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Abraham K, Kanters TA, Wagg AS, Huige N, Hutt E, Al MJ. Benefits of a digital health technology for older nursing home residents. A de-novo cost-effectiveness model for digital health technologies to aid in the assessment of toileting and containment care needs. PLoS One 2024; 19:e0295846. [PMID: 38166006 PMCID: PMC10760782 DOI: 10.1371/journal.pone.0295846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/30/2023] [Indexed: 01/04/2024] Open
Abstract
The aim of this study was first, to introduce a comprehensive, de-novo health economic (HE) model incorporating the full range of activities involved in toileting and containment care (T&CC) for people with incontinence, capturing all the potential benefits and costs of existing and future Digital Health Technologies (DHT) aimed at improving continence care, for both residential care and home care. Second, to use this novel model to evaluate the cost-effectiveness of the DHT TENA SmartCare Identifi in the implementation of person-centred continence care (PCCC), compared with conventional continence care for Canadian nursing home residents. The de-novo HE model was designed to evaluate technologies across different care settings from the perspective of several stakeholders. Health states were based on six care need profiles with increasing need for toileting assistance, three care stages with varying degrees of toileting success, and five levels of skin health. The main outcomes were incremental costs and quality-adjusted life years. The effectiveness of the TENA SmartCare Identifi was based primarily on trial data combined with literature and expert opinion where necessary. Costs were reported in CAD 2020. After 2 years, 21% of residents in the DHT group received mainly toileting as their continence care strategy compared with 12% in the conventional care group. Conversely, with the DHT 15% of residents rely mainly on absorbent products for incontinence care, compared with 40% with conventional care. On average, residents lived for 2.34 years, during which the DHT resulted in a small gain in quality-adjusted life years of 0.015 and overall cost-savings of $1,467 per resident compared with conventional care. Most cost-savings were achieved through reduced costs for absorbent products. Since most, if not all, stakeholders gain from use of the DHT-assisted PCCC, widespread use in Canadian residential care facilities should be considered, and similar assessments for other countries encouraged.
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Affiliation(s)
- Katharina Abraham
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Tim Andre Kanters
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Adrian Stuart Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Gothenburg Continence Research Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicole Huige
- Essity Hygiene and Health AB, Gothenburg, Sweden
| | - Edward Hutt
- Medica Market Access Ltd, Tonbridge, United Kingdom
| | - Maiwenn Johanna Al
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Kelly AM. A holistic approach to assessing an individual with urinary incontinence. Br J Community Nurs 2023; 28:445-454. [PMID: 37638755 DOI: 10.12968/bjcn.2023.28.9.445] [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: 08/29/2023]
Abstract
Urinary incontinence can have an overwhelmingly negative impact on an individual's quality of life. The personal, physical, psychosocial and sexual implications of urinary incontinence can affect health and well-being. This can increase the risk of falls, depression, anxiety, social isolation alongside a greater need for long-term care from a individual's own home. Statically, the prevalence rates of urinary incontinence increases with age; however, incontinence is not an inevitable or acceptable part of ageing-symptoms can be improved and managed effectively for suffers of this common condition. Urinary incontinence can be challenging to assess, address and overcome for individuals. However health professionals need to have the expertise and experience to undertake a comprehensive continence assessment. When assessment is completed evidence-based interventions can be recommended, implemented and subsequently evaluated.
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Affiliation(s)
- Anne Marie Kelly
- Clinical Nurse Specialist-Continence, Dublin South, Kildare and West Wicklow CHO, Elinor Lyons Building, Meath Campus, Heytesbury Street, Dublin 8
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Göransson C, Larsson I, Carlsson IM. Art of connectedness: Value-creating care for older persons provided with toileting assistance and containment strategies-A critical interpretive synthesis. J Clin Nurs 2022; 32:1806-1820. [PMID: 35034383 DOI: 10.1111/jocn.16216] [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: 09/13/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim was to conduct a synthesis of the literature on value-creating care for older persons with incontinence provided with toileting assistance and containment strategies, from the perspectives of older persons and healthcare professionals. BACKGROUND Incontinence is a health problem for many persons worldwide and the problem will increase as the global population ages. It can have a profound impact on a person's wellbeing, and assistance with toileting and containment strategies is common in home care settings and nursing homes. DESIGN The design was a literature review with an iterative, reflexive and critical approach. METHODS A critical interpretive synthesis was conducted. Ten papers published between 2011 and 2019 were analysed. The PRISMA -ScR Checklist was used in this review. RESULTS Based on the findings, the conceptual construct 'The art of connectedness' was developed, built on co-created care, personalised care and reflective care between the older person and healthcare professionals. Co-created care is based on establishing a relationship, building trust and respecting preferences. Personalised care consists of meeting the person's needs, promoting comfort and maintaining self-determination. Reflective care entails showing empathy, upholding the person's dignity and developing professional competence. CONCLUSIONS Value-creating care consists conceptually of a connectedness that starts with co-creating the care together with the older person in a close relationship. Assistance is given and received based on the older person's individual needs and is highly valued by the older person as it helps them maintain self-determination. Reflective care is of importance for healthcare professionals. RELEVANCE FOR PRACTICE The findings are hoped to enhance healthcare professionals' understanding of how to improve the clinical encounter in nursing when providing assistance. They may also stimulate critical reflection among healthcare professionals on how to improve assistance to meet the older person's values.
