62 Geriatric Surgical Liaison Staff Perspectives of Geriatric Care Before and After Introduction of An Embedded Service

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i18-i20
Author(s):  
K Shah ◽  
R Kyzy ◽  
H Pittaway
Keyword(s):  
Older Patients ◽  
Discharge Planning ◽  
Adverse Outcomes ◽  
Ageing Population ◽  
Emergency Setting ◽  
Complication Rates ◽  
Before And After ◽  
Key Indicators ◽  
The Impact ◽  
Multi Disciplinary Team

Abstract Introduction National evidence demonstrates that older people having surgery, both in the elective and emergency setting, have more adverse outcomes postoperatively when compared with their younger counterparts (1). National reports have recommended daily input from a geriatric team for older patients having surgery (2). At our hospital we have introduced a geriatric surgical liaison consultant as a formal post to ensure daily geriatric input or review for patients over the age of 70 or comorbid younger patients as requested. The aim of this study was to review perspectives across the multi-disciplinary team on care provided to these patients before and after introduction of the surgical liaison team. Methods We created a 10 part questionnaire, which was distributed amongst all members of the multi-disciplinary team, asking them to rate confidence out of 10 in management of comorbidity, polypharmacy, discharge planning, pain assessments and nutrition. These data were then analysed to produce median scores for each category before and after the introduction of the service. We compared the change in scores between the foundation year 1 (FY1) doctors and the remainder of the respondents. Results The below table demonstrates the median scores across all 36 respondents in their confidence with the assessment and management of the 10 key domains before and after the liaison service was introduced: Conclusions Universally within our survey, staff reported improvement in all 10 key indicators of care of older patients on surgery with the introduction of a geriatric surgical liaison team. Greatest benefit was seen within the FY1 group. References 1. McVeigh TP, Al-Azawi D, O'Donoghue GT, Kerin MJ. Assessing the impact of an ageing population on complication rates and in-patient length of stay, Int J Surg, 2013, vol. 11 (pg. 872–5). 2. Wilkinson K. An age old Problem: A Review of the Care Received by Elderly Patients Undergoing Surgery: A Report by the National Confidential Enquiry Into Patient Outcome and Death. London, 2010.

Prescribing in the elderly

2016 ◽  
Vol 10 (2) ◽  
pp. 96-104
Author(s):  
Lucy Webber
Keyword(s):  
Functional Ability ◽  
Older Patients ◽  
Systematic Approach ◽  
Cumulative Effect ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Healthcare Team ◽  
Ageing Population ◽  
Slow Disease Progression ◽  
Unique Challenge

Prescribing in the elderly is a unique challenge faced by every GP. As the ageing population grows, more patients are presenting to GPs with an array of co-morbidities. The cumulative effect of this growth in morbidity is an increase in the prescribing of multiple medications. Although the use of appropriate medication can improve functional ability, slow disease progression and improve symptoms; medication can also cause adverse outcomes. Older patients are at particularly high risk of adverse outcomes, necessitating a rational and systematic approach to prescribing in the elderly. This article focuses on the challenges and pitfalls of prescribing in the elderly, and the ways in which GPs and the wider primary healthcare team can improve their practices for this group of patients.

scholarly journals Intradialytic nutrition and quality of life in Chilean older patients in hemodialysis with protein-energy wasting

2021 ◽  
Author(s):  
Mariana Ayala ◽  
Margarita Marchant ◽  
Cristina Hertz ◽  
Gloria Castillo
Keyword(s):  
Quality Of Life ◽  
Body Composition ◽  
Nutritional Status ◽  
Older Patients ◽  
Nutritional Supplementation ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Before And After ◽  
The Impact

