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Doucet J, Gourdy P, Meyer L, Benabdelmoumene N, Bourdel-Marchasson I. Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities. Clin Interv Aging 2023; 18:1687-1703. [PMID: 37841649 PMCID: PMC10573466 DOI: 10.2147/cia.s423122] [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] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
The population of older adults (≥65 years) with type 2 diabetes mellitus (T2DM) is diverse, encompassing individuals with varying functional capabilities, living arrangements, concomitant medical conditions, and life expectancies. Hence, their categorization into different patient profiles (ie, good health, intermediate health, poor health) may aid in clinical decision-making when establishing glycemic goals and pharmacological treatment strategies. Further granularity in assessing each patient profile through interdisciplinary collaboration may also add precision to therapeutic and monitoring decisions. In this review, we discuss with a multidisciplinary approach how to deliver the best benefit from advanced diabetes therapies and technologies to older adults with T2DM according to each patient profile. There remain however several areas that deserve further research in older adults with T2DM, including the efficacy and safety of continuous glucose monitoring and automated insulin delivery systems, the switch to once-weekly insulin, the effectiveness of multidisciplinary care models, and the use of supported telemedicine and remote blood glucose monitoring in the oldest-old (≥85 years) who particularly require the assistance of others.
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Affiliation(s)
- Jean Doucet
- Department of Polyvalent Internal Medicine, Saint Julien Hospital, Rouen University Hospital, Rouen, France
| | - Pierre Gourdy
- Department of Diabetology, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UT3, Toulouse University, Toulouse, France
| | - Laurent Meyer
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Benabdelmoumene
- Department of Internal Medicine and Geriatrics, University Hospital of Marseille, Marseille, France
| | - Isabelle Bourdel-Marchasson
- CNRS, CRMSB, UMR 5536, University of Bordeaux, Bordeaux, France
- University Hospital of Bordeaux, Bordeaux, France
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Logan B, Viecelli AK, Johnson DW, Aquino EM, Bailey J, Comans TA, Gray LC, Hawley CM, Hickey LE, Janda M, Jaure A, Jose MD, Kalaw E, Kiriwandeniya C, Matsuyama M, Mihala G, Nguyen KH, Pascoe E, Pole JD, Polkinghorne KR, Pond D, Raj R, Reidlinger DM, Scholes-Robertson N, Varghese J, Wong G, Hubbard RE. Study protocol for The GOAL Trial: comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient-identified goals-a cluster randomised controlled trial. Trials 2023; 24:365. [PMID: 37254217 DOI: 10.1186/s13063-023-07363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND An increasing number of older people are living with chronic kidney disease (CKD). Many have complex healthcare needs and are at risk of deteriorating health and functional status, which can adversely affect their quality of life. Comprehensive geriatric assessment (CGA) is an effective intervention to improve survival and independence of older people, but its clinical utility and cost-effectiveness in frail older people living with CKD is unknown. METHODS The GOAL Trial is a pragmatic, multi-centre, open-label, superiority, cluster randomised controlled trial developed by consumers, clinicians, and researchers. It has a two-arm design, CGA compared with standard care, with 1:1 allocation of a total of 16 clusters. Within each cluster, study participants ≥ 65 years of age (or ≥ 55 years if Aboriginal or Torres Strait Islander (First Nations Australians)) with CKD stage 3-5/5D who are frail, measured by a Frailty Index (FI) of > 0.25, are recruited. Participants in intervention clusters receive a CGA by a geriatrician to identify medical, social, and functional needs, optimise medication prescribing, and arrange multidisciplinary referral if required. Those in standard care clusters receive usual care. The primary outcome is attainment of self-identified goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index - Short Form), transfer to residential aged care facilities, cost-effectiveness, and safety (cause-specific hospitalisations, mortality). A process evaluation will be conducted in parallel with the trial including whether the intervention was delivered as intended, any issue or local barriers to intervention delivery, and perceptions of the intervention by participants. The trial has 90% power to detect a clinically meaningful mean difference in GAS of 10 units. DISCUSSION This trial addresses patient-prioritised outcomes. It will be conducted, disseminated and implemented by clinicians and researchers in partnership with consumers. If CGA is found to have clinical and cost-effectiveness for frail older people with CKD, the intervention framework could be embedded into routine clinical practice. The implementation of the trial's findings will be supported by presentations at conferences and forums with clinicians and consumers at specifically convened workshops, to enable rapid adoption into practice and policy for both nephrology and geriatric disciplines. It has potential to materially advance patient-centred care and improve clinical and patient-reported outcomes (including quality of life) for frail older people living with CKD. TRIAL REGISTRATION ClinicalTrials.gov NCT04538157. Registered on 3 September 2020.
