Development of tools to measure dignity for older people in acute hospitals

The Australian health care system is frequently portrayed as being in crisis, with reference to either large financial burdens in the form of hospital deficits, or declining service levels. Older people, characterised as a homogeneous category, are repeatedly identified as a major contributor to the crisis, by unnecessarily occupying acute beds while they await a vacancy in a residential facility. Several enquiries and hospital taskforce management groups have been set up to tackle the problem. This article reviews their findings and strategic recommendations, particularly as they relate to older people. Short-term policy responses are being developed which specifically target older people for early discharge and alternative levels of care, and which, while claiming positive intentions, may introduce new forms of age discrimination into the health system. Few of the currently favoured proposals promote age-inclusivity and older people's rights to equal access to acute care.

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Behavioural and psychiatric symptoms in people with dementia admitted to the acute hospital: prospective cohort study

The British Journal of Psychiatry ◽

10.1192/bjp.bp.113.130948 ◽

2014 ◽

Vol 205 (3) ◽

pp. 189-196 ◽

Cited By ~ 78

Author(s):

Elizabeth L. Sampson ◽

Nicola White ◽

Baptiste Leurent ◽

Sharon Scott ◽

Kathryn Lord ◽

...

Keyword(s):

Cohort Study ◽

Older People ◽

Psychiatric Symptoms ◽

Hospital Staff ◽

Care Quality ◽

Acute Hospital ◽

Medical Illness ◽

People With Dementia ◽

Hospital Patients ◽

Acute Hospitals

BackgroundDementia is common in older people admitted to acute hospitals. There are concerns about the quality of care they receive. Behavioural and psychiatric symptoms of dementia (BPSD) seem to be particularly challenging for hospital staff.AimsTo define the prevalence of BPSD and explore their clinical associations.MethodLongitudinal cohort study of 230 people with dementia, aged over 70, admitted to hospital for acute medical illness, and assessed for BPSD at admission and every 4 (±1) days until discharge. Other measures included length of stay, care quality indicators, adverse events and mortality.ResultsParticipants were very impaired; 46% at Functional Assessment Staging Scale (FAST) stage 6d or above (doubly incontinent), 75% had BPSD, and 43% had some BPSD that were moderately/severely troubling to staff. Most common were aggression (57%), activity disturbance (44%), sleep disturbance (42%) and anxiety (35%).ConclusionsWe found that BPSD are very common in older people admitted to an acute hospital. Patients and staff would benefit from more specialist psychiatric support.

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Barriers to providing palliative care for older people in acute hospitals

Age and Ageing ◽

10.1093/ageing/afq172 ◽

2011 ◽

Vol 40 (2) ◽

pp. 233-238 ◽

Cited By ~ 72

Author(s):

C. Gardiner ◽

M. Cobb ◽

M. Gott ◽

C. Ingleton

Keyword(s):

Palliative Care ◽

Older People ◽

Acute Hospitals ◽

Care For Older People

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11 * REDUCING INAPPROPRIATE ADMISSIONS OF OLDER PEOPLE INTO ACUTE HOSPITALS: THE ROLE OF A RAPID ACCESS CLINIC IN A COMMUNITY HOSPITAL

Age and Ageing ◽

10.1093/ageing/afu036.11 ◽

2014 ◽

Vol 43 (suppl 1) ◽

pp. i3-i3 ◽

Cited By ~ 2

Author(s):

D. Y. Koduah ◽

D. Inegbenebor ◽

J. Ambepitiya ◽

M. Khan ◽

F. Mlinaku ◽

...

Keyword(s):

Older People ◽

Community Hospital ◽

Rapid Access ◽

Acute Hospitals ◽

Inappropriate Admissions ◽

Rapid Access Clinic

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‘I often worry about the older person being in that system’: exploring the key influences on the provision of dignified care for older people in acute hospitals

Ageing and Society ◽

10.1017/s0144686x12000025 ◽

2012 ◽

Vol 33 (3) ◽

pp. 465-485 ◽

Cited By ~ 33

Author(s):

M. CALNAN ◽

W. TADD ◽

S. CALNAN ◽

A. HILLMAN ◽

S. READ ◽

...

