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Yorganci E, Sampson EL, Gillam J, Aworinde J, Leniz J, Williamson LE, Cripps RL, Stewart R, Sleeman KE. Quality indicators for dementia and older people nearing the end of life: A systematic review. J Am Geriatr Soc 2021; 69:3650-3660. [PMID: 34331704 DOI: 10.1111/jgs.17387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/01/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Robust quality indicators (QIs) are essential for monitoring and improving the quality of care and learning from good practice. We aimed to identify and assess QIs for the care of older people and people with dementia who are nearing the end of life and recommend QIs for use with routinely collected electronic data across care settings. METHODS A systematic review was conducted, including five databases and reference chaining. Studies describing the development of QIs for care of older people and those with dementia nearing the end of life were included. QIs were categorized as relating to processes or outcomes, and mapped against six care domains. The psychometric properties (acceptability, evidence base, definition, feasibility, reliability, and validity) of each QI were assessed; QIs were categorized as robust, moderate, or poor. RESULTS From 12,980 titles and abstracts screened, 37 papers and 976 QIs were included. Process and outcome QIs accounted for 780 (79.7%) and 196 (20.3%) of all QIs, respectively. Many of the QIs concerned physical aspects of care (n = 492, 50.4%), and very few concerned spiritual and cultural aspects of care (n = 19, 1.9%). Three hundred and fifteen (32.3%) QIs were robust and of those 220 were measurable using routinely collected electronic data. The final shortlist of 71 QIs came from seven studies. CONCLUSIONS Of the numerous QIs developed for care of older adults and those with dementia nearing the end of life, most had poor or moderate psychometric properties or were not designed for use with routinely collected electronic datasets. Infrastructure for data availability, combined with use of robust QIs, is important for enhancing understanding of care provided to this population, identifying unmet needs, and improving service provision.
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Affiliation(s)
- Emel Yorganci
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Juliet Gillam
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Jesutofunmi Aworinde
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Javiera Leniz
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Lesley E Williamson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Rachel L Cripps
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Katherine E Sleeman
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
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Montero-Odasso MM, Kamkar N, Pieruccini-Faria F, Osman A, Sarquis-Adamson Y, Close J, Hogan DB, Hunter SW, Kenny RA, Lipsitz LA, Lord SR, Madden KM, Petrovic M, Ryg J, Speechley M, Sultana M, Tan MP, van der Velde N, Verghese J, Masud T. Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review. JAMA Netw Open 2021; 4:e2138911. [PMID: 34910151 PMCID: PMC8674747 DOI: 10.1001/jamanetworkopen.2021.38911] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022] Open
Abstract
Importance With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. Objectives To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. Evidence Review A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence- and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic. Findings Of 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (≥11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations. Conclusions and Relevance This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders.
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Affiliation(s)
- Manuel M Montero-Odasso
- Schulich School of Medicine and Dentistry, Division of Geriatric Medicine, Department of Medicine, The University of Western Ontario, London, Ontario, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
| | - Nellie Kamkar
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
| | - Abdelhady Osman
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
| | - Yanina Sarquis-Adamson
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, Australia
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan Winifred Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Rose Anne Kenny
- Department of Medical Gerontology, Mercers Institute for Ageing, St James Hospital, Dublin, Ireland
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kenneth M Madden
- Division of Geriatric Medicine, Department of Medicine, Department of Internal Medicine, Section of Geriatric Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Munira Sultana
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Maw Pin Tan
- Centre for Innovation in Medical Engineering, Faculty of Engineering, University of Malaysia, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - N van der Velde
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joe Verghese
- Institute for Aging Research, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Tahir Masud
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Morciano M, Stokes J, Kontopantelis E, Hall I, Turner AJ. Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England: a national cohort study. BMC Med 2021; 19:71. [PMID: 33663498 PMCID: PMC7932761 DOI: 10.1186/s12916-021-01945-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics. METHODS Daily number of deaths in all residential and nursing homes in England notified to the Care Quality Commission (CQC) from 1 January 2017 to 7 August 2020. Care home-level data linked with CQC care home register to identify home characteristics: client type (over 65s/children and adults), ownership status (for-profit/not-for-profit; branded/independent) and size (small/medium/large). Excess deaths computed as the difference between observed and predicted deaths using local authority fixed-effect Poisson regressions on pre-pandemic data. Fixed-effect logistic regressions were used to model odds of experiencing COVID-19 suspected/confirmed deaths. RESULTS Up to 7 August 2020, there were 29,542 (95% CI 25,176 to 33,908) excess deaths in all care homes. Excess deaths represented 6.5% (95% CI 5.5 to 7.4%) of all care home beds, higher in nursing (8.4%) than residential (4.6%) homes. 64.7% (95% CI 56.4 to 76.0%) of the excess deaths were confirmed/suspected COVID-19. Almost all excess deaths were recorded in the quarter (27.4%) of homes with any COVID-19 fatalities. The odds of experiencing COVID-19 attributable deaths were higher in homes providing nursing services (OR 1.8, 95% CI 1.6 to 2.0), to older people and/or with dementia (OR 5.5, 95% CI 4.4 to 6.8), amongst larger (vs. small) homes (OR 13.3, 95% CI 11.5 to 15.4) and belonging to a large provider/brand (OR 1.2, 95% CI 1.1 to 1.3). There was no significant association with for-profit status of providers. CONCLUSIONS To limit excess mortality, policy should be targeted at care homes to minimise the risk of ingress of disease and limit subsequent transmission. Our findings provide specific characteristic targets for further research on mechanisms and policy priority.
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Affiliation(s)
- Marcello Morciano
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK.
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK.
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Ian Hall
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, UK
- Department of Mathematics, University of Manchester, Manchester, M13 9PL, UK
| | - Alex J Turner
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
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Fang M, Echouffo Tcheugui JB, Pankow JS, Windham BG, Selvin E. Patient-reported preventive care practices in older adults with diabetes. Diabet Med 2021; 38:e14508. [PMID: 33368590 PMCID: PMC7887101 DOI: 10.1111/dme.14508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Fang
- Department of Epidemiology and the Welch Center for
Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD
| | - Justin B. Echouffo Tcheugui
- Division of Endocrinology, Diabetes and Metabolism,
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - James S. Pankow
- Division of Epidemiology and Community Health, University
of Minnesota, Minneapolis, Minnesota
| | - B. Gwen Windham
- Department of Geriatric Medicine, University of Mississippi
School of Medicine, Jackson, Mississippi
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for
Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD
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Frausing KP, Stamp AS. Making a difference: Students' experiences with a dementia care program. Gerontol Geriatr Educ 2021; 42:126-139. [PMID: 31442104 DOI: 10.1080/02701960.2019.1659256] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As the number of elderly citizens in general and the number of persons with dementia in particular rises, the importance of educating geriatric health care professionals increases. Recruitment is, however, impaired by negative stereotypes and insecurity. Previous research has shown that contact with the field of dementia care is important for students' motivation for choosing this career path. This paper presents an extracurricular psychomotor intervention program in which students through eight visits to elderly persons with dementia carry out an intervention involving direct individual contact. Eight psychomotor therapy students participated in follow-up focus group interviews. The purpose was to explore the motivational dynamics that make these experiences meaningful to students. Qualitative analysis of the students' self-assessed outcomes revealed three themes: The relational encounter, Discovering the person, and Making a difference. In combination these themes show important nuances to existing literature on student career dreams by pointing to the benefits of attending to the moment to moment changes in the care situation.
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Affiliation(s)
- Kristian Park Frausing
- VIA Psychomotor Therapy, Faculty of Health Sciences, VIA University College, Randers, Denmark
- VIA Ageing & Dementia, Center for research, Faculty of Health Sciences, VIA University College, Holstebro, Denmark
| | - Anne Schinkel Stamp
- VIA Psychomotor Therapy, Faculty of Health Sciences, VIA University College, Randers, Denmark
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Marr S, McKibbon K, Patel A, McKinnon Wilson J, Hillier LM. The geriatric certificate program: collaborative partnerships for building capacity for a competent workforce. Gerontol Geriatr Educ 2021; 42:13-23. [PMID: 30706766 DOI: 10.1080/02701960.2019.1572004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Many practicing health care providers find themselves ill-prepared to meet the complex care needs of older adults. The Geriatric Certificate Program (GCP) represents a collaborative partnership leveraging existing educational courses, with new courses developed to fill existing education gaps, aimed at improving quality of care for older adults. This paper describes the GCP and examines its impact on knowledge, skills, clinical practice, as well as confidence, comfort, and competence in providing geriatric care. Upon program completion, all graduates (N = 146; 100%) completed an online evaluation survey. The majority of graduates reported (5-point scale: 1 = much less now; 5 = much more now) being more confident (88%), comfortable (83%), and competent (89%) to provide optimal geriatric care than prior to the program. The GCP provides a significant opportunity for health care providers to build their capacity for the care of older adults. Key lessons learned in implementing the GCP and suggestions for further development are discussed.
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Affiliation(s)
- Sharon Marr
- Regional Geriatric Program central, Hamilton, Ontario, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kristy McKibbon
- Regional Geriatric Program central, Hamilton, Ontario, Canada
| | - Anisha Patel
- Regional Geriatric Program central, Hamilton, Ontario, Canada
| | | | - Loretta M Hillier
- Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton, Ontario, Canada
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Wyman MF, Voils CI, Trivedi R, Boyle L, Goldman D, Umucu E, Zuelsdorff M, Johnson AL, Gleason CE. Perspectives of Veterans Affairs mental health providers on working with older adults with dementia and their caregivers. Gerontol Geriatr Educ 2021; 42:114-125. [PMID: 32420824 PMCID: PMC7671942 DOI: 10.1080/02701960.2020.1764356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 06/11/2023]
Abstract
Continuing education directed at building providers' skills and knowledge in geriatrics represents a practical approach to addressing the geriatric mental health (MH) care workforce shortage. To inform the development of professional training curricula, we surveyed MH providers (N = 65) at a Veterans Affairs medical center on working with older persons with dementia (PwD) and informal caregivers. Providers rated service provision to PwD and caregivers as highly important but endorsed modest self-efficacy. Half of respondents were minimally confident in managing risk of harm to self or others in a PwD. Respondents believed PwD can benefit from MH treatments, yet identified several barriers to providing care, including inadequate time and staffing resources. Interest in geriatric training topics was high. Findings demonstrate that MH providers at this site value care provision to PwD and caregivers, and desire additional training to serve this population. System-level barriers to MH care for PwD should also be identified and addressed.
