scholarly journals The International Classification of Functioning, Disabilities, and Health categories rated as necessary for care planning for older patients with heart failure: a survey of care managers in Japan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shigehito Shiota ◽  
Toshiro Kitagawa ◽  
Takayuki Hidaka ◽  
Naoya Goto ◽  
Naoki Mio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medical Care ◽  
Information Sharing ◽  
Older Patients ◽  
Community Dwelling ◽  
Medical Professionals ◽  
Care Planning ◽  
Care Plans ◽  
Care Managers ◽  
Significant Difference

Abstract Background Establishing an information-sharing system between medical professionals and welfare/care professionals may help prevent heart failure (HF) exacerbations in community-dwelling older adults. Therefore, we aimed to identify the ICF categories necessary for care managers to develop care plans for older patients with HF. Methods A questionnaire was administered to 695 care managers in Hiroshima, Japan, on ICF items necessary for care planning. We compared the care managers according to their specialties (medical qualifications and welfare or care qualifications). Furthermore, we created a co-occurrence network using text mining, regarding the elements necessary for collaboration between medical and care professionals. Results There were 520 valid responses (74.8%). Forty-nine ICF items, including 18 for body functions, one for body structure, 21 for activities and participation, and nine for environmental factors, were classified as “necessary” for making care plans for older people with HF. Medical professionals more frequently answered “necessary” than care professionals regarding the 11 items for body functions and structure and three items for activities and participation (p < 0.05). Medical–welfare/care collaboration requires (1) information sharing with related organisations; (2) emergency response; (3) a system of cooperation between medical care and non-medical care; (4) consultation and support for individuals and families with life concerns, (5) management of nutrition, exercise, blood pressure and other factors, (6) guidelines for consultation and hospitalisation when physical conditions worsen. Conclusions Our findings showed that 49 ICF categories were required by care managers for care planning, and there was a significant difference in perception between medical and welfare or care qualifications qualifications.

scholarly journals The International Classification of Functioning, Disabilities, and Health Categories Necessary for Care Planning for Older Patients with Heart Failure: A Survey of Care Managers in Japan

2021 ◽  
Author(s):  
Shigehito Shiota ◽  
Toshiro Kitagawa ◽  
Takayuki Hidaka ◽  
Naoya Goto ◽  
Naoki Mio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medical Care ◽  
Information Sharing ◽  
Older Patients ◽  
Community Dwelling ◽  
Medical Professionals ◽  
Care Planning ◽  
Care Plans ◽  
Care Managers ◽  
Significant Difference

Abstract Background: Establishing an information-sharing system between medical professionals and welfare/care professionals may help prevent heart failure (HF) in community-dwelling older adults. Therefore, we aimed to identify the ICF categories necessary for care managers to develop care plans for older patients with HF. Methods: A questionnaire was administered to 695 care managers in Hiroshima, Japan, on ICF items necessary for care planning. We compared the care managers according to their specialties (medical and welfare). Furthermore, we created a co-occurrence network using text mining, regarding the elements necessary for collaboration between medical and care professionals. Results: There were 520 valid responses (74.8%). Forty-nine ICF items, including 18 for body functions, one for body structure, 21 for activities and participation, and nine for environmental factors, were classified as "necessary" for making care plans for older people with HF. Medical professionals more frequently answered "necessary" than care professionals regarding the 11 items for body functions and structure and three items for activities and participation (p<0.05). Medical–welfare/care collaboration requires (1) information sharing with related organisations; (2) emergency response; (3) a system of cooperation between medical care and non-medical care; (4) consultation and support for individuals and families with life concerns, (5) management of nutrition, exercise, blood pressure and other factors, (6) guidelines for consultation and hospitalisation when physical conditions worsen.Conclusions: Our findings showed that 49 ICF categories were required by care managers for care planning, and there was a significant difference in perception between medical and welfare/care professionals.

Impact of group visits for older patients with heart failure on advance care planning outcomes: Preliminary data

2021 ◽  
Author(s):  
Sangeeta C. Ahluwalia ◽  
Julia I. Bandini ◽  
Alexis Coulourides Kogan ◽  
David B. Bekelman ◽  
Bonnie Olsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Advance Care Planning ◽  
Preliminary Data ◽  
Older Patients ◽  
Care Planning ◽  
Group Visits ◽  
Patients With Heart Failure ◽  
Advance Care

scholarly journals Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024762 ◽  
Author(s):  
Jolien Jeltje Glaudemans ◽  
Eric Moll van Charante ◽  
Jan Wind ◽  
John Jacob Oosterink ◽  
Dick Ludolf Willems
Keyword(s):  
Qualitative Study ◽  
Older People ◽  
General Practitioners ◽  
Advance Care Planning ◽  
Older Patients ◽  
Ad Hoc ◽  
Daily Practice ◽  
Community Dwelling ◽  
Care Planning ◽  
Advance Care

