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Molendijk-van Nieuwenhuyzen K, Belt-van Opstal R, Hakvoort L, Dikken J. Exploring geriatric trauma unit experiences through patients' eyes: a qualitative study. BMC Geriatr 2024; 24:476. [PMID: 38816688 PMCID: PMC11140891 DOI: 10.1186/s12877-024-05023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION The surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit's emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization. METHODS This qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed. RESULTS The findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit. CONCLUSION Effective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.
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Affiliation(s)
| | | | | | - Jeroen Dikken
- De Haagse Hogeschool, Faculteit Gezondheid, Voeding & Sport, Johanna Westerdijkplein 75, 2521 EN, The Hague, The Netherlands
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2
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Munsterman E, Perez A, Hodgson N, Cacchione P. Dementia friendly in the context of hospitalization: A concept analysis using the Walker & Avant Method. J Adv Nurs 2024. [PMID: 38433345 DOI: 10.1111/jan.16133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/06/2023] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
AIM(S) To evaluate the literature to inform and propose a conceptual definition for dementia friendly in the context of hospitalization. METHODS The Walker & Avant method for concept analysis was utilized for this review. DATA SOURCES (INCLUDE SEARCH DATES) Initial search conducted June 2022. Repeated search conducted in February 2023. Databases for the literature search include Scopus, PubMed, CINAHL, PsycINFO, and AGELINE. RESULTS Five attributes of the concept of dementia friendly in the context of hospitalization were identified including: staff knowledge/education, environmental modification, person-centred care, nursing care delivery and inclusion of family caregivers. Based on these attributes a conceptual definition is proposed. CONCLUSION A clarified definition for dementia friendly in the context of hospitalization will aid in understanding the concept, provide guidance for hospitals seeking to implement dementia-friendly interventions and benefit researchers aiming to study the impact of such programs. REPORTING METHOD: n/a. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
| | - Adriana Perez
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy Hodgson
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Werner C, Bauknecht L, Heldmann P, Hummel S, Günther-Lange M, Bauer JM, Hauer K. Mobility outcomes and associated factors of acute geriatric care in hospitalized older patients: results from the PAGER study. Eur Geriatr Med 2024; 15:139-152. [PMID: 37777992 PMCID: PMC10876756 DOI: 10.1007/s41999-023-00869-9] [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: 07/15/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To examine distinct mobility outcomes (locomotor capacity, physical activity, life-space mobility) of acute geriatric care (AGC) in acutely hospitalized older adults and identify predictors associated with these outcomes. METHODS The PAGER study was designed as a prospective observational study. Mobility outcomes of 107 hospitalized older patients (age = 83.2 ± 6.4 years, female: n = 68, 63.6%) receiving AGC were measured at hospital admission and discharge. Locomotor capacity was assessed with the Short Physical Performance Battery (SPPB), 24-h physical activity (step count) with an activity monitor, and life-space mobility with the Life-Space Assessment in Institutionalized Settings (LSA-IS). Baseline demographical, clinical, physical, cognitive, and psychological characteristics were analyzed as candidate predictors of mobility outcomes. RESULTS SPPB (median [interquartile range] 4.0 [2.8-5.0] pt. vs. 5.0 [3.0-6.3] pt.), step count (516 [89-1806] steps vs. 1111 [228-3291] steps), and LSA-IS total score (10.5 [6.0-15.0] pt. vs. 16.3 [12.0-24.1] pt.) significantly improved during AGC (all p < 0.001). Adjusting for baseline status, frailty was identified as an independent negative predictor of SPPB, step count, and LSA-IS at discharge (p = 0.003-0.005). Barthel Index was also independently positively associated with step count (p = 0.017) at discharge, as was the mean daily PA level with SPPB (p = 0.027) at discharge, both independent of baseline status. CONCLUSION AGC improves distinct mobility outcomes in hospitalized older patients. Frailty was consistently found to be an independent negative predictor of all mobility outcomes. Frailty assessment in AGC may be important to identify patients at risk for decreased treatment gains in mobility. Early PA promotion in AGC seems to be beneficial in improving patients' locomotor capacity.
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Affiliation(s)
- Christian Werner
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany.
| | - Laura Bauknecht
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Saskia Hummel
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Michaela Günther-Lange
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
| | - Jürgen M Bauer
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Klaus Hauer
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstraße 110, 70376, Stuttgart, Germany
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4
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Dombrowski W, Mims A, Kremer I, Cano Desandes P, Rodrigo-Herrero S, Epps F, Snow T, Gutierrez M, Nasta A, Epperly MB, Manaloto K, Hansen JC. Dementia Ideal Care: Ecosystem Map of Best Practices and Care Pathways Enhanced by Technology and Community. J Alzheimers Dis 2024; 100:87-117. [PMID: 38848182 PMCID: PMC11307099 DOI: 10.3233/jad-231491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/09/2024]
Abstract
Background Globally, much work has been done by nonprofit, private, and academic groups to develop best practices for the care of people living with dementia (PLWD), including Alzheimer's disease. However, these best practices reside in disparate repositories and tend to focus on one phase of the patient journey or one relevant group. Objective To fill this gap, we developed a Dementia Ideal Care Map that everyone in the dementia ecosystem can use as an actionable tool for awareness, policy development, funding, research, training, service delivery, and technology design. The intended audience includes (and not limited to) policymakers, academia, industry, technology developers, health system leaders, clinicians, social service providers, patient advocates, PLWD, their families, and communities at large. Methods A search was conducted for published dementia care best practices and quality measures, which were then summarized in a visual diagram. The draft diagram was analyzed to identify barriers to ideal care. Then, additional processes, services, technologies, and quality measures to overcome those challenges were brainstormed. Feedback was then obtained from experts. Results The Dementia Ideal Care Map summarizes the ecosystem of over 200 best practices, nearly 100 technology enablers, other infrastructure, and enhanced care pathways in one comprehensive diagram. It includes psychosocial interventions, care partner support, community-based organizations; awareness, risk reduction; initial detection, diagnosis, ongoing medical care; governments, payers, health systems, businesses, data, research, and training. Conclusions Dementia Ideal Care Map is a practical tool for planning and coordinating dementia care. This visualized ecosystem approach can be applied to other conditions.
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Affiliation(s)
- Wen Dombrowski
- CATALAIZE, Chicago, IL, USA
- USC Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Adrienne Mims
- Rainmakers Strategic Solutions, Atlanta, GA, USA
- National Committee for Quality Assurance – NCQA, Washington, DC, USA
- NAPA Advisory Council, Washington, DC, USA
| | - Ian Kremer
- Leaders Engaged on Alzheimer’s Disease – LEAD Coalition, Washington, DC, USA
| | - Pedro Cano Desandes
- Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí – I3PT-CERCA, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Silvia Rodrigo-Herrero
- Memory Unit, Department of Neurology, Juan Ramon Jimenez University Hospital, Huelva, Spain
| | - Fayron Epps
- School of Nursing, University of Texas Health Science Center, San Antonio, TX, USA
| | - Teepa Snow
- Positive Approach, LLC, Efland, NC, USA
- Snow Approach, Inc., Hillsborough, NC, USA
| | | | - Anil Nasta
- Roche Diagnostics Corporation, Indianapolis, IN, USA
| | | | - Katrina Manaloto
- Neurotech Collider Lab, University of California, Berkeley, Berkeley, CA, USA
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Srinivas V, Choubey U, Motwani J, Anamika F, Chennupati C, Garg N, Gupta V, Jain R. Synergistic strategies: Optimizing outcomes through a multidisciplinary approach to clinical rounds. Proc AMIA Symp 2023; 37:144-150. [PMID: 38174031 PMCID: PMC10761132 DOI: 10.1080/08998280.2023.2274230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/12/2023] [Indexed: 01/05/2024] Open
Abstract
Multidisciplinary rounds (MDR) constitute a patient-centered care model wherein professionals from diverse disciplines collaborate in real time to provide specialized expertise. The MDR team, encompassing care partners, hospitalists, nurses, pharmacists, and more, employs a collaborative approach that optimizes patient care through shared goals, electronic record access, regular reviews, and patient involvement. MDRs have evolved to reduce patient mortality, complications, length of stay, and readmissions, and they enhance patient satisfaction and utilization of ancillary services. Family engagement in MDRs further transforms relationships from adversarial to collaborative, leading to improved comprehension of treatment strategies and smoother navigation of challenging conversations. Despite challenges such as time constraints, limited patient coverage, and hierarchical barriers, MDRs are being increasingly conducted across healthcare settings, with positive outcomes.
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Affiliation(s)
- Varsha Srinivas
- PES Institute of Medical Sciences and Research, Kuppam, India
| | | | - Jatin Motwani
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Fnu Anamika
- University College of Medical Sciences, New Delhi, India
| | | | - Nikita Garg
- Children’s Hospital of Michigan, Detroit, Michigan, USA
| | - Vasu Gupta
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Rohit Jain
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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6
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Sunner C, Giles M, Ball J, Barker R, Hullick C, Oldmeadow C, Foureur M. Implementation and evaluation of a nurse-led intervention to augment an existing residential aged care facility outreach service with a visual telehealth consultation: stepped-wedge cluster randomised controlled trial. BMC Health Serv Res 2023; 23:1429. [PMID: 38110923 PMCID: PMC10726593 DOI: 10.1186/s12913-023-10384-z] [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: 04/11/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Up to 75% of residents from residential aged care facilities (RACF) are transferred to emergency departments (ED) annually to access assessment and care for unplanned or acute health events. Emergency department presentations of RACF residents can be both expensive and risky, and many are unnecessary and preventable. Processes or triage systems to assess residents with a health event, prior to transfer, may reduce unnecessary ED transfer. The Aged Care Emergency (ACE) service is a nurse-led ED outreach service that provides telephone support to RACF nurses regarding residents' health events. This service is available Monday to Friday, 8am to 4 pm (ED ACE hours). The primary objective of this study was to assess whether the augmentation of the phone-based ED ACE service with the addition of a visual telehealth consultation (VTC) would reduce RACF rate of ED presentations compared to usual care. The secondary objectives were to 1) monitor presentations to ED within 48 h post VTC to detect any adverse events and 2) measure RACF staff perceptions of VTC useability and acceptability. METHODS This implementation study used a stepped wedge cluster randomised controlled trial design. Study settings were four public hospital EDs and 16 RACFs in two Local Health Districts. Each ED was linked to 4 RACFs with approximately 350 RACF beds, totalling 1435 beds across 16 participating RACFs. Facilities were randomised into eight clusters with each cluster comprising one ED and two RACFs. RESULTS A negative binomial regression demonstrated a 29% post-implementation reduction in the rate of ED presentations (per 100 RACF beds), within ED ACE hours (IRR [95% CI]: 0.71 [0.46, 1. 09]; p = 0.122). A 29% reduction, whilst not statistically significant, is still clinically important and impactful for residents and EDs. A post-hoc logistic regression demonstrated a statistically significant 69% reduction in the probability that an episode of care resulted in an ED presentation within ED ACE hours post-implementation compared to pre-implementation (OR [95% CI]: 0.31 [0.11, 0.87]; p = 0.025). CONCLUSION Findings have shown the positive impact of augmenting ACE with a VTC. Any reduction of resident presentations to a busy ED is beneficial to healthcare overall, but more so to the individual older person who can recover safely and comfortably in their own RACF. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ID ACTR N12619001692123) (02/12/2019) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378629andisReview=true.
