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Ferrah N, Kennedy B, Beck B, Ibrahim J, Gabbe B, Cameron P. A scoping review of models of care for the management of older trauma patients. Injury 2024; 55:111200. [PMID: 38035863 DOI: 10.1016/j.injury.2023.111200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The number of older people hospitalised with major trauma is rapidly increasing. New models of care have emerged, such as co-management, and trauma centres dedicated to delivering geriatric trauma care. The aim of this scoping review was to explore in-hospital models of care for older adults who experience physical trauma. PATIENTS AND METHODS The search was conducted in accordance with the PRISMA- SC (preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews) reporting guidelines. The National Heart Lung, and Blood Institute (NIH) study quality assessment tool was used to evaluate risk of bias in before and after non-randomised experimental studies. RESULTS Of 2127 records returned from the database search, 43 papers were included. We identified five types of care models investigated in the reviewed studies: centralised trauma management, consultation services, co-management, patient care protocols, and alert and triage systems. The majority of patients were admitted under a specialised trauma service, intervention teams were for the most part multidisciplinary, and follow-up of patients post-discharge was seldom reported. Consultation services more often had advanced care and discharge planning as treatment objectives. In contrast, patient care protocol and alert systems commonly had management of anticoagulation as a treatment objective. Overall, the impact of the five models of care on patient outcomes was mixed. DISCUSSION Given the variability in patient characteristics and capabilities of health services, models of care need to be matched to the local profile of older trauma patients. However, some standards should be incorporated into a care model, including identifying goals of care, medication review and follow up post-discharge.
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Affiliation(s)
- Noha Ferrah
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia.
| | - Briohny Kennedy
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia; Department of Forensic Medicine, Monash University, The Victorian Institute of Forensic Medicine, Victoria Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia; Faculty of Medicine, Laval University, Quebec City, Canada
| | - Joseph Ibrahim
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia; Department of Forensic Medicine, Monash University, The Victorian Institute of Forensic Medicine, Victoria Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia; Health Data Research UK, Swansea University Medical School, UK
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Victoria Australia; Emergency and Trauma Centre, The Alfred Hospital, Victoria, Australia
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Ferrah N, Parker C, Ibrahim J, Gabbe B, Cameron P. A qualitative descriptive study exploring clinicians' perspectives of the management of older trauma care in rural Australia. BMC Health Serv Res 2023; 23:704. [PMID: 37381004 DOI: 10.1186/s12913-023-09545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/14/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND For older trauma patients who sustain trauma in rural areas, the risk of adverse outcomes associated with advancing age, is compounded by the challenges encountered in rural healthcare such as geographic isolation, lack of resources, and accessibility. Little is known of the experience and challenges faced by rural clinicians who manage trauma in older adults. An understanding of stakeholders' views is paramount to the effective development and implementation of a trauma system inclusive of rural communities. The aim of this descriptive qualitative study was to explore the perspectives of clinicians who provide care to older trauma patients in rural settings. METHOD We conducted semi-structured interviews of health professionals (medical doctors, nurses, paramedics, and allied health professionals) who provide care to older trauma patients in rural Queensland, Australia. A thematic analysis consisting of both inductive and deductive coding approaches, was used to identify and develop themes from interviews. RESULTS Fifteen participants took part in the interviews. Three key themes were identified: enablers of trauma care, barriers, and changes to improve trauma care of older people. The resilience of rural residents, and breadth of experience of rural clinicians were strengths identified by participants. The perceived systemic lack of resources, both material and in the workforce, and fragmentation of the health system across the state were barriers to the provision of trauma care to older rural patients. Some changes proposed by participants included tailored education programs that would be taught in rural centres, a dedicated case coordinator for older trauma patients from rural areas, and a centralised system designed to streamline the management of older trauma patients coming from rural regions. CONCLUSIONS Rural clinicians are important stakeholders who should be included in discussions on adapting trauma guidelines to the rural setting. In this study, participants formulated pertinent and concrete recommendations that should be weighed against the current evidence, and tested in rural centres.