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Affiliation(s)
- B Logan
- Centre for Health Services Research, University of Queensland, Brisbane, Australia.
| | - A K Viecelli
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - D W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - E M Aquino
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - J Bailey
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - T A Comans
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - L C Gray
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - C M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - L E Hickey
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - M Janda
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - A Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - M D Jose
- Renal Unit, Royal Hobart Hospital, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - E Kalaw
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - C Kiriwandeniya
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - M Matsuyama
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - G Mihala
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - K H Nguyen
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Global Brain Health Institute, Trinity College, Dublin, Ireland
| | - E Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - J D Pole
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - K R Polkinghorne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - D Pond
- School of Rural Medicine, University of New England, Armidale, Australia
- Wicking Centre, University of Tasmania, Hobart, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - R Raj
- School of Medicine, University of Tasmania, Hobart, Australia
- Department of Nephrology, Launceston General Hospital, Launceston, Australia
| | - D M Reidlinger
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - N Scholes-Robertson
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - J Varghese
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - G Wong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - R E Hubbard
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Brisbane, Australia
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Brooks E, Freter S. Adapting Geriatric Day Hospital Care From an In-House to Outreach Process. J Gerontol Nurs 2023; 49:33-38. [PMID: 36989475 DOI: 10.3928/00989134-20230309-06] [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: 03/31/2023]
Abstract
Outpatient programs have been challenged to find ways to deliver services while adhering to coronavirus disease protocols. Our Geriatric Day Hospital (GDH) Falls Clinic changed from a 6-week in-house program to an outreach program incorporating telephone assessments and home visits. We evaluated whether the outreach program was effective in improving patient outcomes in 23 serially enrolled clients. Statistically significant gains were achieved with falls, Berg Balance Scale scores, functional reach measurements, and pain management scores. Access to social support from family or friends led to higher implementation of recommendations. There was an inability to predict which clients would improve from an outreach program, but it was evident that the program benefited some clients and provided a viable alternative to an in-person program. [Journal of Gerontological Nursing, 49(4), 33-38.].
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Nukari JM, Laasonen MR, Arkkila EP, Haapanen ML, Poutiainen ET. Goal attainment in individual and group-based neuropsychological interventions for young adults with dyslexia in a randomized controlled trial. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-11. [PMID: 36476247 DOI: 10.1080/23279095.2022.2137025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this study, we investigated the outcome of goal attainment in individual and group-based neuropsychological intervention for young adults with dyslexia. Participants (N = 120) were randomly assigned to individual intervention, group intervention, or wait-list control group. Attainment of goals set personally before the intervention was evaluated after the intervention using Goal Attainment Scaling. The participants were asked to report the number of concrete changes made in their study or working habits at five months (after intervention or wait-list control time), at ten months, and 15 months post-interventions. Potential predictive factors for predicting goal attainment were evaluated including background and cognitive variables, self-reported psychological variables (mood, cognitive and behavioral strategies, self-esteem, quality of life), and self-reported behavioral variables (concrete changes made, time used to work on intervention matters). Based on the results, personal goals were, on average, met especially in individual intervention. Nearly 50% of goal attainment was explained by intervention type, behavioral and cognitive strategies, concrete changes made, cognitive capacity, and used time. Concrete changes, e.g., adopting new strategies and methods in study or working habits, were reported in both interventions and more than during the wait-list control period. The changes seemed long-lasting as fifteen months post-intervention, 76.4% reported still using the learned strategies. A structured and relatively short neuropsychological intervention for dyslexia in either individual or group format can lead to attaining pre-set personal goals and positive behavioral changes that can last up to over a year post-intervention.