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Affiliation(s)
- Carla Sunner
- Hunter New England Local Health District, Newcastle, 2300, Australia.
- University of Newcastle, Callaghan, 2308, Australia.
| | - Michelle Giles
- Hunter New England Local Health District, Newcastle, 2300, Australia
- University of Newcastle, Callaghan, 2308, Australia
| | - Jean Ball
- Hunter New England Local Health District, Newcastle, 2300, Australia
| | - Roslyn Barker
- Hunter New England Local Health District, Newcastle, 2300, Australia
| | - Carolyn Hullick
- Hunter New England Local Health District, Newcastle, 2300, Australia
- University of Newcastle, Callaghan, 2308, Australia
| | | | - Maralyn Foureur
- Hunter New England Local Health District, Newcastle, 2300, Australia
- University of Newcastle, Callaghan, 2308, Australia
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Lacey Q. Acute Care for Elders and Nurses Improving Care for Health System Elders Models in Acute Care: Are We Still Using These Geriatric Models of Care? Crit Care Nurs Clin North Am 2023; 35:513-521. [PMID: 37838423 DOI: 10.1016/j.cnc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Care models for older adults have been studied for more than 30 years. Several models of care for older adults were created in the acute care setting to prevent hospital-acquired disability and decline-a phenomenon frequently observed among older patients admitted in the acute care setting. The Acute Care for Elders (ACE) model and the Nurses Improving Care for Health System Elders program were 2 such models that sought to improve the quality of care for older adults and reduce their cost for care. Where are they today? Are we still using these care models in the acute care setting?
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Affiliation(s)
- Quinn Lacey
- School of Nursing, LSU Health-New Orleans, 1900 Gravier Street, New Orleans, LA 70112, USA.
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8
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Lynch DH, Mournighan K, Dale M, Spangler HB, Gotelli J, Davis R, Felton K, Lingley-Brown K, Busby-Whitehead J, Batsis JA, Hanson LC. Establishing and sustaining an acute care for elders unit: An incremental journey to success. J Am Geriatr Soc 2023; 71:3031-3039. [PMID: 37610294 DOI: 10.1111/jgs.18561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
Acute Care for Elders (ACE) units reduce hospital-associated delirium, functional decline, and lengths of stay. However, establishing and sustaining such units have proven difficult. There are only 43 ACE units among the >3500 hospitals in the United States. This study describes an iterative quality improvement process, which allowed us to establish and sustain an ACE unit care model in a modern academic hospital. This continuous process was centered on implementing the key principles of the ACE unit model of care: patient-centered care assessments, medical care review, specialized prepared environment, early mobilization, physical therapy, and early planning for discharge to home. Quality of care and patient outcomes data for older adults admitted to our ACE unit includes mortality index (observed/expected) consistently <1 (FY22 = 0.86), 30-day readmission rate of <10% (FY22 9.31%), and length of stay index of ~1 (FY22 1.07). We describe how work on our ACE unit has led to hospital-wide initiatives, including dementia-friendly hospital certification. Our hope is that others can use this process to enhance the dissemination of the ACE unit model of care.
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Affiliation(s)
- David H Lynch
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kimberly Mournighan
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maureen Dale
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hillary B Spangler
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John Gotelli
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ronald Davis
- University of North Carolina Hospital at Chapel Hill, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kittra Felton
- University of North Carolina Hospital at Chapel Hill, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kara Lingley-Brown
- University of North Carolina Hospital at Chapel Hill, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John A Batsis
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laura C Hanson
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
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9
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Tenforde AS, Alexander JJ, Alexander M, Annaswamy TM, Carr CJ, Chang P, Díaz M, Iaccarino MA, Lewis SB, Millett C, Pandit S, Ramirez CP, Rinaldi R, Roop M, Slocum CS, Tekmyster G, Venesy D, Verduzco-Gutierrez M, Zorowitz RD, Rowland TR. Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research. PM R 2023; 15:1156-1174. [PMID: 37354209 DOI: 10.1002/pmrj.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Joshua J Alexander
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Marcalee Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Thiru M Annaswamy
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Conley J Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philip Chang
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Stephen B Lewis
- Physiatry-Pharmacy Collaborative, NJ Institute for Successful Aging, Princeton, New Jersey, USA
| | - Carolyn Millett
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | | | | | - Robert Rinaldi
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Megan Roop
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Gene Tekmyster
- Department of Orthopedic Surgery, Keck Medicine of USC, Los Angeles, California, USA
| | | | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard D Zorowitz
- Department of Rehabilitation Medicine, MedStar National Rehabilitation Network, Georgetown University, Washington, District of Columbia, USA
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10
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Yuksel JM, Ulen KR, Varghese D, Noviasky J. Pharmacist Involvement in an Acute Care of the Elderly Team: Impact on Appropriate Medication Use. Sr Care Pharm 2023; 38:338-345. [PMID: 37496166 DOI: 10.4140/tcp.n.2023.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background Currently, our institution does not have a full-time pharmacist rounding with the inpatient acute care of the elderly (ACE) team daily. We sought to evaluate the involvement of a clinical pharmacy service within the ACE team and its impact on appropriate medication use. Objective The primary outcome was the number of drug-related problems (DRPs) and potentially inappropriate medications (PIMs) detected by the pharmacist compared with no pharmacist on the ACE team. Secondary outcomes included length of stay, 30-day re-hospitalization, and accepted DRPs and PIMs recommendations made by the pharmacist. Methods This was a retrospective, single-center, cohort study. The control cohort consisted of patients seen over 3 months when no pharmacist was present. The intervention cohort comprised patients seen over 3 months when a pharmacist was present on the ACE team. Patients were excluded if there was not a documented chart note from a geriatric provider or pharmacist. Results A total of 125 patients were included in the intervention group and 106 patients in the control group. Regarding the primary outcome, the control cohort had significantly fewer identified PIMs and DRPs in comparison with the intervention cohort (P < 0.001; P < 0.01, respectively). There was no significant difference in length of stay (P = 0.317). There was a statistical difference between groups regarding 30-day readmission rates (P = 0.007). Conclusion Our study shows that the inclusion of a pharmacist on the ACE team was associated with more DRPs, and PIMs identified, creating a positive impact on patient care and 30-day readmission.
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Affiliation(s)
| | - Kelly R Ulen
- 1 Upstate Community Hospital, Syracuse, New York
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11
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Fournaise A, Andersen-Ranberg K, Lauridsen JT, Espersen K, Gudex C, Bech M. Conceptual framework for acute community health care services - Illustrated by assessing the development of services in Denmark. Soc Sci Med 2023; 324:115857. [PMID: 37001279 DOI: 10.1016/j.socscimed.2023.115857] [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: 08/02/2022] [Revised: 02/13/2023] [Accepted: 03/17/2023] [Indexed: 04/22/2023]
Abstract
Acute community health care services can support continuity of care by acting as a bridge between the primary and secondary health care sectors in the early detection of acute disease and provision of treatment and care. Although acute community health care services are a political priority in many countries, the literature on their organization and effect is limited. We present a conceptual framework for describing acute community health care services that can be used to support the policies and guidelines for such services. For illustrative purposes, we apply the framework to the Danish acute community health care services using implementation data from 2020 and identify gaps and opportunities for learning. The framework identifies two key pairs of dimensions: (1) capacity & capability, and (2) coordination & collaboration. These dimensions, together with the governance structure and quality assurance initiatives, are of key importance to the effect of acute community health care services. While all Danish municipalities have implemented acute community health care services, application of the framework indicates considerable variation in their approaches. The conceptual framework provides a systematic approach supporting the development, implementation, evaluation, and monitoring of acute community health care services and can assist policymakers at both national and local levels in this work.
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Affiliation(s)
- Anders Fournaise
- Department of Cross-sectoral Collaboration, Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark; Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark; Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
| | - Karen Andersen-Ranberg
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark; Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark; Danish Aging Research Center, University of Southern Denmark, J. B. Winsløws Vej 9b, 5000, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense, Denmark.
| | - Jørgen T Lauridsen
- Department of Economics, University of Southern Denmark, Campusvej 55, 5000, Odense, Denmark.
| | - Kurt Espersen
- Department of Cross-sectoral Collaboration, Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark.
| | - Claire Gudex
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense, Denmark; Open Patient data Explorative Network (OPEN), Region of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense, Denmark.
| | - Mickael Bech
- Department of Political Science and Public Management, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
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Skains RM, Zhang Y, Osborne JD, O'Leary T, Fowler ME, Markland A, Buford TW, Brown CJ, Kennedy RE. Hospital-associated disability due to avoidable hospitalizations among older adults. J Am Geriatr Soc 2023; 71:1395-1405. [PMID: 36661192 PMCID: PMC10976455 DOI: 10.1111/jgs.18238] [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: 04/22/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hospital-associated disability (HAD) is a common complication during the course of acute care hospitalizations in older adults. Many admissions are for ambulatory care sensitive conditions (ACSCs), considered potentially avoidable hospitalizations-conditions that might be treated in outpatient settings to prevent hospitalization and HAD. We compared the incidence of HAD between older adults hospitalized for ACSCs versus those hospitalized for other diagnoses. METHODS We conducted a retrospective cohort study in inpatient (non-ICU) medical and surgical units of a large southeastern regional academic medical center. Participants were 38,960 older adults ≥ 65 years of age admitted from January 1, 2015, to December 31, 2019. The primary outcome was HAD, defined as decline on the Katz Activities of Daily Living (ADL) scale from hospital admission to discharge. We used generalized linear mixed models to examine differences in HAD between hospitalizations with a primary diagnosis for an ACSC using standard definitions versus primary diagnosis for other conditions, adjusting for covariates and repeated observations for individuals with multiple hospitalizations. RESULTS We found that 10% of older adults were admitted for an ACSC, with rates of HAD in those admitted for ACSCs lower than those admitted for other conditions (16% vs. 20.7%, p < 0.001). Age, comorbidity, admission functional status, and admission cognitive impairment were significant predictors for development of HAD. ACSC admissions to medical and medical/surgical services had lower odds of HAD compared with admissions for other conditions, with no significant differences between ACSC and non-ACSC admissions to surgical services. CONCLUSIONS Rates of HAD among older adults hospitalized for ACSCs are substantial, though lower than rates of HAD with hospitalization for other conditions, reflecting that acute care hospitalization is not a benign event in this population. Treatment of ACSCs in the outpatient setting could be an important component of efforts to reduce HAD.
