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Kok S, Schoonhoven L, Vernooij LM, Reitsma JB, Verstraten C, Metzelthin SF, Bleijenberg N, de Man-van Ginkel JM. The effectiveness of Function Focused Care among patients acutely admitted to hospital: A stepped wedge cluster trial. Int J Nurs Stud 2024; 160:104893. [PMID: 39321557 DOI: 10.1016/j.ijnurstu.2024.104893] [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: 12/20/2023] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND During acute hospital admission, patients often experience loss of functional status. A low level of physical activity is associated with higher levels of loss of functional status. Stimulating physical activity to maintain functional status is considered essential nursing care. Function Focused Care is a promising approach stimulating physical activity. In a previous study, Function Focused Care in Hospital was deemed feasible. OBJECTIVE To determine the effectiveness of Function Focused Care in Hospital compared with usual care on the functional status of hospitalized stroke and geriatric patients. DESIGN A multicenter stepped wedge cluster trial. METHODS A neurological and a geriatric ward of an academic hospital and a general hospital in the Netherlands participated in this study; each was considered a cluster in the trial. The primary outcome was patients' functional status over time, measured with the Barthel Index and Elderly Mobility Scale. Secondary outcomes were the patients' length of stay, fear of falling, self-efficacy, motivation, resilience, and outcome expectations for functional and exercise activities. Data was collected at hospital admission (baseline), day of discharge, and three and six months after discharge via patient files and questionnaires and analyzed with generalized linear mixed models. RESULTS In total, we included 892 patients, of which 427 received Function Focused Care in Hospital and 465 received usual care. Although we did not find significant differences in the Barthel Index and Elderly Mobility Scale at discharge or follow-up, we found a significant decrease in the mean length of stay (-3.3 days, 95 % CI -5.3 to -1.1) in favor of the Function Focused Care in Hospital group. In addition, in the Function Focused Care in Hospital group, a larger proportion of patients were discharged to home compared to the control group (38.2 % vs. 29.0 %, p = 0.017), who were discharged more often to a care facility. CONCLUSION The length of hospital stay was substantially decreased, and discharge to home was more common in the group receiving Function Focused Care in Hospital with equal levels of independence in Activities of Daily Living and mobility in both groups upon discharge. Although significant differences in the Barthel Index and Elderly Mobility Scale were not found, we observed that neurological and geriatric patients were discharged significantly earlier compared to the control group. REGISTRATION https://onderzoekmetmensen.nl/en/trial/24287 (date of first recruitment: 05-02-2016). TWEETABLE ABSTRACT Patients receiving Function Focused Care in Hospital were discharged from the hospital 3.3 days earlier and discharged home more often than the group of patients receiving care as usual. @umcutrecht @hogeschoolutrecht.
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Affiliation(s)
- Selma Kok
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, the Netherlands.
| | - Lisette Schoonhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Lisette M Vernooij
- Division of Vital Functions, department intensive care and anesthesiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
| | - Johannes B Reitsma
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands
| | | | - Silke F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Postbus 616, 6200 MD Maastricht, the Netherlands
| | - Nienke Bleijenberg
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, the Netherlands
| | - Janneke M de Man-van Ginkel
- Academic Nursing & Department of Gerontology and Geriatrics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands.
