Best practice interventions to improve the management of older people in acute care settings: a literature review

2007 ◽  
Vol 60 (2) ◽  
pp. 113-126 ◽  
Author(s):  
Louise Hickman ◽  
Phillip Newton ◽  
Elizabeth J. Halcomb ◽  
Esther Chang ◽  
Patricia Davidson
Keyword(s):  
Literature Review ◽  
Older People ◽  
Acute Care ◽  
Best Practice ◽  
Acute Care Settings

scholarly journals An analysis of equity in treatment of hip fractures for older patients with dementia in acute care hospitals: observational study using nationwide hospital claims data in Japan

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shinichi Tomioka ◽  
Megumi Rosenberg ◽  
Kiyohide Fushimi ◽  
Shinya Matsuda
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Acute Care ◽  
Waiting Time ◽  
Older Patients ◽  
Acute Care Hospitals ◽  
Care Quality ◽  
Severe Dementia ◽  
People With Dementia ◽  
Acute Care Settings

Abstract Background Globally, and particularly in countries with rapidly ageing populations like Japan, there are growing concerns over the heavy burden of ill health borne by older people, and the capacity of the health system to ensure their access to quality care. Older people with dementia may face even greater barriers to appropriate care in acute care settings. Yet, studies about the care quality for older patients with dementia in acute care settings are still few. The objective of this study is to assess whether dementia status is associated with poorer treatment by examining the association of a patient’s dementia status with the probability of receiving surgery and the waiting time until surgery for a hip fracture in acute care hospitals in Japan. Methods All patients with closed hip fracture were extracted from the Diagnosis Procedure Combination (DPC) database between April 2014 and March 2018. After excluding complicated cases, we conducted regressions with multilevel models. We used two outcome measures: (i) whether the patient received a surgery or was treated by watchful waiting; and (ii) number of waiting days until surgery after admission. Results Two hundred fourteen thousand six hundred one patients discharged from 1328 hospitals were identified. Among them, 159,173 patients received surgery. Both 80–89 year-olds (OR 0.87; 95% CI, 0.84, 0.90) and those 90 years old and above (OR 0.67; 95% CI, 0.65, 0.70) had significantly lower odds ratios for receiving surgery compared to 65–79 year-olds. Those with severe dementia had a significantly greater likelihood of receiving surgery compared to those without dementia (OR 1.21; 95% CI, 1.16, 1.25). Patients aged 90 years old and above had shorter waiting time for surgery (Coef. -0.06; 95% CI, − 0.11, − 0.01). Mild dementia did not have a statistically significant impact on the number of waiting days until surgery (P = 0.34), whereas severe dementia was associated with shorter waiting days (Coef. -0.08; 95% CI, − 0.12, − 0.03). Conclusions These findings suggest physicians may be taking proactive measures to preserve physical function for those with severe dementia and to avoid prolonged hospitalization although there are no formal guidelines on prioritization for the aged and dementia patients.

Frailty is associated with pain and cognitive function in older people in post-acute care settings

2020 ◽  
Vol 41 (5) ◽  
pp. 530-535
Author(s):  
Mimi M.Y. Tse ◽  
Rick Y.C. Kwan ◽  
Simone S.M. Ho ◽  
Patricia M. Davidson ◽  
Peggy P.P. Cheng ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Older People ◽  
Acute Care ◽  
Acute Care Settings ◽  
Post Acute Care

scholarly journals P082: Correlation between serum and blood gas: a review on the accuracy of electrolyte readings obtained blood gases

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S106-S106
Author(s):  
J. Lindgren ◽  
S. Dowling
Keyword(s):  
Literature Review ◽  
Patient Care ◽  
Acute Care ◽  
Point Of Care ◽  
Blood Gases ◽  
Validity And Reliability ◽  
Physiological Level ◽  
High Acuity ◽  
Acute Care Settings ◽  
Sodium And Potassium

Introduction: In the Emergency Department (ED), increasing time pressures and acuity require physicians to have access to quick and reliable data to guide patient care decisions. Blood gases (BGs) allow quick access to key information, and are used frequently in the ED. Our objective was to review the literature on reliability and accuracy of electrolyte measurements obtained from BGs in high acuity settings. Methods: A comprehensive literature review was conducted in September of 2015. The search strategy, done in conjunction with a medical librarian, identified studies that assessed the accuracy of BGs when compared to traditional laboratory serum measurements. Prior to the review we determined sodium and potassium would be the area of focus. Eligibility parameters for the studies included samples from acute care areas - the ED and ICU - and a comparison of BG and serum values taken simultaneously from the patient. Results: Our review included 12 studies, 9 in adult and 3 in pediatrics. There were approximately 1,135 patients included, consisting of 851 adult and 284 pediatric cases. The results were mixed; 9 studies agreed that sodium and potassium readings from BGs were accurate enough to guide acute care decisions, 5 did not. Furthermore, important questions were raised regarding the varying accuracy of BGs depending on what physiological level the electrolytes were at during the time of collection, i.e. at critical vs non-critical levels. Conclusion: This is the first literature review to examine the existing evidence on the accuracy of BGs in acute care environments. Given the variability in the results, a larger study needs to be done to determine the validity and reliability of blood gases for electrolytes in acute care settings. Only by ensuring the accuracy of data collected via point-of-care BGs can the most informed decisions be made surrounding patient care in acute care settings.