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Affiliation(s)
- Rachel M. Skains
- Departments of Emergency Medicine and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yue Zhang
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John D. Osborne
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tobias O'Leary
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Alayne Markland
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama, USA
| | - Thomas W. Buford
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama, USA
| | - Cynthia J. Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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Yen HY, Liu D, Chi MJ, Huang HY. Awareness of and subjective needs for post-discharge healthcare services among older adult patients. BMC Nurs 2023; 22:129. [PMID: 37072840 PMCID: PMC10111708 DOI: 10.1186/s12912-023-01247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 03/13/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Increasing patient awareness of post-discharge care resources is an effective strategy to reduce rehospitalization rates and medical costs. Therefore, the purpose of this study was to explore hospitalized older adult patients' awareness of and subjective demands for post-discharge healthcare services. METHODS A cross-sectional study design was conducted from November 2018 to May 2020. STROBE statement was completed. Participants were inpatients over 65 years of age in the general ward of a medical center in northern Taiwan. A questionnaire was used to collect data by face-to-face interviews. Two hundred and twelve participants were recruited. Home nursing care, home rehabilitation, home respiratory therapy, home services, assistive devices rental, and transportation were the main post-discharge healthcare services in this study. RESULTS Overall, 83.5% of older adult patients were aware of and 55.7% of the older adult patients demanded at least one post-discharge healthcare services. Logistic regression results found that, patients experiencing moderate to severe disability and cognitive impairment, and those hospitalized in the past year had significantly higher demands for services. CONCLUSIONS Developing post-discharge healthcare services for older adult patients provides continuous patient-centered services for assisting patients and their families in adapting to the transition period of the post-acute stage. Satisfying these demands is beneficial for older adult patients and their families, as well as for reducing readmissions and medical costs.
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Affiliation(s)
- Hsin-Yen Yen
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, 250 Wuxing St, Taipei, 11031, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Doresses Liu
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mei-Ju Chi
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, 250 Wuxing St, Taipei, 11031, Taiwan.
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Hao-Yun Huang
- Registered Nurse, Gold Coast University Hospital, Southport, QLD, Australia
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Espaulella-Ferrer M, Molist-Brunet N, Espaulella-Panicot J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Otero-Viñas M. Medication Assessment in an Older Population during Acute Care Hospitalization and Its Effect on the Anticholinergic Burden: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5322. [PMID: 37047938 PMCID: PMC10094232 DOI: 10.3390/ijerph20075322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
(1) Background: Anticholinergic and sedative drugs (ASDs) contribute to negative health outcomes, especially in the frail population. In this study, we aimed to assess whether frailty increases with anticholinergic burden and to evaluate the effects of medication reviews (MRs) on ASD regimens among patients attending an acute care for the elderly (ACE) unit. (2) Methods: A cohort study was conducted between June 2019 and October 2020 with 150 consecutive patients admitted to our ACE unit. Demographic, clinical, and pharmacological data were assessed. Frailty score was determined using the Frail-VIG index (FI-VIG), and ASD burden was quantified using the drug burden index (DBI). In addition, the MR was performed using the patient-centered prescription (PCP) model. We used a paired T-test to compare the DBI pre- and post-MR and univariate and multivariate regression to identify the factors associated with frailty. (3) Results: Overall, 85.6% (n = 128) of participants showed some degree of frailty (FI-VIG > 0.20) and 84% (n = 126) of patients received treatment with ASDs upon admission (pre-MR). As the degree of frailty increased, so did the DBI (p < 0.001). After the implementation of the MR through the application of the PCP model, a reduction in the DBI was noted (1.06 ± 0.8 versus 0.95 ± 0.7) (p < 0.001). After adjusting for covariates, the association between frailty and the DBI was apparent (OR: 11.42, 95% (CI: 2.77-47.15)). (4) Conclusions: A higher DBI was positively associated with frailty. The DBI decreased significantly in frail patients after a personalized MR. Thus, MRs focusing on ASDs are crucial for frail older patients.
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Affiliation(s)
- Mariona Espaulella-Ferrer
- Servei Territorial de Geriatria i Cures Pal·Liatives d’Osona i el Ripollés, Hospital Universitari de la Santa Creu de Vic, Hospital Universitari de Vic, 08500 Vic, Spain
- Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Nuria Molist-Brunet
- Servei Territorial de Geriatria i Cures Pal·Liatives d’Osona i el Ripollés, Hospital Universitari de la Santa Creu de Vic, Hospital Universitari de Vic, 08500 Vic, Spain
- Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Joan Espaulella-Panicot
- Servei Territorial de Geriatria i Cures Pal·Liatives d’Osona i el Ripollés, Hospital Universitari de la Santa Creu de Vic, Hospital Universitari de Vic, 08500 Vic, Spain
- Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | | | - Emma Puigoriol-Juvanteny
- Epidemiology Department, Hospital Universitari de Vic, 08500 Vic, Spain
- Multidisciplinary Inflamations Research Group (MIRG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Marta Otero-Viñas
- Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
- Faculty of Science, Technology and Engineering, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
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15
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Wu S, Zhao Y, Ning H, Hu H, Feng H. Research progress in the hospitalization-associated disability among elderly patients. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:455-462. [PMID: 37164929 PMCID: PMC10930072 DOI: 10.11817/j.issn.1672-7347.2023.220333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Indexed: 05/12/2023]
Abstract
Hospitalized patients who lose one or more activities of daily living at the time of discharge compared with 2 weeks before admission (before acute onset) are referred to as hospitalization-associated disability (HAD). The incidence of HAD is high among elderly patients, which leads to the increased readmission rates, long-term care rates, and mortality, bringing a huge burden on patients, families, and society. It is vital for doctors and nurses to identify the risk factors of HAD of the elderly patients and take targeted intervention measures to prevent and improve HAD. At present, the research on HAD in foreign countries is relatively perfect, while the research on HAD in China is still in its infancy, and there is still lack of systematic research and reports on the incidence, influencing factors, and intervention measures of HAD. Domestic clinical nursing practice can learn from foreign mature interventions, carry out cultural adjustment, create a friendly environment in the hospital for elderly patients, pay attention to the assessment of the influencing factors of HAD in elderly patients, and provide personalized and patient-centered nursing measures for hospitalized elderly patients according to the assessment results, maintain their function during hospitalization and prevent the occurrence of HAD.
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Affiliation(s)
- Shuang Wu
- Xiangya Nursing School, Central South University, Changsha 410013.
| | - Yinan Zhao
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Hongting Ning
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Hengyu Hu
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Hui Feng
- Xiangya Nursing School, Central South University, Changsha 410013.
- Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha 410013, China.
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16
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Coelho-Júnior HJ, Marzetti E. Editorial: Mediterranean Diet, In-Hospital Exercise, and the Incidence of Hospital-Acquired Disability in Old Patients. J Nutr Health Aging 2023; 27:498-499. [PMID: 37498096 DOI: 10.1007/s12603-023-1939-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023]
Affiliation(s)
- H J Coelho-Júnior
- Hélio José Coelho-Júnior, Emanuele Marzetti, Center for Geriatric Medicine (Ce.M.I.), Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (H.J.C.-J), (E.M.); Tel: +39 (06) 3015-4859
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17
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Ijadi Maghsoodi A, Pavlov V, Rouse P, Walker CG, Parsons M. Efficacy of acute care pathways for older patients: a systematic review and meta-analysis. Eur J Ageing 2022; 19:1571-1585. [PMID: 36692788 PMCID: PMC9729482 DOI: 10.1007/s10433-022-00743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/18/2022] Open
Abstract
Meeting the needs of acute geriatric patients is often challenging, and although evidence shows that older patients need tailored care, it is still unclear which interventions are most appropriate. The objective of this study is to systematically evaluate the hospital-wide acute geriatric models compared with conventional pathways. The design of the study includes hospital-wide geriatric-specific models characterized by components including patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment, and follow-up after discharge. Primary and secondary outcomes were considered, including functional decline, activities of daily living (ADL), length-of-stay (LoS), discharge destination, mortality, costs, and readmission. A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 20 studies reporting on 15 trials and acutely admitted patients with an average age of 79, complex conditions and comorbidities to acute geriatric-specific pathways (N = 13,595) were included. Geriatric-specific models were associated with lower costs (weighted mean difference, WMD = - $174.98, 95% CI = -$332.14 to - $17.82; P = 0.03), and shorter LoS (WMD = - 1.11, 95% CI = - 1.39 to - 0.83; P < 0.001). No differences were found in functional decline, ADL, mortality, case fatalities, discharge destination, or readmissions. Geriatric-specific models are valuable for improving patient and system-level outcomes. Although several interventions had positive results, further research is recommended to study hospital-wide geriatric-specific models.
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Affiliation(s)
- Abtin Ijadi Maghsoodi
- Department of Information Systems and Operations Management, Faculty of Business and Economics, University of Auckland, Auckland, New Zealand ,Department of Intelligence & Insights, Te Whatu Ora Health New Zealand Waikato District, Hamilton, New Zealand
| | - Valery Pavlov
- Department of Information Systems and Operations Management, Faculty of Business and Economics, University of Auckland, Auckland, New Zealand
| | - Paul Rouse
- Department of Accounting and Finance, Faculty of Business and Economics , University of Auckland, Auckland, New Zealand
| | - Cameron G. Walker
- Department of Engineering Science, Faculty of Engineering , University of Auckland, Auckland, New Zealand
| | - Matthew Parsons
- School of Health , University of Waikato, Hamilton, New Zealand ,Te Whatu Ora Health New Zealand Waikato District, Hamilton, New Zealand
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18
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Rogers SE, Flood KL, Kuang QY, Harrison JD, Malone ML, Cremer J, Palmer RM. The current landscape of Acute Care for Elders units in the United States. J Am Geriatr Soc 2022; 70:3012-3020. [PMID: 35666631 PMCID: PMC9588489 DOI: 10.1111/jgs.17892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The clinical benefits of Acute Care for Elders (ACE) units have been established for over 25 years. However, how widely disseminated ACE units are in the United States and the degree of fidelity to the key elements of this model of care are unknown. Our objective was to identify all existing ACE units in the United States and to obtain detailed information about variations in implementation. METHODS The strategy to identify current ACE units began with online searches and snowball sampling using contacts from professional societies and workgroups. Next, a request for information regarding the existence of ACE units was sent to the remaining US hospitals listed in a national hospital database. An online survey was sent to identified ACE unit contacts to capture information on implementation characteristics and the five key elements of ACE units. RESULTS There were 3692 hospitals in the database with responses from 2055 (56%) hospitals reporting the presence or absence of an ACE unit. We identified 68 hospitals (3.3%) with an existing or previous ACE unit. Of these 68 hospitals, 50 (74%) completed the survey and reported that 43 ACE units were currently open and 7 had been closed. Of the 43 currently open ACE units, most are affiliated with an academic hospital and there is variable implementation of each of the five key ACE elements (from 69% to 98%). CONCLUSIONS Among the 50 hospitals to complete the survey, 43 current ACE units were identified, with variable fidelity to the key elements. Estimates of prevalence of ACE units and fidelity to key elements are limited by nonresponses to the national survey request by nearly half of hospitals.
