scholarly journals Exploring how occupational therapists and physiotherapists evaluate rehabilitation potential of older people in acute care

2021 ◽  
pp. 030802262110113
Author(s):  
Gemma Bradley ◽  
Katherine Baker ◽  
Catherine Bailey
Keyword(s):  
Older People ◽  
Acute Care ◽  
Occupational Therapists ◽  
Information Provision ◽  
Reasoning Process ◽  
Individual Interviews ◽  
The United Kingdom ◽  
Rehabilitation Potential ◽  
Baseline Information ◽  
Clinical Records

Introduction Evaluations of rehabilitation potential are an everyday occurrence, yet the concept is poorly understood and there is a lack of understanding about the reasoning process. This study aimed to explore how occupational therapists and physiotherapists evaluated the rehabilitation potential of older people following an acute hospital admission. Method Focused ethnography was utilised, primarily using observation, interviewing and review of records within one acute medical ward in a general hospital in the United Kingdom. Five patient participants gave consent for their episode of care to be studied, for interactions with professionals to be observed and for their clinical records to be reviewed. Three occupational therapists and two physiotherapists then participated in individual interviews. Findings Thematic analysis of data led to the identification of a four-stage reasoning process. The four stages are as follows: gathering baseline information; provision of curative and supportive interventions; provision and monitoring of rehabilitative interventions; the evaluation of rehabilitation potential and decision about the subsequent pathway. Conclusions The reasoning process illustrates the professional reasoning of occupational therapists and physiotherapists when evaluating rehabilitation potential for older adults in acute care. However, it also highlights vulnerabilities to professional reasoning which may contribute to subjectivity, inconsistency or risk to patients.

scholarly journals Accessibility and informational barriers to an age friendly railway

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Charles Musselwhite ◽  
Kelly Roberts
Keyword(s):  
Older People ◽  
Information Provision ◽  
Rolling Stock ◽  
Content Type ◽  
Rail Network ◽  
The United Kingdom ◽  
Key Issues ◽  
The Uk ◽  
Informational Barriers ◽  
Practical Implications

Purpose Against a backdrop in an increase in the number of older people in the United Kingdom (UK) and an increase in the amount of travel per person for this age group, the number of older people using the railway is in decline. The purpose of this paper is to report on an investigation is a first step towards ascertaining why through audits of issues and problems on rolling stock and station platforms. Design/methodology/approach Rolling stock and station audits were carried out by older people across a rail network in the South West of the UK. A total of 72.2 hours of auditing took place across different sizes of station and different types of rolling stock. Findings Two main themes were found across both rolling stock and station audits: accessibility and information provision. With regards to accessibility, boarding and especially alighting from the train was the key issue. Across stations and in rolling stock luminance, was a key issue for older people with places being too dark or moving from places that were bright to dark. Use of stairs at stations between platforms, especially when the station is crowded was an issue. In terms of information, key issues were found with signage being too cluttered, small, hidden and inconsistent and audible announcements being difficult to decipher. Practical implications There must be improvements made to railways to help older people feel more safe and secure using them. It is suggested step free and level accessibility is found boarding and alighting from the train, but also from station entrance to carriage. Better signage is needed throughout the station and on trains, with large repeated fonts used. Lighting needs to be revisited throughout to ensure areas are bright and well-lit both on station platforms and onboard. Further research needs to look at these findings in relation to slip, trips and fall accident rates. Originality/value There is very little research on older people’s perceptions and barriers to railway use. This adds value in being one of the only studies to do so, especially from the perspective of older people themselves as co-researchers.

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

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.

scholarly journals What matters most in acute care: an interview study with older people living with frailty

2021 ◽  
Author(s):  
James David van Oppen ◽  
Timothy John Coats ◽  
Simon Paul Conroy ◽  
Jagruti Lalseta ◽  
Kay Phelps ◽  
...  
Keyword(s):  
Older People ◽  
Acute Care ◽  
Public Involvement ◽  
Healthcare Delivery ◽  
Information Provision ◽  
Patient And Public Involvement ◽  
Adverse Outcomes ◽  
Information Control ◽  
Expert Review ◽  
Outcome Goals

Abstract Background Healthcare outcome goals are central to person-centred acute care, however evidence among older people is scarce. Older people who are living with frailty have distinct requirements for healthcare delivery and have distinct risk for adverse outcomes from healthcare. There is insufficient evidence for whether those living with frailty also have distinct healthcare outcome goals. This study explored the nature of acute care outcome goals in people living with frailty. Methods Healthcare outcome goals were explored using semi-structured patient interviews. Participants aged over 65 with Clinical Frailty Score 5-8 (mild to very severe frailty) were recruited during their first 72 hours in a UK hospital. Purposive, maximum variation sampling was guided by lay partners from a Patient and Public Involvement Forum specialising in ageing-related research. Qualitative analysis used a blended approach based on framework and constant comparative methodologies for the identification of themes. Findings were validated through triangulation with participant, lay partner, and technical expert review. Results The 22 participants were aged 71 to 98 and had mild to very severe frailty. One quarter were living with dementia. Most participants had reflected on their situation and considered their outcome goals. Theme categories (and corresponding sub-categories) were ‘Autonomy’ (information, control, and security) and ‘Functioning’ (physical, psychosocial, and relief). A novel ‘security’ theme was identified, whereby participants sought to feel safe in their usual living place and with their health problems. Those living with milder frailty were concerned to maintain ability to support loved ones, while those living with most severe frailty were concerned about burdening others. Conclusions Outcome goals for acute care among older participants living with frailty were influenced by the insecurity of their situation and fear of deterioration. Patients may be supported to feel safe and in control through appropriate information provision and functional support.