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Affiliation(s)
- Mary F. Wyman
- W.S. Middleton Memorial Veterans Hospital, Madison, WI
- University of Wisconsin School of Medicine & Public Health
| | - Corrine I. Voils
- W.S. Middleton Memorial Veterans Hospital, Madison, WI
- University of Wisconsin School of Medicine & Public Health
| | - Ranak Trivedi
- Stanford University, Palo Alto, CA
- VA Palo Alto Health Care System, Palo Alto, CA
| | - Lisa Boyle
- W.S. Middleton Memorial Veterans Hospital, Madison, WI
- University of Wisconsin School of Medicine & Public Health
| | | | - Emre Umucu
- University of Texas, El Paso, El Paso, TX
| | - Megan Zuelsdorff
- University of Wisconsin School of Medicine & Public Health
- School of Nursing, University of Wisconsin
| | - Adrienne L. Johnson
- W.S. Middleton Memorial Veterans Hospital, Madison, WI
- UW Center for Tobacco Research and Intervention, Madison, WI
| | - Carey E. Gleason
- W.S. Middleton Memorial Veterans Hospital, Madison, WI
- University of Wisconsin School of Medicine & Public Health
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Jester DJ, Hyer K, Guerra L, Robinson BE, Andel R. Beliefs regarding geriatrics primary care topics among medical students and internal medicine residents. Gerontol Geriatr Educ 2021; 42:46-58. [PMID: 31476132 DOI: 10.1080/02701960.2019.1661841] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study evaluated beliefs regarding 25 content areas essential to the primary care of older adults and attitudes toward aging held by first-yearmedical students and Internal Medicine residents. A survey of 136 medical students and 61 Internal Medicine residents was conducted at an academic health-center. Beliefs were assessed by the 25-item Geriatrics Clinician-Educator Survey. Gap scores reflecting the difference in ratings between self-rated importance and knowledge were calculated. Attitudes toward aging was assessed by the Images of Aging Scale. Students and residents expressed similar beliefs about the importance of content areas, but students provided lower ratings in knowledge. Students reported larger gap scores in areas that reflected general primary care (e.g., chronic conditions, medications), whereas residents reported larger gap scores in areas that reflected specialists' expertise (e.g., driving risk, cognition, psychiatric symptoms). Attitudes toward aging did not differ appreciably between students and residents. Our findings suggest that primary care topics applicable for any age demographic were rated as most important by first-year medical students and Internal Medicine residents. Topics relevant to older populations--particularly those requiring specialists' knowledge of or requiring sensitive discussion with older adults-were rated as less important and were less well-mastered.
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Affiliation(s)
- Dylan J Jester
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Lucy Guerra
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Bruce E Robinson
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
- Department of Geriatrics, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Ross Andel
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
- Department of Neurology, 2nd Medical Faculty, Charles University, Prague, Czech Republic
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El Hayek S, Cheaito MA, Nofal M, Abdelrahman D, Adra A, Al Shamli S, AlHarthi M, AlNuaimi N, Aroui C, Bensid L, Emberish AM, Larnaout A, Radwan A, Slaih M, Al Sinawi H. Geriatric Mental Health and COVID-19: An Eye-Opener to the Situation of the Arab Countries in the Middle East and North Africa Region. Am J Geriatr Psychiatry 2020; 28:1058-1069. [PMID: 32425474 PMCID: PMC7233242 DOI: 10.1016/j.jagp.2020.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 01/10/2023]
Abstract
While the detrimental ramifications of the COVID-19 outbreak on the mental wellbeing of the general public continue to unravel, older adults seem to be at high risk. As the geriatric population continues to grow in the Middle East and North Africa (MENA) region, it is essential to explore the influence of this outbreak on geriatric mental health, a topic often neglected. In this review, we depict the status of geriatric psychiatry in the Arab countries of the MENA region, exploring the variations from one nation to another. While some have a null exposure to the field, resources and expertise in other countries range from very limited to extensive. Furthermore, we highlight the measures implemented in the Arab region to address mental health during the COVID-19 outbreak; these tend to be insufficient when targeting the geriatric population. Finally, we provide short- and long-term recommendations to stakeholders that aim at enhancing the mental healthcare of older adults in the Arab countries of the MENA region, particularly during this pandemic.
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Affiliation(s)
- Samer El Hayek
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
| | - Mohamad Ali Cheaito
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | - Ali Adra
- Department of Psychiatry, Damascus University, Damascus, Syria
| | | | - Mansour AlHarthi
- Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | | | - Chaimaa Aroui
- Ibn Rushd Psychiatry University Center, Casablanca, Morocco
| | - Lynda Bensid
- University of Algiers, Drid Hocine Hospital specialized in Psychiatry, Department A, Algiers, Algeria
| | | | - Amine Larnaout
- Razi Hospital, Faculty of medicine of Tunis, Tunis El Manar University, Cite Romana, Tunis, Tunisia
| | - Ahmed Radwan
- Hamad Medical Corporation, Mental Health Service, Doha, Qatar
| | - Mohammad Slaih
- National Center for Mental Health, Ministry of Health, Jordan
| | - Hamed Al Sinawi
- Department of Behavioural Medicine, Sultan Qaboos University, Muscat, Oman
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Blunt D. Defining, monitoring and improving quality in Welsh care homes. Nurs Older People 2020; 32:28-32. [PMID: 32077271 DOI: 10.7748/nop.2020.e1218] [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] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
Despite the focus on quality in care homes, and the body of evidence that drives policy and practice, care home residents in Wales experience variations in quality of care. Quality is not easily defined, and care providers may have differing views on quality and how it is monitored. Health and social care professionals - including nurses - should understand the factors that affect quality in care homes. Quality improvement projects can support the development of a workplace culture that can sustain quality in care homes. This article defines quality, details methods that may be used to monitor quality, and outlines how quality in care homes can be improved.
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Affiliation(s)
- Duncan Blunt
- Cwm Taf Morgannwg University Health Board, Abercynon, Wales
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Greene M, Myers J, Tan JY, Blat C, O’Hollaren A, Quintanilla F, Hsue P, Shiels M, Hicks ML, Olson B, Grochowski J, Oskarsson J, Havlir D, Gandhi M. The Golden Compass Program: Overview of the Initial Implementation of a Comprehensive Program for Older Adults Living with HIV. J Int Assoc Provid AIDS Care 2020; 19:2325958220935267. [PMID: 32715875 PMCID: PMC7385829 DOI: 10.1177/2325958220935267] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
The population with HIV is aging and has unique health needs. We present findings from an evaluation of the geriatric-HIV program, Golden Compass, at San Francisco General Hospital. We used the implementation science framework, RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to guide the evaluation and used quantitative and qualitative methods to assess RE-AIM dimensions. From January 2017 to June 2018, 198 adults age ≥50 years participated in the program, with an estimated reach of 17%. Providers and patients indicated high acceptability of the program and were satisfied with clinics and classes. Colocation of services, specific pharmacy and geriatric assessments, and social support from classes were valued (effectiveness). Provider adoption was high, and the program was implemented as originally designed. Areas for improvement included challenges of framing aging services to patients. Future efforts will focus on expanding the reach of the program and examining long-term outcomes.
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Affiliation(s)
- Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Janet Myers
- Division of Prevention Science, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Judy Y. Tan
- Division of Prevention Science, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Cinthia Blat
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California–San Francisco, San Francisco, CA, USA
| | - Allison O’Hollaren
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Francisco Quintanilla
- Division of Geriatrics, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Priscilla Hsue
- Division of Cardiology, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Mary Shiels
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Mary Lawrence Hicks
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Bill Olson
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Janet Grochowski
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Jon Oskarsson
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Diane Havlir
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
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Anderson JE, Ross AJ, Lim R, Kodate N, Thompson K, Jensen H, Cooney K. Nursing teamwork in the care of older people: A mixed methods study. Appl Ergon 2019; 80:119-129. [PMID: 31280795 DOI: 10.1016/j.apergo.2019.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
Healthcare is increasingly complex and requires the ability to adapt to changing demands. Teamwork is essential to delivering high quality care and is central to nursing. The aims of this study were to identify the processes that underpin nursing teamwork and how these affect the care of older people, identify the relationship between perceived teamwork and perceived quality of care, and explore in depth the experience of working in nursing teams. The study was carried out in three older people's wards in a London teaching hospital. Nurses and healthcare assistants completed questionnaires (n = 65) on known dynamics of teamwork (using the Nursing Teamwork Survey) together with ratings of organisational quality (using an adapted AHRQ HSPS scale). A sample (n = 22; 34%) was then interviewed about their perceptions of care, teamwork and how good outcomes are delivered in everyday work. Results showed that many care difficulties were routinely encountered, and confirmed the importance of teamwork (e.g. shared mental models of tasks and team roles and responsibilities, supported by leadership) in adapting to challenges. Perceived quality of teamwork was positively related to perceived quality of care. Work system variability and the external environment influenced teamwork, and confirmed the importance of team adaptive capacity. The CARE model shows the centrality of teamwork in adapting to variable demand and capacity to deliver care processes, and the influence of broader system factors on teamworking.
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Affiliation(s)
- J E Anderson
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK.
| | - A J Ross
- Dental School, University of Glasgow, UK
| | - R Lim
- Reading School of Pharmacy, University of Reading, UK
| | - N Kodate
- School of Applied Social Science, University College Dublin, UK
| | - K Thompson
- School of Social Science, Liverpool Hope University, UK
| | - H Jensen
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Cooney
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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14
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Tiilikainen E, Hujala A, Kannasoja S, Rissanen S, Närhi K. "They're always in a hurry" - Older people´s perceptions of access and recognition in health and social care services. Health Soc Care Community 2019; 27:1011-1018. [PMID: 30723951 DOI: 10.1111/hsc.12718] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
The article examines older people's perceptions of quality of life from the perspective of access and use of health and social care services. The data include focus group discussions with older people living alone. The data were analysed using thematic analysis focusing on the older people's collective views on health and social care services as supportive or restrictive factors for their quality of life. Two central themes were present in all the focus group discussions: the importance of accessing services and information regarding the services, and need for recognition within the services/by the professionals. Both themes were connected to the older people's desire to maintain autonomy in their everyday life despite increasing functional disabilities, which was seen as an important factor of quality of life. The older people felt that accessing and finding information about the services was difficult, and dependent on the professional's good will and the older person's own financial resources. Within the services, older people experienced a lack of recognition of their own personhood and individual needs. The participants felt that they were easily bypassed and left out of negotiations regarding their own care. The article highlights the importance of developing health and social care services and practices towards a more holistic approach recognising older people's individual needs.
