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Schattner A. The spectrum of hospitalization-associated harm in the elderly. Eur J Intern Med 2023; 115:29-33. [PMID: 37391309 DOI: 10.1016/j.ejim.2023.05.025] [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: 01/19/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 07/02/2023]
Abstract
Acutely ill patients are not infrequently referred to the hospital and admitted, when they could be diagnosed and managed in the ambulatory setting or by hospital-level care at home. Avoidable admissions are particularly regrettable when the wide spectrum of hospitalization-associated patient harm is considered. It includes acute discomfort to the patient due to multiple disturbing hospital stressors; an emotional trauma; the burden of multiple redundant tests begetting false-positive and incidental findings triggering further testing and cascades; highly prevalent adverse events and serious harm associated with medical care, such as nosocomial infections, delirium, falls, and adverse drug events; and a complex array of post-discharge complications including significant physical and functional decline; cognitive decline; flawed transitions of care; common post-discharge adverse events; and a substantial risk of readmission, restarting the vicious cycle and compromising patient well-being, safety, and outcomes. Elderly patients are especially vulnerable, but in-hospital patient harm is not limited to older adults and is associated with increased length of stay, escalating costs, and mortality. The myriad types of harm that often accompany hospital admission is often not fully appreciated. Better awareness may result in better preventive strategies, in finding alternatives to hospital admission in some cases, and may contribute towards an improved patient experience and safety when hospitalization is mandatory, and the provision of enhanced care in the vulnerable post-discharge period.
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Affiliation(s)
- Ami Schattner
- The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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Ford DM, Budworth L, Lawton R, Teale EA, O’Connor DB. In-hospital stress and patient outcomes: A systematic review and meta-analysis. PLoS One 2023; 18:e0282789. [PMID: 36893099 PMCID: PMC9997980 DOI: 10.1371/journal.pone.0282789] [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] [Received: 07/12/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Hospital inpatients are exposed to high levels of stress during hospitalisation that may increase susceptibility to major adverse health events post-hospitalisation (known as post-hospital syndrome). However, the existing evidence base has not been reviewed and the magnitude of this relationship remains unknown. Therefore, the aim of the current systematic review and meta-analysis was to: 1) synthesise existing evidence and to determine the strength of the relationship between in-hospital stress and patient outcomes, and 2) determine if this relationship differs between (i) in-hospital vs post-hospital outcomes, and (ii) subjective vs objective outcome measures. METHODS A systematic search of MEDLINE, EMBASE, PsychINFO, CINAHL, and Web of Science from inception to February 2023 was conducted. Included studies reported a measure of perceived and appraised stress while in hospital, and at least one patient outcome. A random-effects model was generated to pool correlations (Pearson's r), followed by sub-group and sensitivity analyses. The study protocol was preregistered on PROSPERO (CRD42021237017). RESULTS A total of 10 studies, comprising 16 effects and 1,832 patients, satisfied the eligibility criteria and were included. A small-to-medium association was found: as in-hospital stress increased, patient outcomes deteriorated (r = 0.19; 95% CI: 0.12-0.26; I2 = 63.6; p < 0.001). This association was significantly stronger for (i) in-hospital versus post-hospital outcomes, and (ii) subjective versus objective outcome measures. Sensitivity analyses indicated that our findings were robust. CONCLUSIONS Higher levels of psychological stress experienced by hospital inpatients are associated with poorer patient outcomes. However, more high-quality, larger scale studies are required to better understand the association between in-hospital stressors and adverse outcomes.
