Occupational Therapists' Perceptions of Predischarge Home Assessments with Older Adults in Acute Care

Abstract Many hospitalized older adults experience delayed discharge. Transitional care programs (TCPs) provide short-term care to these patients to prepare them for transfer to nursing homes or back to the community. There are knowledge gaps related to the processes and outcomes of TCPs. We conducted a scoping review following Arksey & O’Malley’s framework to identify the: 1) characteristics of older patients served by TCPs, 2) services provided within TCPs, and 3) outcomes used to evaluate TCPs. We searched bibliographic databases and grey literature. We included papers and reports involving community-dwelling older adults aged ≥ 65 years and examined the processes and/or outcomes of TCPs. The search retrieved 4828 references; 38 studies and 2 reports met the inclusion criteria. Most studies were conducted in Europe (n=19) and America (n=13). Patients admitted to TCPs were 59-86 years old, had 2-10 chronic conditions, 26-74% lived alone, the majority were functionally dependent and had mild cognitive impairment. Most TCPs were staffed by nurses, physiotherapists, occupational therapists, social workers and physicians, and support staff. The TCPs provided 5 major types of services: assessment, care planning, treatment, evaluation/care monitoring and discharge planning. The outcomes most frequently assessed were discharge destination, mortality, hospital readmission, length of stay, cost and functional status. TCPs that reported significant improvement in older adults’ functions (which was the main goal of the TCPs) included multiple services delivered by multidisciplinary teams. There is a wide variation in the operationalization of TCPs within and between countries.

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The Impact of Function Focused Care From Acute Care to Home Care and Nursing Homes

Innovation in Aging ◽

10.1093/geroni/igaa057.2148 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 629-629

Author(s):

Silke Metzelthin ◽

Sandra Zwakhalen ◽

Barbara Resnick

Keyword(s):

Older Adults ◽

The Netherlands ◽

Home Care ◽

Acute Care ◽

Long Term Care ◽

Functional Decline ◽

Term Care ◽

The Us ◽

The Impact

Abstract Functional decline in older adults often lead towards acute or long-term care. In practice, caregivers often focus on completion of care tasks and of prevention of injuries from falls. This task based, safety approach inadvertently results in fewer opportunities for older adults to be actively involved in activities. Further deconditioning and functional decline are common consequences of this inactivity. To prevent or postpone these consequences Function Focused Care (FFC) was developed meaning that caregivers adapt their level of assistance to the capabilities of older adults and stimulate them to do as much as possible by themselves. FFC was first implemented in institutionalized long-term care in the US, but has spread rapidly to other settings (e.g. acute care), target groups (e.g. people with dementia) and countries (e.g. the Netherlands). During this symposium, four presenters from the US and the Netherlands talk about the impact of FFC. The first presentation is about the results of a stepped wedge cluster trial showing a tendency to improve activities of daily living and mobility. The second presentation is about a FFC training program. FFC was feasible to implement in home care and professionals experienced positive changes in knowledge, attitude, skills and support. The next presenter reports about significant improvements regarding time spent in physical activity and a decrease in resistiveness to care in a cluster randomized controlled trial among nursing home residents with dementia. The fourth speaker presents the content and first results of a training program to implement FFC in nursing homes. Nursing Care of Older Adults Interest Group Sponsored Symposium

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Strategies Older New Zealanders Use to Participate in Day-To-Day Occupations

British Journal of Occupational Therapy ◽

10.4276/030802211x13204135680820 ◽

2011 ◽

Vol 74 (11) ◽

pp. 509-516 ◽

Cited By ~ 4

Author(s):

Clare Hocking ◽

Juanita Murphy ◽

Kirk Reed

Keyword(s):

Public Health ◽

Physical Activity ◽

Older Adults ◽

New Zealand ◽

Older People ◽

Exploratory Study ◽

Occupational Therapists ◽

Falls Prevention ◽

Public Health Messages ◽

The Impact

Aim: This exploratory study aimed to uncover the strategies that older adults employ to ameliorate the impact of impairments and barriers to participation. Method: Eight participants were interviewed in their own homes, in a town or city in New Zealand. Findings: Inductive analysis of data revealed four main categories of strategies: strategies to keep safe, to recruit and accept help, to meet social and biological needs (nutritional and medical), and to conserve financial, material and bodily resources. Discussion: The study supports some previous findings of strategies used by older people, and demonstrates that enquiring into the strategies that older people devise and adopt into their own lives is a productive line of inquiry. The strategies described differ from those that occupational therapists recommend, and do not incorporate public health messages about the benefits of physical activity or recommendations about falls prevention. Conclusion: The findings suggest that asking older clients about the strategies that they use will uncover valuable information for therapists giving advice or issuing equipment to help older adults to manage in the community.