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Affiliation(s)
- Noha Ferrah
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC, 3004, Australia.
| | - Catriona Parker
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC, 3004, Australia
| | - Joseph Ibrahim
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC, 3004, Australia
- Department of Forensic Medicine, Monash University, The Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC, 3004, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC, 3004, Australia
- Health Data Research UK, Swansea University Medical School, Swansea, Wales
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Ferrah N, Beck B, Ibrahim J, Gabbe B, McLellan MS, Cameron P. Older trauma patients with isolated chest injuries have low rates of complications. Injury 2022; 53:4005-4012. [PMID: 36243582 DOI: 10.1016/j.injury.2022.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/24/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The number of older adults hospitalised for injury is growing rapidly. The population-adjusted incidence of isolated thoracic injuries in older adults is also growing. While some older adults are at high risk of post-traumatic complications, not all older adults will need treatment in a major trauma service (MTS). The aim of this study was to characterise older patients with isolated chest injuries, determine the rates of post-traumatic complications, including respiratory failure and pneumonia, and the factors associated with the risk of developing these complications. PATIENTS AND METHODS This was a retrospective review of patients aged 65 years and over with isolated chest trauma, from January 2007 to June 2017, using data from the Victorian State Trauma Registry. Patient characteristics and rates of complications were compared between patients with 1. isolated rib fractures, and 2. complex chest injury. Multivariable logistic regression was used to identify predictors of respiratory failure, and pneumonia. RESULTS The study population comprised 5401 patients aged 65 years or more, with isolated chest injuries. Two-thirds (65%) of all patients had isolated rib fractures, and 58% of patients (n = 3156) were directly admitted to a non-major trauma centre. Complications were uncommon, with 5.45% of all patients (n = 295) having pneumonia and 3.2% (n = 175) having respiratory failure. Factors associated with increased risk of pneumonia and respiratory failure included advancing age, smoking, chronic obstructive pulmonary disease, congestive heart failure, and more severe and complex chest injury. The adjusted odds of complications were lowest amongst patients not classified as major trauma and receiving definitive treatment in non-MTS. DISCUSSION Our findings suggest that rates of complications in older patients with isolated chest trauma in this study were low, and that there is a large group of patients with isolated, uncomplicated rib fractures, who may not need to be treated in a major trauma centre. Further work should be undertaken to appropriately risk stratify and manage older adults with isolated chest trauma.
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Affiliation(s)
- Noha Ferrah
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia.
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia; Faculty of Medicine, Laval University, Quebec City, Canada
| | - Joseph Ibrahim
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia; Department of Forensic Medicine, Monash University, The Victorian Institute of Forensic Medicine, VIC Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia; Health Data Research UK, Swansea University Medical School, United Kingdom
| | - Ms Susan McLellan
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC 3004, Australia; Emergency and Trauma Centre, The Alfred Hospital, VIC, Australia
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Ferrah N, Dipnall J, Gabbe B, Cameron P, Ibrahim J, Beck B. Injury profiles and clinical management of older patients with major trauma. Australas J Ageing 2021; 41:116-125. [PMID: 34611973 DOI: 10.1111/ajag.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to characterise the most common injury profiles and interventions in older major trauma patients, and how they change with age. METHODS This is a retrospective review of interventions, injury profiles and outcomes of major trauma patients aged 65 years and older from 2007 to 2018, using data from the Victorian State Trauma Registry. A latent class analysis (LCA) was used to identify homogenous injury groups. RESULTS The LCA identified five injury profiles: isolated head injury; chest/upper limb injuries; multi-trauma; isolated spine; and head/chest/upper limb. Among 10,001 patients, 50% had an isolated head injury, and 83% of patients received definitive treatment at a major trauma centre. 50% of patients received a surgical or non-surgical intervention, and 36% underwent surgery. These proportions declined with increasing age. CONCLUSIONS Older patients with major trauma are a heterogeneous group, whose mechanisms and patterns of injury, and clinical management change with increasing age.
