assigned patients, exerting extra effort for learning, receiving support from preceptors in clinical settings, and being attentive to communications from staff. The collaboration between clinical preceptors and academic nursing lecturers is crucial in providing a positive learning environment for students to complete clinical tasks effectively.
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Affiliation(s)
- Laila Al-Daken
- College of Nursing, Sultan Qaboos University, Muscat, Oman
| | | | | | | | - Mohammad Al Qadire
- College of Nursing, Sultan Qaboos University, Muscat, Oman
- Adult Health Department, Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
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Naughton C, Galvin R, McCullagh R, Horgan F. Comprehensive geriatric assessment-where are we now, where do we need to be in the context of global ageing? Age Ageing 2023; 52:afad210. [PMID: 37967124 DOI: 10.1093/ageing/afad210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Indexed: 11/17/2023] Open
Abstract
Comprehensive geriatric assessment (CGA) is the cornerstone of modern geriatric medicine and the framework around which conventional and new models of care for older people are developed. Whilst there are a substantial number of reviews synthesising the evidence on patient and service outcomes from CGA, as an intervention it remains poorly described. There is a lack of detail on how a CGA plan is coordinated, delivered and followed up, especially outside of acute care. This commentary reflects on the authors' experience of extracting data from 57 published studies on CGA. CGA as an intervention is akin to a 'black box' in terms of describing and measuring participants' interactions with CGA activity in terms of time, frequency and amount (dose) received. There is also a lack of detail on how newly established CGA teams become effective, interdisciplinary, high functioning and sustainable teams. The CGA knowledge-do gap persists with a need to draw from complex system theory and implementation science frameworks to better describe the intervention and understand the influence of the organisation and health service within which CGA is operationalised. Equally, the voice of older people, families and staff is critical in the conduct and evaluation of CGA, and how it evolves as a model to meet the growing needs of ageing populations.
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Affiliation(s)
- Corina Naughton
- School of Nursing and Midwifery, College of Medicine and Health, University College Cork, College Road, Cork T12 AK54, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick V94 T9PX, Ireland
| | - Ruth McCullagh
- School of Clinical Therapies, University College Cork, Nano Nagle Place, Douglas St, Cork T12 X70A, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2 D02 YN77 Ireland
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Law KY, Cross J, Dhesi J, Partridge J. Developing the workforce to deliver perioperative medicine for older people undergoing surgery: a transdisciplinary education programme. Future Healthc J 2023; 10:321-324. [PMID: 38162222 PMCID: PMC10753214 DOI: 10.7861/fhj.2022-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Patients who are older, frail and medically complex are increasingly presenting for elective and emergency surgical interventions. Comprehensive Geriatric Assessment (CGA) and optimisation methodology improve morbidity and mortality in older surgical patients. However, there is a need to develop an extended and flexible workforce to provide patient-centred quality perioperative care and to simultaneously tackle the growing backlog of planned surgery following the Coronavirus 2019 (COVID-19) pandemic. At Guy's and St Thomas' NHS Foundation Trust, Perioperative Medicine for Older People (POPS) delivers a transdisciplinary education programme for foundation doctors, specialty registrars and advanced clinical practitioners to develop a blended team with shared capabilities and goals in perioperative care. This case study outlines the framework of how the education programme was developed and its evaluation, and the ongoing work of POPS to disseminate knowledge and promote national innovation and collaboration.
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Affiliation(s)
- Kar Yee Law
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jason Cross
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jugdeep Dhesi
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK; honorary professor, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; honorary associate professor, Division of Surgery and Interventional Science, University College London, UK
| | - Judith Partridge
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK; honorary senior lecturer, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
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Instenes I, Breivik K, Borregaard B, Larsen AI, Allore H, Bendz B, Deaton C, Rotevatn S, Norekvål TM. Phenotyping Self-Reported Health Profiles in Octogenarians and Nonagenarians After Percutaneous Coronary Intervention: A Latent Profile Analysis. Heart Lung Circ 2023; 32:1321-1333. [PMID: 37925313 DOI: 10.1016/j.hlc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/11/2023] [Accepted: 09/01/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Little is known about self-reported health in octogenarians (≥80 years) and nonagenarians (≥90 years) following percutaneous coronary intervention (PCI), including characteristics of different health outcomes. This study aimed to phenotype latent health profiles of self-reported health in older adults 2 months post-PCI. METHODS A prospective, multicentre, real-world study (CONCARDPCI) of 270 octogenarians and nonagenarians was performed with five validated and standardised measures of self-reported health at 2 months post-PCI. Latent profile analysis was used to identify health profiles, and multinomial logistic regression analyses were used to investigate the associations between patient characteristics and health profiles. RESULTS Three latent health profiles were identified: The Poor health profile included 29%, the Moderate health profile included 39%, and the Good health profile included 32% of the participants. Older adults who were frail (OR 2.50, 95% CI 1.17-5.33), had a low exercise level (OR 0.49, 95% CI 0.39-0.95), and low alcohol intake (OR 0.61, 95% CI 0.39-0.95) were more likely to belong to the Poor health profile relative to the Good health profile. Furthermore, older age (OR 1.19, 95% CI 1.03-1.37) and lower exercise level (OR 0.64, 95% CI 0.43-0.97) were associated with belonging to the Moderate health profile relative to the Good health profile. CONCLUSION Two months after PCI, most participants displayed having Moderate to Good health profiles. Those with a Poor health profile were more likely to be frail and less active. These findings highlight that follow-up care has to be patient-centred and tailored to improve the health status of older adults.
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Affiliation(s)
- Irene Instenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kyrre Breivik
- Regional Centre for Child and Youth Mental Health and Child Welfare-West, Bergen, Norway
| | - Britt Borregaard
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Biostatistics, Yale School of Public Health, Yale University, Yale School of Public Health, New Haven, CT, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
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Monteiro MCD, Martins MMFPDS, Schoeller SD. Interdisciplinary health consultations for older people in Portugal: primary care and hospitals. Rev Gaucha Enferm 2023; 44:e20220275. [PMID: 37909513 DOI: 10.1590/1983-1447.2023.20220275.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To analyze the perspective of doctors, nurses, and social workers about practices for older people health in primary care and in hospitals; to create guidelines for the practice of interdisciplinary consultations. METHOD Cross-sectional study involving 291 professionals from public institutions in the northern region of Portugal. Data were collected between May/2018 and March/2019, using a questionnaire which was then subjected to descriptive and analytical statistical analysis. RESULTS The usefulness of scales for elderly people showed no differences between hospital and primary care. Hospital professionals collected the following data: eyesight/hearing; medication; direct contact or contact by writing between professionals; daily team meetings; need to share information among colleagues. Primary care professionals, in turn, valued: weight/height, swallowing; the need for home visits; direct contact or via e-mail between professionals; weekly team meetings. CONCLUSION The practices of the professionals suggested an intervention model with common aspects in both groups, but with specificities for both primary and hospital care.
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Affiliation(s)
| | | | - Soraia Dornelles Schoeller
- Universidade Federal de Santa Catarina (UFSC). Departamento de Enfermagem. Florianópolis, Santa Catarina, Brasil
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Nagano A, Onaka M, Maeda K, Ueshima J, Shimizu A, Ishida Y, Nagami S, Miyahara S, Nishihara K, Yasuda A, Satake S, Mori N. Prevalence and Characteristics of the Course of Dysphagia in Hospitalized Older Adults. Nutrients 2023; 15:4371. [PMID: 37892446 PMCID: PMC10609669 DOI: 10.3390/nu15204371] [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: 09/08/2023] [Revised: 09/30/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Sarcopenic dysphagia (SD) is an emerging concern in geriatric medicine. This study aimed to identify the prevalence, progression, and distinct attributes of SD in patients in the Department of Geriatric Medicine. Older adult patients admitted between 2021 and 2022 were enrolled. The department conducts a comprehensive geriatric assessment (CGA) combined with a multidisciplinary team-based intervention, setting the standard for medical care. We diligently assessed the occurrence and development of dysphagia at both the admission and discharge phases. Of the 180 patients analyzed (38.9% male, mean age 86.0 ± 6.6 years), 22.8% were diagnosed with SD at admission, thrice the rate of other dysphagia variants. Only one patient had new-onset dysphagia during hospitalization, attributed to SD. Patients with SD showed a better recovery rate (18.9%) than those with other dysphagia types. Patients with diminished swallowing capacity had compromised nutritional profiles, diminished energy and protein consumption, and extended fasting durations. Although sarcopenia is a prevalent inducer of dysphagia in older adults, an integrated approach in geriatric medicine involving rehabilitation, nutrition, and dentistry is pivotal. Strategies rooted in CGA promise potential for addressing dysphagia.
