scholarly journals 133A Life Changing Decision: Exploring Different Perspectives Of Risk In Care Home Discharge Decision Making

2017 ◽  
Vol 46 (suppl_1) ◽  
pp. i35-i38
Author(s):  
S J Rhynas ◽  
A Garcia Garrido ◽  
J MacArthur ◽  
J Harrison ◽  
A MacLullich ◽  
...  
Keyword(s):  
Decision Making ◽  
Care Home ◽  
Home Discharge

scholarly journals 110ONE CHANCE TO GET IT RIGHT: EXPLORING DIFFERENT PERSPECTIVES ON DECISION MAKING FOR CARE HOME DISCHARGE

2019 ◽  
Vol 48 (Supplement_1) ◽  
pp. i32-i35
Author(s):  
G Logan ◽  
S J Rhynas ◽  
J K Burton
Keyword(s):  
Decision Making ◽  
Care Home ◽  
Home Discharge

scholarly journals Data linkage and statistical modelling to provide stratified risk assessment for HAI

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Kim Kavanagh ◽  
Jiafeng Pan ◽  
Chris Robertson ◽  
Marion Bennie ◽  
Charis Marwick ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Gastric Acid ◽  
Clinical Decision Making ◽  
Care Home ◽  
Clinical Decision ◽  
Elevated Risk ◽  
Defined Daily Dose ◽  
Healthcare Associated Infection ◽  
Healthcare Associated

ABSTRACT ObjectivesThe use of “real-time” data to support individual patient management and outcome assessment requires the development of risk assessment models. This could be delivered through a learning health system by the building robust statistical analysis tools onto the existing linked data held by NHS Scotland’s Infection Intelligence Platform (IIP) and developed within the Scottish Healthcare Associated Infection Prevention Institute (SHAIPI). This project will create prediction models for the risk of acquiring a healthcare associated infection (HAI), and particular outcomes, at the point of GP consultation/ hospital admission which could aid clinical decision making. ApproachWe demonstrate the capability using the HAI Clostridium difficile (CDI) from 2010-2013. Using linked national individual level data on community prescribing, hospitalisations, infections and death records we extracted all cases of CDI and by comparing to matched population-based controls, examined the impact of prior hospital admissions, care home residence, comorbidities, exposure to gastric acid suppressive drugs and antibiotic exposure, defined as both cumulative (total defined daily dose (DDD)) and temporal antimicrobial exposure in the previous 6 months, to the risk of CDI acquisition. Antimicrobial exposure was considered for all drugs and the higher risk broad spectrum antibiotics (4Cs). Associations are assessed using conditional logistic regression. Using cross-validation we assess the ability of the model to accurately predict CDI infection. Risk scores for acquisition of CDI are estimated by combining these predictions with age and gender population incidence. ResultsIn the period 2010-2013 there were 1446 cases of CDI with matched 7964 controls. A significant dose-response relationship for exposure to any antimicrobial (1-7 DDDs OR=2.3 rising to OR=4.4 for 29+ DDDs) and, with elevated risk, to the 4C group (1-7 DDDs OR=3.8 rising to OR=17.9 for 29+ DDDs). Exposure elevates CDI risk most in the month after prescription but for 4C antimicrobials the elevated risk remains 6 months later (4C OR=12.4 within 1 month, OR=2.6 4-6 months later). The risk of CDI was also increased with more co-morbidities, previous hospitalisations, care home residency, increased number of prescriptions, and gastric acid suppression. ConclusionDespite limitations to current application in practice,(paucity of patient level in-hospital prescribing data and constraints of the timeliness of the data), when fully developed this system will enable risk classification to identify patients most at risk of HAI and adverse outcomes to aid clinical decision making.

scholarly journals When Frail Older People Relocate in Very Old Age, Who Makes the Decision?