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Affiliation(s)
- Elisa Tiilikainen
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anneli Hujala
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Kannasoja
- Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland
| | - Sari Rissanen
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kati Närhi
- Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland
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15
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Hibbert PD, Wiles LK, Cameron ID, Kitson A, Reed RL, Georgiou A, Gray L, Westbrook J, Augustsson H, Molloy CJ, Arnolda G, Ting HP, Mitchell R, Rapport F, Gordon SJ, Runciman WB, Braithwaite J. CareTrack Aged: the appropriateness of care delivered to Australians living in residential aged care facilities: a study protocol. BMJ Open 2019; 9:e030988. [PMID: 31243038 PMCID: PMC6597647 DOI: 10.1136/bmjopen-2019-030988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice ('appropriate care') in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims of CareTrack Aged are to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia. METHODS AND ANALYSIS We will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage sampling method. Experienced nurses, trained in the CareTrack Aged methods ('surveyors'), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents' QoL using validated questionnaires. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, St Leonards, New South Wales, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Richard L Reed
- Flinders University General Practice and Primary Health Care, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Len Gray
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hanna Augustsson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Susan J Gordon
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - William B Runciman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Abstract
In our ageing society diabetes imposes a significant burden in terms of the numbers of people with the condition, diabetes-related complications including disability, and health and social care expenditure. Older people with diabetes can represent some of the more complex and difficult challenges facing the clinician working in different settings, and the recognition that we have only a relatively small (but increasing) evidence base to guide us in diabetes management is a limitation of our current approaches. Nevertheless, in this review we attempt to explore what evidence there is to guide us in a comprehensive scheme of treatment for older adults, often in a high-risk clinical state, in terms of glucose lowering, blood pressure and lipid management, frailty care and lifestyle interventions. We strive towards individualized care and make a call for action for more high-quality research using different trial designs.
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Affiliation(s)
- A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich, UK
| | | | | | - M Munshi
- Harvard Medical School and Joslin Clinic, Boston, MA, USA
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Ludlow K, Churruca K, Ellis LA, Mumford V, Braithwaite J. Understanding the priorities of residents, family members and care staff in residential aged care using Q methodology: a study protocol. BMJ Open 2019; 9:e027479. [PMID: 30850419 PMCID: PMC6429870 DOI: 10.1136/bmjopen-2018-027479] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Residential aged care facilities (RACFs) are under increasing pressure to provide high-quality, round the clock care to consumers. However, they are often understaffed and without adequate skill mix and resources. As a result, staff must prioritise care by level of importance, potentially leading to care that is missed, delayed or omitted. To date, the literature on prioritisation and missed care has been dominated by studies involving nursing staff, thereby failing to take into account the complex networks of diverse stakeholders that RACFs comprise. This study aims to investigate the priorities of residents, family members and care staff in order to make comparisons between how care is prioritised in RACFs by the different stakeholder groups. METHODS AND ANALYSIS This study comprises a Q sorting activity using Q methodology, a think-aloud task, a demographics questionnaire and semi-structured interview questions. The study will be conducted in five RACFs across NSW and QLD, Australia. Using purposive sampling, the project will recruit up to 33 participants from each of the three participant groups. Data from the Q sorting activity will be analysed using the analytic software PQMethod to identify common factors (shared viewpoints). Data from the think-aloud task and semi-structured interviews questions will be thematically analysed using the Framework Method and NVivo qualitative data analysis software. ETHICS AND DISSEMINATION The study has been approved by St Vincent's Health and Aged Care Human Research and Ethics Committee and Macquarie University Human Research Ethics Committee. It is expected that findings from the study will be disseminated: in peer-reviewed journals; as an executive report to participating facilities and a summary sheet to participants; as a thesis to fulfill the requirements of a Doctor of Philosophy; and presented at conferences and seminars.
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Affiliation(s)
- Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Pooler JA, Hartline-Grafton H, DeBor M, Sudore RL, Seligman HK. Food Insecurity: A Key Social Determinant of Health for Older Adults. J Am Geriatr Soc 2019; 67:421-424. [PMID: 30586154 PMCID: PMC6816803 DOI: 10.1111/jgs.15736] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer A. Pooler
- Advanced Analytics Practice Area, IMPAQ International, LLC, Columbia, Maryland
| | | | | | - Rebecca L. Sudore
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, California
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Medicine, Innovation and Implementation Center for Aging and Palliative Care (I-CAP), Division of Geriatrics, University of California, San Francisco, California
| | - Hilary K. Seligman
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco
- The UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
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EVANS CATHERINEJ, ISON LUCY, ELLIS‐SMITH CLARE, NICHOLSON CAROLINE, COSTA ALESSIA, OLUYASE ADEJOKEO, NAMISANGO EVE, BONE ANNAE, BRIGHTON LISAJANE, YI DEOKHEE, COMBES SARAH, BAJWAH SABRINA, GAO WEI, HARDING RICHARD, ONG PAUL, HIGGINSON IRENEJ, MADDOCKS MATTHEW. Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review. Milbank Q 2019; 97:113-175. [PMID: 30883956 PMCID: PMC6422603 DOI: 10.1111/1468-0009.12373] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Policy Points We identified two overarching classifications of integrated geriatric and palliative care to maximize older people's quality of life at the end of life. Both are oriented to person-centered care, but with differing emphasis on either function or symptoms and concerns. Policymakers should both improve access to palliative care beyond just the last months of life and increase geriatric care provision to maintain and optimize function. This would ensure that continuity and coordination for potentially complex care needs across the continuum of late life would be maintained, where the demarcation of boundaries between healthy aging and healthy dying become increasingly blurred. Our findings highlight the urgent need for health system change to improve end-of-life care as part of universal health coverage. The use of health services should be informed by the likelihood of benefits and intended outcomes rather than on prognosis. CONTEXT In an era of unprecedented global aging, a key priority is to align health and social services for older populations in order to support the dual priorities of living well while adapting to a gradual decline in function. We aimed to provide a comprehensive synthesis of evidence regarding service delivery models that optimize the quality of life (QoL) for older people at the end of life across health, social, and welfare services worldwide. METHODS We conducted a rapid scoping review of systematic reviews. We searched MEDLINE, CINAHL, EMBASE, and CDSR databases from 2000 to 2017 for reviews reporting the effectiveness of service models aimed at optimizing QoL for older people, more than 50% of whom were older than 60 and in the last one or two years of life. We assessed the quality of these included reviews using AMSTAR and synthesized the findings narratively. RESULTS Of the 2,238 reviews identified, we included 72, with 20 reporting meta-analysis. Although all the World Health Organization (WHO) regions were represented, most of the reviews reported data from the Americas (52 of 72), Europe (46 of 72), and/or the Western Pacific (28 of 72). We identified two overarching classifications of service models but with different target outcomes: Integrated Geriatric Care, emphasizing physical function, and Integrated Palliative Care, focusing mainly on symptoms and concerns. Areas of synergy across the overarching classifications included person-centered care, education, and a multiprofessional workforce. The reviews assessed 117 separate outcomes. A meta-analysis demonstrated effectiveness for both classifications on QoL, including symptoms such as pain, depression, and psychological well-being. Economic analysis and its implications were poorly considered. CONCLUSIONS Despite their different target outcomes, those service models classified as Integrated Geriatric Care or Integrated Palliative Care were effective in improving QoL for older people nearing the end of life. Both approaches highlight the imperative for integrating services across the care continuum, with service involvement triggered by the patient's needs and likelihood of benefits. To inform the sustainability of health system change we encourage economic analyses that span health and social care and examine all sources of finance to understand contextual inequalities.
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Affiliation(s)
- CATHERINE J. EVANS
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
- Sussex Community NHS Foundation TrustBrighton General Hospital
| | - LUCY ISON
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - CLARE ELLIS‐SMITH
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - CAROLINE NICHOLSON
- King's College London, Florence Nightingale Faculty of NursingMidwifery & Palliative Care
- St Christopher's Hospice
| | - ALESSIA COSTA
- King's College London, Florence Nightingale Faculty of NursingMidwifery & Palliative Care
| | - ADEJOKE O. OLUYASE
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - EVE NAMISANGO
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - ANNA E. BONE
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - LISA JANE BRIGHTON
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - DEOKHEE YI
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - SARAH COMBES
- King's College London, Florence Nightingale Faculty of NursingMidwifery & Palliative Care
| | - SABRINA BAJWAH
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - WEI GAO
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - RICHARD HARDING
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - PAUL ONG
- World Health Organisation Centre for Health Development
| | - IRENE J. HIGGINSON
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - MATTHEW MADDOCKS
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
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Stein J, Liegert P, Dorow M, König HH, Riedel-Heller SG. Unmet health care needs in old age and their association with depression - results of a population-representative survey. J Affect Disord 2019; 245:998-1006. [PMID: 30699886 DOI: 10.1016/j.jad.2018.11.096] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 09/18/2018] [Revised: 11/09/2018] [Accepted: 11/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the demographic changes, unmet health care needs are expected to increase in the elderly population. The aim of this study was to analyse the distribution of met and unmet needs and their association with depression in old age. METHODS Based on a population-representative telephone survey of the elderly population aged 75 + years and older, a sample of 845 individuals was assessed via structured clinical interviews. Data on unmet needs were collected via the adapted German version of the Camberwell Assessment of Need for the Elderly (CANE). Descriptive and interferential statistical analyses were run. RESULTS Most frequently, unmet needs were reported in the CANE sections memory, physical health and mobility. Significant differences with regard to age and gender were observed. Further, regression analyses revealed that unmet needs were significantly associated with depression. LIMITATIONS Data on unmet needs were only assessed from the participants' perspectives. The cross-sectional design of the study does not allow drawing conclusions on causality of results. CONCLUSION This study provides, for the first time in Germany, population-representative data on unmet health care needs in the oldest old and represents an important starting point in the field of health and social care as well as the development of tailored treatment and interventions in old age.