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Affiliation(s)
- Noha Ferrah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Joanna Dipnall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Vic., Australia
| | - Joseph Ibrahim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Department of Forensic Medicine, Monash University, The Victorian Institute of Forensic Medicine, Melbourne, Vic., Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Faculty of Medicine, Laval University, Quebec City, QC, Canada
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Abeysekera N, Mich C, Mahoney A, Abeysekera A, MacPhail A, Ibrahim J, Jose M, Turner R, Ferrah N. Evaluating the need for an integrated geriatric service in older general surgery patients. ANZ J Surg 2021; 91:341-347. [PMID: 33656262 DOI: 10.1111/ans.16612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite the success of an orthogeriatric model in improving outcomes of older patients, there is a paucity of evidence in general surgical disciplines. The aim of this project was to assess the viability of acute kidney injury (AKI) as an indicator of the care of older patients admitted under general surgery. METHODS A retrospective review of the medical records of patients aged 75 years and older admitted under general surgery between 1 July 2015 and 30 June 2018 at the Royal Hobart Hospital was conducted. Twenty randomly selected cases were reviewed by an expert panel to assess the preventability of AKI. RESULTS Of 314 patients, the most common diagnosis was small bowel obstruction. Less than half of all patients underwent a procedural intervention. There were 32 (10%) cases of AKI; 13 (4%) had pre-hospital and 19 (6%) had inpatient. Diabetes and bowel ischaemia were over-represented in patients with an AKI, otherwise there was no significant difference between the groups. Patients with an AKI were significantly more likely to die, require an unplanned intensive care unit admission and less likely to return to their original residence. Overall, the expert panel agreed that the AKI was foreseeable and mitigable. CONCLUSION Our patients presented with diagnoses that often did not require surgical intervention but not infrequently experienced medical complications. These patients may benefit from a shared model of care and AKI could be a useful indicator to measure the efficiency of this service.
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Affiliation(s)
- Natasha Abeysekera
- Tasmanian School of Medicine, The University of Tasmania, Hobart, Tasmania, Australia
| | - Christian Mich
- Tasmanian School of Medicine, The University of Tasmania, Hobart, Tasmania, Australia
| | - Adam Mahoney
- Department of Anaesthesia and Perioperative Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Ashvini Abeysekera
- Department of Otolaryngology and Head and Neck Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Aleece MacPhail
- Subacute Services, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Joseph Ibrahim
- Subacute Services, Ballarat Health Services, Ballarat, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia
| | - Matthew Jose
- Tasmanian School of Medicine, The University of Tasmania, Hobart, Tasmania, Australia.,Renal Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Richard Turner
- Tasmanian School of Medicine, The University of Tasmania, Hobart, Tasmania, Australia.,Department of General Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Noha Ferrah
- Tasmanian School of Medicine, The University of Tasmania, Hobart, Tasmania, Australia.,Department of General Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
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Ferrah N, Walker SR. Weekend Carotid Endarterectomies are Not Associated with a Greater Risk of Stroke and/or Death in Australia and New Zealand. Ann Vasc Surg 2020; 71:145-156. [PMID: 32800885 DOI: 10.1016/j.avsg.2020.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data from multiple surgical studies and settings have reported an increase in adverse events in patients admitted or treated on weekends. The aim of this study was to investigate short-term outcomes for patients undergoing carotid endarterectomy (CEA) in Australia and New Zealand based on the day of surgery. METHODS This is a retrospective observational cohort study. Analysis of 7,857 CEAs recorded for more than 4 years in the Australasian Vascular Audit database was performed. Multivariate logistic regression was used to compare the following outcomes between CEAs performed during the week and on the weekend: (1) in-hospital stroke and/or death; (2) other postoperative complications; and (3) shorter (2 days or less) length of stay (LOS). RESULTS A total of 7,857 CEAs were recorded, with significantly more procedures performed during the week (n = 7,333, P < 0.001). There was no statistically significant difference in the frequency of stroke and/or death or other complications between CEAs performed during the week or on the weekend (P = 0.294 and P = 0.806, respectively). However, there was a significant difference in LOS for procedures performed during the weekend, with more of these patients being discharged within 2 days compared with procedures performed during the week (56.8% vs. 51.5%; P = 0.003). Multivariable logistic regression found no effect of day of the week on the odds of postoperative stroke and/or death (P = 0.685). Day of surgery was also not associated with greater odds of other complications (P = 0.925). However, CEAs performed by nonconsultants had significantly lower adjusted odds of other complications (3.1% vs. 4.1%; P = 0.033). The adjusted odds of having a shorter LOS were significantly greater for operations taking place on the weekend (P = 0.003). CONCLUSIONS In Australia and New Zealand, there appears to be no disadvantage to performing CEA on the weekend, in terms of stroke and/or death. Level of experience of the primary operator does not affect rates of stroke and/or death after CEA. Weekend CEA is associated with a shorter hospital LOS.