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Affiliation(s)
- Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1, Imazuyamanaka-cho, Nishinomiya 663-8211, Japan;
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
| | - Masami Onaka
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
- Nutrition Therapy Support Center, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute 480-1195, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
- Department of Nutritional Service, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Food and Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano 380-8525, Japan
| | - Yuria Ishida
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Nutrition, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute 480-1195, Japan
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki 701-0193, Japan;
| | - Shuzo Miyahara
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Keiji Nishihara
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Akiyuki Yasuda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Shosuke Satake
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
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23
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Britton H. Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project. BMJ Open Qual 2023; 12:e002405. [PMID: 37793675 PMCID: PMC10551953 DOI: 10.1136/bmjoq-2023-002405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND NHS staff recruitment and retention have failed to keep pace with service demands and workforce burn-out is of significant concern. This quality improvement project (QIP) aimed to increase staff time for patient facing care through reducing duplication of hospital board rounds within a 36-bedded NHS inpatient geriatric ward. INTERVENTION Thirty-minute board rounds were reduced from twice daily (Monday-Friday) at 08:30 hours and midday to once daily at midday with the aim of freeing up staff time for patient care. A multidisciplinary team (MDT) safety briefing at 08:30 hours lasting 5-10 min was implemented to enable review of shift pressures and identification of patients who are unwell, newly admitted or due for discharge. Safety briefing format was amended to further support staff prioritisation. METHODS This QIP was underpinned by the model for improvement, using Plan-Do-Study-Act cycles. Data were collected through a staff questionnaire alongside calculation of staff time spent at board rounds and safety huddles. Staff verbal feedback and questionnaire results were also used to improve and modify process'. Patient discharge data were collated via trust metrics as a balancing measure. RESULTS Through board round modification, 25 hours of MDT time was saved each week, with all responding staff reporting increased time for patient facing care following QIP implementation. >85% of questionnaire respondents agreed that board round changes resulted in improvement. Balancing measures collected as part of the project also revealed an increase in weekly ward discharges from an average of 15.75-17.5 confirming no negative impact on patient flow following board round amendments. CONCLUSION While significant staffing shortages continue, local innovations focused on staff time may have the potential to support effective use of limited resources.
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Affiliation(s)
- Hannah Britton
- Care of the elderly medicine, North Bristol NHS Trust, Westbury on Trym, UK
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24
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Radcliffe E, Servin R, Cox N, Lim S, Tan QY, Howard C, Sheikh C, Rutter P, Latter S, Lown M, Brad L, Fraser SDS, Bradbury K, Roberts HC, Saucedo AR, Ibrahim K. What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis. BMC Geriatr 2023; 23:591. [PMID: 37743469 PMCID: PMC10519081 DOI: 10.1186/s12877-023-04256-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate medications (deprescribing). Recent recommendations for effective deprescribing include shared-decision making and a multidisciplinary approach. Our aim was to understand when, why, and how interventions for medication review and deprescribing in primary care involving multidisciplinary teams (MDTs) work (or do not work) for older people. METHODS A realist synthesis following the Realist And Meta-narrative Evidence Syntheses: Evolving Standards guidelines was completed. A scoping literature review informed the generation of an initial programme theory. Systematic searches of different databases were conducted, and documents screened for eligibility, with data extracted based on a Context, Mechanisms, Outcome (CMO) configuration to develop further our programme theory. Documents were appraised based on assessments of relevance and rigour. A Stakeholder consultation with 26 primary care health care professionals (HCPs), 10 patients and three informal carers was conducted to test and refine the programme theory. Data synthesis was underpinned by Normalisation Process Theory to identify key mechanisms to enhance the implementation of MDT medication review and deprescribing in primary care. FINDINGS A total of 2821 abstracts and 175 full-text documents were assessed for eligibility, with 28 included. Analysis of documents alongside stakeholder consultation outlined 33 CMO configurations categorised under four themes: 1) HCPs roles, responsibilities and relationships; 2) HCPs training and education; 3) the format and process of the medication review 4) involvement and education of patients and informal carers. A number of key mechanisms were identified including clearly defined roles and good communication between MDT members, integration of pharmacists in the team, simulation-based training or team building training, targeting high-risk patients, using deprescribing tools and drawing on expertise of other HCPs (e.g., nurses and frailty practitioners), involving patents and carers in the process, starting with 'quick wins', offering deprescribing as 'drug holidays', and ensuring appropriate and tailored follow-up plans that allow continuity of care and management. CONCLUSION We identified key mechanisms that could inform the design of future interventions and services that successfully embed deprescribing in primary care.
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Affiliation(s)
- Eloise Radcliffe
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK.
- NIHR Applied Research Collaboration ARC Wessex, University of Southampton, Southampton, UK.
| | - Renée Servin
- Faculty of Medicine, Imperial College London, South Kensington Campus, London, UK
| | - Natalie Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Stephen Lim
- NIHR Applied Research Collaboration ARC Wessex, University of Southampton, Southampton, UK
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Qian Yue Tan
- NIHR Applied Research Collaboration ARC Wessex, University of Southampton, Southampton, UK
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Clare Howard
- Wessex Academic Health Science Network, Science Park, Chilworth, Southampton, UK
| | - Claire Sheikh
- Hampshire and Isle of Wight Integrated Care Board, Southampton, UK
| | - Paul Rutter
- School of Pharmacy and Biomedical Sciences, Portsmouth University, Portsmouth, UK
| | - Sue Latter
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Mark Lown
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Lawrence Brad
- Westbourne Medical Centre, Westbourne, Bournemouth, UK
| | - Simon D S Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Katherine Bradbury
- NIHR Applied Research Collaboration ARC Wessex, University of Southampton, Southampton, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - Helen C Roberts
- NIHR Applied Research Collaboration ARC Wessex, University of Southampton, Southampton, UK
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Alejandra Recio Saucedo
- School of Healthcare Enterprise and Innovation, Trials and Studies Coordinating Centre, National Institute of Health Research Evaluation, University of Southampton, Southampton, UK
| | - Kinda Ibrahim
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
- NIHR Applied Research Collaboration ARC Wessex, University of Southampton, Southampton, UK
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
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25
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O'Donnell D, Ahern E, Davies C, De Brún A, Donnelly S, Doran T, Drury A, Dunne N, Finucane L, Harnett PJ, Harrison R, Lang D, McAuliffe E, McCarthy M, McGuigan C, Ní Shé É, O'Donoghue G, O'Shea M, Radomska A, Travers J, Whitty H, Devaney C. A realist process evaluation of an intervention to promote competencies in interprofessional collaboration among interdisciplinary integrated care teams for older people: Study protocol. HRB Open Res 2023; 6:49. [PMID: 37854118 PMCID: PMC10579852 DOI: 10.12688/hrbopenres.13729.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 10/20/2023] Open
Abstract
Background: International policy is increasingly committed to placing interdisciplinary team-working at the centre of health and social care integration across the lifespan. The National Clinical Programme for Older People in Ireland has a critical role in the design and implementation of the National Older Person's Service Model, which aims to shift the delivery of care away from acute hospitals towards community-based care. Interdisciplinary Community Specialist Teams for older persons (CST-OPs) play an important role in this service model. To support the development of competencies for interprofessional collaboration and an interdisciplinary team-based approach to care integration, a culture shift will be required within care delivery. Design:This study builds upon a collaborative partnership project which co-designed a framework describing core competencies for interprofessional collaboration in CST-OPs. A realist-informed process evaluation of the framework will be undertaken as the competencies described in the framework are being fostered in newly developed CST-OPs under the national scale-up of the service model. Realist evaluation approaches reveal what worked, why it worked (or did not), for whom and under what circumstances. Three iterative and integrated work packages are proposed which combine multiple methods of data collection, analysis and synthesis. Prospective data collection will be undertaken within four CST-OPs, including qualitative exploration of the care experiences of older people and family carers. Discussion: The realist explanatory theory will provide an understanding of how interprofessional collaboration can be fostered and sustained in various contexts of care integration for older people. It will underpin curriculum development for team-based education and training of health and social care professionals, a key priority area in the national Irish health strategy. It will provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and to realise the goals of integrated care for older people.