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Affiliation(s)
- Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, Leipzig 04103, Germany.
| | - Paula Liegert
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, Leipzig 04103, Germany
| | - Marie Dorow
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, Leipzig 04103, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, Leipzig 04103, Germany
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Molnar F, Frank CC. Optimizing geriatric care with the GERIATRIC 5 Ms. Can Fam Physician 2019; 65:39. [PMID: 30674512 PMCID: PMC6347324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Frank Molnar
- Specialist in geriatric medicine practising in Ottawa, Ont
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Cucinotta D. The Science of Choosing Wisely: should it be applied to any intervention for healthy and active longevity? Acta Biomed 2019; 90:357-358. [PMID: 31125021 PMCID: PMC6776212 DOI: 10.23750/abm.v90i2.8459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 11/14/2022]
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Koopmans L, Damen N, Wagner C. Does diverse staff and skill mix of teams impact quality of care in long-term elderly health care? An exploratory case study. BMC Health Serv Res 2018; 18:988. [PMID: 30572880 PMCID: PMC6302304 DOI: 10.1186/s12913-018-3812-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 12/11/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Many European countries face challenges in long-term care for older people, such as the growing number of older people requiring care, the increasing complexity of their health care problems, and a decreasing workforce that is inadequately prepared. Optimizing the staff and skill mix of health care teams may offer part of the solution for these challenges. The aim of this study was to obtain insight into the development of teams in terms of staff and skill mix, and the influence of staff and skill mix on quality of care, quality of life, and job satisfaction. METHODS Seven teams in elderly care in the Netherlands participated in this exploratory case study. From April 2013 to January 2015, a researcher followed the development of the teams, performed observations at the workplace and held interviews with team members, team captains, and (representatives of) clients. Data-analyses were carried out in MAXQDA 11, by coding interviews and analyzing themes. RESULTS During the project, almost all teams became more diverse in terms of staff and skill mix. In general, there was a trend towards adding (more) higher-qualified health care workers (e.g. nurse) to the team, increasing communication with other disciplines, and enhancing skills of lower-qualified team members. A more diverse staff and skill mix had a positive effect on quality of care and quality of life of clients, and on job satisfaction, but only under certain contextual conditions. Important contextual conditions for successful functioning of a diverse team were a shared view of care by all team members, good communication, autonomy for professionals, and a safe team culture. CONCLUSION A more diverse staff and skill mix, in combination with positive contextual conditions, can result in improved quality of care, quality of life, and job satisfaction. However, a "one size fits all" blueprint for the optimal staff and skill mix, that suits each team and organization, does not exist. This depends on the context, and should be based on the needs of the clients and possible future changes in these needs.
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Affiliation(s)
- L Koopmans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands, currently working at TNO Healthy Living, Leiden, TNO Healthy Living, P.O. Box 3005, NL 2301, DA, Leiden, The Netherlands.
| | - N Damen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands, currently working at Elisabeth-TweeSteden Ziekenhuis (ETZ), Tilburg, The Netherlands
| | - C Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Verver D, Stoopendaal A, Merten H, Robben P, Wagner C. What are the perceived added values and barriers of regulating long-term care in the home environment using a care network perspective: a qualitative study. BMC Health Serv Res 2018; 18:946. [PMID: 30522469 PMCID: PMC6282343 DOI: 10.1186/s12913-018-3770-x] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Changes in Dutch policy towards long-term care led to the Dutch Health and Youth Care Inspectorate testing a regulatory framework focusing on care networks around older adults living independently. This regulatory activity involved all care providers and the older adults themselves. METHODS Semi-structured interviews with the older adults, and focus groups with care providers and inspectors were used to assess the perceived added value of, and barriers to the framework. RESULTS The positive elements of this framework were the involvement of the older adults in the regulatory activity, the focus of the framework on care networks and the open character of the conversations with the inspectors. However, applying the framework requires a substantial investment of time. Care providers often did not perceive themselves as being part of a care network around one person and they expressed concerns about financial and privacy issues when thinking in terms of care networks. CONCLUSIONS The experiences of the client were seen as important in regulating long-term care. Regulating care networks as a whole puts cooperation between care providers involved around one person on the agenda. However, barriers for this form of regulation were also perceived and, therefore, careful consideration when and how to regulate care networks is recommended.
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Affiliation(s)
- Didi Verver
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL, 1081 Amsterdam, BT Netherlands
| | - Annemiek Stoopendaal
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 Rotterdam, PA Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL, 1081 Amsterdam, BT Netherlands
| | - Paul Robben
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 Rotterdam, PA Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL, 1081 Amsterdam, BT Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, the Netherlands
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Ghesquiere AR, Pepin R, Kinsey J, Bartels SJ, Bruce ML. Factors associated with depression detection in a New Hampshire mental health outreach program. Aging Ment Health 2018; 22:1471-1476. [PMID: 28812372 PMCID: PMC5815953 DOI: 10.1080/13607863.2017.1364346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES For mental health outreach programs for older adults, accurately detecting depression is key to quality service provision. Multiple factors, including gender, cognitive impairment, or recent bereavement may affect depression detection, but this is under-studied. Therefore, we sought to both establish rates of depressive symptom detection and to examine factors associated with inaccuracies of detecting depression among participants in a mental health outreach program serving older adults. METHOD We conducted a chart review of 1126 cases in an older adult-focused mental health outreach program in New Hampshire, the Referral Education Assistance & Prevention (REAP) program. Accuracy of depression detection was identified by comparing screen-positive scores for depressive symptoms on the 15-item Geriatric Depression Scale (GDS) to depression identification by counselors on a 'presenting concerns' list. RESULTS Inaccurate depression detection (positive on the GDS but depression not identified by counselors) occurred in 27.6% of cases. Multivariate regression analyses indicated that anxiety, cognitive concerns, and rurality were all associated with detection innaccuracy. CONCLUSION This study appears to be the first to examine factors influencing depression detection in a mental health outreach program. Future efforts should help ensure that all older mental health outreach clients have depression detected at optimal rates.
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Affiliation(s)
- Angela R Ghesquiere
- a Brookdale Center for Healthy Aging, Hunter College , City University of New York , NY , USA
| | - Renee Pepin
- b Dartmouth Centers for Health and Aging , Lebanon , NH , USA
| | | | - Stephen J Bartels
- d The Dartmouth Institute, Geisel School of Medicine at Dartmouth, and Dartmouth Centers for Health and Aging , Lebanon , NH , USA
| | - Martha L Bruce
- d The Dartmouth Institute, Geisel School of Medicine at Dartmouth, and Dartmouth Centers for Health and Aging , Lebanon , NH , USA
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Santoso AMM, Lutomski JE, Hofman CS, Metzelthin SF, Blom JW, van der Wees PJ, Olde Rikkert MGM, Melis RJF. Development of a Patient-Reported Outcome Measure for Geriatric Care: The Older Persons and Informal Caregivers Survey Short Form. Value Health 2018; 21:1198-1204. [PMID: 30314621 DOI: 10.1016/j.jval.2018.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 02/14/2018] [Accepted: 02/21/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The Older Persons and Informal Caregivers Minimum Data Set (TOPICS-MDS) is a standardized data set that was developed to evaluate the quality of multidimensional geriatric care. There is an inherent need to reduce the number of TOPICS-MDS survey items to core outcomes to allow it to be more easily applied as a patient-reported outcome measure in clinical settings. OBJECTIVES To create a TOPICS-short form (TOPICS-SF) and examine its validity. METHODS Data in the TOPICS-MDS from persons aged 65 years and older in the Netherlands were used for the following analyses. Multiple linear regression analyses were performed to select the items and to derive domain weights of TOPICS-SF. A priori hypotheses were made on the basis of psychometric properties of the full-length TOPICS-MDS preference-weighted score (TOPICS-CEP). The validity of TOPICS-SF was evaluated by 1) examining the meta-correlation of the TOPICS-SF score with TOPICS-CEP and two quality-of-life measures, that is, the Cantril Ladder score and the EuroQol five-dimensional questionnaire utility index, and 2) performing mixed multiple regression of TOPICS-SF scores across key sociodemographic characteristics. RESULTS TOPICS-SF scores were strongly correlated with the TOPICS-CEP (r = 0.96) and had stronger correlation with the EuroQol five-dimensional questionnaire utility index compared with the Cantril Ladder (r = 0.61 and 0.38, respectively). TOPICS-SF scores were higher among older persons who were married, living independently, and having higher levels of education. CONCLUSIONS We have developed the 22-item TOPICS-SF and demonstrated its validity, supporting its use as a patient-reported outcome measure in geriatric care.
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Affiliation(s)
- Angelina M M Santoso
- Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jennifer E Lutomski
- Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cynthia S Hofman
- Vilans, Center of Expertise for Long-Term Care, Utrecht, The Netherlands
| | - Silke F Metzelthin
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Philip J van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - René J F Melis
- Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
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Abstract
Suicide is a tragic, traumatic loss, and one of the most emotionally devastating events families, friends, and communities experience. Suicide claims more than 800,000 lives every year, and some of the highest rates of suicide in the United States and globally are among older adults. The purpose of this evidence-based guideline is to help health care providers recognize those at risk for suicide and recommend appropriate and effective secondary suicide prevention interventions. The information in this guideline is intended for health care providers who work in a variety of settings, including hospitals, nursing homes, rehabilitation centers, out-patient clinics, mental health clinics, home health care, and other long-term care facilities. Assessment and preventive treatment strategies were derived by exhaustive literature review and synthesis of the current evidence on secondary prevention of late-life suicide across practice settings. [Journal of Gerontological Nursing, 44(11), 20-32.].