Abstract Purpose The study assessed the impact of intradialytic oral nutritional supplementation on the quality of life in patients receiving hemodialysis and diagnosed with protein energy wasting. Methods A pre-test post-test quasi-experimental study was conducted before and after 3 months of intradialytic oral nutritional supplementation on 109 older hemodialysis patients. We measured before and after 3 months of intradialytic oral nutritional supplementation, the quality of life score, the burden of kidney disease, three quality of life scales and the mental and physical health status using KDQoL-SF™ 1.3, body composition and biochemical parameters of nutritional condition. Results The mean age of the patients was 69.4 ± 3.4 years, 59% were male, and the time on dialysis was 63.5 ± 52.6 months. Comparing the baseline with month 3 of intradialytic oral nutritional supplementation, we observed to better quality of life. In contrast to malnutrition, score, specifically increased significantly score of symptoms/problems list related to hemodialysis, sexual function, social and cognitive function, sleep, pain, energy/fatigue and general state of health. Significant changes were also found in nutritional status, energy intake and body composition indicators. After 3 months of intradialytic oral nutritional supplementation, we observed a nutritional status recovery in one or more indicators in 92% of the patients. Conclusion Our findings indicate that 3 months of intradialysis oral nutritional supplementation improves the components of physical and mental quality of life and nutritional status in older patients receiving hemodialysis diagnosed with loss of protein energy. These results are relevant to improve the experience of patients with protein energy loss receiving hemodialysis.

scholarly journals Hospital nurses’ knowledge regarding older patients: a multicenter study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Christel T. A. J. Derks ◽  
Marjo M. G. M. Hutten - van den Elsen ◽  
Lysette J. Hakvoort ◽  
Mariëlle P. J. van Mersbergen ◽  
Marieke J. Schuurmans ◽  
...  
Keyword(s):  
Nursing Students ◽  
The Netherlands ◽  
Multicenter Study ◽  
Older Patients ◽  
Hospital Nurses ◽  
Ageing Population ◽  
Knowledge And Attitudes ◽  
Knowledge Levels ◽  
The Impact ◽  
Nurses Knowledge

Abstract Background Nursing care in hospitals increasingly involves older adults. A nursing workforce able to care for the ageing population is therefore critical for ensuring quality older adult care. Gaining insight in the knowledge and attitudes of nurses regarding older patients in the Netherlands is needed to develop and increase the impact of education- and quality improvement programs which can positively influence nurses’ knowledge and attitudes regarding older patients. Methods A cross-sectional multicenter study was performed. Data was collected in ten tertiary medical teaching hospitals well spread across the Netherlands (89 wards, 2902 nurses). Knowledge levels were measured using the Knowledge about Older Patient-Quiz (KOP-Q), consisting of 30 true-false questions. Knowledge levels of registered nurses are compared with knowledge levels known from literature of first year nursing students; last year nursing students; nurses; and nurse specialist. Potential associated factors considered were: age; sex; education; experience; opinions and preferences. Opinion and preferences regarding working with older patients were measured by three questions: 1) which patient group nurses preferred to work with; 2) how nurses feel about the increase of older patients in the hospital; and 3) whether nurses find it difficult to care for older patients. Results From all wards, a representative sample of 1743 registered hospital nurses working on all 89 wards participated. On all wards, a large range in knowledge levels is observed between nurses, with 37% of nurses presenting knowledge levels comparable with nursing student and 31% of nurses presenting knowledge levels comparable with nurse specialists. Knowledge is related to age (p < .001), work experiences (p < .001), preparatory secondary education (p < .001) and nurses education level (p = .012). A minority (12.5%) prefers working with older patients and most nurses do not find it difficult. Conclusions This study shows that there is a large diversity in knowledge levels of Dutch hospital nurses in every hospital, on every ward. A majority of nurses demonstrate negative opinions and preferences. This implies that older patients admitted can receive different levels of quality of care on the same day as nurses with different knowledge levels provide care during the various shifts. Findings demonstrate an urgent need for education programs with themes regarding essential care for older patients in the Netherlands.

scholarly journals The global challenge of ageing population – Part II: the impact on health services, and the optimum healthcare strategy for older patients