ObjectivesAdvance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice.Design, setting and participantsA qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews.ResultsApproaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive geriatric assessments and periodic assessments. Meetings were aimed at making agreements in anticipation of future care, at providing information and encouraging older people to take further steps in ACP. With ad hoc approaches, respondents discussed only one or two topics related to the near future. Ad hoc ACP was mainly done with deteriorating patients or when patients or family initiated ACP. Systematic and ad hoc approaches were used simultaneously or sequentially and were both used for initiating and following up on ACP. Due to a lack of time and knowledge of other occasions and topics than the ones respondents used, respondents seemed to underuse many occasions and topics.ConclusionsAwareness of appropriate systematic and ad hoc approaches for ACP, and the focus on providing information and encouraging older people to take further steps in ACP reported in this study can support GPs and improve older patients’ access to ACP.

scholarly journals Risk of cardiac and non-cardiac adverse events in community-dwelling older patients with atrial fibrillation: a prospective cohort study in the Netherlands

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e021681 ◽  
Author(s):  
Sander van Doorn ◽  
Annerien Tavenier ◽  
Frans H Rutten ◽  
Arno W Hoes ◽  
Karel G M Moons ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Adverse Events ◽  
Vascular Disease ◽  
Prospective Cohort ◽  
Older Patients ◽  
Community Dwelling ◽  
Cardiac Events ◽  
High Age

ObjectivesPatients with atrial fibrillation (AF) are at increased risk of many adverse events, notably stroke. To prevent all adverse outcomes, integrated AF care is advocated though the potential domain for such multidisciplinary management is still unclear. Therefore, insight in the systemic nature of AF and identifying patients at risk of adverse events after oral anticoagulation is needed. The aim of this study is to first describe the risk of hospitalisation and mortality in community-dwelling older patients with AF using anticoagulants, and second to assess the association between traditional cardiac risk factors and these outcomes.DesignA prospective cohort.SettingGeneral practice.Participants2068 patients with AF using oral anticoagulants.Outcome measuresWe calculated incidence rates (IRs) of ischaemic stroke, bleeding, hospitalisations and mortality, and compared risk factors using Cox regression between those with and without an adverse event, both for cardiac and non-cardiac causes.ResultsDuring a median follow-up of 2.7 (IQR 2.2–3.0) years, the IR per 100 person-years was 22.1 for hospitalisations and 6.7 for mortality. Non-cardiac events outnumbered cardiac events (IRs 15.7 vs 7.6 per 100 person-years for hospitalisation, p<0.001 and 5.0 vs 1.7, p<0.001 for mortality). As a comparison, the IRs for stroke and major bleeding were 1.7 and 0.8 per 100 person years, respectively. In multivariate models, high age, heart failure and vascular disease were independently associated with all-cause hospitalisation and— in addition to diabetes, previous stroke and renal disease—for all-cause mortality.ConclusionsIn anticoagulated community-dwelling patients with AF, stroke risk is effectively reduced and thus fairly low, whereas risks of hospitalisation and mortality remain high, importantly mainly for non-cardiac causes. Notably high age, heart failure and vascular disease are predictive for such outcomes and may be of value in identifying high-risk patients in the future.Trial registration numberNTR3741.

scholarly journals The association between geriatric treatment and 30-day readmission risk among medical inpatients aged ≥75 years with multimorbidity

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262340
Author(s):  
Marte Sofie Wang-Hansen ◽  
Hege Kersten ◽  
Jūratė Šaltytė Benth ◽  
Torgeir Bruun Wyller
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Readmission Rate ◽  
Female Gender ◽  
Community Dwelling ◽  
Referral Letter ◽  
Geriatric Ward ◽  
Old Patients ◽  
Significant Difference ◽  
Medical Wards

