scholarly journals Fragmentation of care: a major challenge for older people living with multimorbidity

2021 ◽  
Vol 15 ◽  
Author(s):  
Nafisat Oladayo Akintayo-Usman
Keyword(s):  
Older People ◽  
Effective Means ◽  
Healthcare Providers ◽  
Professional Collaboration ◽  
Person Centered Care ◽  
Care Approach ◽  
Centered Care ◽  
Public Health Challenge ◽  
New Guidelines ◽  
Fragmentation Of Care

As the world’s aging population is rising, so too is the prevalence of multimorbidity increasing among older adults. Multimorbidity is therefore a growing public health challenge among the older population. Researchers have reported fragmentation of care to be one of the major problems facing this population. The leading factors responsible for this issue are use of disease-centered approaches and specialism to manage people living with multimorbidity; poor communication between professionals and people with multimorbidity; and poor communication among the professionals caring for these people. Failure to address this problem leads to increased treatment burden, including polypharmacy. There is therefore a need for all healthcare professionals caring for older people living with multimorbidity to address this problem by providing continuous, coordinated person-centered care. For the person-centered care approach to be well-coordinated and continuous, there is a need for effective means of sharing information among healthcare providers, to facilitate inter-professional collaboration; extension of consultation time to better enable healthcare providers to understand the patient's needs; review of organizational frameworks and policies where necessary; and development of new guidelines for the management of multimorbidity.

scholarly journals Person-Centered Care in Persons Living with Dementia: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Kyung Hee Lee ◽  
Ji Yeon Lee ◽  
Bora Kim
Keyword(s):  
Systematic Review ◽  
Cognitive Function ◽  
Effect Size ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
Healthcare Providers ◽  
Clinical Excellence ◽  
Dementia Care ◽  
Person Centered Care ◽  
Centered Care

Abstract Background and Objectives The concept of person-centered care has been utilized/adapted to various interventions to enhance health-related outcomes and ensure the quality of care delivered to persons living with dementia. A few systematic reviews have been conducted on the use of person-centered interventions in the context of dementia care, but to date, none have analyzed intervention effect by intervention type and target outcome. This study aimed to review person-centered interventions used in the context of dementia care and examine their effectiveness. Research Design and Methods A systematic review and meta-analysis were conducted. We searched through five databases for randomized controlled trials that utilized person-centered interventions in persons living with dementia from 1998 to 2019. Study quality was assessed using the National Institute for Health and Clinical Excellence. The outcomes of interest for the meta-analysis were behavioral and psychological symptoms in dementia (BPSD) and cognitive function assessed immediately after the baseline measurement. Results In total, 36 studies were systematically reviewed. Intervention types were: reminiscence, music, and cognitive therapies, and multisensory stimulation. Thirty studies were included in the meta-analysis. Results showed a moderate effect size for overall intervention, a small one for music therapy, and a moderate one for reminiscence therapy on BPSD and cognitive function. Discussion and Implications Generally speaking, person-centered interventions showed immediate intervention effects on reducing BPSD and improving cognitive function, although the effect size and significance of each outcome differed by intervention type. Thus, healthcare providers should consider person-centered interventions as a vital element in dementia care.

scholarly journals Healthcare professionals’ practice and interactions in older peoples’ cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maiken Hjuler Persson ◽  
Christian Backer Mogensen ◽  
Jens Søndergaard ◽  
Helene Skjøt-Arkil ◽  
Pernille Tanggaard Andersen
Keyword(s):  
Decision Making ◽  
Older People ◽  
New Public Management ◽  
Healthcare Professionals ◽  
Clinical Care ◽  
Research Integrity ◽  
Care Practice ◽  
Observation Study ◽  
Person Centered Care ◽  
Centered Care

Abstract Background Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals’ identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals’ practice. Aim This study aimed to explore and analyse how healthcare professionals’ interactions and practice influence older peoples’ clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged. Methods This qualitative study arises from a hermeneutical stand within the interpretative paradigm. Focusing on the healthcare professionals’ interactions and practice we followed the clinical care trajectories of seven older people (aged > 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines. Results The analysis revealed four themes: 1)“The end justifies the means – ‘I know what is best for you’”, 2)“Basic needs of care overruled by system effectiveness”, 3)“Treatment as a bargain”, and 4)“Healthcare professionals as solo detectives”. Conclusion Dissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.

scholarly journals ‘Patient-Centered Care’ for Complex Patients with Type 2 Diabetes Mellitus–-Analysis of Two Cases

2013 ◽  
Vol 6 ◽  
pp. CMED.S12231 ◽  
Author(s):  
Jennifer M. Hackel
Keyword(s):  
Older Adults ◽  
Diabetes Management ◽  
Tight Control ◽  
Patient Centered ◽  
Treatment Approaches ◽  
Person Centered Care ◽  
Complex Patients ◽  
Centered Care ◽  
New Guidelines ◽  
Primary Care Practitioners

