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McKinnon I, Iranpour A, Charlton A, Green E, Groom F, Watts O, McKenna D, Hackett S. Models of care in secure services for people with intellectual and developmental disability: Implementing the Walkway to Wellness. Crim Behav Ment Health 2024; 34:144-162. [PMID: 38279962 DOI: 10.1002/cbm.2328] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 01/04/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Changes to policy around inpatient services for people with intellectual and developmental disability (IDD) who offend, have led to a need for services to reconsider their models of care. This has led to calls for more tailored, patient-centred care models, with less reliance solely on offence-related treatment programmes which can be unsuitable for a growing proportion of patients with more complex cognitive and behavioural difficulties. In response, the Walkway to Wellness (W2W) was developed at one National Health Service Trust providing secure services to people with IDD, with the intention of delivering a more collaborative, co-produced and goal-oriented care model that was better understood by staff and patient stakeholders. AIMS To evaluate the implementation of the W2W using Normalisation Process Theory (NPT), an evidence-based theoretical approach is used across a number of health settings. METHODS Staff were invited to complete a short questionnaire, using the NPT informed Normalisation Measure Development questionnaire, at two time points along the implementation process. Patients were invited to complete a simplified questionnaire. Both groups were asked for their views on the W2W and the process of its implementation. RESULTS Although the W2W was more familiar to staff at the second time point, scores on the four NPT constructs showed a trend for it being less embedded in practice, with significant results concerning the ongoing appraisal of the new model. Patient views were mixed; some saw the benefit of more goal-oriented processes, but others considered it an additional chore hindering their own perceived goals. CONCLUSION Early involvement of all stakeholders is required to enhance the understanding of changes to models of care. Live feedback should be used to refine and revise the model to meet the needs of patients, carers and staff members.
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Affiliation(s)
- Iain McKinnon
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Arman Iranpour
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Anne Charlton
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
| | - Ellen Green
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
| | - Faye Groom
- School of Psychology, Newcastle University, Newcastle-upon-Tyne, UK
| | - Oliver Watts
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
| | - Dannielle McKenna
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
| | - Simon Hackett
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
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Gerakios F, Yarnall AJ, Bate G, Wright L, Davis D, Stephan BCM, Robinson L, Brayne C, Stebbins G, Taylor JP, Burn DJ, Allan LM, Richardson SJ, Lawson RA. Delirium is more common and associated with worse outcomes in Parkinson's disease compared to older adult controls: results of two prospective longitudinal cohort studies. Age Ageing 2024; 53:afae046. [PMID: 38497236 PMCID: PMC10945294 DOI: 10.1093/ageing/afae046] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Inpatient prevalence of Parkinson's disease (PD) delirium varies widely across the literature. Delirium in general older populations is associated with adverse outcomes, such as increased mortality, dementia, and institutionalisation. However, to date there are no comprehensive prospective studies in PD delirium. This study aimed to determine delirium prevalence in hospitalised PD participants and the association with adverse outcomes, compared to a control group of older adults without PD. METHODS Participants were hospitalised inpatients from the 'Defining Delirium and its Impact in Parkinson's Disease' and the 'Delirium and Cognitive Impact in Dementia' studies comprising 121 PD participants and 199 older adult controls. Delirium was diagnosed prospectively using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria. Outcomes were determined by medical note reviews and/or home visits 12 months post hospital discharge. RESULTS Delirium was identified in 66.9% of PD participants compared to 38.7% of controls (p < 0.001). In PD participants only, delirium was associated with a significantly higher risk of mortality (HR = 3.3 (95% confidence interval [CI] = 1.3-8.6), p = 0.014) and institutionalisation (OR = 10.7 (95% CI = 2.1-54.6), p = 0.004) 12 months post-discharge, compared to older adult controls. However, delirium was associated with an increased risk of developing dementia 12 months post-discharge in both PD participants (OR = 6.1 (95% CI = 1.3-29.5), p = 0.024) and in controls (OR = 13.4 (95% CI = 2.5-72.6), p = 0.003). CONCLUSION Delirium is common in hospitalised PD patients, affecting two thirds of patients, and is associated with increased mortality, institutionalisation, and dementia. Further research is essential to understand how to accurately identify, prevent and manage delirium in people with PD who are in hospital.
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Affiliation(s)
- Florence Gerakios
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
| | - Gemma Bate
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Wright
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Blossom C M Stephan
- Institute of Mental Health, School of Medicine, Nottingham University, Nottingham, UK
- Dementia Centre of Excellence, EnAble Institute, Curtin University, Perth, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Brayne
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Glenn Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
| | - David J Burn
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Sarah J Richardson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
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