Mobilizing Elders: An Interprofessional Effort

Abstract Older adults often experience functional decline during hospitalization as a result of immobility. Such decline has associated adverse outcomes, including gait instability, falls, pressure injuries, delirium, and new nursing home admissions. Our objective was to create an effective and sustainable in-hospital mobility program through enhanced interdisciplinary cooperation in an Acute Care of the Elderly (ACE) unit. An interdisciplinary team at UNC’s 25-bed ACE unit planned and delivered enhanced patient mobility beginning in July 2020. We used an input-process-output model to design and analyze an intervention based on enhanced collaboration. Inputs included a mobility taskforce which was comprised of physicians, nurses, physical and occupational therapists, and quality improvement specialists. Through regular meetings, each taskforce member contributed to the study design and were empowered to identify barriers to implementation. Outputs included stakeholder engagement and mobility rates. Early results show a doubling in mobility rates over a 6-month period with consistent and enthusiastic stakeholder engagement. Observations of such benefits include: a) stakeholder inclusion from each discipline ensured implementation that was pragmatic and easily incorporated into the daily workflow; b) mobility champions regularly disseminated information to their respective disciplines, leading to changes using a quality improvement process; and c) barriers to implementation were rapidly identified, and mobility champions were motivated to find solutions, allowing cohesive incorporation of a broad spectrum of priorities. An interprofessional team model is effective to mobilize hospitalized older adults, potentially reducing adverse hospital outcomes. Successful implementation of such programs is dependent on interprofessional collaboration.

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The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

10.21203/rs.3.rs-36075/v1 ◽

2020 ◽

Author(s):

Anne Griffin ◽

Aoife O´Neill ◽

Margaret O´Connor ◽

Damien Ryan ◽

Audrey Tierney ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Functional Ability ◽

Hospital Admissions ◽

Functional Decline ◽

Secondary Analysis ◽

Adverse Outcomes ◽

Nutrition Status

Abstract BackgroundMalnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. MethodsSecondary analysis of data collected from a randomised trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from baseline to 30-days and 6-month follow-up were used for statistical analysis.ResultsAmong 353 older adults (mean age 79.6 years (SD=7.0); 59.2% (n=209) female) the prevalence of malnutrition was 7.6% (n=27) and ‘risk of malnutrition’ was 28% (n=99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. At 6-months, a reported further decline in functional ability was more likely among those who were malnourished compared to those who had normal nutritional status. ConclusionOver one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to long-term care at 30 days. Trial registration: Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018. https://clinicaltrials.gov/ct2/show/NCT03739515

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Interprofessional Team-Based Care

10.1093/med/9780190466268.003.0029 ◽

2018 ◽

Author(s):

Beverly Lunsford ◽

Terry A. Mikovich

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Health Care ◽

Health Care Professionals ◽

Interprofessional Collaboration ◽

Functional Decline ◽

Care Program ◽

Coordination Of Care ◽

Palliative Care Teams

As older adults live longer, they experience a concomitant increase in chronic illness, which may be associated with a more frequent need for health care and intermittent or progressive functional decline. There is an increased need for regular health care monitoring as well as treatment and coordination of care among multiple providers and across settings to prevent, delay, or minimize decline in health and quality of life. Interprofessional collaboration is critical for safe coordination of care, reduction of duplication in services, and cost containment. Health care professionals who serve older adults are developing new models of collaboration to provide more integrated and person-centered approaches to maintaining the quality of life for older adults, especially those with multiple chronic illnesses. These models include health-oriented teams, home and community-based services, Acute Care for Elders (ACE), home-based primary care, Program of All-Inclusive Care for the Elderly (PACE), comprehensive geriatric assessment, and palliative care teams.

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The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial

BMC Geriatrics ◽

10.1186/s12877-020-01852-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Anne Griffin ◽

Aoife O’Neill ◽

Margaret O’Connor ◽

Damien Ryan ◽

Audrey Tierney ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Functional Ability ◽

Hospital Admissions ◽

Functional Decline ◽

Secondary Analysis ◽

Adverse Outcomes ◽

Nutrition Status

Abstract Background Malnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. Methods Secondary analysis of data collected from a randomised controlled trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit to 30-days and 6-month follow-up were used for statistical analysis. Results Among 353 older adults (mean age 79.6 years (SD = 7.0); 59.2% (n = 209) female) the prevalence of malnutrition was 7.6% (n = 27) and ‘risk of malnutrition’ was 28% (n = 99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant. Conclusion Over one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to a nursing home at 30 days. Trial registration Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018.