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Abstract
The care of frail older people admitted with hip fracture has improved greatly over the last half-century, largely as a result of combined medical care and surgical care and the rise - over the last four decades - of large-scale hip fracture audit. A series of European initiatives evolved. The first national hip fracture audit was the Swedish Rikshöft in the late 1980s, and the largest so far is the UK National Hip Fracture Database (NHFD), launched in 2007. An external evaluation of the NHFD demonstrated statistically significant increases in survival at up to 1 year associated with improved early care: with rising geriatrician involvement and falling delays to surgery, and from which lessons have been learned. Comparable national audits have emerged since in northern Europe and in Australia and New Zealand, and most recently in Spain and Japan. Like the NHFD, these use the synergy of agreed clinical standards and regular - ideally continuous - audit feedback that can prompt and monitor clinical and service developments, often demonstrating both rising quality and improved cost effectiveness. In addition, important benchmarking studies of hip fracture care have been reported from India and China, both of which face huge challenges in providing care of fragility fractures in populations characterised by first-generation mass ageing. The 'halo effect' of the impact of growing expertise in hip fracture care on the care of other fragility fractures is noteworthy and now relevant globally. Although many national audits have now published encouraging reports of progress, the details of context and process determinants of the initiation and development of effective hip fracture audit have received relatively little attention. To address this, an extended discussion section - based on the author's experience of participation in several substantial audits, variously supporting and observing many others, and from his numerous discussions with audit colleagues over the years - may be of value in offering practical advice on some obvious and less obvious practical issues that arise in the setting up of large-scale hip fracture audits in a variety of healthcare contexts.
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Affiliation(s)
- Colin Currie
- Formerly (1979-2010) of Geriatric Medicine Unit, School of Clinical Sciences and Community Health, College of Medicine and Veterinary medicine, Edinburgh University, Royal infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
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Dreinhöfer KE, Mitchell PJ, Bégué T, Cooper C, Costa ML, Falaschi P, Hertz K, Marsh D, Maggi S, Nana A, Palm H, Speerin R, Magaziner J. A global call to action to improve the care of people with fragility fractures. Injury 2018; 49:1393-1397. [PMID: 29983172 DOI: 10.1016/j.injury.2018.06.032] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023]
Abstract
The ageing of society is driving an enormous increase in fragility fracture incidence and imposing a massive burden on patients, their families, health systems and societies globally. Disrupting the status quo has therefore become an obligation and a necessity. Initiated by the Fragility Fracture Network (FFN) at a "Presidents' Roundtable" during the 5th FFN Global Congress in 2016 several leading organisations agreed that a global multidisciplinary and multiprofessional collaboration, resulting in a Global Call to Action (CtA), would be the right step forward to improve the care of people presenting with fragility fractures. So far global and regional organisations in geriatrics/internal medicine, orthopaedics, osteoporosis/metabolic bone disease, rehabilitation and rheumatology were contacted as well as national organisations in five highly populated countries (Brazil, China, India, Japan and the United States), resulting in 81societies endorsing the CtA. We call for implementation of a systematic approach to fragility fracture care with the goal of restoring function and preventing subsequent fractures without further delay. There is an urgent need to improve: To address this fragility fracture crisis, the undersigned organisations pledge to intensify their efforts to improve the current management of all fragility fractures, prevent subsequent fractures, and strive to restore functional abilities and quality of life.
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Affiliation(s)
- K E Dreinhöfer
- Department of Musculoskeletal Rehabilitation, Prevention and Health Service Research, Center for Sport Science and Sport Medicine (CSSB), Center for Musculoskeletal Surgery (CMSC), Charité Universitätsmedizin, Berlin, Germany; Department of Orthopedics and Traumatology, Medical Park Berlin Humboldtmühle, Berlin, Germany; FFN, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland.
| | - P J Mitchell
- FFN, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland; School of Medicine, Sydney Campus, The University of Notre Dame Australia, 140 Broadway, Sydney, NSW, 2007, Australia
| | - T Bégué
- Service de Chirurgie Orthopédique, Traumatologique et Réparatrice, Hôpital Antoine Béclère, Université Paris-Sud, 157, rue de la porte de Trivaux, 92140, Clamart, France; European Federation of National Associations of Orthopaedics and Traumatology (EFORT), Chair Science Committee, EFORT, La Pièce 2, 1180, Rolle, Switzerland
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, United Kingdom; NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom; IOF, 9 rue Juste-Olivier, CH-1260, Nyon, Switzerland
| | - M L Costa
- FFN, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - P Falaschi
- FFN, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland; Sapienza University of Rome, Via di Grottarossa, 1035, 00187, Rome, Italy
| | - K Hertz
- Trauma and Orthopaedic Directorate, Newcastle Road, Stoke-on-Trent, ST4 6QG, United Kingdom; International Collaboration of Orthopaedic Nursing (ICON) Chair, Sweden
| | - D Marsh
- FFN, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland; University College London, Gower St, Bloomsbury, London, WC1E 6BT, United Kingdom
| | - S Maggi
- Aging Branch-IN, National Research Council, Via Giustiniani, 2, 35128, Padua, Italy; EuGMS Secretariat Via Roma 10, 16121, Genoa, Italy
| | - A Nana
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, United States; IGFS, 1215 E Robinson Street, Orlando, FL, 32801, United States
| | - H Palm
- FFN, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland; Department of Orthopedics, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - R Speerin
- FFN, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland; Musculoskeletal Network, NSW Agency for Clinical Innovation, Level 4, 67 Albert Avenue, Chatswood, NSW, 2067, Australia
| | - J Magaziner
- FFN, c/o MCI Schweiz AG, Schaffhauserstrasse 550, 8052, Zürich, Switzerland; University of Maryland School of Medicine, 660 West Redwood Street, Baltimore, MD, 21201 USA
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Yang L, Zhang J, Xu B, Tang S, Hou J, Ma M, Shi Z. [Construction of the competency model for junior caregivers for the elderly based on the combination of medical and endowment model]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2018; 43:679-684. [PMID: 30110012 DOI: 10.11817/j.issn.1672-7347.2018.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To construct a competency model for junior caregivers for the elderly and to provide a reference for the selection, evaluation and training for the junior caregivers for the elderly.
Methods: Firstly, we drafted the primary competency model for junior caregivers for the elderly through literature review. Then, we used Delphi method to carry out 2 rounds of questionnaire survey for 20 experts to optimize the indicators for primary model. The weight of each indicator is determined by analytic hierarchy process (AHP) and expert sequencing method.
Results: The effective recovery rates of the two-round questionnaire were 87% and 100%, respectively. The expert authority coefficient was 0.70-0.93, and the average authority coefficient was 0.80. The final version of the competency model for junior caregivers for the elderly included 4 first-grade indexes, 11 second-grade indexes and 37 third-grade indexes.
Conclusion: The competency model for the junior caregivers for the elderly is reliable and can be used as the reference standard for the selection, evaluation and training for the junior caregivers for the elderly.
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Affiliation(s)
- Li Yang
- Nursing Faculty, Changde Vocational Technical College, Changde Hunan 415000; Xiangya Nursing School, Central South University, Changsha 410013,China
| | - Jinghui Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Binbin Xu
- Xiangya Nursing School, Central South University, Changsha 410013, China
| | - Siyuan Tang
- Xiangya Nursing School, Central South University, Changsha 410013, China
| | - Jianmei Hou
- Xiangya Nursing School, Central South University, Changsha 410013, China
| | - Mengdan Ma
- Xiangya Nursing School, Central South University, Changsha 410013, China
| | - Zhengkun Shi
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
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Willging CE, Sommerfeld DH, Jaramillo ET, Lujan E, Bly RS, Debenport EK, Verney SP, Lujan R. "Improving Native American elder access to and use of health care through effective health system navigation". BMC Health Serv Res 2018; 18:464. [PMID: 29914446 PMCID: PMC6006994 DOI: 10.1186/s12913-018-3182-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/03/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Public insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care. METHODS This community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders. DISCUSSION The information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities. TRIAL REGISTRATION This protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404 . Registered June 6, 2018.
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Affiliation(s)
- Cathleen E. Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM 87106 USA
- Department of Anthropology, University of New Mexico, MSC01-1040, Anthropology 1, Albuquerque, NM 87131 USA
| | - David H. Sommerfeld
- Department of Psychiatry, University of California, 9500 Gilman Drive (8012) La Jolla, San Diego, CA 92093-0812 USA
| | - Elise Trott Jaramillo
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM 87106 USA
- Department of Anthropology, University of New Mexico, MSC01-1040, Anthropology 1, Albuquerque, NM 87131 USA
| | - Erik Lujan
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM 87106 USA
| | - Roxane Spruce Bly
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM 87106 USA
| | - Erin K. Debenport
- Department of Anthropology, University of California, Los Angeles, 374 Portola Plaza, 341 Haines Hall, Box 951553, Los Angeles, CA 90095 USA
| | - Steven P. Verney
- Department of Psychology, University of New Mexico, MSC03-2220, 1, Albuquerque, NM 87131 USA
| | - Ron Lujan
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM 87106 USA
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Sundseth AC, Gjelstad S, Straand J, Rosvold EO. General practitioners' prescriptions of benzodiazepines, Z-hypnotics and opioid analgesics for elderly patients during direct and indirect contacts. A cross-sectional, observational study. Scand J Prim Health Care 2018; 36:115-122. [PMID: 29656692 PMCID: PMC6066290 DOI: 10.1080/02813432.2018.1459164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe Norwegian general practitioners' (GPs') prescription patterns of benzodiazepines, Z-hypnotics and opioid analgesics (BZO-drugs) to elderly (≥70 years) patients. DESIGN, SUBJECTS AND SETTING Cross sectional, observational study. Contact- and prescription data from 148 Norwegian GPs, issued for elderly patients during eight months in 2008. GP-patient contacts were categorized as direct contacts (DC: face-to-face consultations) or indirect contacts (IC: via third party, phone or mail). Explanatory variables were characteristics linked to the GPs, patients, and practices. During analyses, GPs' number of listed patients, share of which for elderly patients, and total number of patient consultations during the period (proxy for practice activity), were categorized in quintiles (Q1-5) by number of GPs. MAIN OUTCOME MEASURES Number of BZO-drug prescriptions and quantities issued during direct- and indirect GP-patient contacts. RESULTS In total, 62% of BZO-prescriptions were issued during ICs. Of all prescriptions, 66% were large quantum packages (50 tablets or more), 62% out of which were prescribed during ICs. During the study period, 50% of the patients received repeat prescriptions. Prescribing during ICs was associated with low over all practice activity (Q1) and many (Q5) older patients on the GP's lists. CONCLUSION GPs' BZO-drug prescribing to elderly occur more frequently during ICs than within DCs, and are more commonly issued as large quantity packages. This indicates that regular- or long-term use among elderly is common, contrasting with previous and current national guidelines, which recommend regular clinical assessments and short time or intermittent use of BZO-drugs. Key Points GPs frequently prescribe benzodiazepines, Z-hypnotics and opioid (BZO) drugs for elderly people. BZO-drugs are frequently issued during indirect GP-patient contacts and in relatively large quantities, indicating regular or long-term use. GPs' BZO-drug prescribing patterns contrast with national guidelines recommending clinical assessment and short time or intermittent use of BZO-drugs.