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You L, Wang S, Wang Y, Zhu L, Wang T, Yu X, Dong J, Guan Y. Factors promoting and hindering resilience in youth with inflammatory bowel disease: A descriptive qualitative study. Nurs Open 2024; 11:e2150. [PMID: 38629398 PMCID: PMC11022225 DOI: 10.1002/nop2.2150] [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: 11/05/2021] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
AIM To explore factors promoting and hindering resilience in youth with inflammatory bowel disease (IBD) based on Kumpfer's resilience framework. DESIGN A descriptive qualitative study design with an interpretative approach was used. METHODS Participants consisted of 10 youths with IBD from a tertiary hospital in Beijing (China) recruited using the purposive sampling method. Data were collected by semi-structured interviews from December 2020 to March 2021. The directed content analysis was performed for data analysis. RESULTS Both promoting factors and hindering factors could be divided into personal factors and environmental factors. Thirteen themes were identified. The promoting factors included acceptance of illness, strict self-management, previous treatment experience, life goals, family support, medical support and peer encouragement. Stigma, lack of communication, negative cognition, societal incomprehension, economic pressure and academic and employment pressure were hindering factors. CONCLUSION Health care professionals need to develop greater awareness of factors, stemming from both the individual and the outside world, that hinder or promote resilience in order to aid young patients with IBD. Building targeted nursing measures to excavate the internal positive quality of patients, provide external support and promote the development of resilience.
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Affiliation(s)
- Lili You
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Siyao Wang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Yangyang Wang
- Nursing DepartmentPeking Union Medical College HospitalBeijingChina
| | - Lingling Zhu
- Nursing DepartmentPeking Union Medical College HospitalBeijingChina
| | - Tiantian Wang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Xiang Yu
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Jing Dong
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Yuxia Guan
- Department of Internal MedicinePeking Union Medical College HospitalBeijingChina
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Wells CL, Resnick B, McPherson R, Frampton K. Implementation of the UMove Mobility Program to Promote Safe Patient Mobility and Reduce Falls in the Hospital Setting. Res Gerontol Nurs 2024; 17:19-29. [PMID: 37878599 DOI: 10.3928/19404921-20231013-01] [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: 10/27/2023]
Abstract
The purpose of the current quality improvement (QI) project was to implement the UMove Early Mobility Program to engage patients in safe out of bed (OOB) activities and reduce falls, specifically focusing on toileting-related falls, during the hospital stay. Eight nursing units implemented the UMove program, including the UMove Mobility Screen (UMove MS), to select strategies to reduce toileting-related falls while increasing mobility. De-identified, unit-based data were collected from hospital reports. Nursing had a 95% documentation compliance rate for the UMove MS, and OOB activities and ambulation were documented at 50% and 57%, respectively. There was no statistical difference found in reducing toileting-related falls or sustaining increased OOB activities across the 15-month QI project. Toileting-related falls approached significance with a rate reduction from 1.77 pre-implementation to 0.23 at 6 months and no toileting-related falls at 12 months. Despite no significant findings, there is evidence that clinical changes occurred with nurses assessing and promoting mobility, while implementing strategies to reduce toileting-related falls. [Research in Gerontological Nursing, 17(1), 19-29.].
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Resnick B, Boltz M, Galik E, Kuzmik A, Drazich BF, McPherson R, Wells CL. Factors Associated With Function-Focused Care Among Hospitalized Older Adults With Dementia. Am J Crit Care 2023; 32:264-274. [PMID: 37391379 DOI: 10.4037/ajcc2023440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Function-focused care is an approach used to increase physical activity in hospitalized older adults with dementia. OBJECTIVE To explore factors associated with participation in function-focused care in this patient population. METHODS This was a cross-sectional descriptive study using baseline data from the first 294 participants in an ongoing study on testing function-focused care for acute care using the evidence integration triangle. Structural equation modeling was used for model testing. RESULTS The mean (SD) age of the study participants was 83.2 (8.0) years, and the majority were women (64%) and White (69%). Sixteen of the 29 hypothesized paths were significant and explained 25% of the variance in participation in function-focused care. Cognition, quality of care interactions, behavioral and psychological symptoms associated with dementia, physical resilience, comorbidities, tethers, and pain were all indirectly associated with function-focused care through function and/or pain. Tethers, function, and quality of care interactions were all directly associated with function-focused care. The χ2/df was 47.7/7, the normed fit index was 0.88, and the root mean square error of approximation was 0.14. CONCLUSION For hospitalized patients with dementia, the focus of care should be on treating pain and behavioral symptoms, reducing the use of tethers, and improving the quality of care interactions in order to optimize physical resilience, function, and participation in function-focused care.