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Older Adults’ Perceptions of Feeling Safe in Urban and Rural Acute Care

JONA The Journal of Nursing Administration ◽

10.1097/nna.0b013e3182786013 ◽

2013 ◽

Vol 43 (1) ◽

pp. 30-36 ◽

Cited By ~ 6

Author(s):

Sue Lasiter ◽

Joanne Duffy

Keyword(s):

Older Adults ◽

Acute Care

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Assessing Housing Accessibility for Older Adults in Japan: A Content Validity Study

Innovation in Aging ◽

10.1093/geroni/igaa057.357 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 108-108

Author(s):

Rumiko Tsuchiya-Ito ◽

Björn Slaug ◽

Tomonori Sano ◽

Miki Tajima ◽

Sakiko Itoh ◽

...

Keyword(s):

Older Adults ◽

Content Validity ◽

Assessment Tool ◽

Occupational Therapists ◽

Building Design ◽

Validity Study ◽

Housing Enabler ◽

Item List ◽

Existing Housing ◽

Rigorous Procedure

Abstract Scientifically validated tools to assess housing accessibility for older adults in Japan have been lacking. To address this, a rigorous procedure of adapting an existing housing assessment tool—the Housing Enabler, developed in Sweden—for valid use in Japan was conducted. The original tool was translated into the Japanese language, using established translation procedures. In the process, researchers checked the appropriateness of technical terms and adjusted specifications to be in accordance with Japanese standards. An expert panel approach was used to validate the content of the Japanese Housing Enabler. Thirteen certified occupational therapists, architects and care-managers (average experience=14.5 years) participated as experts in the content validity study. They rated each item with regard to relevance for assessing housing accessibility in Japan, on a scale from 1(=Not relevant) to 4(= Highly relevant). They suggested adjustments and additions that they found to be relevant to capture particularities of Japanese housing and building design. After individual ratings, the experts gathered for consensus discussions on suggested revisions of the item list. As a result, the number of items was substantially increased (from 161 to 283). A content validity index (CVI) was calculated for each item (i.e., the proportion of experts rating the relevance as at least 3). Using a recommended threshold of CVI ≥0.78, more than 90% of the items were considered relevant, thus supporting the content validity. However, the large amount of items might jeopardize the feasibility of the instrument. Further studies are needed to evaluate feasibility, criterion-related validity and aspects of reliability.

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Acute care utilization risk among older adults living undiagnosed or unaware of dementia

Journal of the American Geriatrics Society ◽

10.1111/jgs.17550 ◽

2021 ◽

Author(s):

Halima Amjad ◽

Quincy M. Samus ◽

Jin Huang ◽

Sneha Gundavarpu ◽

Julie P. W. Bynum ◽

...

Keyword(s):

Older Adults ◽

Acute Care ◽

Care Utilization ◽

Acute Care Utilization

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RecoverNow: A patient perspective on the delivery of mobile tablet-based stroke rehabilitation in the acute care setting

International Journal of Stroke ◽

10.1177/1747493018790031 ◽

2018 ◽

Vol 14 (2) ◽

pp. 174-179 ◽

Cited By ~ 6

Author(s):

Karen Mallet ◽

Rany Shamloul ◽

Michael Pugliese ◽

Emma Power ◽

Dale Corbett ◽

...

Keyword(s):

Acute Care ◽

Stroke Rehabilitation ◽

Care Setting ◽

Hand Function ◽

Occupational Therapists ◽

Fine Motor ◽

Stroke Patients ◽

Acute Setting ◽

Cognitive Therapies ◽

Mobile Tablets

Background/aim We previously reported the feasibility of RecoverNow (a mobile tablet-based post-stroke communication therapy in acute care). RecoverNow has since expanded to include fine motor and cognitive therapies. Our objectives were to gain a better understanding of patient experiences and recovery goals using mobile tablets. Methods Speech-language pathologists or occupational therapists identified patients with stroke and communication, fine motor, or cognitive/perceptual deficits. Patients were provided with iPads individually programmed with applications based on assessment results, and instructed to use it at least 1 h/day. At discharge, patients completed a 19-question quantitative and open-ended engagement survey addressing intervention timing, mobile device/apps, recovery goals, and therapy duration. Results Over a six-month period, we enrolled 33 participants (three did not complete the survey). Median time from stroke to initiation of tablet-based therapy was six days. Patients engaged in therapy on average 59.6 min/day and preferred communication and hand function therapies. Most patients (63.3%) agreed that therapy was commenced at a reasonable time, although half expressed an interest in starting sooner, 66.7% reported that using the device 1 h/day was enough, 64.3% would use it after discharge, and 60.7% would use it for eight weeks. Sixty-seven percent of patients expressed a need for family/friend/caregiver to help them use it. Conclusion Our results suggest that stroke patients are interested in mobile tablet-based therapy in acute care. Patients in the acute setting prefer to focus on communication and hand therapies, are willing to begin within days of their stroke and may require assistance with the tablets.

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