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Affiliation(s)
- Daniel M. Ford
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
- * E-mail:
| | - Luke Budworth
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, United Kingdom
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Rebecca Lawton
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Elizabeth A. Teale
- Academic Unit for Aging and Stroke Research, University of Leeds, Leeds, United Kingdom
| | - Daryl B. O’Connor
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
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Yildirim H, Işik K. Psychometric evaluation of the Hospitalisation-Related Stressors Questionnaire for Elderly Patients. Psychogeriatrics 2021; 21:166-174. [PMID: 33354854 DOI: 10.1111/psyg.12651] [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: 10/08/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stress can threaten the health and recovery of patients, and determining the level of stress can be an important factor in curing illnesses. The aim was to adapt the Hospitalisation-Related Stressors Questionnaire for Elderly Patients (HRSQ-EP) and perform its psychometric evaluation. METHODS In the study, the method of developing a scale and determining the construct validity and reliability of this scale was used. The research was carried out with elderly patients who were hospitalised. The research was conducted in two main phases; in the first phase, after providing expert opinion for the language validity of the scale, the content and face validity were confirmed and then confirmatory and exploratory factor analyses were applied for content validity and reliability in the second phase. RESULTS The new scale, which was formed as a result of evaluating the construct validity, consisted of three factors and 15 items, and all factors explained 67.1% of the total variance. Kaiser-Meyer-Olkin, which determined the suitability of the measurement tool for factor analysis, was determined as 0.901 and Bartlett test 0.000. The adapted short form is a simple and easy-to-understand tool for determining the stress levels of hospitalised elderly individuals. HRSQ-EP provided evidence that it demonstrates adequate internal consistency, reliability and construct validity. CONCLUSION The results suggested that the adapted measurement tool will be useful. The scale is recommended to be evaluated in different populations to determine cultural differences.
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Affiliation(s)
- Hilal Yildirim
- Department of Puplic Health Nursing, Faculty of Nursing, Inonu University, Malatya, Turkey
| | - Kevser Işik
- Department of Public Health Nursing, Faculty of Health Sciences, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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Ulrich RS, Cordoza M, Gardiner SK, Manulik BJ, Fitzpatrick PS, Hazen TM, Perkins RS. ICU Patient Family Stress Recovery During Breaks in a Hospital Garden and Indoor Environments. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 13:83-102. [DOI: 10.1177/1937586719867157] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: Measure the immediate change in intensive care unit (ICU) family members’ state stress levels from the beginning to the end of a person’s visit to a hospital garden and compare the changes produced by the garden with those associated with spending time in indoor hospital environments intended for respite and relaxation. Background: No previous research has compared the efficacy of different physical environments as interventions to foster stress reduction in family members of ICU patients, a group of hospital visitors known to experience high levels of distress. Method: A convenience sample of 42 ICU patient family (from 42 different families) completed the Present Functioning Visual Analogue Scales (PFVAS) before and after each visit (128 total visits) to a garden, an atrium/café, or ICU waiting room. Results: Stress scores significantly declined (i.e., improved) from the start to the end of a break on all PFVAS subscales ( p < .0001) in both the garden and indoors locations. However, it is noteworthy that garden breaks resulted in significantly greater improvement in the “sadness” scale than breaks in indoor locations ( p = .03), and changes in all five other PFVAS scores showed somewhat more reduction of stress for breaks spent in the garden than indoors, although these differences were not statistically significant. Conclusion: Creating an unlocked garden with abundant nature located close to an ICU can be an effective intervention for significantly mitigating state stress in family members of ICU patients and can be somewhat more effective than indoor areas expressly designed for family respite and relaxation.
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Affiliation(s)
- Roger S. Ulrich
- Center for Healthcare Architecture, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Makayla Cordoza
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Musavi Z, Alavi M, Alimohammadi N, Hosseini H. Development and initial psychometric evaluation of the hospitalization-related stressors questionnaire for elderly patients. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:516-520. [PMID: 27904637 PMCID: PMC5114798 DOI: 10.4103/1735-9066.193416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Various factors threaten the health and recovery of hospitalized elderly, including stressors in medical service centers. Therefore, the aim of the present study was to develop and preliminary validate a measurement tool to assess hospitalization-related stressors (HRS) among the elderly. MATERIALS AND METHODS This methodological research was conducted in 2015. The study was performed in two main phases. In the first phase, which was to develop the questionnaire, the data were collected through literature review, interview with few elderly patients, and calculating content validity index with the participation of 16 experts. The second phase included preliminary validation of the questionnaire in which a convenient sample of 200 hospitalized elderly patients recruited from 4 educational medical centers of the Isfahan University of Medical Sciences were studied. Principal component analysis method was used to identify the factorial structure of the questionnaire. In order to evaluate validity, Cronbach's alpha coefficient was calculated. RESULTS After evaluating the results and relocating and merging some of the items, a version of 26 items in 7 categories was prepared with acceptable internal consistency (Cronbach's alpha coefficient from 0.67 to 0.78 for the components and 0.83 for the tool). CONCLUSIONS In this study, we were able to identify a set of important components and indicators of HRS in elderly; so it can be used as a useful instrument. Future studies are recommended in order to develop and validate this tool in other communities.