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Affiliation(s)
- Anne Cathrine Sundseth
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
- CONTACT Anne Cathrine SundsethDepartment of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Svein Gjelstad
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
| | - Jorund Straand
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
- General Practice Research Unit, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elin O. Rosvold
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
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Herrmann A, Sauerborn R. General Practitioners' Perceptions of Heat Health Impacts on the Elderly in the Face of Climate Change-A Qualitative Study in Baden-Württemberg, Germany. Int J Environ Res Public Health 2018; 15:ijerph15050843. [PMID: 29695135 PMCID: PMC5981882 DOI: 10.3390/ijerph15050843] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/11/2018] [Accepted: 04/16/2018] [Indexed: 11/16/2022]
Abstract
Heat health impacts (HHI) on the elderly are a growing concern in the face of climate change and aging populations. General practitioners (GPs) have an important role in health care for the elderly. To inform the development of effective prevention measures, it is important to investigate GPs’ perceptions of HHI. Twenty four qualitative expert interviews were conducted with GPs and analyzed using the framework approach. GPs were generally aware of heat health impacts, focusing on cardiovascular morbidity and volume imbalances. Perceptions of mortality and for instance impacts on respiratory diseases or potentially risky drugs in heat waves partly diverged from findings in literature. GPs judged the current relevance of HHI differently depending on their attitudes towards: (i) sensitivity of the elderly, (ii) status of nursing care and (iii) heat exposure in Baden-Württemberg. Future relevance of HHI was perceived to be increasing by most GPs. The main cause identified for this was population aging, while impacts of climate change were judged as uncertain by many. GPs’ perceptions, partly diverging from literature, show that GPs’ knowledge and awareness on HHI and climate change needs to be strengthened. However, they also emphasize the need for more research on HHI in the ambulant health care setting. Furthermore, GPs perceptions suggest that strong nursing care and social networks for elderly are major elements of a climate resilient health system.
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Affiliation(s)
- Alina Herrmann
- Institute of Public Health Heidelberg, University Hospital Heidelberg, 69120 Heidelberg, Germany.
- Network Aging Research, University of Heidelberg, 69115 Heidelberg, Germany.
| | - Rainer Sauerborn
- Institute of Public Health Heidelberg, University Hospital Heidelberg, 69120 Heidelberg, Germany.
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Burn AM, Fleming J, Brayne C, Fox C, Bunn F. Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care. BMJ Open 2018; 8:e020521. [PMID: 29550782 PMCID: PMC5875605 DOI: 10.1136/bmjopen-2017-020521] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In 2012-2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges. DESIGN Qualitative study involving interviews, focus groups and thematic content analysis. SETTING Primary care and secondary care across six counties in the East of England. PARTICIPANTS Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals. RESULTS We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs' lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding. CONCLUSIONS The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.
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Affiliation(s)
- Anne-Marie Burn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jane Fleming
- Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Chris Fox
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Frances Bunn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
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Abstract
OBJECTIVE The study objective was to assess the effects of an interorganisational educational intervention called the 'Meeting Point' on patient safety culture among staff in hospital and nursing home wards. DESIGN The study employs a quasi-experimental, non-randomised design with a hospital and nursing home intervention group and a hospital and nursing home control group. The study uses one preintervention and two postintervention survey measurements. The intervention group participated in an educational programme 'The Meeting Point' including interorganisational staff meetings combining educational sessions with a discussion platform focusing on quality and safety in transitional care of the elderly. RESULTS The results show a stable development over time for the patient safety culture factor 'Handoff and transitions', and small improvements for 'Overall perceptions of patient safety culture' and 'Organisational learning - continuous improvement' for the hospital intervention group. No similar development was reported in the nursing home intervention group, which is most likely explained by ongoing organisational changes. Qualitative data show the existence of ongoing initiatives in the hospital to improve transitional care, but not all were connected to the 'Meeting Point'. CONCLUSION The 'Meeting Point' has the potential to be a useful measure for healthcare professionals when aiming to improve patient safety culture in transitional care. Further refinement of the key components and testing with a more robust study design will be beneficial.
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Affiliation(s)
- Marianne Storm
- Faculty of Health Sciences, Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Jörn Schulz
- Department of Research, Helse Stavanger HF, Stavanger, Norway
| | - Karina Aase
- Faculty of Health Sciences, Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
- Regional Centre for Age-related Medicine and Coordination, Stavanger University Hospital, Stavanger, Norway
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Joling KJ, van Eenoo L, Vetrano DL, Smaardijk VR, Declercq A, Onder G, van Hout HPJ, van der Roest HG. Quality indicators for community care for older people: A systematic review. PLoS One 2018; 13:e0190298. [PMID: 29315325 PMCID: PMC5760020 DOI: 10.1371/journal.pone.0190298] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 12/12/2017] [Indexed: 11/22/2022] Open
Abstract
Background Health care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality. Methods Relevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality. Results Searches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain ‘Additional evidence, formulation and usage’ (51%), followed by ‘Scientific evidence’ (39%) and ‘Stakeholder involvement’ (28%). Conclusion A substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes. PROSPERO Registration: 2014:CRD42014007199
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Affiliation(s)
- Karlijn J. Joling
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | | | - Davide L. Vetrano
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Universita`Cattolica Sacro Cuore, Rome, Italy
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
- Stockholm University, Stockholm, Sweden
| | - Veerle R. Smaardijk
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Anja Declercq
- LUCAS, KU Leuven, University of Leuven, Leuven, Belgium
| | - Graziano Onder
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Universita`Cattolica Sacro Cuore, Rome, Italy
| | - Hein P. J. van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Henriëtte G. van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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Fajreldines A, Schnitzler E, Insua JT, Valerio M, Davide L, Pellizzari M. [Reduction of inappropriate prescriptions and adverse effects to medications in hospitalized elderly patients]. Medicina (B Aires) 2018; 78:11-17. [PMID: 29360070] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Together, potentially inappropriate prescribing of medications (PIP) and appropriate prescribing omission (APO) constitute a problem that requires multiple interventions to reduce its size and the occurrence of adverse drug events (ADE). This study aims to assess PIP, APO, ADE before and after the intervention of a clinical pharmacist over medical prescriptions for elderly hospitalized patients. In a before-after study, a total of 16 542 prescriptions for 1262 patients were analyzed applying the criteria defined in both STOPP- START (screening tool of older people's prescriptions and screening tool to alert to right treatment). The intervention consisted in lectures and publications on STOPP-START criteria made available to all the areas of the hospital and suggestions made by the clinical pharmacist to the physician on each individual prescription. Before intervention, PIM was 48.9% on admission and 46.1% at discharge, while after the intervention it was 47.4% on admission and 16.7% at discharge. APO was 10% on admission and 7.6% at discharge, while after intervention it was 12.2% on admission and 7.9% at discharge. ADE were 50.9% before and 34.4% after intervention. The frequency of return to emergency was 12.2% and 4.7% before and after intervention. PIM, EAM, conciliation error, clinically serious drug interaction, and delirium were reduced to statistically significant levels. In line with various international studies, the intervention showed to attain positive results.
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Affiliation(s)
- Ana Fajreldines
- Departamento de Calidad y Seguridad del Paciente, Hospital Alemán, Buenos Aires, Argentina. E-mail:
| | - Eduardo Schnitzler
- Departamento de Desarrollo Académico, Hospital Austral, Pilar, Buenos Aires, Argentina
| | - Jorge T Insua
- Sistema de Información Hospitalario, Hospital Austral, Pilar, Buenos Aires, Argentina
| | - Mariana Valerio
- Servicio de Farmacia, Hospital Austral, Pilar, Buenos Aires, Argentina
| | - Laura Davide
- Servicio de Farmacia, Hospital Austral, Pilar, Buenos Aires, Argentina
| | - Marcelo Pellizzari
- Departamento de Calidad y Seguridad del Paciente, Hospital Austral, Pilar, Buenos Aires, Argentina
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Murray SA, Chinn DJ, Sheikh A. Access to Psychological and Psychiatric Services Needs to be Improved for the Dying. J R Soc Med 2017; 99:601. [PMID: 17139059 PMCID: PMC1676329 DOI: 10.1177/014107680609901204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zubair M, Chadborn NH, Gladman JRF, Dening T, Gordon AL, Goodman C. Using comprehensive geriatric assessment for quality improvements in healthcare of older people in UK care homes: protocol for realist review within Proactive Healthcare of Older People in Care Homes (PEACH) study. BMJ Open 2017; 7:e017270. [PMID: 29018069 PMCID: PMC5652454 DOI: 10.1136/bmjopen-2017-017270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Care home residents are relatively high users of healthcare resources and may have complex needs. Comprehensive geriatric assessment (CGA) may benefit care home residents and improve efficiency of care delivery. This is an approach to care in which there is a thorough multidisciplinary assessment (physical and mental health, functioning and physical and social environments) and a care plan based on this assessment, usually delivered by a multidisciplinary team. The CGA process is known to improve outcomes for community-dwelling older people and those in receipt of hospital care, but less is known about its efficacy in care home residents. METHODS AND ANALYSIS Realist review was selected as the most appropriate method to explore the complex nature of the care home setting and multidisciplinary delivery of care. The aim of the realist review is to identify and characterise a programme theory that underpins the CGA intervention. The realist review will extract data from research articles which describe the causal mechanisms through which the practice of CGA generates outcomes. The focus of the intervention is care homes, and the outcomes of interest are health-related quality of life and satisfaction with services; for both residents and staff. Further outcomes may include appropriate use of National Health Service services and resources of older care home residents. The review will proceed through three stages: (1) identifying the candidate programme theories that underpin CGA through interviews with key stakeholders, systematic search of the peer-reviewed and non-peer-reviewed evidence, (2) identifying the evidence relevant to CGA in UK care homes and refining the programme theories through refining and iterating the systematic search, lateral searches and seeking further information from study authors and (3) analysis and synthesis of evidence, involving the testing of the programme theories. ETHICS AND DISSEMINATION The PEACH project was identified as service development following submission to the UK Health Research Authority and subsequent review by the University of Nottingham Research Ethics Committee. The study protocols have been reviewed as part of good governance by the Nottinghamshire Healthcare Foundation Trust. We aim to publish this realist review in a peer-reviewed journal with international readership. We will disseminate findings to public and stakeholders using knowledge mobilisation techniques. Stakeholders will include the Quality Improvement Collaboratives within PEACH study. National networks, such as British Society of Gerontology and National Care Association will be approached for wider dissemination. TRIAL REGISTRATION NUMBER The realist review has been registered on International Prospective Register of Systematic Reviews (PROSPERO 2017: CRD42017062601).