Occupational therapy and allied health use for older people in acute care: A description of services, time, and readmission in an Australian setting

2020 ◽  
pp. 030802262095657
Author(s):  
Linda Barclay ◽  
Aislinn Lalor ◽  
Bianca Furmston ◽  
Ellie Fossey ◽  
Louise Farnworth ◽  
...  
Keyword(s):  
Occupational Therapy ◽  
Older People ◽  
Acute Care ◽  
Allied Health ◽  
Care Service ◽  
Health Care Service ◽  
Hospital Setting ◽  
Occupational Therapists ◽  
Preliminary Evidence ◽  
Hospital Data

Introduction Acute care readmissions of older people are an ongoing concern in many countries. Occupational therapists are well positioned to play a significant role in contributing to improved outcomes and fewer readmissions following discharge from acute hospitals, yet there is a lack of empirical evidence to support this claim. Methods This study used a retrospective clinical audit of secondary hospital data to investigate and describe the time spent on occupational therapy, and the range of occupational therapy and other allied health services provided to older people admitted to acute care, in one Australian health care service. Results Occupational therapists conducted numerous assessments and interventions to support patients and to prepare them for safe discharge home. Occupational therapy was significantly associated with length of stay. Readmission was not related directly or significantly to time spent in occupational therapy or any other factor included in this study. However, of the people who received occupational therapy, there was a higher percentage readmitted when they had more services already in place on admission and when they lived alone. Conclusions This study provides preliminary evidence regarding the contact time and range of occupational therapy assessments and interventions provided to older people in the acute hospital setting.

scholarly journals Updating OMERACT Core Set of Domains for ANCA-associated Vasculitis: Patient Perspective Using the International Classification of Function, Disability, and Health

2019 ◽  
Vol 46 (10) ◽  
pp. 1415-1420 ◽  
Author(s):  
Nataliya Milman ◽  
Eilish McConville ◽  
Joanna C. Robson ◽  
Annelies Boonen ◽  
Peter Tugwell ◽  
...  
Keyword(s):  
The United States ◽  
International Classification ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Personal Factors ◽  
Disability And Health ◽  
Individual Interviews ◽  
The United Kingdom ◽  
Anca Associated Vasculitis ◽  
Core Set

Objective.Aspects of antineutrophil cytoplasmic antibodies–associated vasculitis (AAV) prioritized by patients with AAV were described using the International Classification of Function, Disability, and Health (ICF).Methods.Items identified during 14 individual interviews were incorporated into an ICF-based questionnaire administered to participants of 2 vasculitis patient symposia: 36 in the United Kingdom and 63 in the United States.Results.Categories identified as at least “moderately relevant” by ≥ 5% of subjects included 44 body functions, 14 body structures, 35 activities and participation, 31 environmental factors, and 38 personal factors.Conclusion.Identified categories differ from those identified by the current Outcome Measures in Rheumatology (OMERACT) core set and those prioritized by vasculitis experts.

scholarly journals Validation and psychometric evaluation of the Dutch person-centred care of older people with cognitive impairment in acute care (POPAC) scale

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Annette Keuning-Plantinga ◽  
Evelyn J. Finnema ◽  
Wim Krijnen ◽  
David Edvardsson ◽  
Petrie F. Roodbol
Keyword(s):  
Factor Analysis ◽  
Cognitive Impairment ◽  
Quality Of Care ◽  
Confirmatory Factor Analysis ◽  
Older People ◽  
Root Mean Square ◽  
Acute Care ◽  
Mean Square ◽  
Confirmatory Factor

Abstract Background Person-centred care is the preferred model for caring for people with dementia. Knowledge of the level of person-centred care is essential for improving the quality of care for patients with dementia. The person-centred care of older people with cognitive impairment in acute care (POPAC) scale is a tool to determine the level of person-centred care. This study aimed to translate and validate the Dutch POPAC scale and evaluate its psychometric properties to enable international comparison of data and outcomes. Methods After double-blinded forward and backward translations, a total of 159 nurses recruited from six hospitals (n=114) and via social media (n=45) completed the POPAC scale. By performing confirmatory factor analysis, construct validity was tested. Cronbach’s alpha scale was utilized to establish internal consistency. Results The confirmatory factor analysis showed that the comparative fit index (0.89) was slightly lower than 0.9. The root mean square error of approximation (0.075, p=0.012, CI 0.057–0.092) and the standardized root mean square residual (0.063) were acceptable, with values less than 0.08. The findings revealed a three-dimensional structure. The factor loadings (0.69–0.77) indicated the items to be strongly associated with their respective factors. The results also indicated that deleting Item 5 improved the Cronbach’s alpha of the instrument as well as of the subscale ‘using cognitive assessments and care interventions’. Instead of deleting this item, we suggest rephrasing it into a positively worded item. Conclusions Our findings suggest that the Dutch POPAC scale is sufficiently valid and reliable and can be utilized for assessing person-centred care in acute care hospitals. The study enables nurses to interpret and compare person-centred care levels in wards and hospital levels nationally and internationally. The results form an important basis for improving the quality of care and nurse-sensitive outcomes, such as preventing complications and hospital stay length.

Diploma Awards: Summer 1989

1989 ◽  
Vol 52 (9) ◽  
pp. 361-363
Keyword(s):  
United Kingdom ◽  
Occupational Therapy ◽  
Occupational Therapists ◽  
Republic Of Ireland ◽  
The United Kingdom ◽  
The Future ◽  
The Republic

Congratulations to the following who, having fulfilled all the requirements, have been awarded their Diplomas by the College of Occupational Therapists. The journal wishes them every success in the future and hopes their careers will be both interesting and rewarding. This list contains the names of successful candidates from occupational therapy schools in all parts of the United Kingdom and in the Republic of Ireland. The school's location is shown in brackets after each name.

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