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Affiliation(s)
- Barbara Resnick
- Barbara Resnick is a professor at the University of Maryland School of Nursing, Baltimore
| | - Marie Boltz
- Marie Boltz is a professor at Penn State University, University Park, Pennsylvania
| | - Elizabeth Galik
- Elizabeth Galik is a professor at the University of Maryland School of Nursing, Baltimore
| | - Ashley Kuzmik
- Ashley Kuzmik is a postdoctoral student at Penn State University, University Park, Pennsylvania
| | - Brittany F Drazich
- Brittany F. Drazich is a postdoctoral student at the University of Maryland School of Nursing, Baltimore
| | - Rachel McPherson
- Rachel McPherson is a postdoctoral student at the University of Maryland School of Nursing, Baltimore
| | - Chris L Wells
- Chris L. Wells is a physical therapist at the University of Maryland Medical System, Baltimore
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Strijbos DO, van der Sluis G, Boymans TAEJ, de Groot S, Klomp S, Kooijman CM, Reneman MF, Kuijer PPFM. Implementation of back at work after surgery (BAAS): A feasibility study of an integrated pathway for improved return to work after knee arthroplasty. Musculoskeletal Care 2022; 20:950-959. [PMID: 35506461 PMCID: PMC10084307 DOI: 10.1002/msc.1633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Optimizing return to work after knee arthroplasty is becoming more important because of the growing incidence of KA among workers and poor return to work outcomes. The purpose of this study is to investigate the feasibility of Back At work After Surgery (BAAS): an integrated clinical pathway for return to work after knee arthroplasty. METHOD Working patients who received unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) between January 2021 and November 2021, younger than 65 years and motivated to return to work were eligible to participate. Feasibility was investigated on five domains: reach, dose delivered, dose received, fidelity and patients' attitudes. These outcomes were obtained by a patient-reported questionnaire and an interview with the occupational case manager and medical case manager. RESULTS Of the eligible 29 patients, eleven were willing to participate (response rate 38%; due to travel distance to and from the hospital). The dose delivered was between 91 and 100%, except information given about return to work from the orthopedic surgeon which was 18%. The dose received was 100%. For fidelity, case managers reported nine shortcomings for which five solutions were mentioned. In terms of patients' attitude, all patients were satisfied and one patient mentioned an improvement. CONCLUSIONS In terms of reach, participation was low: only 29%. The BAAS clinical pathway seems feasible based on dose delivered, dose received, fidelity and patient attitudes. The next step is to assess the effectiveness of the BAAS clinical pathway for return to work.
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Affiliation(s)
- Daniël O. Strijbos
- Department of Public and Occupational HealthAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Research Programs Musculoskeletal HealthSports and Rehabilitation & DevelopmentAmsterdam Movement Sciencesthe Netherlands
- Department of Health InnovationsNij Smellinghe Hospital DrachtenDrachtenthe Netherlands
| | - Geert van der Sluis
- Department of Health InnovationsNij Smellinghe Hospital DrachtenDrachtenthe Netherlands
- Hanze University of Applied Sciences GroningenGroningenthe Netherlands
| | | | | | | | - Carolien M. Kooijman
- Department of OrthopedicsNij Smellinghe hospital Drachten9202 NNDrachtenCompagnonsplein 1the Netherlands
| | - Michiel F. Reneman
- Department of RehabilitationUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - P. Paul F. M. Kuijer
- Department of Public and Occupational HealthAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Research Programs Musculoskeletal HealthSports and Rehabilitation & DevelopmentAmsterdam Movement Sciencesthe Netherlands
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Resnick B, Boltz M, Galik E, Kuzmik A, Ellis J, Wells C, Zhu S. Testing Function Focused Care for Acute Care using the Evidence Integration Triangle: Protocol description. Res Nurs Health 2022; 45:300-313. [PMID: 35274750 PMCID: PMC9064936 DOI: 10.1002/nur.22223] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/09/2022]
Abstract
This manuscript provides the protocol for a National Institute of Aging-funded cluster randomized clinical trial that focuses on helping nurses in acute care to engage patients with dementia in physical activity while hospitalized using an approach referred to as function-focused care. Physical activity is defined as bodily movement produced by skeletal muscles resulting in the expenditure of energy and includes functional tasks such as bathing and dressing, leisure activity, ambulation, and moderate and vigorous intensity physical activity such as dancing, bike riding, or walking upstairs. The development of Function Focused Care for Acute Care (FFC-AC) was based on the Social Ecological Model and Social Cognitive Theory and includes four steps: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Patient Goals; and (4) Mentoring and Motivating of Staff (all levels of nursing staff), Patients, and Families. Function-focused care activities include motivating older patients to participate in bed mobility; personal care activities such as bathing, dressing, ambulating as they are able; and other types of physical activities. The integration of the intervention among the nurses on the units is guided by the Evidence Integration Triangle (EIT), which includes the participation of a stakeholder team and practical outcome measures. The intervention is therefore referred to as FFC-AC-EIT. In addition to describing the protocol developed to test the effectiveness and feasibility of FFC-AC-EIT, a description of ways to overcome some of the barriers and challenges that can be encountered with this study is provided.