2019 ◽  
Author(s):  
Ian Sammy ◽  
Joanne Paul ◽  
Arvind Ramnarine ◽  
Joseph Ramdhanie
Keyword(s):  
Health Services ◽  
Acute Care ◽  
Older Patients ◽  
Population Ageing ◽  
World Health ◽  
Ageing Population ◽  
Electronic Search ◽  
Study Results ◽  
The World ◽  
The Impact

Objectives: Analysis of data from the World Health Organization over the past 50 years, has demonstrated a transition towards population ageing globally. This has a significant impact on acute care services as well as on the approach to patient care in the acute setting. Methods: A narrative review of the literature was undertaken using Medline, CINAHL and the Cochrane Database, supplemented by manual searches of the literature, and further guided by the reference lists of relevant papers identified in the electronic search. No restriction was placed on the type of paper to be included in the study. Results: The initial electronic search of the three databases included 239 papers, of which 87 were found to be relevant and included in this review. Among the papers included were those which described the unique challenges posed by the ageing population, proposed modifications to the delivery of health services and recommended adaptations in the approach to older patients in the acute care setting. Conclusion: Population ageing is a significant global phenomenon, affecting both developed and developing regions of the world. More work is needed, particularly in the developing world, to better understand the impact of ageing on our population.

007 The impact of demographic changes on the presentation and outcome of stroke: experiences of the oldest old in the murrumbidgee region

2018 ◽  
Vol 89 (6) ◽  
pp. A4.2-A4
Author(s):  
Alice Powell ◽  
Paul Finucane ◽  
Martin Jude ◽  
Jenna Mewburn ◽  
Katherine Mohr ◽  
...  
Keyword(s):  
Functional Status ◽  
Older Patients ◽  
Oldest Old ◽  
Residential Aged Care ◽  
Ageing Population ◽  
Demographic Changes ◽  
Stroke Treatment ◽  
Demographic Groups ◽  
The Future ◽  
The Impact

IntroductionDemographic changes are leading to an ageing population with a disproportionate increase in the oldest old. Stroke is a leading cause of death and disability in Australia and is particularly prevalent in the elderly. The Murrumbidgee region has a population profile that is 14 years ahead of national Australia and therefore data from this population portends how stroke may present nationally in the future. Existing research suggests that stroke risk factors, subtype, treatment provided and outcomes differ between younger and older demographic groups. This study seeks to build a profile of the experiences of stroke in the oldest old and compare variables with two younger cohorts to test a number of hypotheses about background, treatment and outcomes.MethodsData was collected retrospectively from the electronic medical records of 100 stroke patients consecutively admitted to the Wagga Wagga Rural Referral Hospital Acute Stroke Unit. They were split into three demographic groups; young old, 65–74 old (75 to 84) and oldest old (85 and older) and comparisons were made of baseline functional status and risk factor profile, stroke type, stroke treatment and outcomes.ResultsOlder people admitted with stroke were more likely to be female with poorer premorbid functional status and higher numbers living in residential care. Atrial fibrillation (p=0.008) and hypertension (p=0.01) were significantly more common with advancing age while rates of smoking (p=0.006) were higher in younger patients. Stroke mechanism was predominantly cardioembolic in older patients and embolic stroke of undetermined source (ESUS) in the youngest group. Stroke severity and stroke treatment did not vary according to age. However, outcomes were poorer with rates of dependency (p=0.03) and residential aged care facility placement (p=0.06) increased among older patients post stroke.ConclusionThese data provide an indication of how stroke may manifest in our ageing population in the future.

scholarly journals Assessing the impact of an ageing population on complication rates and in-patient length of stay

2012 ◽  
Vol 10 (8) ◽  
pp. S49-S50
Author(s):  
Terri McVeigh ◽  
Dhafir Al-Azawi ◽  
Gerrard O'Donoghue ◽  
Michael Kerin
Keyword(s):  
Length Of Stay ◽  
Ageing Population ◽  
Complication Rates ◽  
The Impact