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Affiliation(s)
- Zahra Musavi
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mousa Alavi
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrollah Alimohammadi
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Habibollah Hosseini
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Georgopoulou S, Efraimidou S, MacLennan SJ, Ibrahim F, Cox T. Antiphospholipid (Hughes) syndrome: description of population and health-related quality of life (HRQoL) using the SF-36. Lupus 2014; 24:174-9. [DOI: 10.1177/0961203314551809] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective Antiphospholipid (Hughes) syndrome (APS) affects mainly women 15 to 50 years of age and is responsible for approximately 20% of strokes in people <40 years. Little is known about the psychological burden of this long-term condition. We investigated HRQoL in APS. Methods We conducted a cross-sectional survey involving 270 members of the Hughes Syndrome Foundation worldwide. Data included HRQoL (SF-36), demographics, and APS-related self-reported major issues. Response rate was 60%. Results T-tests indicated significantly worse mean scores for seven of the eight domains of the SF-36 in secondary antiphospholipid syndrome (SAPS) compared to primary antiphospholipid syndrome (PAPS), e.g. bodily pain t(263) = 6.10 p < 0.001 except for mental health t(267) = 1.95 p = 0.053. PAPS appeared to be associated with poorer HRQoL in most mental health domains but overall better physical domains compared to systemic lupus erythematosus (SLE) alone. SAPS appeared to have a more adverse impact on HRQoL compared to PAPS and SLE. Major issues identified: pain and fatigue, lack of health care professional/public awareness, and medication unpredictability. Conclusion HRQoL in PAPS appears to be generally better than SLE and SAPS in physical domains, but poorer in mental domains. APS patients might need more social support in terms of information and awareness of the condition to improve their coping strategies.
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Affiliation(s)
- S Georgopoulou
- Academic Department of Rheumatology, King’s College London, London, United Kingdom
| | - S Efraimidou
- Centre for Sustainable Working Life, School of Business, Economics & Informatics, Birkbeck University of London, London, United Kingdom
| | - S J MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - F Ibrahim
- Academic Department of Rheumatology, King’s College London, London, United Kingdom
| | - T Cox
- Centre for Sustainable Working Life, School of Business, Economics & Informatics, Birkbeck University of London, London, United Kingdom
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Lafont C, Gérard S, Voisin T, Pahor M, Vellas B. Reducing "iatrogenic disability" in the hospitalized frail elderly. J Nutr Health Aging 2011; 15:645-60. [PMID: 21968859 DOI: 10.1007/s12603-011-0335-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hospitalization is the first cause of functional decline in the elderly: 30 to 60% of elderly patients lose some independence in basic activities of daily living (ADL) during a stay in hospital. This loss of independence results from the acute condition that led to admission, but is also related to the mode of management. OBJECTIVE This paper is a review of the literature on functional decline in elderly hospitalized patients. It is the first stage in a project aiming to prevent dependence that is induced during the course of care. METHODS During a 2-day workshop in Monaco, a task force of 20 international experts discussed and defined the concept of "iatrogenic disability". RESULTS 1- "Iatrogenic disability" was defined by the task force as the avoidable dependence which often occurs during the course of care. It involves three components that interact and have a cumulative effect: a) the patient's pre-existing frailty, b) the severity of the disorder that led to the patient's admission, and lastly c) the hospital structure and the process of care. 2- The prevention of "iatrogenic disability" involves successive stages. - becoming aware that hospitalization may induce dependence. Epidemiological studies have identified at-risk populations by the use of composite scores (HARP, ISAR, SHERPA, COMPRI, etc). - considering that functional decline is not a fatality. Quality references have already been defined. Interventions to prevent dependence in targeted populations have been set up: simple geriatric consultation teams, single-factor interventions (aimed for example at mobility, delirium, iatrogenic disorders) or multidomain interventions (such as GEM and ACE units, HELP, Fast Track, NICHE). These interventions are essentially centered on the patient's frailty and have limited results, as they take little account of the way the institution functions, which is not aimed at prevention of functional decline. The process of care reveals shortcomings: lack of geriatric knowledge, inadequate evaluation and management of functional status. The group suggests that interventions must not only identify at-risk patients so that they may benefit from specialized management, but they must also target the hospital structure and the process of care. This requires a graded "quality approach" and rethinking of the organization of the hospital around the elderly person.