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Fiona Scheibl ◽  
Morag Farquhar ◽  
Jackie Buck ◽  
Stephen Barclay ◽  
Carol Brayne ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Old Age ◽  
Residential Care ◽  
Care Home ◽  
Later Life ◽  
Old People ◽  
Care Needs ◽  
Health Crisis ◽  
Age In Place

Abstract Background and Objectives Older people are likely to transition to a new home closer to family who can provide assistance or to long-term residential care as their health declines and their care needs increase. A minority choose to move to “age-friendly” housing before the onset of disability, but the majority prefer to “age in place” and defer moving until health crises compel a transition. Older people living with dementia are likely to move into residential care, but not much is known about the role they play in decision making around these moves. This qualitative study addresses this gap in knowledge by examining how a rare cohort of “older old” people, most with some level of cognitive impairment, were involved in decisions surrounding assistance seeking and moving to a care home. Research Design and Methods Thematic analysis of qualitative interview data from Cambridge City over-75s Cohort (CC75C) study participants aged 95 years and older, who had moved in later life, and their proxy informants (n = 26). Results Moves at such an old age were made due to a complexity of push and pull factors which had layered dynamics of decision making. In most cases (n = 22), decision making involved other people with varying degrees of decision ownership. Only four older people, who moved voluntarily, had full ownership of the decision to move. Many relatives reported being traumatized by events leading up to the move. Discussion and Implications “Older old” people are sometimes unable to make their own decisions about moving due to the urgency of health crisis and cognitive decline. There is a need to support relatives to discuss moving and housing options at timely junctures before health crises intervene in an effort to optimize older people’s participation in decision making.

Implementation of eHealth to support assessment and decision-making for residents with dementia in long-term care: systematic review (Preprint)

2021 ◽  
Author(s):  
Juliet Gillam ◽  
Nathan Davies ◽  
Jesutofunmi Aworinde ◽  
Emel Yorganci ◽  
Janet E Anderson ◽  
...  
Keyword(s):  
Decision Making ◽  
Long Term Care ◽  
Care Home ◽  
End Users ◽  
Care Homes ◽  
Successful Implementation ◽  
Key Factors ◽  
Term Care ◽  
Care Assessment

BACKGROUND As dementia progresses, symptoms and concerns increase causing considerable distress for the person and caregivers. Integration of care between care homes and healthcare services is vital to meet increasing care needs and maintain quality of life. However, access to high-quality healthcare is inequitable. eHealth offers a potential solution, by supporting remote specialist input on care processes like clinical assessment and decision-making, and streamlining care on site. How best to implement eHealth in the care home setting is unclear. OBJECTIVE This review aimed to identify key factors that influence implementation of eHealth for people living with dementia in long-term care. METHODS A systematic search of EMBASE, PsychInfo, MEDLINE and CINHAL was conducted to identify studies published between 2000-2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analysed and deductively mapped onto the six constructs of the adapted Consolidated Framework for Implementation Research (CFIR). Results are presented as a narrative synthesis. RESULTS 29 studies were included, focusing on a variety of eHealth interventions including remote video-consultations and clinical decision support tools. Key factors which influenced eHealth implementation were identified across all six constructs of the CFIR. Most concerned the Inner Setting construct about requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership and sufficient training and resources. Four novel subconstructs were identified to inform implementation requirements to meet resident needs and engage end-users. CONCLUSIONS Implementing eHealth in care homes for people with dementia is multi-factorial and complex, involving interaction between the resident, staff and organisation. Application of the CFIR for care homes requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed, and translated into 18 practical recommendations on implementation of eHealth in long-term care to guide implementers or innovators in care homes. The policy imperative for integrated health and social care demands successful implementation of eHealth, to maximise uptake and drive improvements.

scholarly journals A qualitative study of older people with minimal care needs experiences of their admission to a nursing home with Registered Nurse care

2015 ◽  
Vol 16 (2) ◽  
pp. 94-105 ◽  
Author(s):  
Alice K. Stevens ◽  
Helen Raphael ◽  
Sue M. Green
Keyword(s):  
Decision Making ◽  
Grounded Theory ◽  
Qualitative Study ◽  
Older People ◽  
Registered Nurse ◽  
Care Home ◽  
Care Homes ◽  
Care Needs ◽  
Content Type ◽  
Health And Social Care

