Modell Donaustadt: A best practice example for treatment of mental and physical comorbidity in long-term care

2016 ◽  
Vol 33 (S1) ◽  
pp. S37-S37
Author(s):  
B. Hobl ◽  
B. Schreiber

Evidence consistently demonstrates that people with long-term mental health conditions develop serious physical comorbidities at an earlier age than the average population. These physical comorbidities are often exacerbated because long-term psychiatric conditions reduce the patient's ability to manage somatic symptoms effectively, thus hindering treatment. This highlights the critical importance of continuous support by primary care physicians and nursing staff. People with persistent mental illnesses typically require long-term care significantly earlier than people without mental illness.As a consequence, elderly patients with chronic mental illnesses who are essentially unable or unprepared to function in the outside world or are in need of constant medical attention are typically placed into long-term care facilities and nursing homes geared to serving physically disabled elderly.These LTC institutions have no capacity to provide specific care for mentally ill patients. Difficulties in treating psychiatric patients in these LTC facilities often result in transfers to and repeated admissions in acute psychiatric hospitals.In an effort to resolve the “revolving-door” situation of these patients and reduce the rates of re-admission to acute psychiatric hospitals, Modell Donaustadt was developed. In the talk, Modell Donaustadt will be presented as a best practice example for the treatment of mental and physical comorbidities in long-term care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 602-602
Author(s):  
Rachael Spalding ◽  
Peter Lichtenberg

Abstract Despite surrounding social stigma and stereotypes of the “asexual older adult,” older adults, including those residing in long-term care facilities, indicate that expressing their sexuality continues to be important to them (Doll, 2013). This presentation will feature presentations regarding recent research and perspectives relevant to late-life sexuality with a focus on how issues of sexual expression may particularly emerge in long-term care settings. Dr. Maggie Syme will present findings from mixed-methods, consumer-based approaches that elucidate how current and future long-term care residents view late-life sexuality, with a focus on the practical applications of these findings to inform facility administration and policies. Ethical and legal issues surrounding sexuality in long-term care will be discussed by Dr. Pamela Teaster, who will present ethical models that can translate into potential best-practice recommendations and strategies. Rachael Spalding will discuss the paucity of psychometrically sound assessment tools for measuring attitudes towards late-life sexuality and discuss their development of such a measure. Finally, Dr. Lilanta Bradley and Dr. Pamela Payne-Foster will present a framework for sexual agency in late-life and identify relevant gaps in the literature regarding gender, ethnicity/race, and geographical differences. Ultimately, this presentation will offer a forum for lively discussion among attendees regarding these pertinent topics.


1993 ◽  
Vol 56 (12) ◽  
pp. 437-440 ◽  
Author(s):  
Sheila H Merriman ◽  
Kay Kench

Eight female patients attended up to eight group sessions run conjointly by an occupational therapist and a dietitian. Video feedback was used during the course of sessions. The patients were all residents in long-term care in the Continuing Care Division of St Andrew's Hospital and had been identified by medical staff as wishing to lose weight and having scope for improvement in posture and/or appearance. Seven of the eight subjects lost weight [mean loss (n=8) 1.18 kg: range −3.1 kg to +2.4 kg]. There was a significant weight loss in these seven subjects (t=3.669, df=6, significant at 0.01 level). The authors judged that there had been improvement in one or more areas of posture and/or appearance in seven of the eight patients.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Abe ◽  
S. Tsunawaki ◽  
M. Dejonckheere ◽  
C. T. Cigolle ◽  
K. Phillips ◽  
...  

Abstract Background While dementia is a common problem in Japan and the US, primary care physicians' practices and perspectives about diagnosing dementia in these different healthcare systems are unknown. Methods Qualitative research was conducted in an ethnographic tradition using semi-structured interviews and thematic analysis in primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of geographic areas (rural/urban), gender, age, and years of experience as primary care physicians. Results Participants in Japan and the US voiced similar practices for making the diagnosis of dementia and held similar views about the desired benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers. Conclusions Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing and treatment options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US.