Early Discharge of Newborns and Mothers: A Critical Review of the Literature

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 716-726 ◽  
Author(s):  
Paula Braveman ◽  
Susan Egerter ◽  
Michelle Pearl ◽  
Kristen Marchi ◽  
Carol Miller
Keyword(s):  
Low Income ◽  
Critical Review ◽  
English Language ◽  
Discharge Planning ◽  
A Priori ◽  
Early Discharge ◽  
Clinic Visit ◽  
Adverse Outcomes ◽  
Hospital Stays ◽  
The Impact

Objective. To determine whether research supports the advisability of early discharge of healthy newborns and mothers. Methods. Critical review of English-language literature cited in the Index Medicus or the International Nursing Index. Findings. No adequately designed studies have examined discharge before 48 hours after delivery without additional postdischarge services. Few studies have examined the consequences of recommending a clinic visit within the first days after discharge; studies of this practice among low-income populations found high no-show rates. Some small studies suggest that early discharge is likely to be safe for selected populations at low psychosocial, socioeconomic, and medical risk, with careful antenatal screening and preparation and multiple postpartum home visits. Some studies suggested adverse outcomes associated with early discharge even with early follow-up. Conclusions. Published research provides little knowledge of the consequences of short maternal/newborn hospital stays or varying postdischarge practices for the general population. The studies that have concluded that early discharge was safe were applied under restricted circumstances or were too small to detect clinically significant effects on important outcomes. Further research is needed to inform clinical and reimbursement policy on health services in the first days of life and parenting. Rigorous studies of sufficient size are needed to examine the impact of different hospital stays and different postdischarge practices on a range of outcomes for mothers and newborns in diverse populations and settings. Given a priori concerns, decisions on neonatal/obstetric discharge planning should be made cautiously.

Increasing age as a major determinant of major adverse outcomes in patients with atrial fibrillation: the EURObservational research programme in atrial fibrillation general long-term registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Boriani ◽  
M Proietti ◽  
C Laroche ◽  
O Piot ◽  
D.A Lane ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Events ◽  
Adverse Outcomes ◽  
Major Determinant ◽  
Funding Source ◽  
Ageing Population ◽  
Kaplan Meier ◽  
The Impact ◽  
Major Adverse Events

Abstract Introduction Increasing age is a well-known determinant for incident atrial fibrillation (AF) as well as for adverse outcomes. With a progressively ageing population in Europe (and elsewhere), contemporary data are needed to investigate the impact of age in relation to major adverse events in AF patients. Purpose To evaluate the impact of increasing age on major adverse outcomes in a contemporary European AF cohort. Methods Patients enrolled in the EORP-AF Long Term General Registry were categorized by age: &lt;65, 65–74, 75–84, and ≥85 years. Any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death, CV death, all-cause mortality were considered as outcomes. Results Among the 9762 patients included in this analysis, 2946 (30.2%) were &lt;65 years, 3288 (33.7%) were 65–74 years, 2954 (30.3%) were 75–84 years and 574 (5.9%) were ≥85 years. With increasing age categories, there was a progressively higher prevalence of most risk factors and comorbidities. Accordingly, both mean CHA2DS2-VASc and HAS-BLED scores were progressively higher across the age categories (both p&lt;0.0001). At discharge, use of any oral anticoagulant (OAC) drug was lower in patients ≥85 years compared to those aged 65–74 or 75–84 years (83.6% vs. 89.4% and 88.8%, respectively) but significantly higher than in those &lt;65 years (80.2%) [p&lt;0.001]. Rate of all major adverse events progressively increased across the age categories, being higher in those aged ≥85 (all p&lt;0.001). Kaplan-Meier curves showed an increasing cumulative risk across the age groups for all the outcomes (p&lt;0.0001) (Figure 1). A fully adjusted Cox regression analysis demonstrated a progressively increasing association between age categories and the risk of all major adverse outcomes (Table 1). Conclusions In a large contemporary cohort of European AF patients, increasing age was a major determinant of major adverse outcomes. Figure 1. Kaplan-Meier Curves for All-Cause Death Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies supported its activities with unrestricted grants.