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Affiliation(s)
- Carina Göransson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ingrid Larsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Understanding how to facilitate continence for people with dementia in acute hospital settings: a mixed methods systematic review and thematic synthesis. Syst Rev 2021; 10:199. [PMID: 34229762 PMCID: PMC8262033 DOI: 10.1186/s13643-021-01743-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 06/13/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND People living with dementia (PLWD) are at significant risk of developing urinary and/or faecal incontinence and are also at risk of functional incontinence or being labelled as being incontinent. Despite the growing population of PLWD and importance of continence care, little is known about the appropriate management, organisation, and interactional strategies for PLWD admitted to acute hospitals. This mixed methods systematic review and thematic synthesis sought to identify successful strategies across all care settings that could then be used to inform innovations in continence care for PLWD in the acute hospital setting. METHODS In phase 1, a scoping search of two electronic databases (MEDLINE and PsycINFO) and a consultation with stakeholders was undertaken. Findings were presented to the project steering group and two priority areas for phase 2 were identified which were communication and individualised care plans. In phase 2, eight databases and relevant UK government and other organisational websites were searched for English language citations from inception to August 2020. Critical appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT Version 11). Thematic synthesis was employed and the strength of synthesised findings for the intervention studies was assessed using the GRADE approach and the confidence in synthesised qualitative and survey findings was assessed using the CERQual approach. RESULTS In phase 1, 1348 citations were found and 75 included. In phase 2, 6247 citations were found, 14 research studies and 14 policy and guidance documents were included. The quality of studies varied. Material was synthesised into three overarching syntheses which were: communication this is dignified, person-centred and respectful; communication during outpatients apointments and delivering individualised continence care. CONCLUSIONS Recognising that PLWD are not always able to communicate their continence needs verbally is important. Incorporating interpersonal and communication skills into the context of continence care within training for those working with this patient group is crucial for continence to be maintained during an acute admission. Continence care in the acute setting should be tailored to the individual and be developed in partnership with staff and caregivers. TRIAL REGISTRATION PROSPERO: CRD42018119495 .
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Pettersson C, Nilsson M, Andersson M, Wijk H. The impact of the physical environment for caregiving in ordinary housing: Experiences of staff in home- and health-care services. APPLIED ERGONOMICS 2021; 92:103352. [PMID: 33395590 DOI: 10.1016/j.apergo.2020.103352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 06/12/2023]
Abstract
The strong driving forces for ageing in place demand sustainable solutions for the housing and care of older people and the health and safety of home- and health-care staff. The aim of the study was to elucidate staff experiences of providing home- and health-care to older people living in ordinary housing. This study was part of a larger project investigating the relation between home design and conditions for care in ordinary housing. The data were gathered through focus group interviews with staff in home- and health-care. Three main themes were found according to staff experiences of particular rooms' sizes and proportions, spatial configurations, and aspects to consider when designing new housing. This study contributes important knowledge about essential features of the physical environment for staff providing home- and health-care for older people in their own homes and to aid the development of functionally sustainable housing to minimise injuries to staff.
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Affiliation(s)
- Cecilia Pettersson
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden; School of Health Sciences, Örebro University, Örebro, Sweden.
| | | | - Morgan Andersson
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Helle Wijk
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden; Institute of Health and Care Sciences, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Ebrahimi Z, Patel H, Wijk H, Ekman I, Olaya-Contreras P. A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings. Geriatr Nurs 2020; 42:213-224. [PMID: 32863037 DOI: 10.1016/j.gerinurse.2020.08.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
THE PURPOSE of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+). METHOD A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish. RESULTS In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation. CONCLUSION Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.