2018 ◽  
Vol 5 (1) ◽  
pp. 711-724

Long term care (LTC) facilities, also called nursing homes, are often ripe for conflicts which cause stress for residents, their families and staff. This article presents the results of a survey showing how nursing facility administrators in Harris County, Texas, managed conflict within their facilities and how a more positive approach was consistently reflected in how their facilities were rated in US government quality consumer ratings. The concept at the centre of this study, SOS-Semantics of Self in Conflict™, recognises that the degradation of standards due to conflict is not just an event in a nursing care facility. It is a process that is heavily influenced, and in some cases exacerbated, by the way in which facility administrators react to conflict. These reactions have important broader implications for the facility’s best practice retrospectively.


Author(s):  
Clemens Becker ◽  
Jean Woo ◽  
Chris Todd

Falls are very common among older people, with 30–40% of people aged 65 or over falling each year. Incidence increases with age, is particularly high in residential care settings, and has a considerable burden in terms of morbidity, mortality, use of health services, and reductions in quality of life. In the first section of this chapter we define falls, then review the epidemiology of falls in the community, and acute hospital, residential, and long-term care. We review and identify the major risk factors for falls and the assessment and screening tools used to detect risk and resources of best practice recommendations for clinical practice. In the second section, we provide overviews of best practice in prevention and clinical management, first for older people living independently in the community, then for acute hospital care, and thirdly for residential and long-term care.


2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S375-S376
Author(s):  
Teresa Fitzgerald ◽  
Regina Nailon ◽  
Kate Tyner ◽  
Sue Beach ◽  
Margaret Drake ◽  
...  

Abstract Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a quality improvement initiative supported by the NE Department of Health and Human Services. This initiative utilizes subject matter experts (SMEs) including infectious diseases physicians and certified infection preventionists (IP) to assess and improve infection prevention and control programs (IPCP) in various healthcare settings. NE ICAP conducted on-site surveys and observations of IPCP in many volunteer facilities to include long-term care facilities (LTCF) between November 2015 and July 2017. SMEs provided on-site coaching and made best practice recommendations (BPR) for priority implementation. Impact of this intervention on LTCF IPCP was examined. Methods Using a standardized questionnaire, follow-up phone calls were made with LTCF to evaluate implementation of the BPR one-year post-assessment. Descriptive analyses were performed to examine BPR implementation in LTCF that had follow-up between 4/4/17 to 4/17/18 and to identify factors that promoted or impeded BPR implementation. Results Overall, 45 LTCF were assessed. The top 5 IC categories requiring improvement were audit and feedback practices (28 of 45, 62%), PPE supplies at point of use (62%), IC risk assessments (58%), TB risk assessments (56%), and supply and linen storage practices (56%). Follow-up assessments were completed for 270 recommendations in 25 LTCF. Recommendations reviewed ranged from three to 26 per LTCF (median = 15). The majority of the 270 recommendations (n = 162, 60%) had been either completely (35%) or partially (25%) implemented by the time of the follow-up calls. The ICAP visit itself was reported as the most helpful resource for BPR implementation (77 of 162). Lack of staffing was the most commonly mentioned barrier to implementation when LTCF implemented BPR partially or implementation was not planned (37 of 85). BPR Implementation most frequently involved additional staff training (64 of 162), review of policies and procedures (38 of 162), and implementing audit (34 of 162) and/or feedback (23 of 162) programs. Conclusion Numerous IC gaps exist in LTCF. Peer-to-peer feedback and coaching by SMEs facilitated implementation of many BPR directed toward mitigating identified IC gaps. Disclosures All authors: No reported disclosures.


2009 ◽  
Vol 10 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Anna Placentino ◽  
Luciana Rillosi ◽  
Emanuela Papa ◽  
Giovanni Foresti ◽  
Andrea Materzanini ◽  
...  

2021 ◽  
Author(s):  
Michiko Abe ◽  
Shinji Tsunawaki ◽  
Melissa DeJonckheere ◽  
Christine T. Cigolle ◽  
Kristin Phillips ◽  
...  

Abstract Background: To explore the perspectives and approaches of primary care physicians in Japan and the US on diagnosing dementia.Methods: Qualitative comparison conducted in ethnographic tradition using semi-structured interviews and thematic analysis. Primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of the practice area (rural/urban), gender, age, and years of experience as a primary care physician. Results: Participants in Japan and the US voiced similar approaches for making the diagnosis of dementia and held similar views about the desire benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers.Conclusions: Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US.


2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Lisa A. Cranley ◽  
Janice M. Keefe ◽  
Deanne Taylor ◽  
Genevieve Thompson ◽  
Amanda M. Beacom ◽  
...  

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