Background Readmission to hospital is frequent among older patients and reported as a post-discharge adverse outcome. The effect of treatment in a geriatric ward for acutely admitted older patients on mortality and function is well established, but less is known about the possible influence of such treatment on the risk of readmission, particularly in the oldest and most vulnerable patients. Our aim was to assess the risk for early readmission for multimorbid patients > 75 years treated in a geriatric ward compared to medical wards and to identify risk factors for 30-day readmissions. Methods Prospective cohort study of patients acutely admitted to a medical department at a Norwegian regional hospital. Eligible patients were community-dwelling, multimorbid, receiving home care services, and aged 75+. Patients were consecutively included in the period from 1 April to 31 October 2012. Clinical data were retrieved from the referral letter and medical records. Results We included 227 patients with a mean (SD) age of 86.0 (5.7) years, 134 (59%) were female and 59 (26%) were readmitted within 30 days after discharge. We found no statistically significant difference in readmission rate between patients treated in a geriatric ward versus other medical wards. In adjusted Cox proportional hazards regression analyses, lower age (hazard ratio (95% confidence interval) 0.95 (0.91–0.99) per year), female gender (2.17 (1.15–4.00)) and higher MMSE score (1.03 (1.00–1.06) per point) were significant risk factors for readmission. Conclusions Lower age, female gender and higher cognitive function were the main risk factors for 30-day readmission to hospital among old patients with multimorbidity. We found no impact of geriatric care on the readmission rate.

scholarly journals Characterization and Comparison of How the Public, Medical Professionals and Technical Communities Utilize Facebook Groups to Facilitate Idea Sharing and Crowdsourcing During the COVID-19 Pandemic (Preprint)

2020 ◽  
Author(s):  
Helen Xun ◽  
Waverley He ◽  
Jonlin Chen ◽  
Scott Sylvester ◽  
Sheera F Lerman ◽  
...  
Keyword(s):  
Social Media ◽  
Information Sharing ◽  
Resource Sharing ◽  
Collective Intelligence ◽  
Medical Professionals ◽  
Evidence Based ◽  
Significant Difference ◽  
Medical Groups ◽  
Professional Opinion ◽  
Technical Professionals

BACKGROUND Strict social distancing measures resulting from the COVID-19 pandemic have led people to rely more heavily on social media, such as Facebook Groups, as a means of communication and information sharing. Multiple Facebook Groups have been developed by medical professionals, lay people, and engineering or technical groups to discuss current issues and possible solutions to the medical crisis. OBJECTIVE To characterize Facebook groups created by laypersons, medical professionals, and technical professionals, with specific focus on information dissemination and requests for crowdsourcing. METHODS The Facebook social media platform was queried for user-created Groups with the keywords “COVID,” “Coronavirus,” and “SARS-CoV-2” at a single time point on March 31st, 2020. Characteristics for each group were collected, including language, privacy setting, security requirement to join group, and membership type. For each membership type, the group with the greatest number of members was selected, and in each of these groups, the Top 100 posts using Facebook’s algorithm were identified. Each post was categorized and characterized (evidence-based, crowd-sourced, and whether the poster self-identified). STATA Statistical Software and were used to perform statistical analysis. RESULTS Our search yielded 257 COVID-19-related Facebook Groups Majority of the groups (89%, 229) were for laypersons, 10% (26) were for medical professionals, and only 1% (2) groups were for technical professionals. The number of members in medical groups (mean=21,215, SD=35,040) was significantly greater than those in laypersons groups (mean=7,623, SD=19,480), p<0.01. Medical groups were significantly more likely to require security checks to join the group (81% vs 43%, P<.001) and less likely to be public (3 vs 123, P<.001) compared to laypersons groups. Medical groups had the highest user engagement, averaging 502 ± 633 reactions (P<.01) and 224 ± 311 comments (P<.01) per post. Medical professionals were more likely to use the Facebook groups for education and information sharing, including academic posts (P<.001), idea sharing (P=.003), resource sharing (P=.02) and professional opinion (P<.001), and request for crowdsourcing (P=0.003). Laypersons groups were more likely to share news (P<.001), humor and motivation (P<.001), and layperson opinions (P<.001). There was no significant difference in the number of evidence-based posts between the groups CONCLUSIONS Medical professionals utilize Facebook groups as a forum to facilitate collective intelligence (CI) and are more likely to use the Facebook groups for education and information sharing, including academic posts, idea sharing, resource sharing, and professional opinion. This suggests the power of social media to facilitate CI across geographical distances. Laypersons groups were more likely to share news and humor and motivation, suggesting utilization of Facebook Groups to provide comedic relief as a coping mechanism. Further investigations are necessary to study Facebook groups’ roles in facilitating collective intelligence, crowdsourcing, education, and community building.