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Successful implementation of a trans-jurisdictional, primary care, anticipatory care planning intervention for older adults at risk of functional decline: interviews with key health professionals

BMC Health Services Research ◽

10.1186/s12913-021-06896-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dagmar Anna S. Corry ◽

Gillian Carter ◽

Frank Doyle ◽

Tom Fahey ◽

Patrick Gillespie ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Health Systems ◽

Health Professionals ◽

Functional Decline ◽

Successful Implementation ◽

Care Planning ◽

Nurse Training ◽

Sustainable Implementation ◽

Patient Health

Abstract Background Aging populations present a challenge to health systems internationally, due to the increasing complexity of care for older adults living with functional decline. This study aimed to elicit expert views of key health professionals on effective and sustainable implementation of a nurse-led, person-centred anticipatory care planning (ACP) intervention for older adults at risk of functional decline in a primary care setting. Methods We examined the feasibility of an ACP intervention in a trans-jurisdictional feasibility cluster randomized controlled trial consisting of home visits by research nurses who assessed participants’ health, discussed their health goals and devised an anticipatory care plan following consultation with participants’ GPs and adjunct clinical pharmacist. As part of the project, we elicited the views and recommendations of experienced key health professionals working with the target population who were recruited using a ‘snowballing technique’ in cooperation with older people health networks in the Republic of Ireland (ROI) and Northern Ireland (NI), United Kingdom [n = 16: 7 ROI, 9 NI]. Following receipt of written information about the intervention and the provision of informed consent, the health professionals were interviewed to determine their expert views on the feasibility of the ACP intervention and recommendations for successful implementation. Data were analyzed using thematic analysis. Results The ACP intervention was perceived to be beneficial for most older patients with multimorbidity. Effective and sustainable implementation was said to be facilitated by accurate and timely patient selection, GP buy-in, use of existing structures within health systems, multidisciplinary and integrated working, ACP nurse training, as well as patient health literacy. Barriers emerged as significant work already undertaken, increasing workload, lack of time, funding and resources, fragmented services, and geographical inequalities. Conclusions The key health professionals perceived the ACP intervention to be highly beneficial to patients, with significant potential to prevent or avoid functional decline and hospital admissions. They suggested that successful implementation of this primary care based, whole-person approach would involve integrated and multi-disciplinary working, GP buy in, patient health education, and ACP nurse training. The findings have potential implications for a full trial, and patient care and health policy. Trial registration Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019.

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Frailty in Critical Care: Examining Implications for Clinical Practices

Critical Care Nurse ◽

10.4037/ccn2018336 ◽

2018 ◽

Vol 38 (3) ◽

pp. 29-35 ◽

Cited By ~ 4

Author(s):

Jennifer A. Gibson ◽

Sarah Crowe

Keyword(s):

Older Adults ◽

Critical Care ◽

Functional Decline ◽

Hospital Length ◽

Adverse Outcomes ◽

Hospital Length Of Stay ◽

Clinical State ◽

Clinical Practices ◽

Delivery Of Care ◽

Prolonged Hospital

Frailty is an aging-related, multisystem clinical state characterized by loss of physiological reserves and diminished capacity to withstand exposure to stressors. Frailty increases the risk of serious adverse outcomes, compared with that of nonfrail people of the same age. Adverse outcomes can be severe and may include procedural complications, delirium, significant functional decline and disability, prolonged hospital length of stay, extended recovery periods, and death. As older adults make up a continually growing proportion of hospitalized patients, critical care nurses need to understand how to recognize frailty and be familiar with related clinical practice implications. Such knowledge underpins effective organization and delivery of care strategies aimed at minimizing harm and maximizing positive outcomes for frail older adults. Drawing from recent literature, this article explores frailty and critical illness by discussing 2 dominant models of the concept. Using a clinical case study, links between frailty and critical care nursing practices are highlighted and clinical considerations are explored.