Purpose – Residential care for older people in the UK includes care homes with and without 24-hour Registered Nurse (RN) care. Reduced autonomy and personal wealth can result when people assessed as having minimal care needs, enter and reside in care homes with RN care. The purpose of this paper is to explore the experiences of older people with minimal care needs admission to care homes with RN care. Design/methodology/approach – A qualitative study using a grounded theory method was undertaken. In total, 12 care home with RN care residents assessed as not requiring nursing care were interviewed. Initial sampling was purposive and progressed to theoretical. Interviews were analysed using the grounded theory analysis method of constant comparison and theory development. Findings – Two main categories emerged: “choosing the path”, which concerned the decision to enter the home, and “settling in”, which related to adaptation to the environment. Findings suggested participants who perceived they had greater control over the decision-making process found it easier to settle in the care home. The two categories linked to form an emerging framework of “crossing the bridge” from independent living to care home resident. Research limitations/implications – The findings contribute to the understanding of factors influencing admission of older people with minimal care needs to care homes with RN care and highlight the importance of informed decision making. Practical implications – Health and social care professionals must give informed support and advice to older people seeking care options to ensure their needs are best met. Originality/value – This study enabled older people with minimal care needs admission to care homes with RN care to voice their experiences.

scholarly journals Making a move: care-home residents' experiences of relocation

2003 ◽  
Vol 23 (2) ◽  
pp. 225-241 ◽  
Author(s):  
JAN REED ◽  
GLENDA COOK ◽  
AILEEN SULLIVAN ◽  
CHRIS BURRIDGE
Keyword(s):  
Decision Making ◽  
United Kingdom ◽  
Older People ◽  
Influencing Factors ◽  
Care Home ◽  
Active Role ◽  
Case Note ◽  
The United Kingdom ◽  
Domestic Environments ◽  
Selection Of

Studies in environmental gerontology have progressed our understanding of the ways in which older people respond to and manage the environments in which they live, including their decisions about relocation and the influencing factors. Much of this work, however, has been done with relatively healthy and mobile older people living in domestic environments. It is often the case that when care-home residents move, the decisions are taken by others while the residents are passive and maybe hardly consulted. Far from the residents' preferences and initiatives being instrumental, they are moved by imposition. In the United Kingdom, the setting of this study, such imposed moves are common, partly because registration regulations restrict the range of care that a home can provide, and make some moves unavoidable. A questionnaire was distributed to care homes in two English local authorities to determine the incidence of relocation, and 10 homes were approached to take part in further studies, which included case-note audits, and interviews with staff and 12 older people who had relocated. The study found that the pattern of moves was complex, and that some residents were active in deciding to relocate and in the selection of the relocation home. The study concludes, however, that for residents to have an active role, they must be given support both to access the information required for decision-making and to implement their decisions.

scholarly journals Continuums of Change in a Competence-Building Initiative Addressing End-of-Life Communication in Swedish Elder Care

2021 ◽  
pp. 104973232110129
Author(s):  
Therese Johansson ◽  
Carol Tishelman ◽  
Joachim Cohen ◽  
Lars E. Eriksson ◽  
Ida Goliath
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Residential Care ◽  
Elder Care ◽  
Care Home ◽  
Knowledge Exchange ◽  
Residential Care Home ◽  
Eol Care ◽  
End Of Life Communication ◽  
Care Decision

Conversations about values for the end-of-life (EoL) between residents, relatives, and staff may allow EoL preparation and enable value-concordant care, but remain rare in residential care home (RCH) practice. In this article, longitudinal qualitative analysis was used to explore changes in staff discussions about EoL conversations throughout workshop series based on reflection and knowledge exchange to promote EoL communication in RCHs. We identified three overall continuums of change: EoL conversations became perceived as more feasible and valuable; conceptualizations of quality EoL care shifted from being generalizable to acknowledging individual variation; and staff’s role in facilitating EoL communication as a prerequisite for care decision-making was emphasized. Two mechanisms influenced changes: cognitively and emotionally approaching one’s own mortality and shifting perspectives of EoL care. This study adds nuance and details about changes in staff reasoning, and the mechanisms that underlie them, which are important aspects to consider in future EoL competence-building initiatives.

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