scholarly journals The systematic approach to improving care for Frail Older Patients (SAFE) study: A protocol for co-designing a frail older person’s pathway

2018 ◽  
Vol 1 ◽  
pp. 9 ◽  
Author(s):  
Éidín Ní Shé ◽  
Mary McCarthy ◽  
Deirdre O'Donnell ◽  
Orla Collins ◽  
Graham Hughes ◽  
...  
Keyword(s):  
Older People ◽  
Acute Care ◽  
Older Patients ◽  
Public Involvement ◽  
Systematic Approach ◽  
Functional Decline ◽  
Interdisciplinary Approach ◽  
Realist Review ◽  
Structured Interviews ◽  
Organ Systems

Background: Frailty is the age-accelerated decline across multiple organ systems which leads to vulnerability to poor resolution of homeostasis after a stressor event. This loss of reserve means that a minor illness can result in a disproportionate loss of functional ability. Improving acute care for frail older patients is now a national priority and an important aspect of the National Programme for Older People in Ireland. Evidence suggests that an interdisciplinary approach incorporating rapid comprehensive geriatric assessment and early intervention by an interdisciplinary team can reduces susceptibility to hospitalisation related functional decline. The aim of the Systematic Approach to Improving Care for Frail Older Patients (SAFE) is to develop and explore the process of implementing a model of excellence in the delivery of patient-centred integrated care within the context of frail older people’s acute admissions. Methods: The SAFE study will employ a mixed methodology approach, including a rapid realist review of the current literature alongside a review of baseline data for older people attending the emergency department. Semi-structured interviews will be undertaken to document the current pathway. The intervention processes and outcomes will be jointly co-designed by a patient and public involvement (PPI) group together with the interdisciplinary healthcare professionals from hospital, community and rehabilitation settings. Successive rounds of Plan-Do-Study-Act cycles will then be undertaken to test and refine the pathway for full implementation. Discussion: This research project will result in a plan for implementing an integrated, patient-centred pathway for acute care of the frail older people which has been tested in the Irish setting. During the process of development, each element of the new pathway will be tested in turn to ensure that patient centred outcomes are being realised. This will ensure the resulting model of care is ready for implementation in the context of the Irish health service.

scholarly journals The systematic approach to improving care for Frail Older Patients (SAFE) study: A protocol for co-designing a frail older person’s pathway

2018 ◽  
Vol 1 ◽  
pp. 9 ◽  
Author(s):  
Éidín Ní Shé ◽  
Mary McCarthy ◽  
Deirdre O'Donnell ◽  
Orla Collins ◽  
Graham Hughes ◽  
...  
Keyword(s):  
Older People ◽  
Acute Care ◽  
Older Patients ◽  
Public Involvement ◽  
Systematic Approach ◽  
Functional Decline ◽  
Interdisciplinary Approach ◽  
Realist Review ◽  
Structured Interviews ◽  
Organ Systems

Background: Frailty is the age-accelerated decline across multiple organ systems which leads to vulnerability to poor resolution of homeostasis after a stressor event. This loss of reserve means that a minor illness can result in a disproportionate loss of functional ability. Improving acute care for frail older patients is now a national priority and an important aspect of the National Programme for Older People in Ireland. Evidence suggests that an interdisciplinary approach incorporating rapid comprehensive geriatric assessment and early intervention by an interdisciplinary team can reduces susceptibility to hospitalisation related functional decline. The aim of the Systematic Approach to Improving Care for Frail Older Patients (SAFE) is to develop and explore the process of implementing a model of excellence in the delivery of patient-centred integrated care within the context of frail older people’s acute admissions. Methods: The SAFE study will employ a mixed methodology approach, including a rapid realist review of the current literature alongside a review of baseline data for older people attending the emergency department. Semi-structured interviews will be undertaken to document the current pathway. The intervention processes and outcomes will be jointly co-designed by a patient and public involvement (PPI) group together with the interdisciplinary healthcare professionals from hospital, community and rehabilitation settings. Successive rounds of Plan-Do-Study-Act cycles will then be undertaken to test and refine the pathway for full implementation. Discussion: This research project will result in a plan for implementing an integrated, patient-centred pathway for acute care of the frail older people which has been tested in the Irish setting. During the process of development, each element of the new pathway will be tested in turn to ensure that patient centred outcomes are being realised. This will ensure the resulting model of care is ready for implementation in the context of the Irish health service.