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Affiliation(s)
- Maria Zubair
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil H Chadborn
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - John R F Gladman
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
- Collaboration for Leadership in Applied Health Research and Care East Midlands, National Institute of Health Research, Nottingham, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
- School of Health Sciences, City University of London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
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Kirst M, Im J, Burns T, Baker GR, Goldhar J, O'Campo P, Wojtak A, Wodchis WP. What works in implementation of integrated care programs for older adults with complex needs? A realist review. Int J Qual Health Care 2017; 29:612-624. [PMID: 28992156 PMCID: PMC5890872 DOI: 10.1093/intqhc/mzx095] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [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: 10/31/2016] [Revised: 06/08/2017] [Accepted: 07/04/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE A realist review of the evaluative evidence was conducted on integrated care (IC) programs for older adults to identify key processes that lead to the success or failure of these programs in achieving outcomes such as reduced healthcare utilization, improved patient health, and improved patient and caregiver experience. DATA SOURCES International academic literature was searched in 12 indexed, electronic databases and gray literature through internet searches, to identify evaluative studies. STUDY SELECTION Inclusion criteria included evaluative literature on integrated, long-stay health and social care programs, published between January 1980 and July 2015, in English. DATA EXTRACTION Data were extracted on the study purpose, period, setting, design, population, sample size, outcomes, and study results, as well as explanations of mechanisms and contextual factors influencing outcomes. RESULTS OF DATA SYNTHESIS A total of 65 articles, representing 28 IC programs, were included in the review. Two context-mechanism-outcome configurations (CMOcs) were identified: (i) trusting multidisciplinary team relationships and (ii) provider commitment to and understanding of the model. Contextual factors such as strong leadership that sets clear goals and establishes an organizational culture in support of the program, along with joint governance structures, supported team collaboration and subsequent successful implementation. Furthermore, time to build an infrastructure to implement and flexibility in implementation, emerged as key processes instrumental to success of these programs. CONCLUSIONS This review included a wide range of international evidence, and identified key processes for successful implementation of IC programs that should be considered by program planners, leaders and evaluators.
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Affiliation(s)
- Maritt Kirst
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
- Department of Psychology, Wilfrid Laurier University, 75 University Ave. West, Waterloo, ON, Canada N2L 3C5
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
| | - Jennifer Im
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
| | - Tim Burns
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
| | - G. Ross Baker
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
| | - Jodeme Goldhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
- The Change Foundation, 200 Front Street West, Toronto, Canada M5V 3M1
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Canada M5B 1W8
| | - Anne Wojtak
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
- Toronto Central Local Health Integration Network, 250 Dundas St. West, Toronto, Canada M5T 2Z5
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
- Toronto Rehabilitation Institute, 550 University Ave., Toronto, Canada M5G 2A2
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, Canada M4N 3M5
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Brouwers C, Merten H, Willems M, Habraken DJ, Bloemers FW, Biesheuvel TH, van Galen LS, Nanayakkara PWB, Wagner C. Improving care for older patients in the acute setting: a qualitative study with healthcare providers. Neth J Med 2017; 75:335-343. [PMID: 29219828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The proportion of older people needing acute care is rapidly growing, thereby posing an increased burden on the acute care chain. The aim of this study is to gain more insight into the obstacles and potential improvement opportunities of the acute care process for older patients arriving at the hospital. METHODS Semi-structured interviews were conducted to determine the experiences of 18 different primary (i.e. general practitioner, community nurse) and secondary healthcare professionals (i.e. emergency department (ED) nurse, ED physician, geriatric physician, geriatric nurse, ambulance nurse, acute medical unit nurse), and three experts (2 researchers, 1 older adult advisor). RESULTS Four core themes emerged from the interviews: 1) The concept of frailty, awareness concerning frail older patients, and identification of frailty, 2) Barriers in the care process of older patients within the acute care chain, 3) Optimising the discharge process of older patients, and 4) Improvement opportunities suggested by the respondents. Early identification of frailty, improving the continuity of care by means of structured information exchange between care providers in the acute care chain, and a more generalist approach were considered important by the respondents in order to deliver appropriate care to older patients. CONCLUSION This explorative study identified several barriers and improvement opportunities which are important to improve the quality, efficacy and appropriateness of the acute care of older patients. More seems needed in the future in order to share experiences, expertise and develop potential improvement strategies for the acute care of older patients.
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Affiliation(s)
- C Brouwers
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, the Netherlands
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Lawn S, Westwood T, Jordans S, O'Connor J. Support workers as agents for health behavior change: An Australian study of the perceptions of clients with complex needs, support workers, and care coordinators. Gerontol Geriatr Educ 2017; 38:496-516. [PMID: 27050326 DOI: 10.1080/02701960.2016.1165218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An expanding aging population has placed increased demands on health care resources in many countries. Enhancing community aged care support workers' role to support greater client self-management and reablement is therefore timely. This article presents perceptions of the impact of an Australian practice change initiative designed to enhance knowledge, skills, and confidence of support workers to support behavior change in clients with complex health care needs. A comprehensive training program was delivered in 2013. Methods included thematic analysis of interviews with clients, focus groups with support workers and coordinators, and collection of case studies of client/support worker behavior change interactions. Client, support worker, and coordinator responses were highly positive, reporting improvement in the quality of interactions with clients, client health outcomes, care coordination, communication, and teamwork. Mental health literacy remained the biggest knowledge gap. This research showed that support workers are ideally placed to be more actively involved in motivating clients to achieve behavior change goals.
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Affiliation(s)
- Sharon Lawn
- a Flinders Human Behaviour and Health Research Unit , Flinders University , Adelaide , South Australia , Australia
| | - Tania Westwood
- b Service Planning and Primary Health , Southern Adelaide Local Health Network , Adelaide , South Australia , Australia
| | - Sarah Jordans
- c Office for the Ageing , SA Health , Adelaide , South Australia , Australia
| | - Julianne O'Connor
- d Demand Management and Hospital Substitution , Southern Adelaide Local Health Network , Adelaide , South Australia , Australia
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Nyborg I, Danbolt LJ, Kirkevold M. Few opportunities to influence decisions regarding the care and treatment of an older hospitalized family member: a qualitative study among family members. BMC Health Serv Res 2017; 17:619. [PMID: 28859659 PMCID: PMC5579919 DOI: 10.1186/s12913-017-2563-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The drive towards patient involvement in health services has been increasingly promoted. The World Health Organisation emphasizes the family's perspective in comprehensive care. Internationally there is an increased emphasis on what patients and their family tell about the hospital experiences. However, current literature does not adequately address the question of participation experiences among relatives of older hospitalized family members. There is a paucity of research with a generational perspective on relatives' opportunities to exert influence. The aim of the study was to explore relatives' experiences of opportunities to participate in decisions about the care and treatment of older hospitalized family members and whether there are different experiences of influence to the relatives' age. METHODS This was an explorative study applying individual qualitative interviews. The interviews were analysed following hermeneutic methodological principles. Two Norwegian geriatric wards participated: one at a university hospital and one at a local hospital. Twelve participants, six women and six men, were purposively selected. The relatives were aged from 36 to 88 (mean age 62) and were spouses, children and/or children-in-law of patients. RESULTS The relatives' experienced opportunities to exert influence were distributed along a continuum ranging from older relatives being reactive waiting for an initiative from health professionals, to younger adults being proactive securing influence. Older "invisible" carers appeared to go unnoticed by the health professionals, establishing few opportunities to influence decisions. The middle-aged relatives also experienced limited influence, but participated when the hospital needed it. However, limited participation seemed to have less impact on their lives than in the older relatives. Middle-aged relatives and younger adults identified strategies in which visibility was the key to increasing the odds of gaining participation. The exceptional case seemed to be some older carers' experiences of influencing decisions with the help of professionals. CONCLUSIONS Our findings suggest that experiences of influence were limited regardless of age. However, the results indicated that participation among relatives decrease with age while vulnerability for not having influence seemed to increase with age. The problem of patient choice most clearly manifested among the older carers, which might indicate that the relatives' age sets terms for opportunities to participate.
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Affiliation(s)
- Ingrid Nyborg
- Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318 Oslo, Norway
- Innlandet Hospital Trust, Kyrre Grepps gate 11, NO-2819 Gjøvik, Norway
| | - Lars Johan Danbolt
- Norwegian School of Theology, Majorstuen, P.O. Box 5144, NO-0302 Oslo, Norway
- Director of The Center for the Psychology of Religion, Innlandet Hospital Trust, P.O. Box 68, NO-2312 Ottestad, Norway
| | - Marit Kirkevold
- Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318 Oslo, Norway
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Abstract
BACKGROUND The management of elderly patients with cancer is influenced by several factors that can vary widely among aging individuals. As the proportion of elderly individuals increases, the need for specific care guidelines for this population is critical. The National Comprehensive Cancer Network (NCCN) has developed guidelines to address these factors when formulating optimal treatment regimens for elderly patients and to avoid significant toxicity and maintain their quality of life. METHODS Factors that influence the appropriate treatment choices for the elderly, such as functional status, comorbidity, polypharmacy, and the presence of anemia, are reviewed, and the guidelines developed by the NCCN for treatment elderly patients are discussed. RESULTS The guidelines address these factors when defining the goal of therapy and formulating individualized treatment approaches for the elderly to provide optimal care for these patients, avoid significant toxicity, and maintain their quality of life. CONCLUSIONS The goal of therapy must be clearly defined, whether survival, remission, cure, or palliation of symptoms. Enrollment of elderly cancer patients onto clinical trials is encouraged so the guidelines can be validated.