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Affiliation(s)
- Johanna M Nukari
- Rehabilitation Foundation, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marja R Laasonen
- Department of Logopedics, Philosophical Faculty, School of Humanities, University of Eastern Finland, Joensuu, Finland
| | - Eva P Arkkila
- Department of Otorhinolaryngology and Phoniatrics, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marja-Leena Haapanen
- Department of Otorhinolaryngology and Phoniatrics, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Erja T Poutiainen
- Rehabilitation Foundation, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Green AR, Aschmann H, Boyd CM, Schoenborn N. Association between willingness to deprescribe and health outcome priorities among U.S. older adults: Results of a national survey. J Am Geriatr Soc 2022; 70:2895-2904. [PMID: 35661991 PMCID: PMC9588518 DOI: 10.1111/jgs.17917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/04/2022] [Accepted: 05/07/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is not known whether older adults' willingness to deprescribe is associated with their health outcome priorities related to medications. METHODS A cross-sectional survey was conducted from March-April 2020 using a nationally representative online panel. The survey presented two vignettes: (1) a preventive medicine; and (2) a symptom-relief medicine. Participants were asked whether they would be willing to stop each medicine if their doctor recommended it, and to rate their level of agreement with two health outcome priorities statements: "I am willing to accept the risk of future side effects … to feel better now," and "I would prefer to take fewer medicines, even if … I may not live as long or may have bothersome symptoms sometimes." Ordinal logistic regression was used to examine associations between willingness to stop each medicine, baseline characteristics and health outcome priorities. RESULTS Of 1193 panel members ≥65 years invited to participate, 835 (70%) completed the survey. Mean (SD) age was 73 years; 496 (59%) had taken a statin and 124 (15%) a prescription sedative-hypnotic. 507 (61%) were willing to stop preventive medicines; 276 (33%) were maybe willing. 419 (50%) were willing to stop symptom-relief medicines; 380 (46%) were maybe willing. Prioritizing fewer medicines was associated with higher odds of being willing to stop symptom-relief medicines (aOR 1.43 [95% CI 1.02-2.00]) and preventive medicines (aOR 1.52 [95% CI 1.05-2.18]). Prioritizing now over future was associated with lower odds of being willing to stop symptom-relief medicines (aOR 0.62 [95% CI 0.39-1.00]). Current/prior use of statins was associated with lower willingness to stop preventive medicines (aOR 0.66 [95% CI 0.48-0.91]). CONCLUSIONS Older adults' health outcome priorities related to medication use are associated with their willingness to consider deprescribing. Future research should determine how best to elicit patients' health outcome priorities to facilitate goal-concordant decisions about medication use.
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Affiliation(s)
- Ariel R. Green
- Division of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Hélène Aschmann
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA,Epidemiology, Biostatistics and Prevention InstituteUniversity of ZurichZurichSwitzerland
| | - Cynthia M. Boyd
- Division of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA,Department of Health Policy and ManagementJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Nancy Schoenborn
- Division of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Napolitani M, Guarducci G, Abinova G, Messina G, Nante N. How to Improve the Drafting of Health Profiles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063452. [PMID: 35329140 PMCID: PMC8950871 DOI: 10.3390/ijerph19063452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 12/10/2022]
Abstract
Delineating patients' health profiles is essential to allow for a proper comparison between medical care and its results in patients with comorbidities. The aim of this work was to evaluate the concordance of health profiles outlined by ward doctors and by epidemiologists and the effectiveness of training interventions in improving the concordance. Between 2018 and 2021, we analyzed the concordance between the health profiles outlined by ward doctors in a private hospital and those outlined by epidemiologists on the same patients' medical records. The checks were repeated after training interventions. The agreement test (Cohen's kappa) was used for comparisons through STATA. The initial concordance was poor for most categories. After our project, the concordance improved for all categories of CIRS. Subsequently, we noted a decline in concordance between ward doctors and epidemiologists for CIRS, so a new training intervention was needed to improve the CIRS profile again. Initially, we found a low concordance, which increased significantly after the training interventions, proving its effectiveness.
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Affiliation(s)
- Margherita Napolitani
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy; (M.N.); (G.G.); (G.M.)
| | - Giovanni Guarducci
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy; (M.N.); (G.G.); (G.M.)
| | | | - Gabriele Messina
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy; (M.N.); (G.G.); (G.M.)
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy; (M.N.); (G.G.); (G.M.)
