A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

Abstract Background A fragility hip fracture is a serious injury in older adults. Following a fragility fracture, a large percentage of patients are unable to regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the utilization of these early mobility recommendations by health care providers within our institution. An evidence to practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence to practice gap. A recent publication of quality standards in Ontario provides an opportunity for a local needs assessment of potential evidence to practice gaps. The aim of this project was to identify evidence to practice gaps in health care provider implementation of recommendations for early mobility after fragility hip fracture surgery.Methods A retrospective chart review was performed to document the rates of early mobility activities during the first five days after hip fracture surgery at a large tertiary centre in Toronto, Ontario. Patients with cognitive impairment were included.Results Early mobility activities in this older adult population are initiated in the first five days after surgery to varying degrees. Between 11% - 50% of patients are not participating in early mobility activities, thereby not meeting recommendations. Those with low pre-fracture function and cognitive impairment have lower rates of participation when compared to those with a high pre-fracture function and no cognitive impairment.Conclusions The chart review has identified a paucity of contextual information which may influence health care providers’ behaviours related to early mobility. The chart audit is limited in its ability to assess the systems issues, which may have an influence on the health care provider behaviour. Considering the lack of information in these areas, we have identified that further work is required to explore factors which may be having an impact on the health care provider’s ability to engage the patients in early mobility activities.

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A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

10.21203/rs.3.rs-16282/v1 ◽

2020 ◽

Author(s):

Lynn Haslam-Larmer ◽

Kevin Woo ◽

Mohammad Auais ◽

Catherine Donnelly ◽

Vincent DePaul

Keyword(s):

Health Care ◽

Cognitive Impairment ◽

Hip Fracture ◽

Health Care Providers ◽

Care Providers ◽

Early Mobility ◽

Fragility Hip Fracture ◽

Hip Fracture Surgery ◽

Fracture Function ◽

Practice Gap

Abstract Background A fragility hip fracture is a serious injury in older adults. Following a fragility fracture, a large percentage of patients are unable to regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the utilization of these early mobility recommendations by health care providers within our institution. An evidence to practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence to practice gap. A recent publication of quality standards in Ontario provides an opportunity for a local needs assessment of potential evidence to practice gaps. Objective To identify if there is an evidence to practice gap in health care provider implementation of recommendations for early mobility after fragility hip fracture surgery. Methods A retrospective chart review was performed to document the rates of early mobility activities during the first five days after hip fracture surgery at a large tertiary centre in Toronto, Ontario. Patients with cognitive impairment were included. Results Early mobility activities in this older adult population are initiated in the first five days after surgery to varying degrees. Between 11% - 50% of patients are not participating in early mobility activities, thereby not meeting recommendations. Those with low pre-fracture function and cognitive impairment have lower rates of participation when compared to those with a high pre-fracture function and no cognitive impairment. Conclusions The chart review has identified a paucity of contextual information which may influence health care providers’ behaviours related to early mobility. The chart audit is limited in its ability to assess the systems issues, which may have an influence on the health care provider behaviour. Considering the lack of information in these areas, we have identified that further work is required to explore factors which may be having an impact on the health care provider’s ability to engage the patients in early mobility activities.

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A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

10.21203/rs.3.rs-23417/v2 ◽

2020 ◽

Author(s):

Lynn Haslam-Larmer ◽

Kevin Woo ◽

Mohammad Auais ◽

Catherine Donnelly ◽

Vincent DePaul

Keyword(s):

Older Adults ◽

Health Care ◽

Cognitive Impairment ◽

Hip Fracture ◽

Functional Ability ◽

Care Providers ◽

Systematic Method ◽

Early Mobility ◽

Fragility Hip Fracture ◽

Practice Gap

Abstract BackgroundA fragility hip fracture is a serious injury in older adults. After experiencing a fracture, a large percentage of patients do not regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the usage of these early mobility recommendations by health care providers within our institution. An evidence-to-practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence-to-practice gap. There were two aims of this project; to describe early mobility activities undertaken on one post surgical unit and b) to identify if there is an evidence-to-practice gap.MethodsAt a large tertiary centre in Toronto, Ontario, medical records from one calendar year were abstracted for older adults (≥65 years of age) recovering from fragility hip fracture repair. Data regarding demographics, co-morbidities, surgery type, post-operative mobility activities, and any post-operative complications were collected. Primary outcomes were evidence of early mobility activities and a comparison to Health Quality Ontario recommendations for fragility hip fracture care.ResultsBetween 11% - 50% of patients are not participating in early mobility activities. By postoperative day five only two patients had walked over 50 metres. Those with low pre-fracture functional ability and a cognitive impairment consistently experienced lower rates of participation compared to patients with a high pre-fracture functional ability and no cognitive impairment. Chi-square tests and regression analysis did not reveal any significant associations with variables.ConclusionsThere is very limited participation in early mobility activities after surgery. The study was unable to identify any significant relationships between several variables that may impact participation. This chart review identified the processes that have been sustained and highlights potential areas for future interventions.