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Ashley Kuzmik
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jeanette Ellis
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Chris Wells
- Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland, USA
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Peters S, Cosco TD, Mackey DC, Sarohia GS, Leong J, Wister A. Quantifying Physical Resilience in Ageing Using Measurement Instruments: A Scoping Review. Physiother Can 2022. [DOI: 10.3138/ptc-2020-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The capacity to recover motor function with pathology or age-related decline is termed physical resilience. It is unknown what outcome domains are captured with existing measurement instruments. Thus, this scoping review aimed to identify measurement instruments for physical resilience, identify research gaps, and make recommendations for future research. Methods: Articles were included from the search when their subject matter included the term resilience in relation to the physical health of older adults. Data on physical resilience measurement instruments were extracted using the outcome domains: body function or structure, activity and participation, and societal impact. Results: The majority of the 33 included articles involved older adults with fractures, cardiac conditions, and cancer. Many measurement instruments quantified body function or structure, and some instruments captured activity and participation, and societal impact of physical resilience. Measurement instruments were pooled into 4 categories: psychological, physiological, motor function, and psychosocial scales. No studies combined all areas of measurement. Conclusions: A potential gap of a measurement instrument capturing social aspects of physical resilience was identified. Comprehensive measurement could identify which outcome domains could be targeted to foster resilience. This knowledge might be useful across many health disciplines and contribute to therapeutic decision-making and rehabilitation strategies.
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Affiliation(s)
- Sue Peters
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Theodore D. Cosco
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
- Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom
| | - Dawn C. Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Gurkaran S. Sarohia
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey Leong
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Wister
- Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
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Kok S, de Man-van Ginkel JM, Verstraten C, Resnick B, Metzelthin SF, Bleijenberg N, Schoonhoven L. Function focused care in hospital: A mixed-method feasibility study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Hospital social work and discharge planning for older people: challenges of working in a clinical setting. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Across the world acute hospitals are under unprecedented pressures due to shrinking budgets and increasing demand, against this backdrop they are also experiencing record levels of activity in Accident & Emergency and delayed transfers of care. Reducing pressure on hospitals by avoiding unnecessary admissions and delayed discharges has risen up the global policy agenda. However, reviews of strategies and policies have rarely involved discussions about the role that hospital social workers play in achieving timely hospital discharge. Yet discharge planning has become a, if not the, central function of these professionals. This paper presents the results of a small-scale exploratory study of hospital social work in an acute hospital in Northern Ireland. The findings reveal that the work of hospital social workers is characterised by increased bureaucracy, an emphasis on targets and a decrease in the time afforded to forming relationships with older people. Hospital social workers highlight concerns that the emphasis on discharge planning and pressures associated with the austerity agenda limits their capacity to provide other more traditional roles such as advocacy and counselling. It is argued that hospital social work should not be narrowly defined as ‘simply’ co-ordinating discharge plans. The tension that arises between expediting hospital discharge and advocating for older people and their families is also discussed.
