Older Adults With Complex Chronic Conditions Who Receive Care at Home: The Importance of Primary Care Assessment

2021 ◽  
Vol 47 (11) ◽  
pp. 31-38
Author(s):  
Raül Sancho Agredano ◽  
Jordi Galimany Masclans ◽  
Eva Maria Guix-Comellas ◽  
Victoria Morin Fraile ◽  
José A. Sarria-Guerrero ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Chronic Conditions ◽  
Complex Chronic Conditions ◽  
Care Assessment ◽  
Care At Home ◽  
At Home

Effectiveness of a Hospital-at-Home Integrated Care Program as Alternative Resource for Medical Crises Care in Older Adults With Complex Chronic Conditions

2018 ◽  
Vol 19 (10) ◽  
pp. 860-863 ◽  
Author(s):  
Miquel À. Mas ◽  
Sebastià J. Santaeugènia ◽  
Francisco J. Tarazona-Santabalbina ◽  
Sara Gámez ◽  
Marco Inzitari
Keyword(s):  
Older Adults ◽  
Integrated Care ◽  
Chronic Conditions ◽  
Care Program ◽  
Complex Chronic Conditions ◽  
Hospital At Home ◽  
Alternative Resource ◽  
At Home

scholarly journals Frailty Screening and Case-Finding for Complex Chronic Conditions in Older Adults in Primary Care

Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 39 ◽  
Author(s):  
Linda Lee ◽  
Tejal Patel ◽  
Loretta Hillier ◽  
Jason Locklin ◽  
James Milligan ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Chronic Conditions ◽  
Case Finding ◽  
Complex Chronic Conditions

scholarly journals Palliative care and complex chronic conditions since the perspective of healthcare professionals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Doñate-Martínez ◽  
L Llop ◽  
J Garcés
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Early Identification ◽  
Chronic Conditions ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Holistic View ◽  
Complex Chronic Conditions ◽  
Symptom Intensity

Abstract Background According to the WHO, palliative care (PC) is applicable early in the course of illness together with other curative therapies. Early PC has demonstrated beneficial effects on quality of life and symptom intensity among cancer patients. However, PC is not as early integrated on the care pathway of complex chronic conditions (CCC). This abstract presents barriers and needs identified to effectively implement early PC on CCC performed under the EU-funded InAdvance project (ref.: 825750). Methods Semi-structured interviews were performed with 16 healthcare professionals (HPs) from primary care and hospital settings working with older patients with CCC in Valencia (Spain). Results Interviews reported that main needs identified to provide early PC are: (a) coordinated strategies between multi-setting HPs to an early identification of CCC patients in need of PC; (b) adequate resources to attend patients' PC needs from a holistic view, i.e. psychosocial and spiritual needs; and (c) early integration of basic PC at primary care teams. The main barriers identified were: (a) stereotypes associated to the traditional PC approach; (b) poor knowledge from HPs of the PC holistic approach; and (c) lack of specific protocols or pathways for CCC in need of PC. Conclusions Specific skills and resources are the most relevant needs to effectively provide early PC among patients with CCC. First, it is urgent to demystify the negative culture-related vision of PC that is commonly associated to sedation and last days of a person's life. Also, multidisciplinary HPs require specific training to identify and provide early PC tailored to CCC. And, it is required a strategic and multi-setting organizational approach with fluent information flow and coordinated roles. Key messages Healthcare expenditure would be considerably reduced, especially at hospital and emergency units, with an early identification of patients with CCC in need of PC. Empowering primary HPs in PC would improve the quality of care of patients with CCC.

scholarly journals HEALTHCARE PROVIDERS’ EXPERIENCES IN CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S317-S318
Author(s):  
Jenny Ploeg ◽  
Marie-Lee Yous ◽  
Kimberly Fraser ◽  
Sinéad Dufour ◽  
Sharon Kaasalainen ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Home Care ◽  
Family Caregivers ◽  
Chronic Conditions ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Multiple Chronic Conditions ◽  
Team Approach ◽  
Personal Support

Abstract The management of multiple chronic conditions (MCC) in older adults living in the community is complex. Little is known about the experiences of interdisciplinary primary care and home providers who care for this vulnerable group. The aim of this study was to explore the experiences of healthcare providers in managing the care of community-living older adults with MCC and to highlight their recommendations for improving care delivery for this group. A qualitative interpretive description design was used. A total of 42 healthcare providers from two provinces in Canada participated in semi-structured interviews. Participants represented diverse disciplines (e.g., physicians, nurses, social workers, personal support workers) and settings (e.g., primary care and home care). Thematic analysis was used to analyze interview data. The experiences of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), involving and supporting family caregivers, (4) using a team approach for holistic care delivery, (5) encountering rewards and challenges in caring for older adults with MCC, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers highlighted the need for a more comprehensive integrated system of care to improve care management for older adults with MCC and their family caregivers. Specifically, they suggested increased care coordination, more comprehensive primary care visits with an interprofessional team, and increased home care support.