Keyword(s):

Older People ◽

Participant Observation ◽

Quality Care ◽

Economic Resources ◽

Present System ◽

Older Person ◽

Acute Medicine ◽

Acute Hospitals ◽

Fit For Purpose ◽

Care For Older People

ABSTRACTOlder age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusionas well asacute clinical needs.

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496 NON-RANDOMISED FEASIBILITY STUDY OF THE REHABILITATION POTENTIAL ASSESSMENT TOOL (REPAT) IN FRAIL OLDER PEOPLE IN ACUTE SETTING

Age and Ageing ◽

10.1093/ageing/afab118.06 ◽

2021 ◽

Vol 50 (Supplement_2) ◽

pp. ii5-ii7

Author(s):

A Cowley ◽

S E Goldberg ◽

A L Gordon ◽

P A Logan

Keyword(s):

Older People ◽

Feasibility Study ◽

Assessment Tool ◽

Occupational Therapists ◽

Patient Characteristics ◽

Structured Interviews ◽

Clinical Frailty Scale ◽

Mean Values ◽

Rehabilitation Potential ◽

Acute Hospitals

Abstract Introduction Clinicians are often required to decide about patients’ potential to respond to rehabilitation. ‘Rehabilitation potential’ can determine what services patients can access. In acute hospitals clinicians have limited time to assess and deliver rehabilitation which takes into account the complexities of frailty and ageing. We set out to evaluate whether the Rehabilitation Potential Assessment Tool (RePAT)—a 15 item assessment tool and training package which emphasises person-centred approaches—was feasible and could aid rehabilitation decisions. Method A non-randomised feasibility study with nested semi-structured interviews, set in the acute hospital, explored whether RePAT was deliverable and acceptable to staff, patient and carers. A maximum variation sample of physiotherapists and occupational therapists was recruited. Patient and carer participants were recruited from Healthcare of Older People wards. Staff and patient characteristics were summarised using descriptive statistics. Interview data were analysed thematically. Fidelity of completed RePAT items was assessed on how closely they matched tool guidance by two reviewers. Mean values of the two scores were calculated. Results Six staff participants were recruited and trained, and assessed a total of 26 patient participants using RePAT. Mean patient age was 86.16 (±6.39) years. 32% were vulnerable or mildly frail, 42% moderately frail and 26% severely or very severely frail using the Clinical Frailty Scale. Mean time to complete RePAT was 32.7 (±9.6) minutes. 13 out of 15 RePAT items achieved fidelity. RePAT was acceptable and tolerated by staff and patients. Staff participants reported RePAT enabled them to consider the complex and dynamic nature of rehabilitation decisions in a more structured and consistent way. Conclusion RePAT was found to be acceptable and tolerated by staff, carers and patients. It allowed clinicians to make explicit their reasoning behind rehabilitation potential decision-making and encouraged them to become more cognisant of ethical dilemmas and biases.

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Older people in acute hospitals need more care

British Journal of Nursing ◽

10.12968/bjon.2005.14.6.17806 ◽

2005 ◽

Vol 14 (6) ◽

pp. 351-351

Author(s):

George Castledine

Keyword(s):

Older People ◽

Acute Hospitals ◽

More Care

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Postcode Lottery in Healthcare? Findings from the Scottish National Comprehensive Geriatric Assessment in Secondary Care Audit 2019

Healthcare ◽

10.3390/healthcare10010161 ◽

2022 ◽

Vol 10 (1) ◽

pp. 161

Author(s):

Catriona Young ◽

Alison I. C. Donaldson ◽

Christine H. McAlpine ◽

Marc Locherty ◽

Adrian D. Wood ◽

...