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Affiliation(s)
- Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Emer Ahern
- The Office of National Clinical Advisor and Group Lead (NCAGL), Health Service Executive, County Dublin, Ireland
| | - Carmel Davies
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, Dublin 4, Ireland
| | - Thelma Doran
- Public and Patient Representative, Ireland, Ireland
| | - Anne Drury
- Public and Patient Representative, Ireland, Ireland
| | - Nikki Dunne
- Unit 8, 4075 Kingswood Rd, Citywest Business Campus, Family Carers Ireland, Dublin, Dublin 24, Ireland
| | | | - PJ Harnett
- National Clinical Programme for Older People, Health Service Executive, County Dublin, Ireland
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Deirdre Lang
- National Clinical Programme for Older People, Health Service Executive, County Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | | | - Catherine McGuigan
- Age Friendly Ireland, Shared Service Centre, Meath County Council, Buvinda House, Navan, County Meath, Ireland
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Gráinne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Marie O'Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Apolonia Radomska
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - John Travers
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Helen Whitty
- National Clinical Programme for Older People, Health Service Executive, County Dublin, Ireland
| | - Catherine Devaney
- National Clinical Programme for Older People, Health Service Executive, County Dublin, Ireland
- Knowledge User (NCPOP) lead, National Clinical Programme for Older People, County Dublin, Ireland
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26
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Nojomi M, Goharinezhad S, Saraei R, Goharinejad S, Ramezani G, Aalaa M. Exploring the attitudes of general medical students toward older adult's care in a lower middle-income country: implications for medical education. BMC MEDICAL EDUCATION 2023; 23:649. [PMID: 37684593 PMCID: PMC10492309 DOI: 10.1186/s12909-023-04626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE The motivation for this study stemmed from the growing population of older adults and the increasing demand for healthcare professionals who possess the necessary skills and knowledge to provide quality care to this demographic. By exploring the attitudes, perceptions, and beliefs of medical students towards older adult care, the study aimed to identify gaps in their training and areas where improvements can be made to better equip them for this critical aspect of healthcare. METHOD This study was a qualitative thematic analysis. The participants of this research were selected from among the general medicine internship students of Iran University of Medical Sciences by purposive sampling method. In-depth individual semi-structured interviews were used to collect data. Sampling continued until data saturation. The interviews were recorded, transcribed, and analyzed using a hybrid approach of inductive and deductive thematic analysis. Using this approach, the analysis of the data became more adaptable and open-ended, free from the restrictions of pre-existing theoretical frameworks. MAXQDA 22 was used to analyze qualitative data. RESULTS A total of 27 medical students were interviewed semi-structured, and audio files were transcribed immediately after the interview. In the process of reading the interviews carefully and separating the conceptual units into codes, 167 primary codes were obtained, and these codes were divided into five main categories under the title of root factors after constant comparison analysis. Five main themes are including discrimination in service delivery, a lack of inter-professional training, interpersonal communication skills, inadequate infrastructure and human resources, and enhancing attitudes towards older person care through experiential learning. CONCLUSION This study sheds light on the attitudes and perceptions of medical students toward older adult care in a lower-middle-income country. The findings reveal that there are significant gaps in their training and preparation for providing quality care to this demographic profile. The four main categories identified as root factors highlight key areas where improvements can be made in medical education. It is recommended that medical schools in low and middle-income countries consider incorporating these themes into their curricula to better equip future healthcare professionals with the necessary skills and knowledge to provide quality care to older adults.
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Affiliation(s)
- Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Salime Goharinezhad
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Rasoul Saraei
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Goharinejad
- Faculty of Healthcare Science, Deggendorf Institute of Technology, Pfarrkirchen, Germany
| | - Ghobad Ramezani
- Education Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Aalaa
- Department of e-Learning in Medical Education, Center of Excellence for e-Learning in Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Heng LMT, Rajasegeran DD, See AMT, Kannusamy P, Lim SH, Aloweni FBAB, Ang SY. Original Research: Nurse-Reported Missed Care and Its Association with Staff Demographics and the Work Environment. Am J Nurs 2023; 123:28-36. [PMID: 37615466 DOI: 10.1097/01.naj.0000978144.33445.5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Nurses have primary responsibility for many of the care processes and interventions intended to improve patients' health during hospital stays. Accordingly, missed nursing care can negatively impact patient safety and lead to negative clinical outcomes. Missed nursing care is standard care that is not completed, incomplete, or seriously delayed. PURPOSE There is scant literature on nurse-reported missed care (NRMC) in Singapore. Identifying the prevalence of, types of, and reasons for missed care, including staff-related factors, is imperative to understanding the implications of missed care and identifying opportunities for improvement. METHODS Ours is a correlation study of NRMC using convenience sampling. Nurses working on all inpatient units in an acute care hospital in Singapore were recruited to complete the MISSCARE survey, a quantitative tool measuring missed nursing care and the reasons for it. Descriptive statistics was applied to analyze demographics, types of NRMC, and reasons for NRMC. The Pearson χ2 test was used to analyze the correlation between demographics and satisfaction variables and NRMC. RESULTS A total of 314 participants out of 1,944 eligible nurses (response rate, 16%) were recruited. The most commonly reported missed care activities were setting up meals for patients who can feed themselves (87.3%), ambulation (70.1%), attending interdisciplinary conferences (64.3%), providing emotional support to patients and/or family (58%), and turning patients every two hours (56.7%). The most cited reasons for missed care were inadequate number of staff (84.4%), caregiver not in unit or unavailable (76.1%), heavy admission and discharge activity (75.5%), urgent patient situations (74.2%), and unexpected rise in patient volume and/or acuity (73.2%). Younger age, greater experience in role and current unit, inadequate staffing and teamwork, low satisfaction with current role and with being a nurse, and planning to leave the current position were factors significantly associated with greater levels of missed care. CONCLUSION This study demonstrated evidence of NRMC and its associated factors within the local setting. In addition to expanding nursing resources, analyzing nursing work processes, providing support for younger nurses, and improving nursing satisfaction are possible mitigating factors in preventing missed care. Strategies targeting workforce and resource management, greater support for new and younger nurses, and job satisfaction should be considered to address missed care.
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Affiliation(s)
- Laura Mun Tze Heng
- Laura Mun Tze Heng is a staff nurse, Darshini Devi Rajasegeran and Siew Hoon Lim are nurse clinicians, Alicia Min Ting See is a senior staff nurse, and Fazila Binte Abu Bakar Aloweni is senior nurse manager, all at Singapore General Hospital, Singapore. Premarani Kannusamy is deputy director and head of nursing, Youth Preventive Services, and head of nursing, Health Promotion Board, Singapore. Shin Yuh Ang is deputy director of nursing innovation, quality and research, Singapore General Hospital, and director of nursing, National Dental Centre, Singhealth, Singapore. Contact author: Darshini Devi Rajasegeran, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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28
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Prins LAP, Gamble CJ, van Dam van Isselt EF, Stammen RAI, Ettaibi A, Creemers IAM, van Haastregt JCM. An Exploratory Study Investigating Factors Influencing the Outpatient Delivery of Geriatric Rehabilitation. J Clin Med 2023; 12:5045. [PMID: 37568449 PMCID: PMC10420316 DOI: 10.3390/jcm12155045] [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: 06/19/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Outpatient delivery of geriatric rehabilitation (GR) might contribute to preserving the accessibility and quality of GR, whilst dealing with an increasing demand for healthcare in an aging population. However, the application of outpatient GR differs between GR facilities. This study aimed to gain insight into factors influencing outpatient GR utilization. METHODS In this case study, 24 semi-structured interviews were conducted with physicians, physiotherapists, nurse practitioners, occupational therapists, and managers in GR. Interviews were transcribed and analyzed using summative content analysis. RESULTS Various patient-related barriers for using outpatient GR were mentioned including lacking social support and limited capacities and self-management skills. Additionally, professional-related barriers included a lack of awareness and consensus among care professionals regarding the possibilities and potential advantages of outpatient GR. Yet, most perceived barriers were related to efficiency and organization of outpatient GR (e.g., reimbursement system, lacking practical guidance). Still, most participants were in favor of increasing outpatient GR because of expected advantages for patients, GR organizations, and society. CONCLUSIONS Despite experienced barriers, there seems to be agreement on the need to increase outpatient GR application. It is recommended to use the present findings to develop and evaluate new ways of organizing and reimbursing outpatient GR.
