Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders

As a population subgroup, older people are more vulnerable to malnutrition especially those who are institutionalised. Recognition of deteriorating or poor nutritional status is key in reversing the effects of undernutrition and reinforces the value of regular weight checks and/or the use of screening tools. Commercially produced supplements are often the first option used to address undernutrition in both acute and community settings. They can be expensive and, although regularly prescribed, have undergone only limited evaluation of their effectiveness in community settings. An alternative but less researched approach to improve the nutritional status of undernourished people is food fortification. This approach may be particularly useful for older people, given their often small appetites. The ability to eat independently has been significantly related to decreased risk of undernutrition. Assisting people who have difficulty feeding themselves independently should become a designated duty and may be crucial in optimising nutritional status. Lack of nutrition knowledge has been identified as the greatest barrier to the provision of good nutritional care. Education and training of care staff are pivotal for the success of any intervention to address undernutrition. The development of undernutrition is a multi-factorial process and a package of approaches may be required to prevent or treat undernutrition. Nutrition must be at the forefront of care if national care standards are to be met.

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Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: a randomised controlled single-blind mixed method trial

International Journal of Nursing Studies ◽

10.1016/j.ijnurstu.2021.103978 ◽

2021 ◽

pp. 103978

Author(s):

Catherine J. Evans ◽

Anna E. Bone ◽

Deokhee Yi ◽

Wei Gao ◽

Myfanwy Morgan ◽

...

Keyword(s):

Older People ◽

Supportive Care ◽

Usual Care ◽

Mixed Method ◽

Symptom Distress ◽

Short Term ◽

Community Based ◽

Randomised Controlled ◽

Single Blind

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Short-term specialized palliative care in primary care for frail older people and their family carers

http://isrctn.com/ ◽

10.1186/isrctn39282347 ◽

2019 ◽

Author(s):

Lara Pivodic

Keyword(s):

Primary Care ◽

Palliative Care ◽

Older People ◽

Family Carers ◽

Frail Older People ◽

Short Term ◽

Specialized Palliative Care

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Timely short-term specialised palliative care service intervention for frail older people and their family carers in primary care: study protocol for a pilot randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-043663 ◽

2021 ◽

Vol 11 (1) ◽

pp. e043663

Author(s):

Kim de Nooijer ◽

Lara Pivodic ◽

Nele Van Den Noortgate ◽

Peter Pype ◽

Lieve Van den Block

Keyword(s):

Palliative Care ◽

Older People ◽

Care Service ◽

Controlled Trial ◽

Intervention Group ◽

Family Carers ◽

Frail Older People ◽

Short Term ◽

Pilot Randomised Controlled Trial ◽

Randomised Controlled

IntroductionThere is limited evidence regarding the effectiveness of timely integration of short-term specialised palliative care services for older people in primary care. Using a Theory of Change approach, we developed such an intervention, the Frailty+ intervention. We present the protocol of a pilot randomised controlled trial (RCT) with a process evaluation that aims to assess the feasibility and preliminary effectiveness of the Frailty+ intervention.Methods and analysisWe will conduct a pilot RCT in Flanders, Belgium. Frail older people who are discharged to home from hospital will be identified and recruited. Seventy-six will be randomly assigned either to the control group (standard care) or the intervention group (Frailty+ intervention alongside standard care). Data will be collected from patients and family carers. At the core of the Frailty+ intervention is the provision of timely short-term specialised palliative care facilitated by a nurse from the specialised palliative home care service over a period of 8 weeks. We will assess feasibility in terms of recruitment, randomisation, acceptability of the intervention, retention in the programme and data completion. The primary outcome for assessing preliminary effectiveness is a mean score across five key symptoms that are amenable to change (ie, breathlessness, pain, anxiety, constipation, fatigue), measured at baseline and 8 weeks post-baseline. The process evaluation will be conducted in the intervention group only, with measurements at 8–11 weeks post-baseline to evaluate implementation, mechanisms of change and contextual factors.Ethics and disseminationThe study has been approved by the ethics committee of University Hospital Ghent. Results will be used to inform the design of a full-scale RCT and will be published in a peer-reviewed, open access journal.Trial registration numberISRCTN39282347; Pre-results.

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Graduate Medical Education in Otolaryngology: Making Dollars and Sense of Reform

Otolaryngology ◽

10.1177/01945998211004263 ◽

2021 ◽

pp. 019459982110042

Author(s):

Jenny X. Chen ◽

Shivani A. Shah ◽

Vinay K. Rathi ◽

Mark A. Varvares ◽

Stacey T. Gray

Keyword(s):

Medical Education ◽

Graduate Medical Education ◽

Resident Training ◽

Short Term ◽

Graduate Medical ◽

Departmental Leadership ◽

Key Stakeholders ◽

The Face ◽

Funding Cuts

Graduate medical education (GME) is funded by the Centers for Medicare and Medicaid Services through both direct and indirect payments. In recent years, stakeholders have raised concerns about the growth of spending on GME and distribution of payment among hospitals. Key stakeholders have proposed reforms to reduce GME funding such as adjustments to statutory payment formulas and absolute caps on annual payments per resident. Otolaryngology departmental leadership should understand the potential effects of proposed reforms, which could have significant implications for the short-term financial performance and the long-term specialty workforce. Although some hospitals and departments may elect to reduce resident salaries or eliminate positions in the face of GME funding cuts, this approach overlooks the substantial Medicare revenue contributed by resident care and high cost of alternative labor sources. Commitment to resident training is necessary to align both the margin and mission of otolaryngology departments and their sponsoring hospitals.

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Fall Prevention in Dutch Physician Practices: A Descriptive Study

Innovation in Aging ◽

10.1093/geroni/igaa057.758 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 235-235

Author(s):

Wytske Meekes ◽

C J Leemrijse ◽

J C Korevaar ◽

L A M van de Goor

Keyword(s):

The Netherlands ◽

Older People ◽

Fall Prevention ◽

Fear Of Falling ◽

Daily Practice ◽

Health Issues ◽

Frail Older People ◽

Physician Practices ◽

Important Health ◽

Underlying Causes

Abstract Falls are an important health threat among frail older people. Physicians are often the first to contact for health issues and can be seen as designated professionals to provide fall prevention. However, it is unknown what they exactly do and why regarding fall prevention. This study aims to describe what physicians in the Netherlands do during daily practice in regards to fall prevention. About 65 physicians (34 practices) located throughout the Netherlands were followed up for 12 months. When a physician entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the physician received a pop-up asking if the patient is frail. If so, the physician subsequently completed a questionnaire. The physicians completed 1396 questionnaires. More than half (n=726) of the patients had experienced a fall in the previous year and/or had a fear of falling (FOF) and 37% of these patients received fall prevention. Physicians did not know of 20% of the patients if they had experienced a fall and of 29% of the patients if they had a FOF. The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors. The results show that physicians are not always aware of a patient’s fall history and/or FOF and that only part of these patients receives fall prevention. Hence, it might be important to develop and implement strategies for systematic fall risk screening and fall prevention provision in the primary care setting to reduce falls among frail older people.

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