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Affiliation(s)
- Stephanie E. Rogers
- Department of Medicine, Division of Geriatrics; University of California, San Francisco, San Francisco, CA 94143
| | - Kellie L. Flood
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care; University of Alabama at Birmingham, Birmingham, AL 35294
| | - Qiao Yu Kuang
- Department of Medicine, Division of Geriatrics; University of California, San Francisco, San Francisco, CA 94143
| | - James D. Harrison
- Department of Medicine, Division of Hospital Medicine; University of California, San Francisco, San Francisco, CA 94143
| | - Michael L. Malone
- Aurora Senior Services and Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI 53005
| | - Julia Cremer
- Department of Medicine, Division of Geriatrics; University of California, San Francisco, San Francisco, CA 94143
| | - Robert M. Palmer
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23501
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19
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Chang HC, Lu YY, Kao SL. Association of frailty and functional recovery in an Acute Care for Elders unit: a prospective observational study. BMC Geriatr 2022; 22:608. [PMID: 35864478 PMCID: PMC9306076 DOI: 10.1186/s12877-022-03290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Evidence on the effects of Acute Care for Elders (ACE) units in frail older adults remains limited. Therefore, we aimed to evaluate the effects of the ACE unit on functional outcomes in frail older adults. Methods In this prospective observational study, we enrolled 114 consecutive patients aged 65 years and older admitted to the ACE unit for acute medical conditions between October 2019 and September 2020. The FRAIL scale (5-question assessment of fatigue, resistance, aerobic capacity, illnesses, and loss of weight) was used to classify the patients into three groups: robust (score = 0, n = 28), prefrail (score = 1–2, n = 57), and frail (score = 3–5, n = 29). The primary outcome was the activities of daily living (ADL) measured by the Barthel Index at admission and before discharge. Paired sample t-test was employed to determine the difference in ADL. Multiple linear regression analysis, with adjustment for covariates, was conducted to examine the association between frailty status and change in ADL. Results Among 114 patients enrolled (mean age, 79.8 ± 8.1 years; mean length of stay, 6.4 ± 5.6 days), 77 (67.5%) were female. ADL at admission (60.3 ± 31.9) and before discharge (83.7 ± 21.6) were significantly different (P < 0.001). After covariates adjustment, a significant association between frailty status and change in ADL was found (prefrail vs. robust: β = 9.0, 95% confidence interval [CI] 0.3–17.6, P = 0.04; frail vs. robust: β = 13.4, 95% CI 2.7–24.0, P = 0.01). Conclusions Older adults with frailty experienced functional improvement after admission to the ACE unit. Prefrail and frail groups were associated with a more significant change in ADL between admission and discharge compared to the robust group.
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Affiliation(s)
- Hsiao-Chen Chang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd, Hualien, 97002, Taiwan
| | - Yi-Yen Lu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Sheng-Lun Kao
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd, Hualien, 97002, Taiwan. .,Department of Family Medicine, Tzu Chi University, Hualien, Taiwan. .,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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20
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Merchant RA, Ho VWT, Chen MZ, Wong BLL, Lim Z, Chan YH, Ling N, Ng SE, Santosa A, Murphy D, Vathsala A. Outcomes of Care by Geriatricians and Non-geriatricians in an Academic Hospital. Front Med (Lausanne) 2022; 9:908100. [PMID: 35733862 PMCID: PMC9208654 DOI: 10.3389/fmed.2022.908100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction While hospitalist and internist inpatient care models dominate the landscape in many countries, geriatricians and internists are at the frontlines managing hospitalized older adults in countries such as Singapore and the United Kingdom. The primary aim of this study was to determine outcomes for older patients cared for by geriatricians compared with non-geriatrician-led care teams. Materials and Methods A retrospective cohort study of 1,486 Internal Medicine patients aged ≥75 years admitted between April and September 2021 was conducted. They were either under geriatrician or non-geriatrician (internists or specialty physicians) care. Data on demographics, primary diagnosis, comorbidities, mortality, readmission rate, Hospital Frailty Risk Score (HFRS), Age-adjusted Charlson Comorbidity Index, Length of Stay (LOS), and cost of hospital stay were obtained from the hospital database and analyzed. Results The mean age of patients was 84.0 ± 6.3 years, 860 (57.9%) females, 1,183 (79.6%) of Chinese ethnicity, and 902 (60.7%) under the care of geriatricians. Patients under geriatrician were significantly older and had a higher prevalence of frailty, dementia, and stroke, whereas patients under non-geriatrician had a higher prevalence of diabetes and hypertension. Delirium as the primary diagnosis was significantly higher among patients under geriatrician care. Geriatrician-led care model was associated with shorter LOS, lower cost, similar inpatient mortality, and 30-day readmission rates. LOS and cost were lower for patients under geriatrician care regardless of frailty status but significant only for low and intermediate frailty groups. Geriatrician-led care was associated with significantly lower extended hospital stay (OR 0.73; 95% CI 0.56–0.95) and extended cost (OR 0.69; 95% CI 0.54–0.95). Conclusion Geriatrician-led care model showed shorter LOS, lower cost, and was associated with lower odds of extended LOS and cost.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: Reshma Aziz Merchant,
| | - Vanda Wen Teng Ho
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Beatrix Ling Ling Wong
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Zhiying Lim
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Natalie Ling
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Shu Ee Ng
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Amelia Santosa
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Diarmuid Murphy
- Value Driven Outcomes Office, National University Health System, Singapore, Singapore
| | - Anantharaman Vathsala
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore, Singapore
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21
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Norman RE, Sinha SK. Patient outcomes related to receiving care on a dedicated Acute Care for Elders (ACE) unit versus with an ACE order set. J Am Geriatr Soc 2022; 70:2101-2106. [PMID: 35415840 DOI: 10.1111/jgs.17788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Acute Care for Elders (ACE) unit model of care aims to reduce common complications of hospitalization in older adults through early involvement of allied health providers, changes to the care environment, elder-friendly care protocols, and proactive discharge planning. Our hospital established a dedicated 28-bed medical ACE unit. Because of capacity limitations, the number of eligible older medical patients often exceeds the available number of beds. Thus, some ACE unit-eligible patients are instead admitted to other medical or surgical units for their medical care. These "bed-spaced" ACE patients receive care by the same general internists and ACE order set that ACE unit patients are cared under. We sought to compare the health outcomes of ACE-designated patients admitted to the ACE unit versus bed-spaced peers cared for using a protocolized ACE order set. METHODS 3046 ACE-designated patient admissions were analyzed (1499 ACE unit and 1547 bed-spaced). The primary outcomes examined were discharge disposition and in-hospital mortality. Univariate and multivariate comparisons were performed. Propensity matching was used to adjust for case mix in a post-hoc analysis. RESULTS The mean age of participants was 83.5 years for ACE unit patients and 82.6 for bedspaced patients. In adjusted models, ACE unit patients were more likely to be discharged home (OR 1.28 [1.08-1.50], p = 0.003). In an unadjusted analysis, patients admitted to ACE unit were less likely to die in hospital, but this finding did not persist after adjustment for case mix. CONCLUSION Care of older adults delivered on a dedicated ACE unit increases the likelihood of discharge to home when compared to care delivered with an ACE order set alone for general internal medicine patients.
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Affiliation(s)
- Richard E Norman
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Sinai Health and University Health Network, Toronto, Canada
| | - Samir K Sinha
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Sinai Health and University Health Network, Toronto, Canada
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Ramos A, Fonseca C, Pinho L, Lopes M, Brites R, Henriques A. Assessment of Functioning in Older Adults Hospitalized in Long-Term Care in Portugal: Analysis of a Big Data. Front Med (Lausanne) 2022; 9:780364. [PMID: 35372382 PMCID: PMC8964623 DOI: 10.3389/fmed.2022.780364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Functioning assessment is a key tool for health professionals to characterize the person's degree of dependence and plan care. Objectives The objectives were: (1) know the functioning components of older adults hospitalized in the National Network of Continuous Integrated Health Care (NNCIHC) in Portugal; and (2) compare the conceptual frameworks used in this network with the International Classification of Functioning, Disability and Health (ICF). Methods A longitudinal retrospective study is made with 171,414 individuals aged 65 years and over. The Principal Components Analysis (PCA) was realized to reduce the number of variables, previously suggested by a scoping review, about the concepts that characterize the functionality. Then, a consensus meeting was held, where the items were matched with the ICF. Results The average age of the sample is 80.17 years old (SD = 7.383), predominantly female (59%), without a spouse (54%), and with <6 years of education (56.4%). Four concepts were grouped: mobility, life daily activities, instrumental activities, and cognitive status that demonstrated good internal consistency. Most items correspond to ICF, except for the item "taking medication." Conclusion Theoretical and conceptual similarities support the use of instruments based on the ICF in Portugal's healthcare network. We suggest that ICF also encompasses a specific dimension related to medication management, given its importance for people's health.
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Affiliation(s)
- Ana Ramos
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisboa, Portugal
| | - César Fonseca
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Lara Pinho
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Manuel Lopes
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Rui Brites
- Instituto Superior de Economia e Gestão, Universidade de Lisboa, Lisboa, Portugal
| | - Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisboa, Portugal.,Faculdade de Medicina, Instituto de Saúde Ambiental (ISAMB), Universidade de Lisboa, Lisboa, Portugal
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Naughton C, Cummins H, de Foubert M, Barry F, McCullagh R, Wills T, Skelton DA, Dahly D, Palmer B, Murphy A, McHugh S, O'Mahony D, Tedesco S, O Sullivan B. Implementation of the Frailty Care Bundle (FCB) to promote mobilisation, nutrition and cognitive engagement in older people in acute care settings: protocol for an implementation science study. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13473.1] [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] Open
Abstract
Background: Older people are among the most vulnerable patients in acute care hospitals. The hospitalisation process can result in newly acquired functional or cognitive deficits termed hospital associated decline (HAD). Prioritising fundamental care including mobilisation, nutrition, and cognitive engagement can reduce HAD risk. Aim: The Frailty Care Bundle (FCB) intervention aims to implement and evaluate evidence-based principles on early mobilisation, enhanced nutrition and increased cognitive engagement to prevent functional decline and HAD in older patients. Methods: A hybrid implementation science study will use a pragmatic prospective cohort design with a pre-post mixed methods evaluation to test the effect of the FCB on patient, staff, and health service outcomes. The evaluation will include a description of the implementation process, intervention adaptations, and economic costs analysis. The protocol follows the Standards for Reporting Implementation Studies (StaRI). The intervention design and implementation strategy will utilise the behaviour change theory COM-B (capability, motivation, opportunity) and the Promoting Action on Research Implementation in Health Services (i-PARIHS). A clinical facilitator will use a co-production approach with staff. All patients will receive care as normal, the intervention is delivered at ward level and focuses on nurses and health care assistants (HCA) normative clinical practices. The intervention will be delivered in three hospitals on six wards including rehabilitation, acute trauma, medical and older adult wards. Evaluation: The evaluation will recruit a volunteer sample of 180 patients aged 65 years or older (pre 90; post 90 patients). The primary outcomes are measures of functional status (modified Barthel Index (MBI)) and mobilisation measured as average daily step count using accelerometers. Process data will include ward activity mapping, staff surveys and interviews and an economic cost-impact analysis. Conclusions: This is a complex intervention that involves ward and system level changes and has the potential to improve outcomes for older patients.