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
- Correspondence:
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7
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Lin D, Zhang SJ, Lin LL, Qi SY, Gong M, Li SB, Zhang J. The use of goal attainment scaling in the acupuncture of children with intellectual disability. WORLD JOURNAL OF TRADITIONAL CHINESE MEDICINE 2022. [DOI: 10.4103/2311-8571.351509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Evaluating Traditional Chinese Medicine Interventions on Chronic Low Back Pain Using Goal Attainment Scaling. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:8854927. [PMID: 33354222 PMCID: PMC7735859 DOI: 10.1155/2020/8854927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/22/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Extensive studies have been conducted to evaluate the pain relief effect of traditional Chinese medicine (TCM) interventions on patients with low back pain, including in China. However, there is a dearth in the literature documenting the diverse goals of TCM interventions, let alone the overall effect of such interventions. In this study, the goal attainment scaling (GAS) method was adopted to evaluate individualised TCM interventions on chronic low back pain. METHODS A pre-post intervention study was conducted on patients with chronic low back pain who received individualised TCM interventions in community health services. The study was undertaken in three community health centres in Hangzhou of China. A total of 165 eligible patients were invited, and 150 participated in the study, including 136 who completed both pre- and postintervention surveys. Each participant was asked to identify three to five intended goals from a pool of 26 outcome indicators and their corresponding expectations of these goals prior to the TCM interventions. Their conditions were rated against the selected indicators on a self-report five-point Likert scale before and after the TCM interventions, respectively. Gaps between the actual conditions and the expected goals were summed up for each participant and converted into a standardised GAS score, with a higher score indicating higher achievements, and 50 indicting patient expectations were met. Linear regression models were established to determine the factors associated with the pre-post GAS changes after adjustment for variations in other variables. RESULTS On average, an increase of 14.99 (SD = 9.81) in the GAS scores was achieved. This resulted in a mean GAS score of 48.33 (SD = 9.74) after the TCM interventions, falling slightly short (<2) of patient expectations. The multivariate linear regression models revealed that local residents, the retired, and those who perceived lower professional competency of their attending doctors had a smaller increase in the GAS scores after adjustment for variations in other variables. CONCLUSION The individualised TCM interventions can help patients with low back pain to achieve their expected goals as measured by the GAS. Further studies are needed to better understand how patients set up their goals and the professional competency requirements to meet patient expectations.
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Chung YE, Angus DE, Backman C. Impact of a Geriatric Day Hospital Program on Older Adults' Functional Independence and Caregiver Stress: A Non-Experimental, Single Group Pre-/Posttest Study. J Prim Care Community Health 2020; 11:2150132720940504. [PMID: 32639870 PMCID: PMC7346689 DOI: 10.1177/2150132720940504] [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] [Indexed: 11/18/2022] Open
Abstract
Objective: To evaluate the impact of a geriatric day hospital program on older adults’ functional independence and on caregiver stress. Methods: We used a single group pre- and posttest design. The data were collected through chart reviews and follow-up phone calls. Outcomes included fear of falling, balance, functional exercise capacity (walking distance), and caregiver stress. Descriptive statistics were used for sociodemographic data, dependent t test for paired samples of normally distributed data, and the Wilcoxon signed-rank test for determining differences between nonnormally distributed data sets. Results: We found a statistically significant difference in pre (33.54) and post (27.47) mean rank scores for fear of falling (Z = −3.895, P < .001), pre (49.5) and post (59.42) scores for balance (Z = −8.725, P < .001), and pre (250.07 m) and post (291.20 m) for functional exercise capacity (P < .001). No statistically significant difference was found with respect to caregiver stress pre (22.05) and post (19.90) scores (Z = −0.422, P = .673). Discussion: Future research may consider approaching evaluative studies of a similar type using not only quantitative but also qualitative methods to obtain a more comprehensive understanding of older adults’ functional ability and caregiver stress before and after participating in a geriatric day hospital program.
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Affiliation(s)
| | | | - Chantal Backman
- University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Verdoorn S, Blom J, Vogelzang T, Kwint HF, Gussekloo J, Bouvy ML. The use of goal attainment scaling during clinical medication review in older persons with polypharmacy. Res Social Adm Pharm 2019; 15:1259-1265. [DOI: 10.1016/j.sapharm.2018.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/28/2018] [Accepted: 11/02/2018] [Indexed: 12/19/2022]
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11
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Jennings LA, Ramirez KD, Hays RD, Wenger NS, Reuben DB. Personalized Goal Attainment in Dementia Care: Measuring What Persons with Dementia and Their Caregivers Want. J Am Geriatr Soc 2018; 66:2120-2127. [PMID: 30298901 DOI: 10.1111/jgs.15541] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To develop a process of goal-setting and measurement of goal attainment in a dementia care management program. DESIGN Observational. SETTING Dementia care management program in an urban academic medical center. PARTICIPANTS Persons with dementia (N=101) and their caregivers; nurse practitioner dementia care managers (N=5). INTERVENTION Specification of a personalized health goal and action plan and measurement of goal attainment using goal attainment scaling in a clinical care visit. MEASUREMENTS Goal attainment at 6 and 12 months; focus groups of 5 dementia care managers. RESULTS Eighty-four percent of participant goals were nonmedical, 47% were related to quality of life, and 29% were caregiver support goals. Eighty-eight percent of participants felt that the goal they set was meaningful and 74% that the goal-setting process captured something different from usual care, and 85% found the process helpful in planning for future care. At 6 months, 74% of dyads had achieved or exceeded their expected level of goal attainment. Dementia care managers felt that the goal-setting process improved their understanding of what was most important to the patient, helped set expectations about disease progression and care needs, and provided positive reinforcement when goals were accomplished and an opportunity for revision when goals were not met. CONCLUSION Goal setting using goal attainment scaling can be incorporated into the care of persons with dementia to establish and attain person-centered goals. Research is needed to further develop personalized goal attainment as an outcome measure for dementia care. J Am Geriatr Soc 66:2120-2127, 2018.