80 An Exploration of What Stakeholders Reveal About the Behaviours and Personality of Registered Nurses Working in Older People’s Acute Care Settings and the Potential Influence on Nursing Care

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i25-i26
Author(s):  
H Day
Keyword(s):  
Older People ◽  
Personality Traits ◽  
Acute Care ◽  
Nursing Care ◽  
Nursing Staff ◽  
Positive Impact ◽  
Care Delivery ◽  
Structured Interviews ◽  
Authentic Self ◽  
Acute Care Settings

Abstract Background Concern around poor standards of nursing care for older people in hospital has been explored in relation to workload and operational pressures. What is less evident from existing literature is an explanation as to why nurses behave differently under the same pressures within the same concrete situations. Notions of personality and associated behaviours as possible influencers on nursing care delivery are variables that required consideration. Aim To critically explore the behaviours of registered nursing staff working in older people's acute care settings from the perspectives gathered from key stakeholders, and to identify whether there are any distinguishing personality traits that influence effective care delivery for older people. Methods A constructivist grounded theory methodology was used. Semi structured interviews were conducted to gather data from 12 stakeholder participants. Results Through the analysis of data gathered from stakeholders a rubric describing specific behaviours with associated traits emerged leading to the identification of two major types of nursing staff. One group of nurses who work with older people are perceived to have no real desire to do so and in turn their care behaviours are perceived as ‘cold’ and task based. The second group of nurses are perceived as having a true commitment to older people’s wellbeing and their behaviours lead to the delivery of care that is perceived as being highly skilled and compassionate. The proposed theoretical framework that was constructed from this data analysis identifies four key personality traits related to nursing behaviours: conscientiousness, sociability, integrity and coping under a core category heading of ‘the authentic self’. Whilst the authentic self is identified as being the direct influencer on how care is delivered which is defined as the consequence, the influence of context is also taken into account. Conclusions This research offers insights into the meaning of four key traits and the behavioral facets comprising them, the associated behaviors that are displayed and what effect these have on nursing care delivery. Implications for healthcare practice include the potential for further research that can inform the development of educational and recruitment strategies for older people’s nurses which will have a positive impact on the care of the older patient in hospital.

scholarly journals 44The Three Ps of Co-Designing Person-Centred Care for Frail Older People in Acute Care Settings: Public, Patient and Practitioner Involvement

2018 ◽  
Vol 47 (suppl_5) ◽  
pp. v13-v60 ◽  
Author(s):  
Deirdre O’Donnell ◽  
Éidín Ní Shé ◽  
Mary McCarthy ◽  
Thelma Doran ◽  
Anne Donnellan ◽  
...  
Keyword(s):  
Older People ◽  
Acute Care ◽  
Frail Older People ◽  
Acute Care Settings

Older people presenting to acute care hospitals

2017 ◽  
pp. 247-254
Author(s):  
Roger Y. M. Wong
Keyword(s):  
Adverse Events ◽  
Older People ◽  
Acute Care ◽  
Best Practice ◽  
Functional Decline ◽  
Acute Care Hospitals ◽  
Models Of Care ◽  
Hospital Length Of Stay ◽  
Post Discharge ◽  
Point Of Entry

Older people presenting to acute care hospitals are at risk of developing adverse events. Comprehensive geriatric assessment (CGA) in acute care provides standardized assessment and management of geriatric problems. The emergency department is a common point of entry, and strategies that focus on enhancing expertise, equipment, policies, and protocols are helpful. The geriatric consultation service model is commonly deployed, and the geriatric evaluation and management unit (GEMU) is a common ward-based model. The acute care for elders (ACE) unit model is associated with fewer adverse events, less functional decline, shorter hospital length of stay, lower institutionalization risk, and lower cost. The senior friendly hospital (SFH) model requires further studies to confirm its effectiveness. A number of geriatric post-discharge liaison services can smooth the transition of older people returning to the community. Overall these models of care are not mutually exclusive, but together they comprise the best practice for older people.

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