Bereaved Families’ Experiences of End-of-Life Care at Home for Older Adults with Non-Cancer in South Korea

2019 ◽  
Vol 36 (1) ◽  
pp. 42-53 ◽  
Author(s):  
Hanul Lee ◽  
Jiwon Lee ◽  
Jong-Eun Lee
Keyword(s):  
Older Adults ◽  
South Korea ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Care At Home ◽  
At Home

scholarly journals INVOLUNTARY TREATMENT AMONG OLDER ADULTS WITH COGNITIVE IMPAIRMENT RECEIVING NURSING CARE AT HOME.

2018 ◽  
Vol 2 (suppl_1) ◽  
pp. 981-981
Author(s):  
V Moermans ◽  
M Bleijlevens ◽  
H Verbeek ◽  
F Tan ◽  
K Milisen ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Nursing Care ◽  
Involuntary Treatment ◽  
Care At Home ◽  
At Home

scholarly journals A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial

10.2196/25175 ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. e25175
Author(s):  
David H Gustafson Sr ◽  
Marie-Louise Mares ◽  
Darcie C Johnston ◽  
Jane E Mahoney ◽  
Randall T Brown ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Chronic Conditions ◽  
Health Care Use ◽  
Multiple Chronic Conditions ◽  
Secondary Outcomes ◽  
Ehealth Intervention

Background Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients’ lives. Objective This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures. Methods In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ≥30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. Results Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021. Conclusions With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. Trial Registration ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735. International Registered Report Identifier (IRRID) DERR1-10.2196/25175

scholarly journals Older Adults with COVID-19 Can Choose Care at Home: Lessons Learned from New York City

2020 ◽  
Vol 35 (9) ◽  
pp. 2755-2756
Author(s):  
Justina L. Groeger ◽  
Joanna L. Starrels ◽  
Amy R. Ehrlich
Keyword(s):  
Older Adults ◽  
New York ◽  
New York City ◽  
York City ◽  
Lessons Learned ◽  
Care At Home ◽  
At Home

scholarly journals What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zsofia Rozsnyai ◽  
Katharina Tabea Jungo ◽  
Emily Reeve ◽  
Rosalinde K. E. Poortvliet ◽  
Nicolas Rodondi ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Chronic Conditions ◽  
Inappropriate Medication ◽  
Positive Association ◽  
Barriers And Enablers ◽  
Building Trust ◽  
Open Questions ◽  
Strong Positive Association ◽  
Baseline Characteristics

Abstract Background Multimorbidity and polypharmacy are very common in older adults in primary care. Ideally, general practitioners (GPs), should regularly review medication lists to identify inappropriate medication(s) and, where appropriate, deprescribe. However, it remains challenging to deprescribe given time constraints and few recommendations from guidelines. Further, patient related barriers and enablers to deprescribing have to be accounted for. The aim of this study was to identify barriers and enablers to deprescribing as reported by older adults with polypharmacy and multimorbidity. Methods We conducted a survey among participants aged ≥70 years, with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 chronic medications). We invited Swiss GPs, to recruit eligible patients who then completed a paper-based survey on demographics, medications and chronic conditions. We used the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire and added twelve additional Likert scale questions and two open-ended questions to assess barriers and enablers towards deprescribing, which we coded and categorized into meaningful themes. Result Sixty four Swiss GPs consented to recruit 5–6 patients each and returned 300 participant responses. Participants were 79.1 years (SD 5.7), 47% female, 34% lived alone, and 86% managed their medications themselves. Sixty-seven percent of participants took 5–9 regular medicines and 24% took ≥10 medicines. The majority of participants (77%) were willing to deprescribe one or more of their medicines if their doctor said it was possible. There was no association with sex, age or the number of medicines and willingness to deprescribe. After adjustment for baseline characteristics, there was a strong positive association between willingness to deprescribe and saying that because they have a good relationship with their GP, they would feel that deprescribing was safe OR 11.3 (95% CI: 4.64–27.3) and agreeing that they would be willing to deprescribe if new studies showed an avoidable risk OR 8.0 (95% CI 3.79–16.9). From the open questions, the most mentioned barriers towards deprescribing were patients feeling well on their current medicines and being convinced that they need all their medicines. Conclusions Most older adults with polypharmacy are willing to deprescribe. GPs may be able to increase deprescribing by building trust with their patients and communicating evidence about the risks of medication use.

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