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Home Health Registered Nurses’ Experiences With Financial Exploitation of Older Women With Cognitive Impairment

Innovation in Aging ◽

10.1093/geroni/igaa057.2460 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 701-701

Author(s):

Carol Rogers ◽

Lisa DeSpain ◽

Janet Wilson

Keyword(s):

Older Adults ◽

Health Care ◽

Cognitive Impairment ◽

Health Care Providers ◽

Home Health Care ◽

Elder Abuse ◽

Home Health ◽

Care Providers ◽

Financial Exploitation ◽

Data Saturation

Abstract Older adults diagnosed with cognitive impairment (CI) who live at home are at high risk for FE due to dependence on caregivers and diminishing cognitive and financial capacities. Health care providers are mandated reporters for elder abuse, that includes financial exploitation (FE), one of the seven types of older adult maltreatments. Twenty Home Health Care Nurses (HHRN) of older adults in Oklahoma were interviewed to discover their understanding and experiences with FE. Transcripts were analyzed by conventional content analysis. Line-by-line codes were generated inductively and codes were grouped into categories and themes until data saturation was reached. Five themes emerged: Red Flags, Familiar Offenders, Dire Consequences, Barriers/Facilitators, Doing Better. Conclusions: HHRNs are an untapped resource to provide suggestions for improvements of FE detection/reporting of older adults with CI and to help formulate policies, procedures, strategies to improve coordination and communication among healthcare, law enforcement, and social service systems.

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Health Care Providers' Perceptions of Physical Function in Older Adults with Arthroplasty from Hip Fracture

Journal of muscle and joint health ◽

10.5953/jmjh.2015.22.2.67 ◽

2015 ◽

Vol 22 (2) ◽

pp. 67-77 ◽

Cited By ~ 1

Author(s):

Young Ji Ko ◽

JuHee Lee

Keyword(s):

Older Adults ◽

Health Care ◽

Hip Fracture ◽

Physical Function ◽

Health Care Providers ◽

Care Providers

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Making the Informal Formal: Discussing and Completing Advance Care Plans in Care Dyads with Cognitive Impairment

Journal of Palliative Care ◽

10.1177/08258597211063047 ◽

2021 ◽

pp. 082585972110630

Author(s):

Megan Shepherd-Banigan ◽

Cassie B. Ford ◽

Nicole DePasquale ◽

Valerie A. Smith ◽

Emmanuelle Belanger ◽

...

Keyword(s):

Health Care ◽

Cognitive Impairment ◽

Health Care Providers ◽

Living Will ◽

Care Providers ◽

Positive Role ◽

Cross Sectional ◽

Care Plans ◽

Care Partners ◽

Advance Care

Background Discussing advance care planning (ACP) with care partners may be a steppingstone to the completion of advance directives (ADs) for persons with cognitive impairment (PwCIs). Objectives To examine whether PwCI-reported occurrence of and PwCI-care partner agreement about ACP discussions are associated with completion of ADs. Design and Subjects We conducted a secondary, cross-sectional analysis of data from 1672 PwCI-care partner dyads in the BLINDED study. PwCIs were Medicare beneficiaries in the US, aged >65 years, and diagnosed with mild cognitive impairment or dementia. Care partners were identified by PwCIs as being most involved in their health care. Measurements PwCIs’ completion of ADs was determined by 1 or more affirmative responses to dichotomous indicators for formalizing a living will, medical directive, or durable power of attorney for health care. Discussion occurrence was based on PwCI reports and agreement between PwCI and care partner reports of prior conversations about PwCIs’ ACP preferences between PwCIs and care partners. Results In logistic regression models adjusted for PwCI and care partner characteristics, PwCIs who had (vs. had not) discussed ACP were 10% more likely to complete ADs. PwCIs from dyads agreeing (vs. disagreeing) a discussion occurred were 7% more likely to complete ADs. PwCIs from care dyads in agreement (vs. disagreement) about non-discussion were 11% less likely to formalize ADs. Conclusions Discussing ACP with care partners plays a direct, positive role in completing ADs among PwCIs. Health care providers who approach ACP as a dyadic, communicative decision-making process from the outset may facilitate PwCIs’ uptake of ADs.