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10
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Tavares JPDA, Nunes LANV, Grácio JCG. Hospitalized older adult: predictors of functional decline. Rev Lat Am Enfermagem 2021; 29:e3399. [PMID: 33439951 PMCID: PMC7798389 DOI: 10.1590/1518-8345.3612.3399] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 06/16/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify the predictors of functional decline in hospitalized individuals aged 70 or over, between: baseline and discharge; discharge and follow-up, and baseline and three-month follow-up. METHOD a prospective cohort study conducted in internal medicine services. A questionnaire was applied (clinical and demographic variables, and predictors of functional decline) at three moments. The predictors were determined using the binary logistic regression model. RESULTS the sample included 101 patients, 53.3% female, mean age of 82.47 ± 6.57 years old. The predictors that most contributed to decline in hospitalization were the following: previous hospitalization (OR=1.8), access to social support (OR=4.86), cognitive deficit (OR=6.35), mechanical restraint (OR=7.82), and not having a partner (OR=4.34). Age (OR=1.18) and medical diagnosis (OR=0.10) were the predictors between discharge and follow-up. Being older, delirium during hospitalization (OR=5.92), and presenting risk of functional decline (OR=5.53) were predictors of decline between the baseline and follow-up. CONCLUSION the most relevant predictors were age, previous hospitalization, cognitive deficit, restraint, social support, not having a partner, and delirium. Carrying out interventions aimed at minimizing the impact of these predictors can be an important contribution in the prevention of functional decline.
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11
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Mobility in Acute Care for Geriatric Patients with Orthopedic Conditions: a Review of Recent Literature. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00347-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Baldwin CE, Parry SM, Norton L, Williams J, Lewis LK. A scoping review of interventions using accelerometers to measure physical activity or sedentary behaviour during hospitalization. Clin Rehabil 2020; 34:1157-1172. [DOI: 10.1177/0269215520932965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To identify interventions using wearable accelerometers to measure physical activity and/or sedentary behaviour in adults during hospitalization for an acute medical/surgical condition. Data sources: Four databases were searched in August 2019 (MEDLINE, CINAHL, Scopus, EMBASE). Review methods: Studies were selected if they described an intervention in adults with a medical/surgical condition, and concurrently reported an accelerometer-derived measure of physical activity and/or sedentary behaviour while participants were admitted. Items were screened for eligibility in duplicate. Included studies were synthesized to describe intervention types, feasibility and potential effectiveness. Results: Twenty-two studies were included, reporting on 3357 participants (2040 with accelerometer data). Identified types of interventions were: pre-habilitation ( n = 2) exercise ( n = 3), patient behaviour change with self-monitoring ( n = 6), models of care ( n = 5), implementing system change ( n = 2), surgical technique ( n = 2) patients wearing day clothes ( n = 1) and education about activity in hospital ( n = 1). Of 16 studies that reported intervention effects on physical activity, 11 reported a favourable impact including studies of: pre-habilitation, self-monitoring (accelerometry or an activity whiteboard), physiotherapy, an early mobility bundle, minimally invasive surgery, an education booklet and by implementing system change. Of the six studies that reported intervention effects on sedentary behaviour, there was a favourable impact with an activity whiteboard, models of care and an education booklet. Conclusion: Accelerometer-derived measures of physical activity and/or sedentary behaviour have been used to describe sample characteristics and intervention effects in studies of hospitalized adults. Interventions may involve a range of health professionals, but less is known about sedentary behaviour in this setting.