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Flaherty JH, Rodin MB, Morley JE. Changing Hospital Care For Older Adults: The Case for Geriatric Hospitals in the United States. Gerontol Geriatr Med 2022; 8:23337214221109005. [PMID: 35813982 PMCID: PMC9260589 DOI: 10.1177/23337214221109005] [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: 11/17/2022] Open
Abstract
Hospital care of frail older adults is far from optimal. Although some geriatric models of care have been shown to improve outcomes, the effect size is small and models are difficult to fully implement, sustain and replicate. The two root causes for these shortcomings are competing interests (high revenue generating diseases, procedures and surgeries) and current hospital cultures (for example a culture of safety that emphasizes bed alarms and immobility rather than frequent ambulation). Geriatric hospitals would be hospitals completely dedicated to the care of frail older patients, a group which is most vulnerable to the negative consequences of a hospitalization. They would differ from a typical adult hospital because they could implement evidence based principles of successful geriatric models of care on a hospital wide basis, which would make them sustainable and allow for scaling up of proven outcomes. Innovative structural designs, unachievable in a typical adult hospital, would enhance mobility while maintaining safety. Financial viability and stability would be a challenge but should be feasible, likely through affiliation with larger health care systems with other hospitals because of cost savings associated with geriatric models of care (decreased length of stay, increased likelihood of discharge home, without increasing costs).
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Affiliation(s)
- Joseph H Flaherty
- Regional Medical Director of Geriatrics, Envision Physician Services, Dallas, Texas, Division of Geriatrics, University of Texas Southwestern, Dallas, Texas, USA
| | - Miriam B Rodin
- Division of Geriatrics, Department of Internal Medicine, Saint Louis University, St Louis, Missouri
| | - John E Morley
- Division of Geriatrics, Department of Internal Medicine, Saint Louis University, St Louis, Missouri
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Ferretti-Rebustini REDL, Souza-Talarico JND, Fhon JRS, Greenberg SA. El papel de la evaluación en la enfermería de práctica avanzada gerontológica basada en competencias. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0072es] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
RESUMEN El envejecimiento de la población es un desafío a los sistemas de salud y requiere que los profesionales de enfermería en gerontología de práctica avanzada (EGPA) aborden los requisitos específicos y complejos del cuidado de los adultos mayores. La EGPA pone en ejecución prácticas basadas en evidencia dirigidas a pacientes y familiares para la promoción y protección de la salud, prevención de enfermedades, así como su recuperación y rehabilitación. En la gerontología de práctica avanzada basada en competencias, la evaluación integral es esencial para la puesta en práctica de un plan de cuidados. En este ensayo teórico reflexionamos sobre el papel de la evaluación en la enfermería en gerontología de práctica avanzada basada en competencias. Desde nuestro punto de vista, la valoración gerontológica hacia una práctica excelente debe ser integral, multidimensional, interdisciplinar y planificada. La EGPA debe abarcar competencias efectivas en habilidades clínicas y prácticas del cuidado; alfabetización en salud; cuidado colaborativo; gestión de sistemas para la continuidad del cuidado; ética, defensa y agencia moral; y la práctica a través de la investigación basada en la evidencia. Los modelos gerontológicos de cuidado y las competencias de la EGPA sirven como marco de su práctica, mientras que la evaluación es fundamental para un cuidado accesible a los adultos mayores.
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Daly RM, Iuliano S, Fyfe JJ, Scott D, Kirk B, Thompson MQ, Dent E, Fetterplace K, Wright ORL, Lynch GS, Zanker J, Yu S, Kurrle S, Visvanathan R, Maier AB. Screening, Diagnosis and Management of Sarcopenia and Frailty in Hospitalized Older Adults: Recommendations from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Expert Working Group. J Nutr Health Aging 2022; 26:637-651. [PMID: 35718874 DOI: 10.1007/s12603-022-1801-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sarcopenia and frailty are highly prevalent conditions in older hospitalized patients, which are associated with a myriad of adverse clinical outcomes. This paper, prepared by a multidisciplinary expert working group from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR), provides an up-to-date overview of current evidence and recommendations based on a narrative review of the literature for the screening, diagnosis, and management of sarcopenia and frailty in older patients within the hospital setting. It also includes suggestions on potential pathways to implement change to encourage widespread adoption of these evidence-informed recommendations within hospital settings. The expert working group concluded there was insufficient evidence to support any specific screening tool for sarcopenia and recommends an assessment of probable sarcopenia/sarcopenia using established criteria for all older (≥65 years) hospitalized patients or in younger patients with conditions (e.g., comorbidities) that may increase their risk of sarcopenia. Diagnosis of probable sarcopenia should be based on an assessment of low muscle strength (grip strength or five times sit-to-stand) with sarcopenia diagnosis including low muscle mass quantified from dual energy X-ray absorptiometry, bioelectrical impedance analysis or in the absence of diagnostic devices, calf circumference as a proxy measure. Severe sarcopenia is represented by the addition of impaired physical performance (slow gait speed). All patients with probable sarcopenia or sarcopenia should be investigated for causes (e.g., chronic/acute disease or malnutrition), and treated accordingly. For frailty, it is recommended that all hospitalized patients aged 70 years and older be screened using a validated tool [Clinical Frailty Scale (CFS), Hospital Frailty Risk Score, the FRAIL scale or the Frailty Index]. Patients screened as positive for frailty should undergo further clinical assessment using the Frailty Phenotype, Frailty Index or information collected from a Comprehensive Geriatric Assessment (CGA). All patients identified as frail should receive follow up by a health practitioner(s) for an individualized care plan. To treat older hospitalized patients with probable sarcopenia, sarcopenia, or frailty, it is recommended that a structured and supervised multi-component exercise program incorporating elements of resistance (muscle strengthening), challenging balance, and functional mobility training be prescribed as early as possible combined with nutritional support to optimize energy and protein intake and correct any deficiencies. There is insufficient evidence to recommend pharmacological agents for the treatment of sarcopenia or frailty. Finally, to facilitate integration of these recommendations into hospital settings organization-wide approaches are needed, with the Spread and Sustain framework recommended to facilitate organizational culture change, with the help of 'champions' to drive these changes. A multidisciplinary team approach incorporating awareness and education initiatives for healthcare professionals is recommended to ensure that screening, diagnosis and management approaches for sarcopenia and frailty are embedded and sustained within hospital settings. Finally, patients and caregivers' education should be integrated into the care pathway to facilitate adherence to prescribed management approaches for sarcopenia and frailty.
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Affiliation(s)
- R M Daly
- Professor Robin M. Daly, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Victoria, Australia 3125, Phone: +61 3 9244 6040, , ORCID ID: 0000-0002-9897-1598
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Ferretti-Rebustini REDL, Souza-Talarico JND, Fhon JRS, Greenberg SA. The role of assessment in competence-based gerontological advanced practice nursing. Rev Esc Enferm USP 2022; 56:e20220072. [DOI: 10.1590/1980-220x-reeusp-2022-0072en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/27/2022] [Indexed: 11/07/2022] Open
Abstract
ABSTRACT Population aging challenges healthcare systems, requiring gerontological advanced practice nurses (GAPN) to address specific and complex care requirements of older adults. GAPN implement evidence-based practices directed to patients and families, focusing on health promotion and protection, disease prevention, recovery, and rehabilitation. In competence-based gerontological advanced practice, comprehensive geriatric assessment is essential for implementing the care plan. In this theoretical essay we reflect about the role of assessment in competence-based advanced nursing practice directed to the care of older adults. From our perspective, geriatric assessment for a high-quality practice must be comprehensive, multidimensional, interdisciplinary, and planned. GAPN must have solid competencies for clinical skills and caring practices; education for health literacy; collaborative care; system management for continuity of care; ethics, advocacy, and moral agency; and evidenced-based practice inquiry. Gerontological models of care and GAPN competencies serve as frameworks to guide practice while assessment is fundamental for providing age-friendly care to older adults.
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Geen O, Rochwerg B, Wang XM. Optimisation des soins chez les personnes âgées gravement malades. CMAJ 2021; 193:E1850-1859. [PMID: 34872961 PMCID: PMC8648358 DOI: 10.1503/cmaj.210652-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Olivia Geen
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont.
| | - Bram Rochwerg
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont
| | - Xuyi Mimi Wang
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont
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Hansen TK, Pedersen LH, Shahla S, Damsgaard EM, Bruun JM, Gregersen M. Effects of a new early municipality-based versus a geriatric team-based transitional care intervention on readmission and mortality among frail older patients - a randomised controlled trial. Arch Gerontol Geriatr 2021; 97:104511. [PMID: 34479071 DOI: 10.1016/j.archger.2021.104511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/22/2023]
Abstract
Purpose Previous studies reported reduced risk of readmission, mortality and shorter length of hospital stay (LOS) among geriatric patients receiving an early (<24h), hospital-based geriatric team intervention after discharge. The objective of this study was to compare a novel, early municipality-based, nurse-led and general practitioner (GP)-supported transitional care intervention (TCI) to an established hospital-based TCI among frail, older, geriatric patients. Material and methods A randomised controlled trial was conducted within a single geriatric department and the adjacent municipality. Inclusion criteria: acutely admitted, frail patients 75+ years old. Eligible patients were randomly allocated (1:1) to the two TCIs. Primary outcome was 30-day unplanned readmission. Secondary outcomes were 90-day all-cause mortality and LOS. Stratified analysis according to type of dwelling was made. Odds ratios (OR) with 95% confidence intervals (CI), and number needed to treat (NNT) were reported. Results 3,103 patients (median age (IQR): 85 (80-90); 57% female) were included. Readmission rates were 22% in the municipality-based intervention (n=332/1,545), and 18% in the hospital-based intervention (n=276/1,558); OR was 1.27, 95% CI (1.06-1.52), p=0.008 and NNT=27. OR for cohabiting patients was 1.47, 95% CI (1.02-2.08); p=0.035. No significant difference was observed in mortality (22% vs. 21%; OR=1.05, 95% CI (0.89-1.25), p=0.577) or LOS (median (IQR): 6 (2-8) vs. 6 (2-8) days, p=0.1787). Conclusions The new municipality-based, nurse-led and GP-supported intervention was inferior to the hospital-based geriatric team intervention in preventing 30-day readmission among frail, geriatric patients. There was no significant difference between the two interventions in regard to 90-day mortality or LOS.