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Affiliation(s)
- Zahra Ebrahimi
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden.
| | - Harshida Patel
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Chalmers University of Technology, Department of Architecture Sahlgrenska University Hospital Department of Quality Assurance and Patient Safety, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden
| | - Patricia Olaya-Contreras
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ostaszkiewicz J, Dickson-Swift V, Hutchinson A, Wagg A. A concept analysis of dignity-protective continence care for care dependent older people in long-term care settings. BMC Geriatr 2020; 20:266. [PMID: 32727481 PMCID: PMC7392826 DOI: 10.1186/s12877-020-01673-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 12/25/2022] Open
Abstract
Background Although codes of conduct, guidelines and standards call for healthcare practitioners to protect patients’ dignity, there are widespread concerns about a lack of attention to the dignity of older people who need assistance with toileting, incontinence or bladder or bowel care in health or social care settings that provide long-term care. Incontinence and care dependence threatens patient dignity. The aim of this research was to explore, describe and explain the concept of dignity as it relates to continence care for older people requiring long-term care. Methods The first four steps of Rodgers evolutionary method of concept analysis were followed. First, a comprehensive and systematic search of databases and key guidelines about continence care was undertaken to identify empirical research about dignity and continence care in older people in facilities that provide permanent residential or inpatient care of older people for day-to-day living. Data were extracted on the authors, date, sample, country of origin, and key definitions, attributes, contexts and consequences from each included record. Findings were inductively analysed and grouped according to whether they were the key attributes and antecedents of dignity in relation to continence care or the consequences of undignified continence care. Results Of 625 articles identified, 18 were included in the final analysis. Fifty individual attributes were identified that were categorised in 6 domains (respect, empathy, trust, privacy, autonomy and communication). A further 15 were identified that related to the environment (6 physical and 9 social). Key consequences of undignified continence care were also identified and categorised into 3 levels of impact (resident/family member, staff or organisation). Conclusions This research resulted in a conceptual understanding of dignity that can be used as a value or guiding principle in an ethic of care for older people who need assistance with toileting, incontinence or bladder or bowel care in long-term care settings.
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Affiliation(s)
- Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research - Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, VIC, 3220, Australia. .,School of Nursing and Midwifery, Deakin University, Gheringhap St, Geelong, VIC, 3220, Australia. .,National Ageing Research Institute, P.O Box 2127, Royal Melbourne Hospital, 21, Melbourne, VIC, 3530, Australia.
| | - Virginia Dickson-Swift
- Centre for Quality and Patient Safety Research - Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, VIC, 3220, Australia.,School of Nursing and Midwifery, Deakin University, Gheringhap St, Geelong, VIC, 3220, Australia
| | - Alison Hutchinson
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Institute for Healthcare Transformation, Deakin University, Burwood, VIC, 3125, Australia
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Abstract
A multidisciplinary international expert panel was convened to provide input for a proposed decision support tool. This tool will assist health care professionals who are not specialized in incontinence care to assess individuals with urinary and/or fecal incontinence and recommend appropriate person-centered management options for the home care and ambulatory community settings. A targeted literature review was complemented by a series of interviews with experts in continence management, followed by a practitioner survey and rounds of expert opinion. A set of factors for assessment were defined, along with questions created to identify and quantify the factors. In addition, a range of lifestyle intervention, toileting and containment strategies were identified that were appropriate for the decision support tool. Future steps required to progress this work to a functioning tool are described.
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Yoo HW, Kim MG, Oh DN, Hwang JH, Lee KS. Factors Associated with Functional Decline in Older Adults After Discharge from an Acute-Care Hospital. Asian Nurs Res (Korean Soc Nurs Sci) 2019; 13:192-199. [PMID: 31146026 DOI: 10.1016/j.anr.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/13/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE This study was conducted to investigate the trend in functional changes over time and factors associated with the number of areas showing functional decline in older adults who had been discharged from acute care hospitals. METHODS This longitudinal study involved 156 patients aged ≥ 65 years who were admitted to one tertiary hospital in Seoul and discharged home. Authors investigated patient demographic and health-care characteristics and the number of areas showing functional decline at 1 and 3 months after discharge. The data were analyzed using univariate and multivariate Poisson regression models. RESULTS The number of areas showing functional decline increased between admission and 1 month after discharge and had declined slightly at 3 months after discharge. The factors associated with the number of areas showing functional decline at 3 months after discharge were age, education level, and length of hospitalization (p < .05); the factors associated at 1 month after discharge were medical department and caregiver relationship (p < .05). CONCLUSION The results indicate that older patients with no spouse or those with their elderly spouse as their caregiver are at risk of functional decline in a greater number of areas after discharge. Therefore, a comprehensive health-care policy to ensure care continuity is required for functional health maintenance for older adults after hospital discharge.
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Affiliation(s)
- Hai-Won Yoo
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Myo-Gyeong Kim
- Department of Nursing, Seoul Women's College of Nursing, Seoul, Republic of Korea.
| | - Doo-Nam Oh
- Department of Nursing Science, Hoseo University, Asan, Republic of Korea
| | - Jeong-Hae Hwang
- Department of Health Administration, Hayang Cyber University, Seoul, Republic of Korea
| | - Kun-Sei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Republic of Korea
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