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Affiliation(s)
- Noha Ferrah
- Department of Vascular and Endovascular Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Stuart R Walker
- Department of Vascular and Endovascular Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia; Clinical School, University of Tasmania, Hobart, Tasmania, Australia
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Ferrah N, Ibrahim JE. Reply to: Underestimation of the prevalence of medication errors in nursing homes. J Am Geriatr Soc 2019; 68:444. [PMID: 31654525 DOI: 10.1111/jgs.16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Noha Ferrah
- Health Law and Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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Ferrah N, Cameron P, Gabbe B, Fitzgerald M, Judson R, Marasco S, Kowalski T, Beck B. Ageing population has changed the nature of major thoracic injury. Emerg Med J 2019; 36:340-345. [DOI: 10.1136/emermed-2018-207943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 12/18/2022]
Abstract
IntroductionAn increasing proportion of the major trauma population are older persons. The pattern of injury is different in this age group and serious chest injuries represent a significant subgroup, with implications for trauma system design. The aim of this study was to examine trends in thoracic injuries among major trauma patients in an inclusive trauma system.MethodsThis was a retrospective review of all adult cases of major trauma with thoracic injuries of Abbreviated Injury Scale score of 3 or more, using data from the Victorian State Trauma Registry from 2007 to 2016. Prevalence and pattern of thoracic injury was compared between patients with multitrauma and patients with isolated thoracic injury. Poisson regression was used to determine whether population-based incidence had changed over the study period.ResultsThere were 8805 cases of hospitalised major trauma with serious thoracic injuries. Over a 10-year period, the population-adjusted incidence of thoracic injury increased by 8% per year (incidence rate ratio [IRR] 1.08, 95% CI 1.07 to 1.09). This trend was observed across all age groups and mechanisms of injury. The greatest increase in incidence of thoracic injuries, 14% per year, was observed in people aged 85 years and older (IRR 1.14, 95% CI 1.09 to 1.18).ConclusionsAdmissions for thoracic injuries in the major trauma population are increasing. Older patients are contributing to an increase in major thoracic trauma. This is likely to have important implications for trauma system design, as well as morbidity, mortality and use of healthcare resources.
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Jokanovic N, Ferrah N, Lovell JJ, Weller C, Bugeja L, Bell JS, Ibrahim JE. A review of coronial investigations into medication-related deaths in residential aged care. Res Social Adm Pharm 2019; 15:410-416. [DOI: 10.1016/j.sapharm.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/25/2018] [Accepted: 06/11/2018] [Indexed: 01/04/2023]
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Ferrah N, Stephan K, Lovell J, Beiles CB, Ibrahim JE. Rural centres do not have a higher prevalence of post-operative complications than urban centres: a retrospective analysis of a mortality audit. ANZ J Surg 2019; 89:833-841. [PMID: 30790425 DOI: 10.1111/ans.15083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/18/2018] [Accepted: 12/28/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The trend towards centralization of surgical care from rural to high-volume centres is based on studies showing better outcomes for patients requiring complex surgical procedures. However, evidence that this also applies to less complex procedures is lacking. This study therefore aimed to determine whether there was a relationship between geographic location (rural versus urban) of surgical procedures of varying complexity and post-operative complications. METHODS This was a retrospective cohort study examining all in-hospital deaths reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) between 2009 and 2016. Multivariable logistic regression was used to ascertain interactive effects of location and complexity of surgical procedures on post-operative complications, adjusted for potential confounders. RESULTS There was no interactive effect of hospital location and operation complexity on the occurrence of post-operative complications. Post-operative complications were reported in 2160 of 6963 (31%) patients who died post-surgery. Patients operated on in rural centres had lower risk profiles: younger, with lower American Society of Anesthesiologists grades and less likely to present with injury and circulatory diseases. Nonetheless, risk of post-operative complications did not differ between procedures performed in rural compared with urban hospitals. CONCLUSION Results of this study suggest that a wide range of procedures may be safely performed in rural centres. Further prospective studies of unfiltered cohorts are warranted to validate these findings.