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Affiliation(s)
| | | | - Seham Shahla
- Medical Department, Randers Regional Hospital, Randers, Denmark
| | - Else Marie Damsgaard
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Meldgaard Bruun
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Affiliation(s)
- Olivia Geen
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont.
| | - Bram Rochwerg
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont
| | - Xuyi Mimi Wang
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont
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Kresevic D, Pettis JL. Acute care for elders (ACE) units - ensuring age-friendly interdisciplinary care for older. Geriatr Nurs 2021; 42:776-779. [PMID: 34006402 DOI: 10.1016/j.gerinurse.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Denise Kresevic
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106 USA.
| | - Jennifer L Pettis
- Acting Director, Programs, NICHE, NYU Meyers College of Nursing, 380 Second Avenue, Suite 306, New York, NY 10010 USA.
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Sokas C, Yeh IM, Coogan K, Bernacki R, Mitchell S, Bader A, Ladin K, Palmer JA, Tulsky JA, Cooper Z. Older Adult Perspectives on Medical Decision Making and Emergency General Surgery: "It had to be Done.". J Pain Symptom Manage 2021; 61:948-954. [PMID: 33038427 PMCID: PMC8024409 DOI: 10.1016/j.jpainsymman.2020.09.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/21/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
CONTEXT Optimal surgical care for older adults with life-threatening conditions, with high risk of poor perioperative outcomes and morality in the months after surgery, should incorporate an understanding of the patient's treatment goals and preferences. However, little research has explored the patient perspective of decision making and advanced care planning during an emergency surgery episode. OBJECTIVES We sought to better understand older patients' lived experience making decisions to undergo emergency general surgery (EGS) and perceptions of perioperative advance care planning (ACP). METHODS Adults aged 65 and older who underwent one of seven common EGS procedures with lengths of stay more than five days at three Boston-area hospitals were included. Semistructured phone interviews were conducted three months postdischarge. Transcripts were reviewed and coded independently by surgeons and palliative care physicians to identify themes. RESULTS About 31 patients were interviewed. Patients viewed the decision for surgery as a choice of life over death and valued prolonging life. They felt there was no choice but to proceed with surgery but reported that participation in decision making was limited because of severe symptoms, time constraints, and confused thinking. Despite recently surviving a life-threatening illness, patients had not reconsidered their wishes for the future and preferred to avoid future ACP. CONCLUSION Older patients who survived a life-threatening illness and EGS report receiving goal-concordant care in the moment that relieved symptoms and prolonged life but had not considered future care. Interventions to facilitate postoperative ACP should be targeted to this vulnerable group of older adults.
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Affiliation(s)
- Claire Sokas
- Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts, USA
| | - Irene M Yeh
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kathleen Coogan
- Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts, USA
| | - Rachelle Bernacki
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Susan Mitchell
- Hebrew SeniorLife Arthur and Hinda Marcus Institute for Aging Research, Boston, Massachusetts, USA
| | - Angela Bader
- Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts, USA; Department of Anesthesia, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Keren Ladin
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts, USA
| | - Jennifer A Palmer
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA; Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - James A Tulsky
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Zara Cooper
- Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts, USA; Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA.
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Li Y, Lin Y, Bai H. Effects of a structured team nursing model on the efficacy and quality of cardiopulmonary resuscitation in myocardial infarction patients undergoing PCI. Am J Transl Res 2021; 13:3129-3137. [PMID: 34017481 PMCID: PMC8129222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effects of a structured team nursing model on the efficacy and quality of cardiopulmonary resuscitation (CPR) in acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI). METHODS With the random number table, 130 myocardial infarction patients undergoing PCI were divided into two groups, including the control group (n=65) receiving routine emergency resuscitation and nursing care, and the study group (n=65) receiving a structured team care model. The efficacy of CPR, cardiac function, exercise tolerance, ability of daily living activities, quality of life, complication rate and nursing satisfaction were compared between the two groups. RESULTS The door-to-balloon time, length of stay at the emergency department, duration of balloon dilation, bedtime and hospital stay in the study group were shorter than those in the control group (P<0.05). The study group showed lower LVEDD and LVESD and higher LVEF than the control group after nursing (P<0.05). The extend of physical limitation, angina stability, level of disease awareness, number of angina attacks, and treatment satisfaction scores in the 6-MWT, MBI, and SAQ scales in the study group after nursing were higher than those in the control group (P<0.05). The complication rate in the study group (7.69%) was lower than that in the control group (20.00%) (P<0.05). The study group had higher satisfaction with operational skills, teamwork, clinical practice, rescue awareness, orderliness, and timeliness than the control group (P<0.05). CONCLUSION Structured team nursing model is helpful to improve the timeliness and quality of CRP, shorten the treatment time, improve patients' cardiac function and exercise tolerance, improve self-care ability and quality of life, reduce the occurrence of complications, and enhance the patient-nurse relationship.
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Affiliation(s)
- Yangyujing Li
- Department of Emergency, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430014, Hubei Province, China
| | - Yin Lin
- Department of Emergency, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430014, Hubei Province, China
| | - Haitao Bai
- Department of Emergency, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430014, Hubei Province, China
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Koenders N, Marcellis L, Nijhuis-van der Sanden MW, Satink T, Hoogeboom TJ. Multifaceted interventions are required to improve physical activity behaviour in hospital care: a meta-ethnographic synthesis of qualitative research. J Physiother 2021; 67:115-123. [PMID: 33753014 DOI: 10.1016/j.jphys.2021.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
QUESTION What are the views of patients, close relatives and healthcare professionals on physical activity behaviour in hospital care? METHODS A meta-ethnographic synthesis of qualitative studies was conducted with a lines-of-argument analysis. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. The lines of argument were synthesised and mapped in an existing theoretical model. The confidence of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. RESULTS Eleven studies were included and provided data from 290 participants (145 patients, 0 close relatives and 145 healthcare professionals). We have synthesised six lines of argument that explained the (intention of) physical activity behaviour of patients during their hospital stay: patients and healthcare professionals perceive benefits and risks of physical activity for patients' health (high confidence); physical activity gives a sense of freedom, confidence in recovery and mental wellbeing (high confidence); all healthcare professionals should offer timely and tailored physical activity promotion (high confidence); patient motivation to be physically active may be contingent upon encouragement (moderate confidence); family members can influence physical activity behaviour favourably or unfavourably (low confidence); and hospital culture has a negative influence on physical activity behaviour of patients (high confidence). CONCLUSIONS Physical activity behaviour of patients during their hospital stay is a complex phenomenon with multiple interactions at the level of patients, healthcare professionals and hospital culture. Considering the results of this synthesis, multifaceted implementation strategies are needed to improve physical activity intention and behaviour of patients during their hospital stay.
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Affiliation(s)
- Niek Koenders
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
| | - Laura Marcellis
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Maria Wg Nijhuis-van der Sanden
- Department of Allied Healthcare Sciences of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Ton Satink
- Neurorehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Department of Allied Healthcare Sciences of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Reyes B, Diaz S, Engstrom G, Ouslander J. Adherence to care transitions recommendations among high-risk hospitalized older patients. J Am Geriatr Soc 2021; 69:1638-1645. [PMID: 33772760 DOI: 10.1111/jgs.17137] [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: 01/06/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVES Evidence on the effectiveness of inpatient hospital geriatric consultation is scant, and it is unknown whether adherence to specific recommendations will improve care and patient outcomes. This study was conducted to provide insights from a quality improvement project that may help guide further improvements in the effectiveness of these consultations made as a component of a care transitions program (CTP). DESIGN Secondary analysis of the implementation of a multicomponent CTP for high-risk hospitalized patients aged 75 and older. SETTING A 400-bed community teaching hospital. PARTICIPANTS Two hundred and two patients admitted to non-ICU beds who met high-risk criteria. INTERVENTION Inpatient comprehensive geriatric consultation including care transition recommendations, telephone and in-person follow-up weekly for 4 weeks after discharge, and collaboration with post-acute organizations and primary care and specialist physicians to implement recommendations. MEASUREMENTS Primary outcomes for this analysis was 30-day hospital readmissions and adherence to transition of care recommendations. RESULTS The 142 patients with at least one post-discharge visit received 936 care transition recommendations. Overall, 663 (71%) of the 936 care transition recommendations were adhered to (71%). The adherence rate was lower in the 22 patients who were readmitted to the hospital within 30 days (63%) compared to 72% adherence in the 120 patients who were not readmitted. This was not a statistically significant difference, and there were no significant differences in the number and percent adherence in any recommendation category between the two groups. CONCLUSION We found adherence to just over two-thirds of care transition recommendations, similar to a small number of other studies. We did not find a relationship between the number of recommendations and adherence to them with 30-day readmissions to the hospital. Future studies of CTPs should consider several strategies may enhance geriatric consultation care transitions recommendations and adherence to them, and improve patient outcomes.
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Affiliation(s)
- Bernardo Reyes
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Sanya Diaz
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Gabriella Engstrom
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Joseph Ouslander
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
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Liebzeit D, Haske-Palomino M, Gatley L, Boltz M. Nurses' experiences with an inpatient geriatric consulting service at a Midwestern Veterans' hospital: The elder veteran program. Geriatr Nurs 2021; 42:317-324. [PMID: 33556899 DOI: 10.1016/j.gerinurse.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/29/2022]
Abstract
This qualitative project used conventional content analysis of interview data to examine nurses' experience with and perception of the Elder Veteran Program, an inpatient geriatric consulting service, at a midwestern Veterans' hospital. Nurses were recruited from nursing units utilizing the program and completed individual interviews (N = 10). Participants described the impact of the program within four categories: providing comprehensive care to patients, contributing to individual growth of nurses, promoting team-based care, and as a resource. Participants described several barriers and facilitators to implementation of the program on their unit, including workload and time, shifts and availability of program staff, perceived need, inclusion criteria, perception of program staff, education of nurses, communication, and the inpatient environment. This project provides opportunities for further examination of healthcare providers' experience with inpatient geriatric programs, how those experiences may relate to effectiveness of programs, and important areas of support for hospital staff.
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Affiliation(s)
- Daniel Liebzeit
- The University of Iowa College of Nursing USA; Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | | | - Liza Gatley
- William S. Middleton Memorial Veterans Hospital, Nursing Services, Madison, WI, USA.
| | - Marie Boltz
- Pennsylvania State University College of Nursing USA.