RA03.03: THE IMPACT OF ENHANCED RECOVERY AFTER SURGERY (ERAS) ON PATIENTS UNDERGOING OESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 23-23
Author(s):  
Barry Dent ◽  
Jillian Sturrock ◽  
Janine Mckenna ◽  
Claire Taylor ◽  
Helen Jaretzke ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Conflicts Of Interest ◽  
Positive Impact ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Complication Rates ◽  
Early Recovery ◽  
Significant Difference ◽  
The Impact ◽  
Multi Disciplinary Team

Abstract Background Enhanced recovery after surgery (ERAS) is defined as a multimodal care pathway designed to achieve early recovery for patients undergoing surgery. For patients undergoing oesophagectomy such pathways are complex and must involve a wide multi-disciplinary team. The importance of peri-operative nutrition is especially relevant in this patient group. We describe our experience of the impact of an ERAS pathway in a high volume oesophago-gastric unit on both short and medium term patient outcomes. Methods Consecutive patients undergoing open 2 phase subtotal oesophagectomy with two field lymphadenectomy in a 12 month period following the introduction of an ERAS pathway were included in the study. Outcomes were compared with consecutive patients undergoing the same procedure over a 12 month period prior to the introduction of the ERAS pathway. All patients were treated in a single UK unit. Adherence to the ERAS pathway was monitored by a dedicated ERAS coordinator. All data were collected prospectively. Statistical analysis was performed using the Mann-Whitney U test for continuous and Chi2 for categorical data. Results 189 patients were included (97 pre-ERAS and 92 ERAS). There were no demographic differences between the patient groups. The rate of severe post-operative complications (Accordion score 3 + ) was identical between groups (29%). Median length of hospital stay was significantly reduced with ERAS (10 days v 14 days pre-ERAS (P < 0.001)) as was the total readmission rate (21% v 39% P = 0.006). Weight loss following surgery was significantly reduced with ERAS. At 2 weeks 1% of patients had lost over 10% of their pre-operative weight compared with 32% pre-ERAS (P < 0.001). A significant difference was maintained at 6 weeks (9% v 55%), 3 months (19% v 66%) and 6 months (35% v 71%). Conclusion Our results demonstrate the positive impact of ERAS for patients undergoing oesophagectomy. Despite no reduction in post-operative complication rates, both hospital stay and readmission rates were reduced, suggesting a positive impact of ERAS on patients’ response to complications. Far fewer patients were readmitted for nutritional reasons/failure to thrive following the introduction of ERAS. Implementing an ERAS pathway requires a dedicated multi-disciplinary team to provide the required peri-operative care both in the hospital and community. Disclosure All authors have declared no conflicts of interest.

P4538Effect of risk of malnutrition on 30-day mortality among older patients with acute heart failure in emergency departments

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F J Martin Sanchez ◽  
G Llopis Garcia ◽  
F Cuesta Triana ◽  
P Matia Martin ◽  
P Llorens ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Older Patients ◽  
Nutritional Assessment ◽  
Short Form ◽  
Mini Nutritional Assessment ◽  
Routine Screening ◽  
Care Plan ◽  
Emergency Setting ◽  
The Impact

Abstract Introduction There is a need to explore the risk of malnutrition as a modifiable prognostic factor in order to establish routine screening of malnutrition in the emergency setting among older patients with acute heart failure (AH. Objectives To determine the impact of risk of malnutrition on 30-day mortality risk among older patients attended for AHF in the Emergency Department (ED). Methodology We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attended with AHF in 16 Spanish EDs over a 2-month period (January-February 2016). Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) <12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. Results We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1=3.4; 95% CI 1.2–9.7; p=0.020 and adjusted OR by model 2=3.2; 95% CI 1.1–9.2; p=0.030) compared to normal nutritional status. Conclusions The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients attended with AHF in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan. Acknowledgement/Funding Spanish Ministry of Health and FEDER (PI 18/00456, PI 18/00393, PI 17/00972, PI17/1732, PI15/00773, PI15/01019, and PI11/01021)

Sign in / Sign up

Export Citation Format

Share Document