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Affiliation(s)
- Claire E Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Lynda Norton
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Adelaide, SA, Australia
| | - Jill Williams
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Adelaide, SA, Australia
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Beresford B, Mayhew E, Duarte A, Faria R, Weatherly H, Mann R, Parker G, Aspinal F, Kanaan M. Outcomes of reablement and their measurement: Findings from an evaluation of English reablement services. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1438-1450. [PMID: 31368621 PMCID: PMC6851672 DOI: 10.1111/hsc.12814] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/12/2019] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
Reablement - or restorative care - is a central feature of many western governments' approaches to supporting and enabling older people to stay in their own homes and minimise demand for social care. Existing evidence supports this approach although further research is required to strengthen the certainty of conclusions being drawn. In countries where reablement has been rolled out nationally, an additional research priority - to develop an evidence base on models of delivery - is emerging. This paper reports a prospective cohort study of individuals referred to three English social care reablement services, each representing a different model of service delivery. Outcomes included healthcare- and social care-related quality of life, functioning, mental health and resource use (service costs, informal carer time, out-of-pocket costs). In contrast with the majority of other studies, self-report measures were the predominant source of outcomes and resource use data. Furthermore, no previous evaluation has used a global measure of mental health. Outcomes data were collected on entry to the service, discharge and 6 months post discharge. A number of challenges were encountered during the study and insufficient individuals were recruited in two research sites to allow a comparison of service models. Findings from descriptive analyses of outcomes align with previous studies and positive changes were observed across all outcome domains. Improvements observed at discharge were, for most, retained at 6 months follow-up. Patterns of change in functional ability point to the importance of assessing functioning in terms of basic and extended activities of daily living. Findings from the economic evaluation highlight the importance of collecting data on informal carer time and also demonstrate the viability of collecting resource use data direct from service users. The study demonstrates challenges, and value, of including self-report outcome and resource use measures in evaluations of reablement.
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Affiliation(s)
| | - Emese Mayhew
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Ana Duarte
- Centre for Health EconomicsUniversity of YorkYorkUK
| | - Rita Faria
- Centre for Health EconomicsUniversity of YorkYorkUK
| | | | - Rachel Mann
- Social Policy Research UnitUniversity of YorkYorkUK
| | | | - Fiona Aspinal
- School of Life & Medical SciencesUniversity College LondonLondonUK
| | - Mona Kanaan
- Department of Health SciencesUniversity of YorkYorkUK
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14
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Beresford B, Mann R, Parker G, Kanaan M, Faria R, Rabiee P, Weatherly H, Clarke S, Mayhew E, Duarte A, Laver-Fawcett A, Aspinal F. Reablement services for people at risk of needing social care: the MoRe mixed-methods evaluation. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Reablement is an intensive, time-limited intervention for people at risk of needing social care or an increased intensity of care. Differing from home care, it seeks to restore functioning and self-care skills. In England, it is a core element of intermediate care. The existing evidence base is limited.
Objectives
To describe reablement services in England and develop a service model typology; to conduct a mixed-methods comparative evaluation of service models investigating outcomes, factors that have an impact on outcomes, costs and cost-effectiveness, and user and practitioner experiences; and to investigate specialist reablement services/practices for people with dementia.
Methods
Work package (WP) 1, which took place in 2015, surveyed reablement services in England. Data were collected on organisational characteristics, service delivery and practice, and service costs and caseload. WP2 was an observational study of three reablement services, each representing a different service model. Data were collected on health (EuroQol-5 Dimensions, five-level version) and social care related (Adult Social Care Outcomes Toolkit – self-completed) quality of life, practitioner (Barthel Index of Activities of Daily Living) and self-reported (Nottingham Extended Activities of Daily Living scale) functioning, individual and service characteristics, and resource use. They were collected on entry into reablement (n = 186), at discharge (n = 128) and, for those reaching the point on the study timeline, at 6 months post discharge (n = 64). Interviews with staff and service users explored experiences of delivering or receiving reablement and its perceived impacts. In WP3, staff in eight reablement services were interviewed to investigate their experiences of reabling people with dementia.