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Affiliation(s)
- Lidy A. P. Prins
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.P.P.); (C.J.G.)
| | - Chris J. Gamble
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.P.P.); (C.J.G.)
- Stichting Valkenhof, 5555 KL Valkenswaard, The Netherlands
| | | | - Romy A. I. Stammen
- Faculty of Health Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands; (R.A.I.S.); (A.E.); (I.A.M.C.)
| | - Ahlam Ettaibi
- Faculty of Health Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands; (R.A.I.S.); (A.E.); (I.A.M.C.)
| | - Ilse A. M. Creemers
- Faculty of Health Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands; (R.A.I.S.); (A.E.); (I.A.M.C.)
| | - Jolanda C. M. van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.P.P.); (C.J.G.)
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29
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Michel JP, Ecarnot F, Arai H, Chen LK. A novel online training programme for healthcare professionals caring for older adults. Aging Clin Exp Res 2023:10.1007/s40520-023-02464-1. [PMID: 37347354 PMCID: PMC10363062 DOI: 10.1007/s40520-023-02464-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023]
Abstract
The proportion of older people in the world population is growing rapidly. Training and retaining healthcare professionals in sufficient numbers in the field of ageing represents a major challenge for the future, to deal with the healthcare needs of this ageing population. The COVID pandemic has unfortunately compounded shortages of healthcare workers worldwide. There is therefore a pressing need to scale-up the education of healthcare professionals in geriatrics and gerontology. Over the last 30 years, a group of motivated geriatrics physicians from Europe have been striving to educate healthcare professionals in geriatrics and gerontology through various initiatives, and using innovative pedagogic approaches to train physicians, nurses and other healthcare professionals around the world. The COVID-19 pandemic unfortunately put a stop to presence-based training programmes, but prompted the development of the online International Association of Gerontology and Geriatrics (IAGG) eTRIGGER (e-Training In Geriatrics and GERontology) course, a new training course in geriatrics and gerontology for healthcare professionals from a wide range of backgrounds. We outline here the history of the educational initiatives that have culminated in the roll-out of this new programme, and the perspectives for the future.
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Affiliation(s)
| | - Fiona Ecarnot
- EA3920, University of Franche-Comté, Besançon, France
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Liang-Kung Chen
- Center for Health Longevity and Aging Sciences, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
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Lehtomäki K, Soveri LM, Osterlund E, Lamminmäki A, Uutela A, Heervä E, Halonen P, Stedt H, Aho S, Muhonen T, Ålgars A, Salminen T, Kallio R, Nordin A, Aroviita L, Nyandoto P, Kononen J, Glimelius B, Ristamäki R, Isoniemi H, Osterlund P. Resectability, Resections, Survival Outcomes, and Quality of Life in Older Adult Patients with Metastatic Colorectal Cancer (the RAXO-Study). J Clin Med 2023; 12:jcm12103541. [PMID: 37240646 DOI: 10.3390/jcm12103541] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Older adults are underrepresented in metastatic colorectal cancer (mCRC) studies and thus may not receive optimal treatment, especially not metastasectomies. The prospective Finnish real-life RAXO-study included 1086 any organ mCRC patients. We assessed repeated centralized resectability, overall survival (OS), and quality of life (QoL) using 15D and EORTC QLQ-C30/CR29. Older adults (>75 years; n = 181, 17%) had worse ECOG performance status than adults (<75 years, n = 905, 83%), and their metastases were less likely upfront resectable. The local hospitals underestimated resectability in 48% of older adults and in 34% of adults compared with the centralized multidisciplinary team (MDT) evaluation (p < 0.001). The older adults compared with adults were less likely to undergo curative-intent R0/1-resection (19% vs. 32%), but when resection was achieved, OS was not significantly different (HR 1.54 [CI 95% 0.9-2.6]; 5-year OS-rate 58% vs. 67%). 'Systemic therapy only' patients had no age-related survival differences. QoL was similar in older adults and adults during curative treatment phase (15D 0.882-0.959/0.872-0.907 [scale 0-1]; GHS 62-94/68-79 [scale 0-100], respectively). Complete curative-intent resection of mCRC leads to excellent survival and QoL even in older adults. Older adults with mCRC should be actively evaluated by a specialized MDT and offered surgical or local ablative treatment whenever possible.
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Grants
- 2016, 2018, 2019, 2020, 2021, 2022, 2023 Finska Läkaresällskapet
- 2019-2020, 2021, 2022-23 Finnish Cancer Foundation
- 2023 Swedish Cancer Society
- 2022-2023 Radium Hemmets Research Funds
- 2020-2022 Relander's Foundation
- 2016, 2017, 2018, 2019, 2020, 2021,2022, 2023 Competitive State Research Financing of the Expert Responsibility Area of Tampere, Helsinki and Turku
- Tukisäätiö 2019, 2020; OOO 2020 Tampere University Hospital
- 2019, 2020, 2021, 2022 Helsinki University Hospital
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Affiliation(s)
- Kaisa Lehtomäki
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland
| | - Leena-Maija Soveri
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, 00290 Helsinki, Finland
- Department of Oncology, Clinicum, University of Helsinki, 00014 Helsinki, Finland
- Home Care, Joint Municipal Authority for Health Care and Social Services in Keski-Uusimaa, 05850 Hyvinkää, Finland
| | - Emerik Osterlund
- Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, 00290 Helsinki, Finland
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden
| | - Annamarja Lamminmäki
- Department of Oncology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
- Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1A, 70210 Kuopio, Finland
| | - Aki Uutela
- Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, 00290 Helsinki, Finland
- Department of Surgery, Clinicum, University of Helsinki, 00014 Helsinki, Finland
| | - Eetu Heervä
- Department of Oncology, Turku University Hospital, Hämeentie 11, 20520 Turku, Finland
- Department of Oncology, University of Turku, Kiinanmyllynkatu 10, 20520 Turku, Finland
| | - Päivi Halonen
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, 00290 Helsinki, Finland
- Department of Oncology, Clinicum, University of Helsinki, 00014 Helsinki, Finland
| | - Hanna Stedt
- Department of Oncology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
- Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1A, 70210 Kuopio, Finland
| | - Sonja Aho
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland
| | - Timo Muhonen
- Department of Oncology, South Carelia Central Hospital, Valto Käkelän Katu 1, 53130 Lappeenranta, Finland
| | - Annika Ålgars
- Department of Oncology, Turku University Hospital, Hämeentie 11, 20520 Turku, Finland
- Department of Oncology, University of Turku, Kiinanmyllynkatu 10, 20520 Turku, Finland
| | - Tapio Salminen
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland
| | - Raija Kallio
- Department of Oncology, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
| | - Arno Nordin
- Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, 00290 Helsinki, Finland
- Department of Surgery, Clinicum, University of Helsinki, 00014 Helsinki, Finland
| | - Laura Aroviita
- Department of Oncology, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530 Hämeenlinna, Finland
| | - Paul Nyandoto
- Department of Oncology, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland
| | - Juha Kononen
- Docrates Cancer Centre, Docrates Hospital, Saukonpaadenranta 2, 00180 Helsinki, Finland
- Department of Oncology, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden
| | - Raija Ristamäki
- Department of Oncology, Turku University Hospital, Hämeentie 11, 20520 Turku, Finland
- Department of Oncology, University of Turku, Kiinanmyllynkatu 10, 20520 Turku, Finland
| | - Helena Isoniemi
- Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, 00290 Helsinki, Finland
- Department of Surgery, Clinicum, University of Helsinki, 00014 Helsinki, Finland
| | - Pia Osterlund
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, 00290 Helsinki, Finland
- Department of Oncology, Clinicum, University of Helsinki, 00014 Helsinki, Finland
- Department of Gastrointestinal Oncology, Tema Cancer, Karolinska Universitetssjukhuset, Eugeniavägen 3, 17176 Solna, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Solnavägen 1, 17177 Solna, Sweden
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Paulauskaite-Taraseviciene A, Siaulys J, Sutiene K, Petravicius T, Navickas S, Oliandra M, Rapalis A, Balciunas J. Geriatric Care Management System Powered by the IoT and Computer Vision Techniques. Healthcare (Basel) 2023; 11:1152. [PMID: 37107987 PMCID: PMC10138364 DOI: 10.3390/healthcare11081152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
The digitalisation of geriatric care refers to the use of emerging technologies to manage and provide person-centered care to the elderly by collecting patients' data electronically and using them to streamline the care process, which improves the overall quality, accuracy, and efficiency of healthcare. In many countries, healthcare providers still rely on the manual measurement of bioparameters, inconsistent monitoring, and paper-based care plans to manage and deliver care to elderly patients. This can lead to a number of problems, including incomplete and inaccurate record-keeping, errors, and delays in identifying and resolving health problems. The purpose of this study is to develop a geriatric care management system that combines signals from various wearable sensors, noncontact measurement devices, and image recognition techniques to monitor and detect changes in the health status of a person. The system relies on deep learning algorithms and the Internet of Things (IoT) to identify the patient and their six most pertinent poses. In addition, the algorithm has been developed to monitor changes in the patient's position over a longer period of time, which could be important for detecting health problems in a timely manner and taking appropriate measures. Finally, based on expert knowledge and a priori rules integrated in a decision tree-based model, the automated final decision on the status of nursing care plan is generated to support nursing staff.