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.

scholarly journals Consequences of ‘conversations not had’: insights into failures in communication affecting delays in hospital discharge for older people living with frailty

2020 ◽  
Vol 25 (4) ◽  
pp. 213-219 ◽  
Author(s):  
Sabi Redwood ◽  
Bethany Simmonds ◽  
Fiona Fox ◽  
Alison Shaw ◽  
Kyra Neubauer ◽  
...  
Keyword(s):  
Older People ◽  
End Of Life ◽  
Hospital Discharge ◽  
Acute Care ◽  
Health Care Professionals ◽  
Comparative Method ◽  
Care Hospital ◽  
Structured Interviews ◽  
Effective Discharge ◽  
Health And Social Care

Objectives Older people living with frailty (OPLWF) are often unable to leave hospital even if they no longer need acute care. The aim of this study was to elicit the views of health care professionals in England on the barriers to effective discharge of OPLWF. Methods We conducted semi-structured interviews with hospital-based doctors and nurses with responsibility for discharging OPLWF from one large urban acute care hospital in England. The data were analysed using the constant comparative method. Results We conducted interviews with 17 doctors (12 senior doctors or consultants and 5 doctors in training) and six senior nurses. Some of our findings reflect well-known barriers to hospital discharge including service fragmentation, requiring skilled coordination that was often not available due to high volumes of work, and poor communication between staff from different organizations. Participants’ accounts also referred to less frequently documented factors that affect decision making and the organization of patient discharges. These raised uncomfortable emotions and tensions that were often ignored or avoided. One participant referred to ‘conversations not had’, or failures in communication, because difficult topics about resuscitation, escalation of treatment and end-of-life care for OPLWF were not addressed. Conclusions The consequences of not initiating important conversations about decisions relating to the end of life are potentially far reaching not only regarding reduced efficiency due to delayed discharges but also for patients’ quality of life and care. As the population of older people is rising, this becomes a key priority for all practitioners in health and social care. Evidence to support practitioners, OPLWF and their families is needed to ensure that these vital conversations take place so that care at the end of life is humane and compassionate.

scholarly journals Older Patients’ Perspectives on Factors Contributing to Frequent Visits to the Emergency Department: A Qualitative Interview Study

2020 ◽  
Author(s):  
Daisy Kolk ◽  
Anton F. Kruiswijk ◽  
Janet L. MacNeil-Vroomen ◽  
Milan L. Ridderikhof ◽  
Bianca M. Buurman
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Older Patients ◽  
Structured Interviews ◽  
Post Discharge ◽  
Qualitative Interview Study ◽  
Before And After ◽  
Ed Visits ◽  
The Relationship

Abstract Background: Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to collect older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits.Methods: We performed semi-structured interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling to achieve maximum variation in heterogeneity. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached.Results: In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit.Conclusions: This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.

scholarly journals Setting Up Geriatric Care in Subsaharan Africa : A 1-Year Experience in the Yaounde Central Hospital of Cameroon

2021 ◽  
Author(s):  
Marie Josiane Ntsama Essomba ◽  
Victorine Bandolo Nzana ◽  
Raoul Sylvain Simeni Njonnou ◽  
Simeon Pierre Choukem ◽  
Laura Ciaffi ◽  
...  
Keyword(s):  
Older People ◽  
Older Patients ◽  
Functional Decline ◽  
Age Groups ◽  
Therapeutic Education ◽  
Central Hospital ◽  
Model Of Care ◽  
Practice Nurses ◽  
Resource Limited ◽  
Ace Model

Abstract Background: As the share of the older population is growing worldwide, health systems in developing countries need a policy shift to address the challenge of the optimization of healthcare across age groups. Many older people in resource-limited countries will seek specific care due to multimorbidity and frailty, as the burden of non-communicable diseases is getting heavier. Methods: Over a one-year period, we trained healthcare workers and developed new procedures of care in the geriatric unit of the Yaoundé Central Hospital in Cameroon, using the Acute Care for Elders (ACE) model. This model of care in Geriatrics is based on a patient-centered approach and is focused on preventing functional decline in acutely ill older patients. Results: During the implementation of the ACE model, 202 patients were hospitalized in the unit, of whom 60.9% (n=123) were female; the mean (SD) age was 79.3 (8.8) years. A multidisciplinary team was brought together, including a geriatrician, two general practitioners, two geriatric nurses, two advanced practice nurses and a social worker. After a thorough examination of the care procedures, nurses were given complementary missions, such as assessing functional status and providing therapeutic education to the patients and their family members. All hospitalized and ambulatory patients were offered a comprehensive geriatric assessment at the outpatient clinic.Conclusion: It was possible to establish a comprehensive model of care for older patients in our hospital with few trained personnel. Further actions are needed to improve the care of older people in resource-limited 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 An exploration of community pharmacists’ experience, knowledge and perspectives of frailty and medicines optimisation in frail older people: A qualitative study