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Affiliation(s)
- Stuart M Lichtman
- Don Monti Division of Medical Oncology, North Shore University Hospital, Manhasset, NY 11030, USA.
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Richters A, Nieuwboer MS, Perry M, Olde Rikkert MGM, Melis RJF, van der Marck MA. Evaluation of DementiaNet, a network-based primary care innovation for community-dwelling patients with dementia: protocol for a longitudinal mixed methods multiple case study. BMJ Open 2017; 7:e016433. [PMID: 28780556 PMCID: PMC5629707 DOI: 10.1136/bmjopen-2017-016433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Primary healthcare professionals will increasingly be required to manage and optimise their treatment for patients with dementia. With DementiaNet, we aim to reduce the burden of dementia on healthcare services and society through implementation and facilitation of integrated network-based care with increased dementia expertise. DementiaNet is designed as a stepwise approach including clinical leadership, quality improvement cycles and interprofessional training, which are tailor-made to the local context. For example, the composition of the network and improvement goals are tailored to the local context and availability. Here, we describe the linked evaluation study which aims to provide insight in effectiveness, process and mechanism of the DementiaNet approach through an innovative evaluation design. METHODS AND ANALYSIS We designed a longitudinal, mixed methods, multiple case study. Study population consists of two levels: (i) local DementiaNet networks of primary care professionals and (ii) patients and informal caregivers who receive care from these networks. At the start and after 12 and 24 months, quantitative data are collected for each network on: level of network maturity, quality of care indicators and outcomes reported by informal caregivers of dementia patients. We assess changes in networks over time and the association with quality of care and informal caregiver-reported outcomes. Throughout the study, logs about each network are registered. Additionally, semi-structured interviews with network members and informal caregivers will provide insight in experiences and opinions regarding effects and mechanisms through which changes in quantitative outcomes are effectuated. Rich narratives will be constructed about the development of the local networks using collected data. ETHICS AND DISSEMINATION The study protocol was reviewed by the local medical ethics committee; formal judgement was not required (protocol number: 2015-2053). The findings of this study will be disseminated through peer-reviewed publications, conference presentations and presentations for healthcare professionals where appropriate.
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Affiliation(s)
- Anke Richters
- Department of Geriatric Medicine, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud University Medical Center, Department of Geriatric Medicine Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
| | - Minke S Nieuwboer
- Radboud University Medical Center, Department of Geriatric Medicine Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
| | - Marieke Perry
- Radboud University Medical Center, Department of Geriatric Medicine Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud University Medical Center, Department of Geriatric Medicine Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
| | - Rene J F Melis
- Radboud University Medical Center, Department of Geriatric Medicine Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marjolein A van der Marck
- Radboud University Medical Center, Department of Geriatric Medicine Radboud UMC Alzheimer Centre, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Shafiee G, Ostovar A, Heshmat R, Darabi H, Sharifi F, Raeisi A, Mehrdad N, Shadman Z, Razi F, Amini MR, Arzaghi SM, Meybodi HA, Soltani A, Nabipour I, Larijani B. Bushehr Elderly Health (BEH) programme: study protocol and design of musculoskeletal system and cognitive function (stage II). BMJ Open 2017; 7:e013606. [PMID: 28780537 PMCID: PMC5577871 DOI: 10.1136/bmjopen-2016-013606] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Musculoskeletal disorders and cognitive diseases are prevalent, and they are significant determinants of morbidity and mortality in older adults. The aim of this study is to investigate the prevalence of musculoskeletal and cognitive diseases and their risk factors and also to assess their associations during future follow-ups. METHODS AND ANALYSIS Bushehr Elderly Health (BEH) programme is a population-based prospective cohort study being conducted in Bushehr, a southern province of Iran. A total of 3000 older people aged ≥60 years participated in the first stage from which 2772 were eligible to participate in the second stage, which started after 2.5 years. Data including demographic status, lifestyle factors, general healthandmedical history, and mentalandfunctional health are collected through a questionnaire. Anthropometric measures, performance testsandmuscle strength, blood pressure and and body composition measurements are done. A total 25 cc venous blood is taken, and sera are stored at -80°C for possible future analyses. ETHICS AND DISSEMINATION The study protocol was approved by the ethics committee of Endocrinology and Metabolism Research Institute, affiliated to Tehran University of Medical Science as well as the Research Ethics Committee of Bushehr University of Medical Sciences. A written informed consent was signed by all the participants. The study findings will show the prevalence of musculoskeletal disease, cognitive impairment and their risk factors in an elderly population. The participants will be followed during the study to measure the occurrence outcomes.This study will also have the potential to inform the development of beneficial interventions to improve the management of musculoskeletal and cognitive impairment in Iran and other countries in the Middle East.Our findings will be disseminated via scientific publication as well as presentation to stakeholders, including the patients, clinicians, the public and policymakers, via appropriate avenues.
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Affiliation(s)
- Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Darabi
- The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Raeisi
- The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhaleh Shadman
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Faride Razi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Amini
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Masoud Arzaghi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Aghaei Meybodi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Soltani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
OBJECTIVES To provide an overview of the evidence base on the effectiveness of workforce interventions for improving the outcomes for older people with cancer, as well as analysing key features of the workforce associated with those improvements. DESIGN Systematic review. METHODS Relevant databases were searched for primary research, published in English, reporting on older people and cancer and the outcomes of interventions to improve workforce knowledge, attitudes or skills; involving a change in workforce composition and/or skill mix; and/or requiring significant workforce reconfiguration or new roles. Studies were also sought on associations between the composition and characteristics of the cancer care workforce and older people's outcomes. A narrative synthesis was conducted and supported by tabulation of key study data. RESULTS Studies (n=24) included 4555 patients aged 60+ from targeted cancer screening to end of life care. Interventions were diverse and two-thirds of the studies were assessed as low quality. Only two studies directly targeted workforce knowledge and skills and only two studies addressed the nature of workforce features related to improved outcomes. Interventions focused on discrete groups of older people with specific needs offering guidance or psychological support were more effective than those broadly targeting survival outcomes. Advanced Practice Nursing roles, voluntary support roles and the involvement of geriatric teams provided some evidence of effectiveness. CONCLUSIONS An array of workforce interventions focus on improving outcomes for older people with cancer but these are diverse and thinly spread across the cancer journey. Higher quality and larger scale research that focuses on workforce features is now needed to guide developments in this field, and review findings indicate that interventions targeted at specific subgroups of older people with complex needs, and that involve input from advanced practice nurses, geriatric teams and trained volunteers appear most promising.
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Affiliation(s)
- Jackie Bridges
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex
| | - Grace Lucas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Theresa Wiseman
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- The Royal Marsden NHS Foundation Trust
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex
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Hawkes N. Norway ranks first on supporting elderly people, UK 11th. BMJ 2017; 358:j3645. [PMID: 28751494 DOI: 10.1136/bmj.j3645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Beernaert K, Smets T, Cohen J, Verhofstede R, Costantini M, Eecloo K, Van Den Noortgate N, Deliens L. Improving comfort around dying in elderly people: a cluster randomised controlled trial. Lancet 2017; 390:125-134. [PMID: 28526493 DOI: 10.1016/s0140-6736(17)31265-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 02/23/2017] [Accepted: 03/10/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Over 50% of elderly people die in acute hospital settings, where the quality of end-of-life care is often suboptimum. We aimed to assess the effectiveness of the Care Programme for the Last Days of Life (CAREFuL) at improving comfort and quality of care in the dying phase in elderly people. METHODS We did a cluster randomised controlled trial in acute geriatric wards in ten hospitals in Flemish Region, Belgium, between Oct 1, 2012, and March 31, 2015. Hospitals were randomly assigned to implementation of CAREFuL (CAREFuL group) or to standard care (control group) using a random number generator. Patients and families were masked to interventaion allocation; hospital staff were unmasked. CAREFuL comprised a care guide for the last days of life, training, supportive documentation, and an implementation guide. Primary outcomes were comfort around dying, measured with the End-of-Life in Dementia-Comfort Assessment in Dying (CAD-EOLD), and symptom management, measured with the End-of-Life in Dementia-Symptom Management (SM-EOLD), by nurses and family carers. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01890239. FINDINGS 451 (11%) of 4241 beds in ten hospitals were included in the analyses. Five hospitals were randomly assigned to standard health care practice and five to the CAREFuL programme; 118 patients in the control group and 164 in the CAREFuL group were eligible for assessment. Assessments were done for 132 (80%) of 164 patients in the CAREFuL group and 109 (92%) of 118 in the control group by nurses, and 48 (29%) in the CAREFuL group and 23 (19%) in the control group by family carers. Implementation of CAREFuL compared with control significantly improved nurse-assessed comfort (CAD-EOLD baseline-adjusted mean difference 4·30, 95% CI 2·07-6·53; p<0·0001). No significant differences were noted for the CAD-EOLD assessed by family carers (baseline-adjusted mean difference -0·62, 95% CI -6·07 to 4·82; p=0·82) or the SM-EOLD assessed by nurses (-0·41, -1·86 to 1·05; p=0·58) or by family carers (-0·59, -3·75 to 2·57; p=0·71). INTERPRETATION Although a continuous monitoring of the programme is warranted, these results suggest that implementation of CAREFuL might improve care during the last days of life for patients in acute geriatric hospital wards. FUNDING The Flemish Government Agency for Innovation by Science and Technology and the Belgian Cancer Society "Kom Op Tegen Kanker".
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Affiliation(s)
- Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium.
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium
| | - Rebecca Verhofstede
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium
| | - Massimo Costantini
- Palliative Care Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Kim Eecloo
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium
| | - Nele Van Den Noortgate
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium; Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium; Department of Medical Oncology, Ghent University, Ghent, Belgium
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