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Affiliation(s)
| | - Julius Siaulys
- Faculty of Informatics, Kaunas University of Technology, Studentu 50, 51368 Kaunas, Lithuania
| | - Kristina Sutiene
- Department of Mathematical Modeling, Kaunas University of Technology, Studentu 50, 51368 Kaunas, Lithuania
| | - Titas Petravicius
- Faculty of Informatics, Kaunas University of Technology, Studentu 50, 51368 Kaunas, Lithuania
| | - Skirmantas Navickas
- Faculty of Informatics, Kaunas University of Technology, Studentu 50, 51368 Kaunas, Lithuania
| | - Marius Oliandra
- Faculty of Informatics, Kaunas University of Technology, Studentu 50, 51368 Kaunas, Lithuania
| | - Andrius Rapalis
- Biomedical Engineering Institute, Kaunas University of Technology, K. Barsausko 59, 51423 Kaunas, Lithuania
- Faculty of Electrical and Electronics Engineering, Kaunas University of Technology, Studentu 48, 51367 Kaunas, Lithuania
| | - Justinas Balciunas
- Faculty of Medicine, Vilnius University, Universiteto 3, 01513 Vilnius, Lithuania
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32
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Larsson K, Wallroth V, Schröder A. Efforts of a Mobile Geriatric Team from a Next-of-Kin Perspective: A Phenomenographic Study. Healthcare (Basel) 2023; 11:healthcare11071038. [PMID: 37046965 PMCID: PMC10094527 DOI: 10.3390/healthcare11071038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
Many older adults with complex illnesses are today cared for by their next of kin in their own homes and are often sent between different caregivers in public healthcare. Mobile Geriatric Teams (MGTs) are a healthcare initiative for older adults with extensive care needs living at home, coordinated between hospital, primary, and municipal care. The study aims to describe how next of kin experience care efforts from an MGT for their older adult family members. The study has a descriptive qualitative design and uses a phenomenographic approach. Fourteen next of kin to older adult family members who receive efforts from an MGT were interviewed. Two descriptive categories reflecting their experiences emerged: Professional care and No longer having the main responsibility. The study shows that the participants valued that the staff was very competent, that the physician made home visits and could make quick decisions, and that treatments were given at home. They feel that they receive support and experience security and that a burden is lifted from them. Our study shows that through the MGT, next of kin become involved in the care and are relieved of the burden of responsibility of caring for their older family member.
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Affiliation(s)
- Kjerstin Larsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden
| | - Veronika Wallroth
- Division of Social Work (SOCARB), Department of Culture and Society (IKOS), Linköping University, 581 83 Linköping, Sweden
| | - Agneta Schröder
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden
- Department of Nursing, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), 2815 Gjövik, Norway
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33
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Resnick B, Vellega A, Levy C. The Interdisciplinary Care Team Approach in Long-Term Care: Where are We and Where do We Need to Go? J Am Med Dir Assoc 2023; 24:407-409. [PMID: 37005056 DOI: 10.1016/j.jamda.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 04/03/2023]
Affiliation(s)
| | | | - Cari Levy
- University of Colorado, Denver School of Medicine, Denver, CO, USA
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34
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McDonagh J, Ferguson C, Frost SA, Davidson PM. Frailty in Heart Failure: It's Time to Intervene. Heart Lung Circ 2023; 32:438-440. [PMID: 37080638 DOI: 10.1016/j.hlc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Julee McDonagh
- The University of Wollongong, School of Nursing, Faculty of Science, Medicine, and Health, Wollongong, NSW, Australia; The Centre for Chronic and Complex Care, Blacktown Hospital, Sydney, NSW, Australia.
| | - Caleb Ferguson
- The University of Wollongong, School of Nursing, Faculty of Science, Medicine, and Health, Wollongong, NSW, Australia; The Centre for Chronic and Complex Care, Blacktown Hospital, Sydney, NSW, Australia
| | - Steven A Frost
- The University of Wollongong, School of Nursing, Faculty of Science, Medicine, and Health, Wollongong, NSW, Australia
| | - Patricia M Davidson
- The Centre for Chronic and Complex Care, Blacktown Hospital, Sydney, NSW, Australia; The Vice Chancellor's Unit, The University of Wollongong, Wollongong, NSW, Australia
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35
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Barber S, Otis M, Greenfield G, Razzaq N, Solanki D, Norton J, Richardson S, Hayhoe BWJ. Improving Multidisciplinary Team Working to Support Integrated Care for People with Frailty Amidst the COVID-19 Pandemic. Int J Integr Care 2023; 23:23. [PMID: 37303477 PMCID: PMC10253239 DOI: 10.5334/ijic.7022] [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: 09/05/2022] [Accepted: 05/18/2023] [Indexed: 06/13/2023] Open
Abstract
Multidisciplinary team (MDT) working is essential to optimise and integrate services for people who are frail. MDTs require collaboration. Many health and social care professionals have not received formal training in collaborative working. This study investigated MDT training designed to help participants deliver integrated care for frail individuals during the Covid-19 pandemic. Researchers utilised a semi-structured analytical framework to support observations of the training sessions and analyse the results of two surveys designed to assess the training process and its impact on participants knowledge and skills. 115 participants from 5 Primary Care Networks in London attended the training. Trainers utilised a video of a patient pathway, encouraged discussion of it, and demonstrated the use of evidence-based tools for patient needs assessment and care planning. Participants were encouraged to critique the patient pathway, reflect on their own experiences of planning and providing patient care. 38% of participants completed a pre-training survey, 47% a post-training survey. Significant improvement in knowledge and skills were reported including understanding roles in contributing to MDT working, confidence to speak in MDT meetings, using a range of evidence-based clinical tools for comprehensive assessment and care planning. Greater levels of autonomy, resilience, and support for MDT working were reported. Training proved effective; it could be scaled up and adopted to other settings.
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Affiliation(s)
- Susan Barber
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
- Chelsea & Westminster Hospital NHS Foundation Trust, UK
| | - Michaela Otis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
- Chelsea & Westminster Hospital NHS Foundation Trust, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
| | - Nasrin Razzaq
- Harrow CCG The Heights, Middlesex 59-65 Lowlands Road Harrow HA1 3AW, UK
| | - Deepa Solanki
- Integrated Care Education, Harrow ICP and Training Hub, UK
| | - John Norton
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
| | - Sonia Richardson
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
| | - Benedict W. J. Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
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36
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González-Senac NM, Rodríguez-Couso M. Reflecting on oncogeriatrics: What can be done to promote the integration of the comprehensive geriatric assessment in the oncology practice? Rev Esp Geriatr Gerontol 2023; 58:121-122. [PMID: 36894380 DOI: 10.1016/j.regg.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Nicolás M González-Senac
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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37
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Suhail S, Basu S, Batoo SA, Al-Hattab ES, Kanj Ahmed O, Eidahl BJ, Okuno SH. Patient Understanding of Chemotherapy and Goals of Care as Provided by Different Care Team Members. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023:10.1007/s13187-022-02251-y. [PMID: 36595214 PMCID: PMC10366317 DOI: 10.1007/s13187-022-02251-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Chemotherapy can be challenging and overwhelming for patients, but when patients are knowledgeable about chemotherapy, their comfort level, overall satisfaction, and coping improve. It is currently unknown whether patients prefer information about chemotherapy to be provided by specific care team members and whether demographic characteristics affect learning preferences. We developed a 31-question questionnaire that asked patients when chemotherapy information was discussed and who they wanted that information to come from. The questionnaire was given to 50 patients who had completed 1 cycle of chemotherapy. Patients were evenly distributed among age categories of 45 to 64 years, 65 to 74 years, and 75 years or older. Thirty participants (60%) were women, 33 (66%) had high school degrees, and 23 (46%) were receiving their first chemotherapy regimen. Sixty percent of patients best understood goals of care from oncologists, 70% wanted goals of care to come from oncologists, and 61% best understood and wanted to understand logistics of chemotherapy from oncologists. Sixty-six percent of patients understood adverse effects when they were explained by nursing staff, and 56% wanted explanations of adverse effects to come from nursing staff. Patients did not prefer a specific care team member or information source when receiving financial cost information. Patients often preferred to receive chemotherapy information from their oncologist; however, other members of the care team also provided information to patients in a way that was understood.