The Quality of Medical Care Provided to Vulnerable Community-Dwelling Older Patients

2003 ◽  
Vol 139 (9) ◽  
pp. 740 ◽  
Author(s):  
Neil S. Wenger ◽  
David H. Solomon ◽  
Carol P. Roth ◽  
Catherine H. MacLean ◽  
Debra Saliba ◽  
...  
Keyword(s):  
Medical Care ◽  
Older Patients ◽  
Community Dwelling ◽  
Vulnerable Community ◽  
Quality Of Medical Care

Abstract 11015: Why Don’t Heart Failure Patients Respond to Worsening Symptoms?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chin-Yen Lin ◽  
Kathleen Dracup ◽  
Michele M Pelter ◽  
Martha J Biddle ◽  
Debra K Moser
Keyword(s):  
Heart Failure ◽  
Medical Care ◽  
Nyha Class ◽  
Community Dwelling ◽  
Family Needs ◽  
Class Iii ◽  
Family Obligations ◽  
Symptom Appraisal ◽  
Patient Reported ◽  
Symptom Response

Background: Long delays in seeking medical care are common in patients with worsening symptoms of heart failure (HF) and lead to longer lengths of hospital stay, increased healthcare costs, and increased morbidity and mortality. However, patient-reported reasons for delay have rarely been explored. Objective: To describe patient-reported reasons for delay in seeking medical care for worsening symptoms. Methods: As part of a clinical trial designed to reduce HF readmission and mortality for worsening symptoms, we administered the HF Symptom Response Questionnaire to all patients prior to intervention. The instrument measures reasons why patients delay seeking treatment. All patients had a recent hospitalization for HF, were community dwelling in a rural location, and had no cognitive impairments as measured with the Mini-Cog. Results: A total of 614 HF patients (59% male, NYHA class III/IV 35%, 19% without a high school education, mean age 66±13 years, median b-type natriuretic peptide level 186 pg/ml [25th percentile = 72, 75th percentile = 462] were studied. The most common reasons for not seeking early treatment were symptom uncertainty (62.4%), symptoms seem vague or came on too gradually (67.4%), symptoms slightly different from last episode (55.2%) and the symptoms didn’t seem to be serious enough (62.2%). Other reasons include embarrassment at seeking treatment (23.9%), not wanting to second guess the doctor (21.7%), financial concerns (19.9%), transportation issues (16.4%), and other (10.7%). Reasons given in the other category included afraid/don’t like doctors or hospitals, care of pets at home, family needs them, not wanting to bother others, denial/don’t want to know/fear of knowing, and weather. Conclusions: Despite experiencing worsening HF symptoms of such intensity that hospitalization is required, most patients do not perceive that symptoms are intense or certain enough to warrant action. In many, treatment seeking decisions are superseded by factors not related to symptom appraisal such as family obligations, fear or denial, and embarrassment. Education to improve response to worsening HF symptoms requires skills in symptom appraisal, and counseling to overcome personal barriers to seeking treatment.

scholarly journals Risk of left atrial appendage thrombus in older patients with atrial fibrillation

2021 ◽  
Author(s):  
Monika Gawalko ◽  
Monika Budnik ◽  
Beata Uziębło-Życzkowska ◽  
Iwona Gorczyca ◽  
Paweł Krzesiński ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Older Patients ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Young Patients ◽  
Older Age ◽  
Atrial Appendage ◽  
Significant Difference

IntroductionWe aimed to compare the prevalence of left atrial appendage (LAA) thrombus and its predictors between old and young patients with atrial fibrillation (AF).Material and methodsThe study included 1970 patients aged ≥ 65 (n = 822 [41.7%]) and < 65 (n = 1148 [58.3%]) referred for AF cardioversion or ablation preceded by transoesophageal echocardiography (TEE).ResultsOral anticoagulation (OAC) was prescribed in 799 (97.2%) patients aged ≥ 65 years and in 1054 (91.8%) of those aged < 65 years (p < 0.001). In patients treated with OAC, those aged ≥ 65 years less often received vitamin K antagonist (VKA) (267 [33.4%] vs. 416 [39.5%]) and more often non-VKA-OAC (NOAC) (532 [66.6%] vs. 638 [60.5%], p = 0.008, p = 0.008) compared to patients < 65 years. On TEE, LAA thrombus was more often observed in patients aged ≥ 65 years than those aged < 65 years (63 [7.7%] vs. 46 [4.0%], p < 0.001), with an absolute but not statistically significant difference between patients aged 65–74 and ≥ 75 years (47 [7.3%] vs. 16 [8.8%], p = 0.528). In patients aged ≥ 65 years, there was no difference in the prevalence of LAA thrombus between patients treated with VKA and NOAC, in contrast to patients aged < 65 years, in whom such a difference was observed (27 [6.5%] vs. 16 [2.5%], p = 0.002). In multivariate logistic regression, predictors of LAA thrombus in both age groups were older age, non-paroxysmal AF, and heart failure, whereas only in patients aged < 65 years – VKA use, and in those aged ≥ 65 years – lower glomerular filtration rate and platelet count.ConclusionsDespite OAC use, older patients with AF remain at high risk of LAA thrombus formation. Older age, non-paroxysmal AF, and heart failure are predictors of LAA thrombus, irrespective of age.

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