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Affiliation(s)
- Noha Ferrah
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Stephan
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Janaka Lovell
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Charles B Beiles
- Victorian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
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Willoughby M, Kipsaina C, Ferrah N, Bugeja L, Winbolt M, Ibrahim JE. A greater risk of premature death in residential respite care: a national cohort study. Age Ageing 2018; 47:226-233. [PMID: 29253078 DOI: 10.1093/ageing/afx177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background the demand for residential respite care for older persons is high yet little is known about the occurrence of harm, including death in this care setting. Objective to compare the prevalence and nature of deaths among residential respite to permanent nursing home residents. Design retrospective cohort study. Setting australian accredited nursing homes between 1 July 2000 and 30 June 2013. Subjects respite and permanent residents of Australian accredited nursing homes, whose deaths were investigated by Australian coroners. Methods prevalence of deaths of nursing home residents were calculated using routinely generated coronial data stored in the National Coronial Information System. Odds ratios (OR) were calculated to examine residency (respite or permanent) by cause of death. Results of the 21,672 residents who died during the study period, 172 (0.8%) were in respite care. The majority of deaths were due to natural causes. A lower proportion occurred in respite (n = 119, 69.2%) than permanent (n = 18,264, 84.9%) residents. Falls-related deaths in respite as a proportion (n = 41, 23.8%) was almost double that in permanent care (n = 2,638, 12.3%). Deaths from other injury-related causes (such as suicide and choking) were significantly more likely in respite residents (OR = 2.0; 95% confidence interval: 1.1-3.6; P = 0.026). Conclusions this is the first national cohort study examining mortality among respite residents. It established that premature, injury-related deaths do occur during respite care. This is the first step towards better understanding and reducing the risk of harm in respite care.
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Affiliation(s)
- Melissa Willoughby
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Chebi Kipsaina
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Noha Ferrah
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Lyndal Bugeja
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Margaret Winbolt
- La Trobe University, Faculty of Health Sciences, Melbourne, Victoria, Australia
| | - Joseph Elias Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
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Willoughby M, Ibrahim JE, Ferrah N, Bugeja L. Optimising residential respite care in nursing homes: Current problems and solutions for a better future. Int J Older People Nurs 2017; 13:e12180. [PMID: 29168307 DOI: 10.1111/opn.12180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
AIM To examine whether residential respite care increases the risk of harm to older people and suggest directions for future research and policy. BACKGROUND Respite care is a vital part of the aged care system that supports dependent older people and their caregivers to continue residing in the community. There is little research determining whether an older person experiences harm from residential respite. METHODS This commentary considered conceptual research and existing empirical evidence to determine whether the risk of death was greater during residential respite care for older people. RESULTS Evidence on the mortality in contemporary respite care is extremely limited with the majority of studies published almost 20 years ago and focussing on planned respite admissions. The evidence available has limitations in design and lacks comparison groups and key variables relevant to outcome and risk stratification. Nonetheless, it provides a theoretical basis supporting that the potential for harm and mortality may be increased during a residential respite care admission. CONCLUSIONS The question of whether residential respite care presents significant risks to older people remains unanswered. Substantial changes in practice since the last century make the existing empirical evidence redundant. However, there is much to learn by reflecting on omissions of important details from these studies. IMPLICATIONS FOR PRACTICE A full and objective understanding of the harm associated with residential respite care for older people requires reopening and re-examining this area with robust research. Informed professional nursing practice and policy requires an empirical evidence basis to residential respite care.
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Affiliation(s)
- Melissa Willoughby
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
| | - Joseph Elias Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
| | - Noha Ferrah
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
| | - Lyndal Bugeja
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
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Ferrah N, Ibrahim JE, Ranson DL, Beiles CB. Overview of surgical death investigations: could a dreaded experience be turned into an opportunity? ANZ J Surg 2017; 87:755-756. [PMID: 28975744 DOI: 10.1111/ans.14161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Noha Ferrah
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - David L Ranson
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia
| | - Charles Barry Beiles
- Victorian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
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Willoughby M, Kipsaina C, Ferrah N, Blau S, Bugeja L, Ranson D, Ibrahim JE. Mortality in Nursing Homes Following Emergency Evacuation: A Systematic Review. J Am Med Dir Assoc 2017; 18:664-670. [PMID: 28412167 DOI: 10.1016/j.jamda.2017.02.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the risk associated with mortality among nursing home residents within 6 months following an evacuation because of man-made or natural disasters. DESIGN A systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. SETTING All peer-reviewed studies published in English, French, German, or Spanish between January 1, 2000 and December 31, 2015, examining mortality within 6 months of disaster evacuation from a nursing home. MEASUREMENTS Extracted information included study and population characteristics, mortality measures, and risk factors. Studies were examined using the disaster management cycle that considers preparedness, response, recovery, and mitigation. RESULTS The 10 included studies were published between 2010 and 2015 with one-half conducted in the United States. Only 3 studies detailed the preparedness stage, and 4 detailed the response stage of the disaster management cycle. Mortality was measured as an indicator of recovery and was found to be elevated at 1 month [from 0.03% (n = 1088) to 10.5% (n = 75)] 3 months [from 0.08% (n = 3091) to 15.2% (n = 197)], and 6 months [from 14.9% (n = 263) and 16.8% (n = 22)] postevacuation compared with pre-evacuation and sheltering-in-place. Studies identified vulnerable residents as being over 80 years of age, frail, dependent, male residents with multiple comorbidities and, made recommendations on disaster preparedness. CONCLUSIONS There is little research on the effects of evacuation on nursing home residents, which is surprising considering the elevated risk of mortality postevacuation. Evacuation seems to have a negative effect on the survival of nursing home residents independent of the effect of the disaster. Standard evacuation procedures may be less applicable to this vulnerable population because of extra challenges they face in disasters.