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Affiliation(s)
| | - Sandeep Basu
- Oncology/Hematology, Mayo Clinic Health System - Northwest Wisconsin region, 1400 Bellinger St, Eau Claire, WI, 54702, USA
| | - Sameer A Batoo
- Oncology/Hematology, Mayo Clinic Health System - Northwest Wisconsin region, 1400 Bellinger St, Eau Claire, WI, 54702, USA
| | - Eyad S Al-Hattab
- Oncology/Hematology, Mayo Clinic Health System - Northwest Wisconsin region, 1400 Bellinger St, Eau Claire, WI, 54702, USA
| | - Ola Kanj Ahmed
- Oncology/Hematology, Mayo Clinic Health System - Northwest Wisconsin region, 1400 Bellinger St, Eau Claire, WI, 54702, USA
| | - Barbara J Eidahl
- Nursing Administration, Mayo Clinic Health System - Northwest Wisconsin region, Eau Claire, WI, USA
| | - Scott H Okuno
- Oncology/Hematology, Mayo Clinic Health System - Northwest Wisconsin region, 1400 Bellinger St, Eau Claire, WI, 54702, USA.
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Ding J, Yang Y, Wu X, Xiao B, Ma L, Xu Y. The telehealth program of occupational therapy among older people: an up-to-date scoping review. Aging Clin Exp Res 2023; 35:23-40. [PMID: 36344805 PMCID: PMC9640899 DOI: 10.1007/s40520-022-02291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The average life expectancy of older people is increasing, and most seniors desire to age at home and are capable of living independently. Occupational therapy (OT) is client-centered and uses patients' meaningful activities, or occupations, as treatment methods, thus playing an important role in later adulthood. Telemedicine removes the constraints of time and space, and the combination of OT and telemedicine can greatly improve medical efficiency and clinical effectiveness. AIMS The purpose of this scoping review was to examine the scope and effectiveness of telehealth OT for older people. METHODS This scoping review was conducted following the methodological framework proposed by Arksey and O'Malley. We searched the literature in five databases following the PICOS (Population, Intervention, Comparison, Outcome, Study design) guideline, from inception to April 2022. Two trained reviewers independently retrieved, screened, and extracted data, and used a descriptive synthesizing approach to summarize the results. RESULTS The initial search yielded 1249 studies from databases and manual searches, of which 20 were eligible and were included in the final review. A thematic analysis revealed five main themes related to telehealth OT: occupational assessment, occupational intervention, rehabilitation counseling, caregiver support, and activity monitoring. CONCLUSIONS Telehealth OT has been used widely for older people, focusing primarily on occupational assessment and intervention provided conveniently for occupational therapists and older clients. In addition, telehealth OT can monitor patients' activities and provide rehabilitation counseling and health education for the elderly and their caregivers, thus improving the security of their home life and the efficacy of OT. During the COVID-19 pandemic, telehealth will be an effective alternative to face-to-face modalities.
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Affiliation(s)
- Jiangtao Ding
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Yulin Yang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Xiao Wu
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Boheng Xiao
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Lihong Ma
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China.
| | - Yanwen Xu
- Ergonomics and Vocational Rehabilitation Lab. College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China.
- Department of Rehabilitation Medicine, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, 214000, Jiangsu, China.
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39
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Kua J, Teo W, Lim WS. Learning experiences of adaptive experts: a reflexive thematic analysis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1345-1359. [PMID: 36626011 PMCID: PMC9859887 DOI: 10.1007/s10459-022-10166-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/15/2022] [Indexed: 06/17/2023]
Abstract
Whilst adaptive experts have well-researched beliefs and attitudes towards learning, what is unclear are the interactions that occur within the learning environment that constitute their learning experiences. The practice of geriatric medicine emphasises the interdisciplinary care of complex frail older adults. Our study sets out to understand the learning experiences of adaptive experts in geriatric medicine by examining how interactions at the intra-personal, inter-personal and organisational levels contributed to the development of adaptive expertise. We conducted an exploratory qualitative study through semi-structured interviews of 16 geriatricians experts from a tertiary hospital in Singapore. Data were analyzed via reflexive thematic analysis. The core essence of the learning experiences was described as a journey of 'knowing when we do not know', which was characterised by three themes: (i) Anchoring ethos of person-centric care where the experts drew upon their values to develop a holistic view of the patient beyond the medical domain, (ii) Enabling stance of being curious where their curiosity and openness to learning was nurtured through the practice of reflection, and with the benefit of time as a commodity and for development of expertise, and (iii) Scaffolding organisational culture of inquiry where an environment that is supportive of learning is built on the culture of psychological safety and the culture of mentoring. Taken together, our study highlighted the importance of interactions at the intra-personal, inter-personal and organisational levels in the learning experiences of adaptive experts.
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Affiliation(s)
- Joanne Kua
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Winnie Teo
- Group Education, National Healthcare Group, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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40
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Mapping Genetics and Epigenetics to Explore the Pathways beyond the Correlated Ageing Phenotype. Genes (Basel) 2022; 13:genes13112169. [DOI: 10.3390/genes13112169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/11/2022] [Accepted: 11/19/2022] [Indexed: 11/22/2022] Open
Abstract
Ageing is defined by the decline in the biological and physiological functions over time, which leads to health problems and increases risks of diseases. The modern societies are characterised by an ageing population, which represents challenges for the healthcare system. Within this context, there is a need to better understand the biological mechanisms beyond ageing in order to optimise geriatric therapies and medical approaches. Herein, we suggest exploring the genetic and epigenetic patterns related to ageing and correlate them with the ageing-related phenotype of the biological entities in order to establish mechanistic links and map the molecular pathways. Such links would have diverse implications in basic research, in clinics, as well as for therapeutic studies.
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41
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Cooper DJ, Lear S, Sithole N, Shaw A, Stark H, Ferris M, Bradley J, Maxwell P, Goodfellow I, Weekes MP, Seaman S, Baker S. Demographic, behavioural and occupational risk factors associated with SARS-CoV-2 infection in UK healthcare workers: a retrospective observational study. BMJ Open 2022; 12:e063159. [PMID: 36343994 PMCID: PMC9644078 DOI: 10.1136/bmjopen-2022-063159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Healthcare workers (HCWs) are at higher risk of SARS-CoV-2 infection than the general population. This group is pivotal to healthcare system resilience during the COVID-19, and future, pandemics. We investigated demographic, social, behavioural and occupational risk factors for SARS-CoV-2 infection among HCWs. DESIGN/SETTING/PARTICIPANTS HCWs enrolled in a large-scale sero-epidemiological study at a UK university teaching hospital were sent questionnaires spanning a 5-month period from March to July 2020. In a retrospective observational cohort study, univariate logistic regression was used to assess factors associated with SARS-CoV-2 infection. A Least Absolute Shrinkage Selection Operator regression model was used to identify variables to include in a multivariate logistic regression model. RESULTS Among 2258 HCWs, highest ORs associated with SARS-CoV-2 antibody seropositivity on multivariate analysis were having a household member previously testing positive for SARS-CoV-2 antibodies (OR 6.94 (95% CI 4.15 to 11.6); p<0.0001) and being of black ethnicity (6.21 (95% CI 2.69 to 14.3); p<0.0001). Occupational factors associated with a higher risk of seropositivity included working as a physiotherapist (OR 2.78 (95% CI 1.21 to 6.36); p=0.015) and working predominantly in acute medicine (OR 2.72 (95% CI 1.57 to 4.69); p<0.0001) or medical subspecialties (not including infectious diseases) (OR 2.33 (95% CI 1.4 to 3.88); p=0.001). Reporting that adequate personal protective equipment (PPE) was 'rarely' available had an OR of 2.83 (95% CI 1.29 to 6.25; p=0.01). Reporting attending a handover where social distancing was not possible had an OR of 1.39 (95% CI 1.02 to 1.9; p=0.038). CONCLUSIONS The emergence of SARS-CoV-2 variants and potential vaccine escape continue to threaten stability of healthcare systems worldwide, and sustained vigilance against HCW infection remains a priority. Enhanced risk assessments should be considered for HCWs of black ethnicity, physiotherapists and those working in acute medicine or medical subspecialties. Workplace risk reduction measures include ongoing access to high-quality PPE and effective social distancing measures.