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Affiliation(s)
- Lee A Jennings
- Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Los Angeles, Los Angeles, California
| | - Karina D Ramirez
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Ron D Hays
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Neil S Wenger
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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12
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Roberts JC, Lattimore S, Recht M, Jackson S, Gue D, Squire S, Robinson KS, Price V, Denne M, Richardson S, Rockwood K. Goal Attainment Scaling for haemophilia (GAS-Hēm): testing the feasibility of a new patient-centric outcome measure in people with haemophilia. Haemophilia 2018; 24:e199-e206. [PMID: 29626387 DOI: 10.1111/hae.13454] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 01/24/2023]
Abstract
INTRODUCTION To address the need for a patient-reported outcome that can measure clinically and personally meaningful change in people with haemophilia (PwH) on prophylaxis, an approach based on Goal Attainment Scaling (GAS) was developed: the GAS-Hēm. AIM To establish real-world feasibility of GAS-Hēm in PwH. METHODS Patients aged 5-65 years were enroled from four North American centres for a 12-week study. The primary outcome was the proportion of participants who completed GAS-Hēm interviews at baseline, 6 and 12 weeks. GAS-Hēm scores were obtained by subject- and clinician-rated goal attainment at Weeks 6 and 12, and compared with quality of life (QoL) measures and annualized bleed rate (ABR) for construct validity. Goals were evaluated qualitatively for content validity. Responsiveness was calculated using standardized response means (SRM). RESULTS Forty-two participants set 63 goals. Participants preferred to define (37/63) their own goals or further individualize (23/63) from the GAS-Hēm menu. Thirty of the 37 self-defined goals were matched to goals on the GAS-Hēm menu. The most common goal areas were: weight, exercise and nutrition (n = 17); leisure activities (n = 8); and joint problems (n = 7). Both participant- and clinician-rated GAS-Hēm scores at 6 weeks (n = 40) and 12 weeks (n = 41) demonstrated satisfactory goal attainment (SRM [subject-rated] at 12 weeks for adult and paediatric groups was 1.25 and 1.16, respectively). Correlations of GAS-Hēm scores with QoL measures and ABR were uniformly small. CONCLUSION GAS-Hēm was feasible and tapped constructs not captured by ABR or QoL measures.
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Affiliation(s)
- J C Roberts
- Bleeding & Clotting Disorders Institute, Peoria, IL, USA
| | - S Lattimore
- The Hemophilia Center at Oregon Health & Science University, Portland, OR, USA
| | - M Recht
- The Hemophilia Center at Oregon Health & Science University, Portland, OR, USA
| | - S Jackson
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada
| | - D Gue
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada
| | - S Squire
- Division of Hematology, University of British Columbia, Vancouver, BC, Canada
| | | | - V Price
- IWK Health Center, Halifax, NS, Canada
| | - M Denne
- Shire, US Medical Affairs, Chicago, IL, USA
| | | | - K Rockwood
- Dalhousie University, Halifax, NS, Canada.,DGI Clinical Inc., Halifax, NS, Canada
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O'Caoimh R, Kennelly S, O'Shea D. Can the Geriatric Day Hospital Act As a Hub for Services for Older People across the Spectrum of Ageing from Active Ageing to Advanced Frailty? Front Med (Lausanne) 2018; 5:23. [PMID: 29552560 PMCID: PMC5840151 DOI: 10.3389/fmed.2018.00023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/23/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland, Galway, Galway, Ireland.,National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Siobhán Kennelly
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, Ireland.,Department of Medicine for the Elderly, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Diamuid O'Shea
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, Ireland.,Department of Geriatric Medicine, St Vincent's University Hospital, Dublin, Ireland
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