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Bomze L, Dehom S, Lao WP, Thompson J, Lee N, Cragoe A, Luceno C, Crawley B. Comorbid Dysphagia and Malnutrition in Elderly Hospitalized Patients. Laryngoscope 2021; 131:2441-2447. [PMID: 33493366 DOI: 10.1002/lary.29329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE/HYPOTHESIS Elderly individuals account for one-third of all hospitalizations. The goal of this study was to evaluate the prevalence of dysphagia in elderly patients admitted to a tertiary care center. It also sought to investigate how dysphagia is identified, how it covaries with malnutrition and other conditions, and how it impacts hospital stay. STUDY DESIGN Case Series. METHODS A retrospective chart review was performed. All patients >65 years admitted to a tertiary care center in January and February 2016 were included. Patients with primary psychiatric diagnoses and patients with upper aerodigestive tract malignancy or surgery were excluded. RESULTS A total of 655 patients were identified. Mean age was 76.6 years. Twenty-four percent (155 patients) had dysphagia while 43% (282 patients) had malnutrition. Thirteen percent (84 patients) had both dysphagia and malnutrition. Fifty percent of patients who had malnutrition were seen by speech language pathology (SLP). One hundred percent of malnourished patients that saw SLP were identified as having dysphagia. Three hundred and eighty-two patients (58%) were seen by the dietician but not by SLP. Multiple logistic regression indicated that the presence of dysphagia was positively associated with age, presence of malnutrition, admission to either cardiology or neurology service as compared to medicine service, and history of stroke. CONCLUSIONS One-quarter of elderly patients admitted to our tertiary care center had dysphagia. Dysphagia, especially when linked with malnutrition, has poorer outcomes and increased healthcare costs. Our data suggests a possible disconnect between malnutrition diagnosis and dysphagia identification. This is an important area of intervention that has the potential to improve the treatment and outcomes of these patients. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Laura Bomze
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A
| | - Salem Dehom
- School of Nursing, Loma Linda University, Loma Linda, California, U.S.A
| | - Wilson P Lao
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A
| | - Jordan Thompson
- School of Medicine, Loma Linda University, Loma Linda, California, U.S.A
| | - Nathan Lee
- School of Medicine, Loma Linda University, Loma Linda, California, U.S.A
| | - Andrea Cragoe
- School of Medicine, Loma Linda University, Loma Linda, California, U.S.A
| | - Cesar Luceno
- School of Medicine, Loma Linda University, Loma Linda, California, U.S.A
| | - Brianna Crawley
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A.,Voice and Swallowing Center, Loma Linda University, Redlands, California, U.S.A
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38
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Powers JS. Geriatric Care Models. Geriatrics (Basel) 2021; 6:geriatrics6010006. [PMID: 33445434 PMCID: PMC7838773 DOI: 10.3390/geriatrics6010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/07/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- James S. Powers
- The Department of Veterans Affairs Tennessee Valley Healthcare System Geriatrics Research, Education, and Clinical Center, Nashville, TN 37212, USA;
- The Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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Chodos AH, Cassel CK, Ritchie CS. Can the Safety Net be Age-Friendly? How to Address Its Important Role in Caring for Older Adults with Geriatric Conditions. J Gen Intern Med 2020; 35:3338-3341. [PMID: 32632790 PMCID: PMC7661593 DOI: 10.1007/s11606-020-06010-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/23/2020] [Indexed: 01/26/2023]
Abstract
The safety net, a collection of public hospitals, federally qualified health centers (FQHCs), and publicly funded community-based healthcare entities, provides essential care to middle-aged and older adults with geriatric conditions. The role of the safety net for these adults will intensify over the next two decades with the growing numbers of middle-aged and older adults with adverse social determinants of health and premature geriatric conditions. The foundation for addressing their needs is to detect geriatric conditions and then focus care plans on the impact of these factors on function, which predicts mortality and quality of life more than chronic conditions alone. To detect geriatric conditions in safety net populations, the Age-Friendly Health System (AFHS) framework offers an evidence-based focus on the 4Ms: Mentation, Mobility, Medications, and what Matters. Further incorporating geriatric care models that target the 4Ms and are adapted to safety net populations will enable age-friendly care that optimizes health and addresses what matters to older people.
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Affiliation(s)
- Anna Haseltine Chodos
- Division of Geriatric, Department of Medicine, University of California, San Francisco, CA, USA. .,Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Christine Karen Cassel
- Division of Geriatric, Department of Medicine, University of California, San Francisco, CA, USA
| | - Christine Seel Ritchie
- Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
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Sokas CM, Cowan J, Dalton MK, Coogan K, Bader A, Bernacki R, Orkaby AR, Cooper Z. Association Between Patient-Reported Frailty and Non-Home Discharge Among Older Adults Undergoing Surgery. J Am Geriatr Soc 2020; 68:2909-2913. [PMID: 33031587 DOI: 10.1111/jgs.16846] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Identifying surgical patients at risk for discharge to a post-acute facility has the potential to reduce hospital length of stay, improve postoperative planning, and increase patient satisfaction. We sought to examine the association between a positive response to a preoperative patient-reported frailty screen and non-home discharge (NHD). DESIGN Prospective cohort. SETTING Urban tertiary academic preoperative evaluation center. PARTICIPANTS Convenience sample of patients aged 60 and older evaluated from November 2018 to August 2019) undergoing one of 14 major elective general and vascular operations with an expected length of stay of 3 days or longer. METHODS Items from the previously validated Fatigue, Resistance, Ambulation, Illnesses, Loss of weight (FRAIL) screen were modified, and patients were queried on fatigue, activity against resistance, ambulation, and weight loss. Multivariable logistic regression adjusting for age and sex was used to determine the association between patient-reported items and NHD. RESULTS A total of 230 patients were included for analysis. The average age of the cohort was 70.1 (standard deviation = 7.1); 91.7% were White, and 52.4% were female. There were 24 patients (10.4%) who were not discharged home. They were more likely to report fatigue (54% vs 29%; P = .01), weight loss (58% vs 21%; P < .01), and difficulty with activity against resistance (33% vs 7%; P < .01) before surgery. In adjusted analysis, patients who self-reported frailty (FRAIL screen ≥2) were significantly more likely to have an NHD (odds ratio [OR] = 4.5; 95% confidence interval [CI] = 1.7-11.7; P < .01), as were patients who responded "yes" to any question from the FRAIL screen (OR = 2.5; 95% CI = 1.7-3.5; P < .01). A positive response to difficulty with activity against resistance or recent weight loss showed similar odds of NHD (OR = 7.6; 95% CI = 2.6-23.9; P < .01; and OR = 7.9; 95% CI = 2.9-21.6; P < .01, respectively). CONCLUSION Patient response to screening questions on the FRAIL screen identified those at highest risk of NHD. The FRAIL screening tool is practical, easy to apply, and could be used during preoperative counseling to identify patients likely to have increased discharge planning needs.
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Affiliation(s)
- Claire M Sokas
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jane Cowan
- Department of Surgery, Columbia University, New York, New York, USA
| | - Michael K Dalton
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kathleen Coogan
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Angela Bader
- Department of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rachelle Bernacki
- Psychosocial Oncology and Palliative Care, Dana Farber Institute, Boston, Massachusetts, USA
| | - Ariela R Orkaby
- New England GRECC, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Interprofessional Collaboration: A Model for Nurse Executives to Follow to Support Magnet® Designation. J Nurs Adm 2020; 50:E8-E11. [PMID: 32925667 DOI: 10.1097/nna.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This case study reveals how 1 organization moved beyond traditional professional boundaries to achieve Magnet recognition.
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42
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Curiati PK, Gil-Junior LA, Morinaga CV, Ganem F, Curiati JA, Avelino-Silva TJ. Predicting Hospital Admission and Prolonged Length of Stay in Older Adults in the Emergency Department: The PRO-AGE Scoring System. Ann Emerg Med 2020; 76:255-265. [DOI: 10.1016/j.annemergmed.2020.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 01/13/2023]
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King B, Bodden J, Steege L, Brown CJ. Older adults experiences with ambulation during a hospital stay: A qualitative study. Geriatr Nurs 2020; 42:225-232. [PMID: 32861430 DOI: 10.1016/j.gerinurse.2020.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/21/2022]
Abstract
Older adults often lose their ability to independently ambulate during a hospital stay. Few studies have investigated older adults' experiences with ambulation during hospitalization. The purpose of this study was to understand older adults' perceptions of and experiences with ambulation during a hospital admission. A qualitative study using Inductive Content Analysis was conducted. Community-dwelling older adults (N = 11) were recruited to participant in five focus group meetings each lasting 90 min. All individuals participated in each focus group. Participants described high complexity in deciding whether or not they could ambulate. Six categories were identified: Uncertainty, Restriction Messaging, Non-Welcoming Space, Caring for Nurse and Self, Feeling Isolated, and Presenting Self. This study provides a detailed understanding of older adults' experiences and perceptions of a hospital stay. Findings from this study can serve as a foundation for future interventions to improve older adult patient ambulation during hospitalization.
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Affiliation(s)
- Barbara King
- APRN-BC University of Wisconsin- Madison, School of Nursing.
| | - Jillian Bodden
- UW Health, Department of Geriatrics, University of Wisconsin- Madison, School of Nursing
| | | | - Cynthia J Brown
- Division of Gerontology, Geriatrics and Palliative Care, Comprehensive Center for Healthy Aging, University of Alabama at Birmingham
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Prevalence of Geriatric Syndromes and the Need for Hospice Care in Older Patients of the Emergency Department: A Study in an Asian Medical Center. Emerg Med Int 2020; 2020:7174695. [PMID: 32724676 PMCID: PMC7382720 DOI: 10.1155/2020/7174695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background The prevalence of geriatric syndromes and the need for hospice care in the emergency department (ED) in Asian populations remain unclear. This study was conducted to fill the data gap. Methods Using a newly developed emergency geriatric assessment (EGA), we investigated the prevalence of geriatric syndromes and the need for hospice care in older ED patients of a tertiary medical center between September 1, 2016, and January 31, 2017. Results We recruited a total of 693 patients with a mean age of 78.0 years (standard deviation 8.2 years), comprising 46.6% of females. According to age subgroups, 37.4% of patients were aged 65-74 years, 37.4% were aged 75-84 years, and 25.2% were aged ≥85 years. The prevalence rates of geriatric syndromes were as follows: delirium (11.4%), depression (23.4%), dementia (43.1%), deterioration of activities of daily living (ADL) for <1 year (29.4%), vision impairment (22.2%), hearing impairment (23.8%), sleep disturbance (13.1%), any fall in <1 year (21.8%), polypharmacy (28.7%), pain (35.1%), pressure ulcer (5.6%), incontinence or retention (29.6%), indwelling device or physical restrain (21.6%), nutrition problem (35.7%), frequent use of medical resources (50.1%), lack of advance care planning (84.0%), caregiver problem (4.6%), socioeconomic problem (5.5%), and need for family meeting (6.2%). The need for hospice care was 11.9%. Most geriatric syndromes increased with advancing age except depression, sleep disturbance, polypharmacy, pain, nutrition problem, lack of advance care planning, caregiver problem, and socioeconomic problem. Conclusion Geriatric syndromes and the need for hospice care were common in the older ED patients. Further studies about subsequent intervention for improving geriatric care are needed.