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A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

International Journal of Orthopaedic and Trauma Nursing ◽

10.1016/j.ijotn.2021.100846 ◽

2021 ◽

pp. 100846

Author(s):

Lynn Haslam-Larmer ◽

Mohammad Auais ◽

Catherine Donnelly ◽

Kevin Woo ◽

Vincent DePaul

Keyword(s):

Health Care ◽

Hip Fracture ◽

Systematic Method ◽

Early Mobility ◽

Fragility Hip Fracture ◽

Record Review

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The needs of Pacific families affected by age-related cognitive impairment in New Zealand: interviews with providers from health-care organisations

Journal of Primary Health Care ◽

10.1071/hc21082 ◽

2021 ◽

Vol 13 (4) ◽

pp. 317

Author(s):

Vanda Symon ◽

Rosalina Richards ◽

Pauline Norris ◽

Talai Mapusua ◽

Leigh Hale

Keyword(s):

Health Care ◽

Cognitive Impairment ◽

New Zealand ◽

Cognitive Decline ◽

Health Care Providers ◽

Service Providers ◽

Care Providers ◽

Access To Services ◽

Age Related ◽

Poor Access

ABSTRACTINTRODUCTIONPacific populations in New Zealand are aging, but little is known in the health-care environment about their experiences with cognitive impairment.AIMThe aim was to explore the needs of Pacific peoples affected by age-related cognitive decline from the perspectives of health-care providers.METHODSSix health-care service providers from organisations focused on Pacific patients were interviewed to determine services available to aged Pacific peoples, access, and whether they met Pacific people’s needs.RESULTSThree areas of concern were identified by all participants: access to services; getting a diagnosis; and communication and language. Many experienced a lack of information and poor access to services. Diagnosis of cognitive impairment was frequently made difficult by inconsistent access to general practitioners in lower socio-economic areas. Communication was hindered by poor access to information in Pacific languages.DISCUSSIONCommon themes noted by all participating health-care providers indicated the needs of aged Pacific people experiencing cognitive decline were often not being met.

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Case Study Application of an Ethical Decision-Making Process for a Fragility Hip Fracture Patient

Canadian Geriatrics Journal ◽

10.5770/cgj.22.272 ◽

2019 ◽

Vol 22 (1) ◽

pp. 7-12 ◽

Cited By ~ 1

Author(s):

Lynn Haslam ◽

Vincent DePaul

Keyword(s):

Decision Making ◽

Hip Fracture ◽

Health Care Providers ◽

Ethical Decision ◽

Surgical Repair ◽

Ethical Decision Making ◽

Care Providers ◽

Term Care ◽

Fragility Hip Fracture

In Canada, up to 32,000 older adults experience a fragility hip fracture. In Ontario, the Ministry of Health and Long Term Care has implemented strategies to reduce surgical wait times and improve outcomes in target areas. These best practice standards advocate for immediate surgical repair, within 48 hours of admission, in order to achieve optimal recovery outcomes. The majority of patients are good candidates for surgical repair; however, for some patients, given the risks of anesthetic and trauma of the operative procedure, surgery may not be the best choice. Patients and families face a dif-ficult and hurried decision, often with no time to voice their concerns, or with little-to-no information on which to guide their choice. Similarly, health-care providers may experience moral distress or hesitancy to articulate other options, such as palliative care. Is every fragility fracture a candidate for surgery, no matter what the outcome? When is it right to discuss other options with the patient? This article examines a case study via an application of a framework for ethical decision-making.

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Three Cases of Severe ME/CFS in Adults

Healthcare ◽

10.3390/healthcare9020215 ◽

2021 ◽

Vol 9 (2) ◽

pp. 215

Author(s):

Leah R. Williams ◽

Carol Isaacson-Barash

Keyword(s):

Health Care ◽

Cognitive Impairment ◽

Health Care Providers ◽

Orthostatic Intolerance ◽

Chronic Fatigue ◽

Care Providers ◽

Mild Case ◽

Healthy Individuals ◽

System Disease ◽

Fatigue Syndrome

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, only partially understood multi-system disease whose onset and severity vary widely. Symptoms include overwhelming fatigue, post-exertional malaise, sleep disruptions, gastrointestinal issues, headaches, orthostatic intolerance, cognitive impairment, etc. ME/CFS is a physiological disease with an onset often triggered by a viral or bacterial infection, and sometimes by toxins. Some patients have a mild case and are able to function nearly on a par with healthy individuals, while others are moderately ill and still others are severely, or even, very severely ill. The cohort of moderately to very severely ill is often housebound or bedbound, has lost employment or career, and has engaged in a long, and often futile, search for treatment and relief. Here, we present three case studies, one each of a moderately ill, a severely ill, and a very severely ill person, to demonstrate the complexity of the disease, the suffering of these patients, and what health care providers can do to help.

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