Implementation of the Frailty Care Bundle (FCB) to promote mobilisation, nutrition and cognitive engagement in older people in acute care settings: protocol for an implementation science study

Background: Older people are among the most vulnerable patients in acute care hospitals. The hospitalisation process can result in newly acquired functional or cognitive deficits termed hospital associated decline (HAD). Prioritising fundamental care including mobilisation, nutrition, and cognitive engagement can reduce HAD risk. Aim: The Frailty Care Bundle (FCB) intervention aims to implement and evaluate evidence-based principles on early mobilisation, enhanced nutrition and increased cognitive engagement to prevent functional decline and HAD in older patients. Methods: A hybrid implementation science study will use a pragmatic prospective cohort design with a pre-post mixed methods evaluation to test the effect of the FCB on patient, staff, and health service outcomes. The evaluation will include a description of the implementation process, intervention adaptations, and economic costs analysis. The protocol follows the Standards for Reporting Implementation Studies (StaRI). The intervention design and implementation strategy will utilise the behaviour change theory COM-B (capability, motivation, opportunity) and the Promoting Action on Research Implementation in Health Services (i-PARIHS). A clinical facilitator will use a co-production approach with staff. All patients will receive care as normal, the intervention is delivered at ward level and focuses on nurses and health care assistants (HCA) normative clinical practices. The intervention will be delivered in three hospitals on six wards including rehabilitation, acute trauma, medical and older adult wards. Evaluation: The evaluation will recruit a volunteer sample of 180 patients aged 65 years or older (pre 90; post 90 patients). The primary outcomes are measures of functional status (modified Barthel Index (MBI)) and mobilisation measured as average daily step count using accelerometers. Process data will include ward activity mapping, staff surveys and interviews and an economic cost-impact analysis. Conclusions: This is a complex intervention that involves ward and system level changes and has the potential to improve outcomes for older patients.

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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

BMC Health Services Research ◽

10.1186/s12913-020-05690-9 ◽

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.

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Nurses' Attitudes Toward Older Patients in Acute Care in Israel

OJIN: The Online Journal of Issues in Nursing ◽

10.3912/ojin.vol18no02ppt01 ◽

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.

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

HRB Open Research ◽

10.12688/hrbopenres.12804.2 ◽

2018 ◽

Vol 1 ◽

pp. 9 ◽

Cited By ~ 1

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.

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

HRB Open Research ◽

10.12688/hrbopenres.12804.1 ◽

2018 ◽

Vol 1 ◽

pp. 9 ◽

Cited By ~ 1

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

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

BMC Health Services Research ◽

10.1186/s12913-020-06048-x ◽

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.

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CHALLENGES FACED BY OLDER PERSONS IN USING PRESCRIPTION MEDICATION LABELS: WHAT NEEDS TO CHANGE?

Innovation in Aging ◽

10.1093/geroni/igz038.2606 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S709-S710

Author(s):

Rahul Malhotra ◽

Sumithra Suppiah ◽

Yi Wen Tan

Keyword(s):

Older People ◽

Limited English Proficiency ◽

Reading Ability ◽

Prescription Medication ◽

Domestic Workers ◽

System Level ◽

Pharmacy Staff ◽

Medication Information ◽

English Reading ◽

Depth Interviews

Abstract In Singapore, while many older people cannot read English, prescription medication labels (PMLs) are predominantly dispensed in English. This qualitative study documented the challenges faced and solutions employed by users (i.e. older Singaporeans) and dispensers (i.e. pharmacy staff) of PMLs. In total, 30 in-depth interviews were conducted; 20 were equally divided between older Singaporeans (≥60 years) who could read English and those with limited/no English reading ability, and 10 were conducted with pharmacy staff across 6 polyclinics. The audio-taped interviews were transcribed verbatim and analysed thematically. The interviews with older Singaporeans and pharmacy staff revealed similar challenges in using PMLs. The first challenge related to reading and understanding PMLs by older people, mainly due to their limited English proficiency (LEP) or illiteracy. Consequently, older Singaporeans often relied on family members, domestic workers or pharmacy staff to help them interpret PMLs. Specifically, to address LEP, pharmacy staff reported translating PML instructions verbally and also handwriting them on PMLs. For illiterate patients, pharmacy staff reported drawing illustrations on PMLs to communicate key medication information. The second challenge related to PML readability, due to small font size. To address this, pharmacy staff routinely re-wrote medication information on PMLs in larger handwriting. Such improvised solutions by pharmacy staff to address the challenges faced by older Singaporeans in using PMLs indicate a pressing need for system-level improvements to PMLs. Improvements such as standardised and legible bilingual medication instructions and/or pictograms would appreciably facilitate medication counselling and allow for better understanding of PMLs by older Singaporeans.

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Older people's satisfaction with intermediate care: a systematic review

Reviews in Clinical Gerontology ◽

10.1017/s0959259808002475 ◽

2007 ◽

Vol 17 (3) ◽

pp. 199-218 ◽

Cited By ~ 3

Author(s):

Andrew Wilson ◽

Suzanne Richards ◽

Janette Camosso-Stefinovic

Keyword(s):

Systematic Review ◽

Older People ◽

Older Patients ◽

Hospital Care ◽

Patient Choice ◽

Intermediate Care ◽

Care Services ◽

The Relationship

Although intermediate care takes a variety of different forms and has developed somewhat differently in different countries, we believe that intermediate-care schemes have enough in common to make it meaningful to examine the relationship between this method of care and the views of older patients receiving either it or its alternatives. This is particularly important as one of the underlying principles of intermediate care is to extend patient choice; furthermore, most intermediate-care services target older people. In this review we examine evidence about whether older people prefer intermediate or hospital care, and what they like and dislike about intermediate care.

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Praktijkadvies rond de aanpak van anafylaxie bij (Covid-19-)vaccinatie bij kwetsbare ouderen (incl. e-learning)

Tijdschrift voor Geneeskunde ◽

10.47671/tvg.77.21.033 ◽

2021 ◽

Author(s):

E. DUYVER ◽

T. VAN DE VELDE ◽

D. RAZOOQI ◽

K. VERSLUYS ◽

M. PETROVIC ◽

...

Keyword(s):

Older People ◽

Older Patients ◽

Large Scale ◽

Vaccination Campaign ◽

Line Treatment ◽

First Line ◽

Practical Advice ◽

E Learning ◽

Treatment Education ◽

First Line Treatment

Practical advice on the anaphylaxis policy for (COVID-19) vaccination in frail, older patients In view of the imminent start of the COVID-19 vaccination campaign, a practical advice based on the available literature on anaphylaxis in older people was drawn up for use in frail, older patients. The present practical advice provides guidance with regard to the diagnosis of anaphylaxis, the first-line treatment, education and necessary material with the purpose of making nursing homes and vaccination centres well prepared for the large-scale COVID-19 vaccination.

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