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Prevention of functional decline through gamified interventions in hospitalized older adults

10.48035/tesis/2454/41077 ◽

2021 ◽

Author(s):

◽

César Cuevas Lara

Keyword(s):

Older Adults ◽

Functional Capacity ◽

Functional Decline ◽

Bed Rest ◽

The Elderly ◽

Doctoral Thesis ◽

Care For The Elderly ◽

Reduced Physical Activity ◽

Multidomain Intervention ◽

Hospitalized Older Adults

This doctoral thesis focuses on the effects of gamified intervention programmes on the functional capacity of hospitalized older adults. Hospitalization is a process that leads to the development of disability in older adults. Hospitalization-associated disability is mainly induced by reduced physical activity and frequent episodes of bed rest during this process of health restoration. Gamified interventions can be a novel and effective strategy to prevent hospitalization-associated functional impairment in elderly patients. This doctoral thesis is based on three studies that have been published in international scientific journals. The first study (Chapter 1) aimed to evaluate the available evidence on the effectiveness of game-based interventions on health parameters (functional capacity, quality of life, etc.) of hospitalized older adults. In the second study (Chapter 2), the main objective was to detail the validation of a pilot multidomain intervention system (physical and cognitive training) based on gamification technologies to improve the functional capacity of hospitalized older adults. In the last study (Chapter 3), the main purpose was to analyse the effects of different modalities of gamified intervention programmes on functional capacity in hospitalized older adults in acute care for the elderly.

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Management of Delirium in Critically Ill Older Adults

Critical Care Nurse ◽

10.4037/ccn2012480 ◽

2012 ◽

Vol 32 (4) ◽

pp. 15-26 ◽

Cited By ~ 23

Author(s):

Michele C. Balas ◽

Michael Rice ◽

Claudia Chaperon ◽

Heather Smith ◽

Maureen Disbot ◽

...

Keyword(s):

Older Adults ◽

Critically Ill ◽

Management Strategy ◽

Functional Decline ◽

Adverse Outcomes ◽

Physical Restraints ◽

Primary Responsibility ◽

Continuous Sedation ◽

Poor Outcomes ◽

New Onset

Delirium in older adults in critical care is associated with poor outcomes, including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment. Diagnosing delirium is complicated because many critically ill older adults cannot communicate their needs effectively. Manifestations include reduced ability to focus attention, disorientation, memory impairment, and perceptual disturbances. Nurses often have primary responsibility for detecting and treating delirium, which can be extraordinarily complicated because patients are often voiceless, extremely ill, and require high levels of sedatives to facilitate mechanical ventilation. An aggressive, appropriate, and compassionate management strategy may reduce the suffering and adverse outcomes associated with delirium and improve relationships between nurses, patients, and patients’ family members.

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120 Communicating Medication-Related Fall Risk via a Patient Portal: What is Important According to Older Fallers in Europe?

Age and Ageing ◽

10.1093/ageing/afz164.120 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv28-iv33

Author(s):

Kim Ploegmakers ◽

Annemiek Linn ◽

Stephanie Medlock ◽

Nathalie Van der Velde ◽

Julia Van Weert

Keyword(s):