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Affiliation(s)
- Melissa Willoughby
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.
| | - Chebiwot Kipsaina
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Noha Ferrah
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Soren Blau
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Lyndal Bugeja
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - David Ranson
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Joseph Elias Ibrahim
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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Ferrah N, Ibrahim JE, Kipsaina C, Bugeja L. Death Following Recent Admission Into Nursing Home From Community Living: A Systematic Review Into the Transition Process. J Aging Health 2017; 30:584-604. [PMID: 28553803 DOI: 10.1177/0898264316686575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study examines the impact of the transition process on the mortality of elderly individuals following their first admission to nursing home from the community at 1, 3, and 6 months postadmission, and causes and risk factors for death. Method: A systematic review of relevant studies published between 2000 and 2015 was conducted using key search terms: first admission, death, and nursing homes. Results: Eleven cohort studies met the inclusion criteria. Mortality within the first 6 month postadmission varied from 0% to 34% (median = 20.2). Causes of deaths were not reported. Heightened mortality was not wholly explained by intrinsic resident factors. Only two studies investigated the influence of facility factors, and found an increased risk in facilities with high antipsychotics use. Discussion: Mortality in the immediate period following admission may not simply be due to an individual’s health status. Transition processes and facility characteristics are potentially independent and modifiable risk factors.
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Affiliation(s)
| | | | | | - Lyndal Bugeja
- Monash University, Victoria, Australia
- Coroners Court of Victoria, Australia
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Ferrah N, Lovell JJ, Ibrahim JE. Systematic Review of the Prevalence of Medication Errors Resulting in Hospitalization and Death of Nursing Home Residents. J Am Geriatr Soc 2016; 65:433-442. [PMID: 27870068 DOI: 10.1111/jgs.14683] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Medication errors (MEs) result in preventable harm to nursing home (NH) residents and pose a significant financial burden. Institutionalized older people are particularly vulnerable because of various organizational and individual factors. This systematic review reports the prevalence of MEs leading to hospitalization and death in NH residents and the factors associated with risk of death and hospitalization. A systematic search was conducted of the relevant peer-reviewed research published between January 1, 2000, and October 1, 2015, in English, French, German, or Spanish examining serious outcomes of MEs in NHs residents. Eleven studies met the inclusion criteria and examined three types of MEs: all MEs (n = 5), transfer-related MEs (n = 5), and potentially inappropriate medications (PIMs) (n = 1). MEs were common, involving 16-27% of residents in studies examining all types of MEs and 13-31% of residents in studies examining transfer-related MEs, and 75% of residents were prescribed at least one PIM. That said, serious effects of MEs were surprisingly low and were reported in only a small proportion of errors (0-1% of MEs), with death being rare. Whether MEs resulting in serious outcomes are truly infrequent, or are underreported because of the difficulty in ascertaining them, remains to be elucidated to assist in designing safer systems.