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Rogers SE, Ko JS, McNicoll L, Mendelson DA. The Diverse Implementation of Geriatrics-Orthopedics Comanagement Programs in the United States. J Am Geriatr Soc 2020; 68:1714-1719. [PMID: 32632949 DOI: 10.1111/jgs.16677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many health systems are establishing geriatrics-orthopedics (Geri-Ortho) comanagement programs; however, there is paucity of published information on existing programs' variations in clinical operations, structure, and reported implementation challenges and perceived successes. OBJECTIVE Our objective was to obtain detailed information about the variety of existing Geri-Ortho comanagement programs in the United States. DESIGN/PARTICPANTS We conducted a cross-sectional survey of 44 existing Geri-Ortho comanagement programs, with 23 (52%) of programs responding. MEASUREMENT Quantitative questions were used to assess operational, staffing, and financial structures; and qualitative questions were used to identify reported challenges and perceived successes of implementation. RESULTS Programs self-identified as urban (n = 23), academic (n = 20), or nonprofit (n = 22) and as having a level I trauma center (n = 17). Most programs (n = 18) were funded fully by the institution. Fourteen programs used geriatricians, and nine used medicine/hospitalists as the supporting clinical service, whereas approximately half (n = 11) used these services in a true comanagement model. Six universal themes were identified as necessary for program implementation. The most commonly described successes perceived by all respondents were improvements in clinical outcomes and better interdisciplinary relationships. Reported challenges included difficulty in interdisciplinary geriatrics education, difficulty in adherence to protocols, and lack of funding for staffing. CONCLUSIONS There are diverse types of Geri-Ortho comanagement programs in the United States, although universal elements exist. Many had similar challenges in implementation, and further studies are needed to determine which implementation elements are critical to clinical and financial outcomes. J Am Geriatr Soc 68:1714-1719, 2020.
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Affiliation(s)
- Stephanie E Rogers
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Jocelyn S Ko
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Lynn McNicoll
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Daniel Ari Mendelson
- Department of Medicine, Division of Geriatrics; School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.,Geriatric Fracture Center, Department of Medicine, Highland Hospital, Rochester, New York, USA
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Khadaroo RG, Warkentin LM, Wagg AS, Padwal RS, Clement F, Wang X, Buie WD, Holroyd-Leduc J. Clinical Effectiveness of the Elder-Friendly Approaches to the Surgical Environment Initiative in Emergency General Surgery. JAMA Surg 2020; 155:e196021. [PMID: 32049271 DOI: 10.1001/jamasurg.2019.6021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Older adults, especially those with frailty, have a higher risk for complications and death after emergency surgery. Acute Care for the Elderly models have been successful in medical wards, but little evidence is available for patients in surgical wards. Objectives To develop and assess the effect of an Elder-Friendly Approaches to the Surgical Environment (EASE) model in an emergency surgical setting. Design, Setting, and Participants This prospective, nonrandomized, controlled before-and-after study included patients 65 years or older who presented to the emergency general surgery service of 2 tertiary care hospitals in Alberta, Canada. Transfers from other medical services, patients undergoing elective surgery or with trauma, and nursing home residents were excluded. Of 6795 patients screened, a total of 684 (544 in the nonintervention group and 140 in the intervention group) were included. Data were collected from April 14, 2014, to March 28, 2017, and analyzed from November 16, 2018, through May 30, 2019. Interventions Integration of a geriatric assessment team, optimization of evidence-based elder-friendly practices, promotion of patient-oriented rehabilitation, and early discharge planning. Main Outcomes and Measures Proportion of participants experiencing a major complication or death (composite) in the hospital, Comprehensive Complication Index, length of hospital stay, and proportion of participants who required an alternative level of care on discharge. Covariate-adjusted, within-site change scores were computed, and the overall between-site, preintervention-postintervention difference-in-differences (DID) were analyzed. Results A total of 684 patients were included in the analysis (mean [SD] age, 76.0 [7.6] years; 327 women [47.8%] and 357 men [52.2%]), of whom 139 (20.3%) were frail. At the intervention site, in-hospital major complications or death decreased by 19% (51 of 153 [33.3%] vs 19 of 140 [13.6%]; P < .001; DID P = .06), and mean (SE) Comprehensive Complication Index decreased by 12.2 (2.5) points (P < .001; DID P < .001). Median length of stay decreased by 3 days (10 [interquartile range (IQR), 6-17] days to 7 [IQR, 5-14] days; P = .001; DID P = .61), and fewer patients required an alternative level of care at discharge (61 of 153 [39.9%] vs 29 of 140 [20.7%]; P < .001; DID P = .11). Conclusions and Relevance To our knowledge, this is the first study to examine clinical outcomes associated with a novel elder-friendly surgical care delivery redesign. The findings suggest the clinical effectiveness of such an approach by reducing major complications or death, decreasing hospital stays, and returning patients to their home residence. Trial Registration ClinicalTrials.gov Identifier: NCT02233153.
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Affiliation(s)
- Rachel G Khadaroo
- Department of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada.,Department of Critical Care Medicine, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey M Warkentin
- Department of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Fiona Clement
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Xiaoming Wang
- Aberhart Centre, Research Facilitation, Alberta Health Services, Edmonton, Alberta, Canada
| | - William D Buie
- Department of Surgery, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Loyd C, Markland AD, Zhang Y, Fowler M, Harper S, Wright NC, Carter CS, Buford TW, Smith CH, Kennedy R, Brown CJ. Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis. J Am Med Dir Assoc 2020; 21:455-461.e5. [PMID: 31734122 PMCID: PMC7469431 DOI: 10.1016/j.jamda.2019.09.015] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/03/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Hospital-associated disability (HAD), defined as loss of independence in activities of daily living (ADL) following acute hospitalization, is observed among older adults. The study objective is to determine overall prevalence of HAD among older adults hospitalized in acute care, and to assess the impact of study initiation year in moderation of prevalence. DESIGN Meta-analysis of data collected from randomized trials, quasi-experimental, and prospective cohort studies. English-language searches to identify included studies were completed February 2018 and updated May 2018 of electronic databases and reference lists of studies and reviews. Included studies were human subjects investigations that measured ADL ≥2 time points before or during and after hospitalization and reported prevalence of ADL decline among older adults. SETTING Acute care hospital units. PARTICIPANTS Adults aged ≥65 years hospitalized in medical-surgical acute care; total sample size across all included studies was 7375. METHODS Independence in ADL was assessed using the Katz Index of Independence in Activities of Daily Living and Barthel Index of Independence in Activities of Daily Living. RESULTS Random effects meta-analysis across included studies identified combined prevalence of HAD as 30% (95% CI 24%, 33%; P < .001). The effect of study initiation year on the prevalence rate was minimal. A large amount of heterogeneity was observed between studies, which may be due in part to nonstandardized measurement of ADL impairment or other methodological differences. CONCLUSIONS AND IMPLICATIONS Hospitalization in acute care poses a significant risk to functional independence of older adults, and this risk is unchanged despite shorter lengths of stay. The evidence supports the continued need for hospital-based programs that provide assessment of functional ability and identification of at-risk older adults in order to better treat and prevent HAD.
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Affiliation(s)
- Christine Loyd
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Alayne D Markland
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL.
| | - Yue Zhang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mackenzie Fowler
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Sara Harper
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Christy S Carter
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas W Buford
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Catherine H Smith
- Lister Hill Library of the Health Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Richard Kennedy
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Cynthia J Brown
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL
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48
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Brown CJ. After Three Decades of Study, Hospital‐Associated Disability Remains a Common Problem. J Am Geriatr Soc 2020; 68:465-466. [DOI: 10.1111/jgs.16349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Cynthia J. Brown
- Birmingham/Atlanta Veterans Affairs Geriatric ResearchEducation and Clinical Center Birmingham Alabama
- Division of Gerontology, Geriatrics, and Palliative CareUniversity of Alabama at Birmingham Birmingham Alabama
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Frumkin K. Toppling Oranges: Death, Disability, Decline, and Readmission of Community-Dwelling Elderly Patients After an Emergency Department Visit. J Emerg Med 2020; 58:339-345. [PMID: 32005609 DOI: 10.1016/j.jemermed.2019.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Every emergency department (ED) faces both a rising tide and a revolving door of elderly patients. Unplanned short-term returns after a recent ED evaluation or hospital admission are sentinel events. Consequences include substantial functional decline, reduced health-related quality of life, and increased risk of dependency or death. Returning families, unaware of the significant likelihood of deterioration after an ED or hospital discharge, often harbor suspicions that something was missed. Literature describing the significant likelihood of functional decline in elderly patients after ED or hospital discharge is presented. Suggestions for incorporating the potential for subsequent deterioration into the evaluation of elderly ED patients and the discussions surrounding disposition decisions are included. DISCUSSION In addition to impacting patients and families, posthospitalization decline and short-term readmissions create serious burdens for hospitals and their EDs. Education, vigilance, specialized geriatric EDs, dedicated inpatient units, and ED access to outpatient services for the elderly can aid in the recognition and mitigation of postvisit functional decline and associated returns. Financial incentives for reducing short-term readmissions can translate into novel approaches and referral arrangements. CONCLUSIONS Currently, and for the foreseeable future, EDs are integral to predicting, identifying, and preventing functional decline in the elderly. For now, we are all Geriatric EDs.
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Affiliation(s)
- Kenneth Frumkin
- Emergency Medicine Department, Naval Medical Center, Portsmouth, Virginia
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50
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Jackman C, Laging R, Laging B, Honan B, Arendts G, Walker K. Older person with vague symptoms in the emergency department: Where should I begin? Emerg Med Australas 2019; 32:141-147. [PMID: 31854096 DOI: 10.1111/1742-6723.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Christine Jackman
- Emergency Department, Cabrini, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Melbourne, Victoria, Australia.,School of Medicine, Deakin University Medical School, Geelong, Victoria, Australia
| | - Rohan Laging
- Emergency Department, Cabrini, Melbourne, Victoria, Australia.,Emergency Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Bridget Laging
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | | | - Glenn Arendts
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Katie Walker
- Emergency Department, Cabrini, Melbourne, Victoria, Australia.,Health Services, Monash University, Melbourne, Victoria, Australia
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