Older Adults ◽

Fall Risk ◽

Functional Decline ◽

Barriers And Facilitators ◽

Successful Implementation ◽

Patient Portal ◽

Mobility Impairments ◽

Potential Barriers ◽

User Friendly ◽

Privacy Issues

Abstract Background Falls are the leading cause of injury and functional decline in older adults. Medication is a leading cause of falls, second only to mobility impairments. Older adults with Fall Risk Increasing Drug (FRID) use are not aware of having a risk of falling and most of them don’t relate fall risk to their drug use. With this European survey we explored if: 1) older adults want to know their personal fall risk, 2) if they want this to be shown via a patient portal, 3) what other elements a patient portal should contain and 4) what potential barriers and facilitators exist for usage of a patient portal. Methods We distributed a questionnaire in 10 European countries that was filled in by 58 older fallers (mean age 75,5 years) who visited a geriatric outpatient clinic. Results Most participants wanted to know their fall risk (82,8%). The most important elements for the Portal, besides fall risk, were information on FRIDs and patient’s illnesses (62%) and access to the medical record (57%). Paying for the system (63%) and privacy issues (53%) were the most important barriers for using the Portal. A user-friendly Portal (57%), the ability to share information with the doctor (47%) and recommendation by doctors (47%) were the most important facilitators. Conclusion More knowledge dissemination is needed to make older fallers aware of medications that can cause falls. This can be done via a Patient Portal. For a successful implementation, the barriers and facilitators should be taken into account.

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Nutrition Risk in Home-Bound Older Adults: Using Dietician-Trained and Supervised Nutrition Volunteers for Screening and Intervention

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.3138/cja.26.4.305 ◽

2007 ◽

Vol 26 (4) ◽

pp. 305-315 ◽

Cited By ~ 8

Author(s):

Sophie Laforest ◽

Benita Goldin ◽

Kareen Nour ◽

Marie-Andrée Roy ◽

Hélène Payette

Keyword(s):

Older Adults ◽

Functional Decline ◽

The Elderly ◽

Home Care Services ◽

Community Dwelling ◽

Nutritional Risk ◽

Nutrition Screening ◽

Nutrition Risk ◽

Care Services ◽

Nutrition Screening Tool

ABSTRACTNutrition screening and early intervention in home-bound older adults are key to preventing unfavourable health outcomes and functional decline. This pilot study's objectives were (a) to test the reliability of the Elderly Nutrition Screening Tool (ENS©) when administered by dietician-trained and supervised nutrition volunteers, and (b) to explore the feasibility of volunteers' doing nutrition screening and intervention for home-bound older adults receiving home care services. Both participating clients (n = 29) and volunteers (n = 15) were community-dwelling older adults. Volunteers met with participating clients, assessed nutritional risk with the ENS©, provided nutritional education, and developed and helped implement intervention plans. To assess ENS© inter-rater reliability, we compared results obtained by nutrition volunteers and a dietician. Agreement was high (≥80%) for most items but was higher among volunteers than between volunteers and the dietician. We conclude that nutrition volunteers can assist in screening and educating older adults regarding nutritional risks, but intervention is best left to professionals.

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The Role of Frailty in Predicting 3 and 6 Months Functional Decline in Hospitalized Older Adults: Findings from a Secondary Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18137126 ◽

2021 ◽

Vol 18 (13) ◽

pp. 7126

Author(s):

João Tavares ◽

Pedro Sa-Couto ◽

João Duarte Reis ◽

Marie Boltz ◽

Elizabeth Capezuti

Keyword(s):

Older Adults ◽

Frailty Index ◽

Functional Decline ◽

Secondary Analysis ◽

Secondary Data ◽

Binary Logistic Regression ◽

Adverse Outcomes ◽

Average Score ◽

Post Discharge ◽

Hospitalized Older Adults

Frailty represents one of the most relevant geriatric syndromes in the 21st century and is a predictor of adverse outcomes in hospitalized older adult, such as, functional decline (FD). This study aimed to examine if frailty, evaluated with the Frailty Index (FI), can predict FD during and after hospitalization (3 and 6 months). Secondary data analysis of a prospective cohort study of 101 hospitalized older adults was performed. The primary outcome was FD at discharge, 3 and 6 months. The FI was created from an original database using 40 health deficits. Functional decline models for each time-point were examined using a binary logistic regression. The prevalence of frailty was 57.4% with an average score of 0.25 (±0.11). Frail patients had significant and higher values for functional decline and social support for all time periods and more hospital readmission in the 3 month period. Multivariable regression analysis showed that FI was a predictor of functional decline at discharge (OR = 1.07, 95% CI = 1.02–1.14) and 3-month (OR = 1.05, 95% CI = 1.01–1.09) but not 6-month (OR = 1.03, 95% CI = 0.99–1.09) follow-up. Findings suggest that frailty at admission of hospitalized older adults can predict functional decline at discharge and 3 months post-discharge.

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