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Affiliation(s)
- Noha Ferrah
- Health Law and Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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Ferrah N, Leder K, Gibney K. Review of the causes and management of chronic gastrointestinal symptoms in returned travellers referred to an Australian infectious diseases service. Aust Fam Physician 2016; 45:333-339. [PMID: 27166472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Thirty to seventy per cent of overseas travellers experience traveller's diarrhoea (TD), a potential cause of serious gastrointestinal (GI) sequelae. However, there is limited evidence on the optimal management of TD. OBJECTIVE The objectives of this article are to characterise the aetiologies and management of returned travellers with ongoing GI symptoms referred to a specialist infectious diseases service. METHODS We conducted a retrospective medical record review of patients referred to the Victorian Infectious Disease Service (VIDS) in 2013-15 with a history of overseas travel and GI symptoms present for longer than two weeks. For each diagnostic group, we compared demographic and travel characteristics, illness course, investigation results, and number of and response to treatments. RESULTS The most common diagnosis was parasitic infection (31 out of 65 patients). Referral was made for infection with a controversial or uncommon organism; negative microbiological findings +/- failed metronidazole treatment; or severe or prolonged infections. DISCUSSION Our results highlight the utility of ordering more than one faecal specimen for oocytes, cysts and parasites (O/C/P) examination, potential benefits of tinidazole use, and role of specialist services for uncertain diagnoses and complex and/or unusual organ-isms.
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Bugeja L, Ibrahim JE, Ferrah N, Murphy B, Willoughby M, Ranson D. The utility of medico-legal databases for public health research: a systematic review of peer-reviewed publications using the National Coronial Information System. Health Res Policy Syst 2016; 14:28. [PMID: 27067413 PMCID: PMC4828834 DOI: 10.1186/s12961-016-0096-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medico-legal death investigations are a recognised data source for public health endeavours and its accessibility has increased following the development of electronic data systems. Despite time and cost savings, the strengths and limitations of this method and impact on research findings remain untested. This study examines this issue using the National Coronial Information System (NCIS). METHODS PubMed, ProQuest and Informit were searched to identify publications where the NCIS was used as a data source for research published during the period 2000-2014. A descriptive analysis was performed to describe the frequency and characteristics of the publications identified. A content analysis was performed to identify the nature and impact of strengths and limitations of the NCIS as reported by researchers. RESULTS Of the 106 publications included, 30 reported strengths and limitations, 37 reported limitations only, seven reported strengths only and 32 reported neither. The impact of the reported strengths of the NCIS was described in 14 publications, whilst 46 publications discussed the impacts of limitations. The NCIS was reported to be a reliable source of quality, detailed information with comprehensive coverage of deaths of interest, making it a powerful injury surveillance tool. Despite these strengths, researchers reported that open cases and missing information created the potential for selection and reporting biases and may preclude the identification and control of confounders. CONCLUSIONS To ensure research results are valid and inform health policy, it is essential to consider and seek to overcome the limitations of data sources that may have an impact on results.
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Affiliation(s)
- Lyndal Bugeja
- />Health Law & Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Australia
- />Coroners Court of Victoria, 65 Kavanagh Street, Southbank, Victoria 3006 Australia
| | - Joseph E. Ibrahim
- />Health Law & Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Australia
| | - Noha Ferrah
- />Health Law & Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Australia
| | - Briony Murphy
- />Health Law & Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Australia
| | - Melissa Willoughby
- />Health Law & Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Australia
- />Coroners Court of Victoria, 65 Kavanagh Street, Southbank, Victoria 3006 Australia
| | - David Ranson
- />Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, 3006 Australia
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Avarguès-Weber A, Dyer AG, Ferrah N, Giurfa M. The forest or the trees: preference for global over local image processing is reversed by prior experience in honeybees. Proc Biol Sci 2015; 282:20142384. [PMID: 25473017 DOI: 10.1098/rspb.2014.2384] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traditional models of insect vision have assumed that insects are only capable of low-level analysis of local cues and are incapable of global, holistic perception. However, recent studies on honeybee (Apis mellifera) vision have refuted this view by showing that this insect also processes complex visual information by using spatial configurations or relational rules. In the light of these findings, we asked whether bees prioritize global configurations or local cues by setting these two levels of image analysis in competition. We trained individual free-flying honeybees to discriminate hierarchical visual stimuli within a Y-maze and tested bees with novel stimuli in which local and/or global cues were manipulated. We demonstrate that even when local information is accessible, bees prefer global information, thus relying mainly on the object's spatial configuration rather than on elemental, local information. This preference can be reversed if bees are pre-trained to discriminate isolated local cues. In this case, bees prefer the hierarchical stimuli with the local elements previously primed even if they build an incorrect global configuration. Pre-training with local cues induces a generic attentional bias towards any local elements as local information is prioritized in the test, even if the local cues used in the test are different from the pre-trained ones. Our results thus underline the plasticity of visual processing in insects and provide new insights for the comparative analysis of visual recognition in humans and animals.