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Affiliation(s)
- C Lafont
- Gérontopôle, Department of Geriatric Medicine, CHU Toulouse, France
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Affiliation(s)
- David J Cook
- *Department of Anesthesiology, Mayo Clinic and Foundation, Rochester, Minnesota; and †Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington
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Abstract
Plans for improving safety in medical care often ignore the patient's perspective. The active role of patients in their care should be recognised and encouraged. Patients have a key role to play in helping to reach an accurate diagnosis, in deciding about appropriate treatment, in choosing an experienced and safe provider, in ensuring that treatment is appropriately administered, monitored and adhered to, and in identifying adverse events and taking appropriate action. They may experience considerable psychological trauma both as a result of an adverse outcome and through the way the incident is managed. If a medical injury occurs it is important to listen to the patient and/or the family, acknowledge the damage, give an honest and open explanation and an apology, ask about emotional trauma and anxieties about future treatment, and provide practical and financial help quickly.
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Affiliation(s)
- C A Vincent
- Clinical Risk Unit, Department of Psychology, University College London, London WC1E 6BT, UK.
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Abstract
OBJECTIVES To examine the prevalence of religious beliefs and practices among medically ill hospitalized older adults and relate them to social, psychological and health characteristics. METHODS AND PROCEDURES Consecutive patients age 60 or over admitted to the general medicine cardiology and neurology services of Duke University Medical Center were evaluated for participation in a depression study. As part of the evaluation, information on religious affiliation, religious attendance, private religious activities, intrinsic religiosity and religious coping was collected. Demographic, social, psychological and physical health characteristics were also assessed. Bivariate and multivariate correlates of religious belief and activity were examined using Pearson correlation and linear regression. RESULTS Of the 542 patients evaluated, detailed information on religious beliefs and behaviors was collected on 455 cognitively unimpaired patients. Over one-half (53.4%) of the sample reported attending religious services once per week or more often; 58.7% prayed or studied the Bible daily or more often; over 85% of patients held intrinsic religious attitudes; and over 40% spontaneously reported that their religious faith was the most important factor that enabled them to cope. Religious variables were consistently and independently related to race (Black), lower education, higher social support and greater life stressors, and religious attendance was associated with less medical illness burden. Religious attendance was also related to lower depressive symptoms, although the association weakened when other covariates were controlled. CONCLUSIONS Religious practices, attitudes and coping behaviors are prevalent among hospitalized medically ill older adults and are related to social, psychological and physical health outcomes. Implications for clinical practice are discussed.
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Affiliation(s)
- H G Koenig
- Center for the Study of Religion/Spirituality and Health, Duke University Medical Center, Durham, North Carolina, USA
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Koenig HG. Differences in psychosocial and health correlates of major and minor depression in medically ill older adults. J Am Geriatr Soc 1997; 45:1487-95. [PMID: 9400559 DOI: 10.1111/j.1532-5415.1997.tb03200.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the differences in correlates of different levels of depression in medically ill hospitalized older adults. DESIGN, SETTING, AND PARTICIPANTS A consecutive series of 542 patients aged 60 or older admitted to the medical inpatient services of Duke Hospital underwent a structured psychiatric evaluation administered by a psychiatrist. MEASUREMENT A wide range of demographic, social, psychiatric, and physical health data were collected, and associations with major and minor depression were assessed. RESULTS Compared with patients without depression, those with major depression were more likely to have a history of prior episodes of depression, higher dysfunctional attitude scores, greater overall severity of medical illness, cognitive impairment, and symptoms of pain or other somatic complaints. Specific medical diagnosis was less important a predictor of major depression than overall severity of medical illness. Compared with patients without depression, those with minor depression were more likely to report non-health-related stressors during the year before hospital admission, have a diagnosis of immune system disorder, and have greater severity of medical illness. When major and minor depression were compared directly, on the other hand, no significant differences were observed except for history of depression, and that relationship was weak and present only when the etiologic approach to diagnosis was used. CONCLUSION During hospital admission, certain psychosocial, psychiatric, and physical health characteristics of older medical patients place them at high risk for different levels of depression. Patients with major and minor depression resemble each other more than they do patients without depression. These findings may help clinicians better understand the causes of different types of depression in this setting and lead to improved diagnosis and treatment.
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Affiliation(s)
- H G Koenig
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA
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