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Affiliation(s)
- Daniel James Cooper
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sara Lear
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nyarie Sithole
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ashley Shaw
- Medical Director's Office, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hannah Stark
- NIHR Bioresource, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Mark Ferris
- Occupational Health, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John Bradley
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Patrick Maxwell
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian Goodfellow
- Department of Pathology, Division of Virology, University of Cambridge, Cambridge, UK
| | - Michael P Weekes
- Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Shaun Seaman
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Jung I, Bloomfield K, Hikaka J, Tatton A, Boyd M. "Making an effort for the very elderly": The acceptability of a multidisciplinary intervention to retirement village residents. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5356-e5365. [PMID: 35913001 PMCID: PMC10087237 DOI: 10.1111/hsc.13957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/22/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
The retirement village (RV) population is a growing one, with many residents having unmet healthcare needs. Despite this, there is a relative paucity of research in the RV community. We previously performed a randomised controlled trial (RCT) of a multidisciplinary (MD) nurse-led community intervention versus usual care within 33 RVs in Auckland, New Zealand. Participant acceptability is an important aspect in assessing intervention feasibility and effectiveness. The aim of this current qualitative study was to assess the acceptability of the intervention in participating residents. Data were collected using semi-structured interviews designed around the Theoretical Framework of Acceptability. Thematic analysis was undertaken using a general inductive approach. Of the 199 participants in the intervention arm of the original RCT, 27 were invited to take part in this qualitative study. Fifteen participants were recruited with a median age of 89 years, 10 were female and all were of European ethnicity. Participants were generally positive about the intervention and research processes. Three themes were identified: (1) participants' understanding of intervention aims and effectiveness; (2) the importance of older adult involvement and (3) level of comfort in the research process. Despite the MD intervention being deemed acceptable across several domains, results provided learning points for the future design of MD interventions in RV residents and older adults more generally. We recommend that future intervention studies incorporate co-design methodologies which may improve the likelihood of intervention success.
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Affiliation(s)
- Isabelle Jung
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Katherine Bloomfield
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
- Waitematā District Health BoardAucklandNew Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Annie Tatton
- Waitematā District Health BoardAucklandNew Zealand
| | - Michal Boyd
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
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Rodrigues AR, Teixeira-Lemos E, Mascarenhas-Melo F, Lemos LP, Bell V. Pharmacist Intervention in Portuguese Older Adult Care. Healthcare (Basel) 2022; 10:1833. [PMID: 36292280 PMCID: PMC9602367 DOI: 10.3390/healthcare10101833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 09/07/2024] Open
Abstract
Healthy ageing has become one of the most significant challenges in a society with an increasing life expectancy. Older adults have a greater prevalence of chronic disease, with the need for multiple medications to appropriately control these issues. In addition to their health concerns, ageing individuals are prone to loneliness, dependence, and economic issues, which may affect their quality of life. Governments and health professionals worldwide have developed various strategies to promote active and healthy ageing to improve the quality of life of older adults. Pharmacists are highly qualified health professionals, easily accessible to the population, thus playing a pivotal role in medication management. Their proximity to the patient puts them in a unique position to provide education and training to improve therapeutic adherence and identify medication-related problems. This paper aims to address the importance of Portuguese community pharmacists in the medication management of older adults, emphasising their intervention in health promotion, patient education, medication-related problems, deprescription, dose administration aids, and medication review and reconciliation. We also discuss home delivery services and medication management in long-term care facilities.
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Affiliation(s)
- Ana Rita Rodrigues
- Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Edite Teixeira-Lemos
- CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Filipa Mascarenhas-Melo
- Drug Development and Technology Laboratory, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, 3000-548 Coimbra, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Luís Pedro Lemos
- Nuclear Medicine Department, Centro Hospitalar e Universitário de Coimbra, 3000-548 Coimbra, Portugal
| | - Victoria Bell
- Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, 3000-548 Coimbra, Portugal
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Construction on teaching quality evaluation indicator system of multi-disciplinary team (MDT) clinical nursing practice in China: A Delphi study. Nurse Educ Pract 2022; 64:103452. [PMID: 36152471 DOI: 10.1016/j.nepr.2022.103452] [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: 05/17/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 11/21/2022]
Abstract
AIM To construct an evaluation indicator system for nursing multi-disciplinary team (MDT) clinical practice in China and to provide quantifiable indicators for MDT clinical teaching courses. METHODS Based on relevant literature retrieval and analysis, a evaluation indicator system of nursing MDT clinical teaching quality was preliminarily constructed using the Donabedian. Structure-Process-Outcome model as theoretical guidance. Then, a final indicators content was formed after two rounds of expert consultation and Analytic Hierarchy Process (AHP) was used to determine the weight of indicators at all levels. RESULTS The effective response rate of the questionnaires in two rounds were 95.23% (20/21) and 100% (20/20) respectively, the expert authority coefficient (Cr) were 0.838 and 0.853 respectively and the Kendall's coefficient of concordance (Kendall's W) of indicators at all levels were 0.137-0.612 (P < 0.05). The final evaluation index system consisted of three one-class indicators, 8 s-class indicators and 28 third-class indicators. CONCLUSION The study constructed a comprehensive set of evaluation indicator system of nursing MDT clinical practice, which was scientific and reliable and provides reference for the clinical teaching quality evaluation of MDT nursing.
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Lippi L, D’Abrosca F, Folli A, Dal Molin A, Moalli S, Maconi A, Ammendolia A, de Sire A, Invernizzi M. Closing the Gap between Inpatient and Outpatient Settings: Integrating Pulmonary Rehabilitation and Technological Advances in the Comprehensive Management of Frail Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159150. [PMID: 35954506 PMCID: PMC9368185 DOI: 10.3390/ijerph19159150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 02/03/2023]
Abstract
Pulmonary rehabilitation (PR) is a well-established intervention supported by strong evidence that is used to treat patients affected by chronic respiratory diseases. However, several barriers still affect its spreading in rehabilitation clinical practices. Although chronic respiratory diseases are common age-related disorders, there is still a gap of knowledge regarding the implementation of sustainable strategies integrating PR in the rehabilitation management of frail patients at high risk of respiratory complications. Therefore, in the present study, we characterized the effects of PR in frail patients, highlighting the evidence supporting its role in improving the complex rehabilitative management of these patients. Moreover, we propose a novel organizational model promoting PR programs for frail patients in both inpatient and outpatient settings. Our model emphasizes the role of interdisciplinary care, specifically tailored to patients and environmental characteristics. In this scenario, cutting-edge technology and telemedicine solutions might be implemented as safe and sustainable strategies filling the gap between inpatient and outpatient settings. Future research should focus on large-scale sustainable interventions to improve the quality of life and global health of frail patients. Moreover, evidence-based therapeutic paths should be promoted and taught in training courses promoting multiprofessional PR knowledge to increase awareness and better address its delivery in frail patients.
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Affiliation(s)
- Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (F.D.); (A.F.); (S.M.)
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Francesco D’Abrosca
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (F.D.); (A.F.); (S.M.)
| | - Arianna Folli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (F.D.); (A.F.); (S.M.)
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy;
- Health Professions’ Direction, “Ospedale Maggiore della Carità” University Hospital, 28100 Novara, Italy
| | - Stefano Moalli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (F.D.); (A.F.); (S.M.)
| | - Antonio Maconi
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy; (A.A.); (A.d.S.)
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy; (A.A.); (A.d.S.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (F.D.); (A.F.); (S.M.)