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Affiliation(s)
- Aurore Avarguès-Weber
- Centre de Recherches sur la Cognition Animale, Université de Toulouse; UPS, 118 route de Narbonne, Toulouse Cedex 9 31062, France Centre de Recherches sur la Cognition Animale, CNRS, 118 route de Narbonne, Toulouse Cedex 9 31062, France
| | - Adrian G Dyer
- Department of Physiology, Monash University, Clayton, Victoria 3800, Australia School of Media and Communication, Royal Melbourne Institute of Technology, Melbourne, Victoria 3000, Australia
| | - Noha Ferrah
- Department of Physiology, Monash University, Clayton, Victoria 3800, Australia
| | - Martin Giurfa
- Centre de Recherches sur la Cognition Animale, Université de Toulouse; UPS, 118 route de Narbonne, Toulouse Cedex 9 31062, France Centre de Recherches sur la Cognition Animale, CNRS, 118 route de Narbonne, Toulouse Cedex 9 31062, France
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Ferrah N, Obieta A, Ibrahim JE, Odell M, Yates M, Loff B. Inequity in health: older rural driving and dementia. Inj Prev 2015; 22:292-6. [PMID: 26091882 DOI: 10.1136/injuryprev-2015-041601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/26/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Noha Ferrah
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Victoria, Australia
| | - Alfredo Obieta
- Sub-acute Services, Ballarat Health Services, Ballarat, Australia
| | - Joseph Elias Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia Sub-Acute Services, Ballarat Health Services, Ballarat, Australia
| | - Morris Odell
- Clinical Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Mark Yates
- Sub-acute Services, Ballarat Health Services and Deakin Clinical School at Ballarat Health Services, Australia
| | - Bebe Loff
- Michael Kirby Centre For Public Health and Human Rights, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ferrah N, Murphy BJ, Ibrahim JE, Bugeja LC, Winbolt M, LoGiudice D, Flicker L, Ranson DL. Resident-to-resident physical aggression leading to injury in nursing homes: a systematic review. Age Ageing 2015; 44:356-64. [PMID: 25630802 DOI: 10.1093/ageing/afv004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/12/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND resident-to-resident aggression (RRA) is an understudied form of elder abuse in nursing homes. OBJECTIVE the purpose of this systematic review was to examine the published research on the frequency, nature, contributing factors and outcomes of RRA in nursing homes. METHODS in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research published in English, French, German, Italian or Spanish between 1st January 1949 and 31st December 2013 describing incidents of RRA in nursing homes. The following information was extracted for analysis: study and population characteristics; main findings (including prevalence, predisposing factors, triggers, nature of incidents, outcomes and interventions). RESULTS eighteen studies were identified, 12 quantitative and 6 qualitative. The frequency of RRA ranged from 1 to 122 incidents, with insufficient information across the studies to calculate prevalence. RRA commonly occurred between exhibitors with higher levels of cognitive awareness and physical functionality and a history of aggressive behaviours, and female targets who were cognitively impaired with a history of behavioural issues including wandering. RRA most commonly took place in the afternoon in communal settings, was often triggered by communication issues and invasion of space, or was unprovoked. Limited information exists on organisational factors contributing to RRA and the outcomes for targets of aggression. CONCLUSIONS we must continue to grow our knowledge base on the nature and circumstances of RRA to prevent harm to an increasing vulnerable population of nursing home residents and ensure a safe working environment for staff.
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Affiliation(s)
- Noha Ferrah
- Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Briony J Murphy
- Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Lyndal C Bugeja
- Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Margaret Winbolt
- The Victoria and Tasmania Dementia Training Study Centre, Australian Centre for Evidence Based Aged Care, Australian Institute for Primary Care and Ageing, Faculty of Health Sciences, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Dina LoGiudice
- National Ageing Research Institute and Melbourne Health, Melbourne, Victoria, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Western Australian Institute for Medical Research, University of Western Australia, Crawley, Western Australia, Australia Royal Perth Hospital, Perth, Western Australia, Australia
| | - David L Ranson
- Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
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