Results
A total of 201 services in 139 local authorities took part in the survey. Services varied in their organisational base, their relationship with other intermediate care services, their use of outsourced providers, their skill mix and the scope of their reablement input. These characteristics influenced aspects of service delivery and practice. The average cost per case was £1728. Lower than expected sample sizes meant that a comparison of service models in WP2 was not possible. The findings are preliminary. At discharge (T1), significant improvements in mean score on outcome measures, except self-reported functioning, were observed. Further improvements were observed at 6 months post discharge (T2), but these were significant for self-reported functioning only. There was some evidence that individual (e.g. engagement, mental health) and service (e.g. service structure) characteristics were associated with outcomes and resource use at T1. Staff’s views on factors affecting outcomes typically aligned with, or offered possible explanations for, these associations. However, it was not possible to establish the significance of these findings in terms of practice or commissioning decisions. Service users expressed satisfaction with reablement and identified two core impacts: regained independence and, during reablement, companionship. Staff participating in WP3 believed that people with dementia can benefit from reablement, but objectives may differ and expectations for regained independence may be inappropriate. Furthermore, staff believed that flexibility in practice (e.g. duration of home visits) should be incorporated into delivery models and adequate provision made for specialist training of staff.
Conclusions
The study contributes to our understanding of reablement, and what the impacts are on outcomes and costs. Staff believe that reablement can be appropriate for people with dementia. Findings will be of interest to commissioners and service managers. Future research should further investigate the factors that have an impact on outcomes, and reabling people with dementia.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Rachel Mann
- Social Policy Research Unit, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Rita Faria
- Centre for Health Economics, University of York, York, UK
| | | | | | - Susan Clarke
- Social Policy Research Unit, University of York, York, UK
| | - Emese Mayhew
- Social Policy Research Unit, University of York, York, UK
| | - Ana Duarte
- Centre for Health Economics, University of York, York, UK
| | | | - Fiona Aspinal
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North Thames, Institute of Epidemiology & Health, University College London, London, UK
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Resnick B, Boltz M. Optimizing Function and Physical Activity in Hospitalized Older Adults to Prevent Functional Decline and Falls. Clin Geriatr Med 2019; 35:237-251. [PMID: 30929885 DOI: 10.1016/j.cger.2019.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Physical activity, defined as bodily movement that expends energy including such things as bed mobility, transfers, bathing, dressing, and walking, has a positive impact on physical and psychosocial outcomes among older adults during their hospitalization and the post hospitalization recovery period. Despite benefits, physical activity is not the focus of care in the acute care setting. Further there are many barriers to engaging patients in physical activity and fall prevention activities including patient, family and provider beliefs, environmental challenges and limitations, hospital policies, and medical and nursing interventions. This paper provides an overview of falls and physical activity prevalence among acute care patients, challenges to engaging patients in physical activity and falls prevention activities and innovative approaches to increase physical activity and prevent falls among older hospitalized patients.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA.
| | - Marie Boltz
- Pennsylvania State University, College of Nursing, 201 Nursing Sciences Building, University Park, PA 16802, USA
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16
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Older patients’ participation in physical activity during hospitalization: A qualitative study of ward nurses’ perceptions in an Asian context. Geriatr Nurs 2019; 40:91-98. [DOI: 10.1016/j.gerinurse.2018.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/08/2018] [Indexed: 01/23/2023]
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18
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Resnick B, Galik E, Wells CL, Boltz M, Renn CL, Dorsey SG. The Impact of Pain Management with Opioids among Older Adults Post Orthopedic Trauma. Pain Manag Nurs 2016; 17:302-10. [DOI: 10.1016/j.pmn.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/26/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
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