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
- Correspondence: ; Tel.: +39-0131-206111
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O'Donnell D, O'Donoghue G, Ní Shé É, O'Shea M, Donnelly S. Developing competence in interprofessional collaboration within integrated care teams for older people in the Republic of Ireland: A starter kit. J Interprof Care 2022; 37:480-490. [PMID: 35880753 DOI: 10.1080/13561820.2022.2075332] [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: 10/16/2022]
Abstract
Current evidence offers little guidance as to how interprofessional collaboration can be fostered within the context of integrated care and older people. This research describes the co-design of core competencies for interprofessional collaboration within integrated care teams for older people and the development of practical guidance to support teams in building proficiency. Using a co-design approach, we conducted three studies (co-design workshops, qualitative interviews, and an online validation forum), the combined output of which is a Core Competency Framework, that includes three domains describing six competencies for proficiency in interprofessional collaboration within integrated care of older people. Domain one, Knowledge of the Team, includes the competencies; understanding roles, and making referrals. Domain two, Communication, includes the competencies; sharing information and communicating effectively and Domain three, Shared Decision-making, includes the final two competencies; supporting decision making with older people and collective clinical decision-making. In presenting a formal understanding of the competencies for interprofessional collaboration in the integrated care of older people and practical guidance for developing proficiency, this framework provides direction for future health service workforce development.
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Affiliation(s)
- Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Dublin, Ireland
| | - Grainne O'Donoghue
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Maire O'Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Dublin, Ireland
| | - Sarah Donnelly
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Dublin, Ireland.,School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
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Tamargo J, Kjeldsen KP, Delpón E, Semb AG, Cerbai E, Dobrev D, Savarese G, Sulzgruber P, Rosano G, Borghi C, Wassman S, Torp-Pedersen CT, Agewall S, Drexel H, Baumgartner I, Lewis B, Ceconi C, Kaski JC, Niessner A. Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:406-419. [PMID: 35092425 DOI: 10.1093/ehjcvp/pvac005] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/28/2021] [Accepted: 01/27/2022] [Indexed: 11/12/2022]
Abstract
Population ageing has resulted in an increasing number of older people living with chronic diseases (multimorbidity) requiring five or more medications daily (polypharmacy). Ageing produces important changes in the cardiovascular system and represents the most potent single cardiovascular risk factor. Cardiovascular diseases (CVDs) constitute the greatest burden for older people, their caregivers, and healthcare systems. Cardiovascular pharmacotherapy in older people is complex because age-related changes in body composition, organ function, homeostatic mechanisms, and comorbidities modify the pharmacokinetic and pharmacodynamic properties of many commonly used cardiovascular and non-cardiovascular drugs. Additionally, polypharmacy increases the risk of adverse drug reactions and drug interactions, which in turn can lead to increased morbi-mortality and healthcare costs. Unfortunately, evidence of drug efficacy and safety in older people with multimorbidity and polypharmacy is limited because these individuals are frequently underrepresented/excluded from clinical trials. Moreover, clinical guidelines are largely written with a single-disease focus and only occasionally address the issue of coordination of care, when and how to discontinue treatments, if required, or how to prioritize recommendations for patients with multimorbidity and polypharmacy. This review analyses the main challenges confronting healthcare professionals when prescribing in older people with CVD, multimorbidity, and polypharmacy. Our goal is to provide information that can contribute to improving drug prescribing, efficacy, and safety, as well as drug adherence and clinical outcomes.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Keld Per Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Copenhagen, and Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Eva Delpón
- Department of Pharmacology and Toxicology, School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid,Spain
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemme Hospital, Oslo, Norway
| | - Elisabetta Cerbai
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Hospital, Rome, Italy
| | - Claudio Borghi
- Medicine and Surgery Science Department, University of Bologna, Bologna, Italy
| | - Seven Wassman
- Cardiology Pasing, Munich, and Faculty of Medicine, University of the Saarland, Homburg/Saar, Germany
| | - Christian Tobias Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, and Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Heinz Drexel
- Department of Internal Medicine and Cardiology, VIVIT Institute, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Basil Lewis
- Department of Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Claudio Ceconi
- UO Cardiologia, Ospedale di Desenzano del Garda, Desenzano del Garda, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Veronese N, Noale M, Cella A, Custodero C, Smith L, Barbagelata M, Maggi S, Barbagallo M, Sabbà C, Ferrucci L, Pilotto A. Multidimensional frailty and quality of life: data from the English Longitudinal Study of Ageing. Qual Life Res 2022; 31:2985-2993. [PMID: 35579730 PMCID: PMC9470717 DOI: 10.1007/s11136-022-03152-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
Purpose Frailty has been found to be associated with poor quality of life (QoL) in older people, but data available are limited to cross-sectional studies. We therefore aimed to assess the association between multidimensional frailty, determined by Multidimensional Prognostic Index (MPI), with mortality and good QoL expectancy (GQoLE) in a large representative sample of older adults, over 10 years of follow-up. Methods In the English Longitudinal Study of Ageing, using the data from 2004–2005 and 2014–2015, MPI was calculated using a weighted score of domains of comprehensive geriatric assessment, i.e., number of difficulties in activities of daily living (ADL) and instrumental ADL, depressive symptoms, number of medical conditions, body mass index, physical activity level, and social aspects. Mortality was assessed using administrative data, GQoLE indicators were used for longitudinal changes in QoL. Results 6244 Participants (mean age 71.8 years, 44.5% males) were followed up for 10 years. After adjusting for potential confounders, compared to people in the MPI low-risk group, people in the moderate (hazard ratio, HR = 4.27; 95% confidence interval, CI 3.55–5.14) and severe-risk group (HR = 10.3; 95% CI 7.88–13.5) experienced a significantly higher mortality rate. During the follow-up period, people in the moderate and severe-risk groups reported lower GQoLE values than their counterparts, independently from age and gender. Conclusions Multidimensional frailty was associated with a higher risk of mortality and significantly lower GQoLE, suggesting that the multifactorial nature of frailty is associated not only with mortality, but also poor QoL. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03152-9.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy.
| | - Marianna Noale
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genoa, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari "Aldo Moro", Bari, Italy
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Marina Barbagelata
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genoa, Italy
| | - Stefania Maggi
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari "Aldo Moro", Bari, Italy
| | - Luigi Ferrucci
- National Institute on Aging, National Institute of Health, Bethesda, MD, USA
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genoa, Italy
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari "Aldo Moro", Bari, Italy
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49
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Gender distribution among geriatricians: perspective from an ageing and developing country. Eur Geriatr Med 2022; 13:999-1003. [DOI: 10.1007/s41999-022-00644-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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50
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Jones A, Maclagan LC, Watt JA, Schull MJ, Jaakkimainen L, Swayze S, Guan J, Bronskill SE. Reasons for repeated emergency department visits among community-dwelling older adults with dementia in Ontario, Canada. J Am Geriatr Soc 2022; 70:1745-1753. [PMID: 35238398 DOI: 10.1111/jgs.17726] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/11/2022] [Accepted: 02/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Community-dwelling older adults living with dementia visit the emergency department (ED) more frequently than other older adults, but research on the reasons for repeated visits is lacking. We examined the rate of repeated ED visits and reasons for visits in a cohort of individuals with dementia. METHODS We conducted a population-based retrospective cohort study of community-dwelling older adults (≥66 years) living with dementia in Ontario, Canada, who visited the ED and were discharged home between April 1, 2010, and March 31, 2019. We calculated the proportion of the population with one, two, and three or more repeat ED visits within 1 year of the baseline visit and the categorized the reason for the visits. RESULTS Our cohort contained 175,863 individuals with dementia who visited the ED at least once. Overall, 66.1% returned at least once to the ED within 1 year, 39.4% returned twice, and 23.5% returned 3 or more times. Visit reasons were heterogenous and were most frequently related to general signs and symptoms (25.3%) while being infrequently due to cognitive or behavioral reasons (5.9%). Individuals typically visited for different reasons across successive visits. CONCLUSIONS Community-dwelling older adults with dementia who visited an ED were very likely to return to the ED within a year, with a substantial proportion visiting multiple times. The high frequency of repeated visits for different reasons highlights the complexity of caring for this population and indicates greater need for comprehensive community and primary care as well as timely communication between the ED and the community.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Jennifer A Watt
- ICES, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Schull
- ICES, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Liisa Jaakkimainen
- ICES, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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