Keyword(s):

Older People ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Rural Areas ◽

Service Access ◽

Front Door ◽

Scottish Highlands ◽

Electronic Data Capture System ◽

Acute Hospitals ◽

Key Aspects

Comprehensive Geriatric Assessment (CGA) is provided differently across Scotland. The Scottish Care of Older People (SCoOP) CGA Audit was a national audit conducted in 2019 to assess this variation in acute hospitals. Two versions of audit questionnaires about the provision of CGA were developed (one each for larger hospitals and remote/rural areas) and piloted. The questionnaires were sent to representatives from all hospitals in Scotland using the REDCap (Research Electronic Data Capture) system. The survey asked each service to provide information on CGA service delivery at the ‘front door’. The questionnaire was open for completion between February and July 2019. Of the 28 Scottish hospitals which receive acute admissions, we received information from 26 (92.9% response rate). Reporting sites included seven hospitals from remote and rural locations in the Scottish Highlands and Islands. Significant variations were observed across participating sites for all key aspects studied: dedicated frailty units, routes of admission, staffing, liaison with other services and rehabilitation provision. The 2019 SCoOP CGA audit highlights areas of CGA services that could be improved and variation in specialist CGA service access, structure and staffing at the front door across Scotland. Whether this variation has an impact on the outcomes of older people requires further evaluation.

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Early Markers of Prolonged Hospital Stays in Older People: A Prospective, Multicenter Study of 908 Inpatients in French Acute Hospitals

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2006.00767.x ◽

2006 ◽

Vol 54 (7) ◽

pp. 1031-1039 ◽

Cited By ~ 60

Author(s):

Pierre-Olivier Lang ◽

Damien Heitz ◽

Guy HÃ©delin ◽

Nicolas Jovenin ◽

...

Keyword(s):

Older People ◽

Multicenter Study ◽

Prospective Multicenter Study ◽

Early Markers ◽

Acute Hospitals ◽

Hospital Stays ◽

Prolonged Hospital

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153 Barriers and Enablers of Assisted Decision-making for Older People in Acute Care Hospitals: A Multi-Stakeholder Inquiry

Age and Ageing ◽

10.1093/ageing/afz102.34 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii1-iii16

Author(s):

Sarah Donnelly ◽

Diarmuid Ó Coimín ◽

Deirdre O'Donnell ◽

Carmel Davies ◽

Éidín Ní Shé ◽

...

Keyword(s):

Decision Making ◽

Older People ◽

Acute Care ◽

Formative Evaluation ◽

Critical Factor ◽

Multiple Perspectives ◽

Barriers And Enablers ◽

Codes Of Practice ◽

Health And Social Care ◽

Acute Hospitals

Abstract Background Ireland’s Assisted Decision-Making (Capacity) Act 2015 breaks from traditional views of capacity to consider the uniqueness of each decision with relation to topic, time and place for those with impaired or fluctuating capacity. It has yet to be commenced, however codes of practice and educational strategies are in development to support health and social care professionals (HSCPs) to practice in accordance with the Act. This study set out to examine barriers and enablers to the adoption of assisted decision making (ADM) involving older people in acute hospitals from multiple perspectives. It describes a pre-implementation formative evaluation informed by the perspectives of relevant stakeholders in ADM practice. Methods In total, 12 key informant interviews and two validation groups were conducted with family carers and older people with and without a diagnosis of dementia in two acute hospitals. In addition, 20 interviews and two validation groups were conducted with HSCPs. Interviews focused on contextual characteristics as well as barriers and enablers of ADM. Results Barriers and enablers included supporting capacity through adopting a functional approach, the physical environment where decision-making takes place, meeting information and support needs, methods of communication, upholding will and preferences, relationships and trust. Time and timing were consistently identified as a critical factor. HSCPs also highlighted the need for specialised education and training on ADM practice. Conclusion The issues identified around ADM will inform the development of a serious discussion game on acute care scenarios, which will be deployed for awareness raising and educational purposes. Findings will also help focus attention on how those working within complex health systems and organisations can practically implement changes to practice in line with ADM legislation.

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