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i6-i6
Author(s):  
L Faulkner ◽  
C M Hughes ◽  
H E Barry
Keyword(s):  
Older People ◽  
Older Patients ◽  
Frailty Index ◽  
External Validation ◽  
Community Pharmacists ◽  
Clinical Aspects ◽  
Frail Older People ◽  
Structured Interviews ◽  
Age Related ◽  
Medicines Optimisation

Abstract Introduction Frailty is a heightened state of vulnerability due to an accumulation of age-related defects in separate physiological systems (1). Frailty is becoming increasingly common, with up to 50% of older adults being diagnosed with mild, moderate or severe frailty (35%, 12% and 3% respectively) (2). Community pharmacists may often be the primary healthcare professional with whom frail older people have most frequent contact due to their convenience and accessibility. Therefore, it is hypothesised that community pharmacists could play a wider role in frailty identification and medicines optimisation for frail older people. Aim To explore community pharmacists’ knowledge of frailty and its assessment, their experiences and contact with frail older patients in the community pharmacy setting, and their perceptions of their role in optimising medicines for frail older people. Methods Two strategies were used to recruit community pharmacists registered in Northern Ireland (NI). Community pharmacists were recruited through the Pharmacy Forum NI bi-monthly newsletter and the School of Pharmacy Undergraduate Placement Network, followed by snowballing. The interview topic guide was developed based on the published literature, current frailty guidelines and through discussion within the research team; it was piloted with four pharmacists. Semi-structured interviews commenced in March 2020. Due to the Covid-19 pandemic, face-to-face interviews were logistically not possible, therefore telephone interviews were conducted at a time convenient to participants. All interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis. Results To date, 14 interviews have been conducted, lasting between 24 and 72 minutes. Apart from one interview, all were conducted over the telephone. Participant characteristics are summarised in Table 1. Analysis of interview transcripts is ongoing. Findings to date have highlighted the key role community pharmacists feel they play in assisting frail older patients with their medicines (especially during the current pandemic). Many saw themselves as a ‘point of contact’ for frail older people and highlighted the holistic approaches they used to care of such patients: “It’s easier to get in contact with us than other healthcare professionals and we tend to be the first port of call really” [CP2]. Interviews highlighted a lack of pharmacist knowledge surrounding frailty as a condition and its assessment, with participants primarily focusing on the physical aspects of frailty (e.g. weight loss, weakness) when observing or ‘informally assessing’ patients. None of the participants reported formally assessing their patients using validated frailty tools or checklists: “It’s not something that I’ve ever thought about. We don’t have any tools readily available to us that I know of and certainly nothing that would be standardised” [CP1]. Conclusion This study has highlighted that community pharmacists felt they could contribute to optimising medicines for frail older people. However, the findings emphasise the need for more formal training for community pharmacists about the clinical aspects of frailty, frailty assessment and future interventions to address the medicines-related issues they have encountered with this patient population. References 1. Shaw RL, Gwyther H, Holland C, Bujnowska M, Kurpas D, Cano A, et al. Understanding frailty: meanings and beliefs about screening and prevention across key stakeholder groups in Europe. Ageing & Society. 2018;38(6): 1223–1252. 2. Hollinghurst J, Fry R, Akbari A, Clegg A, Lyons RA, Watkins A, et al. External validation of the electronic Frailty Index using the population of Wales within the Secure Anonymised Information Linkage Databank. Age and Ageing. 2019;48(6): 922–926.

Nurses' Attitudes Toward Older Patients in Acute Care in Israel

2013 ◽  
Vol 18 (2) ◽  
Author(s):  
Maxim Topaz ◽  
Israel Doron
Keyword(s):  
Nursing Education ◽  
Older People ◽  
Acute Care ◽  
Older Patients ◽  
Health Care Services ◽  
Design Method ◽  
Strong Predictor ◽  
Poor Quality ◽  
Care Services ◽  
Nurses Knowledge

Ageism has been found to negatively affect the health care services that older persons receive, both implicitly through unfair resource allocation by the stakeholders, and explicitly, by providing offensive and poor quality treatment. In this article, the authors review the literature relating to ageing, noting that negative attitudes among caregivers toward older patients in acute care settings are a strong predictor of ageism. They describe a study in which they explored a group of Israeli nurses’ knowledge of ageing and attitudes toward older people in an acute care setting and analyzed the relationship between these variables using a descriptive, correlational design method. Nurses working in one of the largest public hospital in Israel completed Kogan’s Attitudes Towards Older People Scale and Palmore’s Facts on Ageing Quiz. Findings indicated that the nurses’ level of knowledge of ageing was relatively low. The authors discuss nurses’ knowledge of ageing and nurses’ ethnicity as significant predictors of ageist attitudes. They conclude by recommending that nurse educators strengthen gerontological content in the nursing curriculum and provide culturally tailored nursing education to reduce ageism among professional nurses.

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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