Purpose This paper serves to apply and compare aspects of person centered care and recent consensus guidelines to two cases of older adults with poorly controlled diabetes in the context of relatively similar multimorbidity. Methods After review of the literature regarding the shift from guidelines promoting tight control in diabetes management to individualized person centered care, as well as newer treatment approaches emerging in diabetes care, the newer guidelines and potential treatment approaches are applied to the cases. Results By delving into the clinical, behavioral, social, cultural and economic aspects of the two cases in applying the new guidelines, divergent care goals are reached for the cases. Conclusions Primary care practitioners must be vigilant in providing individualized diabetes treatment where multiple chronic illnesses increase the complexity of care. While two older adults with multimorbidity may appear at first to have similar care goals, their unique preferences and support systems, as well as their risks and benefits from tight control, must be carefully weighed in formulating the best approach. Newer pharmaceutical agents hold promise for improving the possibilities for better glycemic control with less self-care burden and risk of hypoglycemia.

scholarly journals Advocating a person-centered care approach to drug safety

2021 ◽  
pp. 1-3
Author(s):  
Josianne Scerri ◽  
Julie Churchill ◽  
David Banks ◽  
Janet Sultana
Keyword(s):  
Drug Safety ◽  
Person Centered Care ◽  
Care Approach ◽  
Centered Care

scholarly journals Continuing education interventions about person-centered care targeted for nurses in older people long-term care: a systematic review

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mari Pakkonen ◽  
Minna Stolt ◽  
Andreas Charalambous ◽  
Riitta Suhonen
Keyword(s):  
Older People ◽  
Continuing Education ◽  
Long Term Care ◽  
Educational Interventions ◽  
Term Care ◽  
Person Centered Care ◽  
Centered Care ◽  
Education Interventions

Abstract Background Person-Centered Care is often seen as an indicator of quality of care. However, it is not known whether and to what extent person-centered care can be enhanced by continuing education interventions in older people’s long-term care settings. This systematic review aimed to analyze and synthesize the existing research literature about person-centered care-based continuing educational interventions for nurses working in long-term care settings for older people. Methods Five databases were searched 6/2019 and updated 7/2020; PubMed (Medline), CINAHL, PsycINFO, Cochrane and Eric using the keywords person-centered car* OR person-centred car * OR patient-centered car* OR client-centered car* OR tailored car* OR resident-centered car* OR individualized car* AND older* OR elder* OR old person* AND Long-Term Care OR Nursing home OR 24-h treatment OR long-term treatment. Twenty-seven full texts from 2587 initially retrieved citations were included. Results The continuing educational interventions found were divided into five themes: person-centered interventions focusing on medication; interaction and caring culture; nurses’ job satisfaction; nursing activities; and older people’s quality of life. The perspective of older people and their next of kin about the influence of continuing education interventions were largely absent. The background theories about interventions, the measurements taken, and the clarity around the building blocks of the continuing-care interventions need further empirical verification. The pedagogical methods used were mainly quite behavioristic mostly lectures and seminars. Conclusion Most of person-centered care continuing education interventions are effective. Still more empirical research-based continuing education interventions are needed that include learner-centered pedagogical methods, with measurable outcomes that consider the opinions of older people and their next of kin. Continuing educational interventions for nurses need to be further developed to strengthen nurse’s competence in person-centered care, job satisfaction and for better quality of care.

scholarly journals Person-Centered Care for Family Caregivers: Co-Designing an Education Program for the Healthcare Workforce

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 327-327
Author(s):  
Jasneet Parmar ◽  
Sharon Anderson ◽  
Cheryl Pollard ◽  
Lesley Charles ◽  
Bonnie Dobbs ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Health Workforce ◽  
Education Program ◽  
Healthcare Providers ◽  
Care Education ◽  
Competency Based Education ◽  
Person Centered Care ◽  
Healthcare Workforce ◽  
Centered Care ◽  
Competency Based

Abstract Background Research recommends the healthcare workforce receive competency-based education to support family-caregivers [FCGs}. typically, education has been directed at FCG’s to increase their care skills rather that at healthcare providers to provide person-centered care to FCGs. Objectives: We present the co-design process used to create a competency-based education program for the healthcare workforce that ensures a person-centered focus on FCGs and introduce our Health Workforce Caregiver-Centered Care Education. Approach: Co-design is the act of creating with stakeholders to ensure useable results that meet stakeholder’s needs. We began by coining the concept “caregiver-centered care,” defined as a collaborative working relationship between families and healthcare providers aimed at supporting FCGs in their caregiving role, decisions about care management, and advocacy. From this definition we co-designed, then validated the Caregiver-Centered Care Competency Framework in a Delphi Process. Stakeholders (n= 101) including FCGs, providers, policy makers, community organizations, researchers, and educational designers then used effective practices for health workforce education to co-design the ‘foundational’ level of a Caregiver Centered Care education. Results Teaching and learning resources include six competency-aligned educational modules with videos and interactive exercises that encourage reflection. With the COVID-19 pandemic, we moved the education online (caregivercare.ca). In the first four months online, 815healthcare providers completed the education. We continue to use mixed methods to evaluate the Caregiver-Centered Care Education, for acceptability and effectiveness, in five care contexts (primary, acute, home, supportive living, long-term care). Conclusion We expect that our education will support caregiver-centered care in all healthcare settings.

scholarly journals Person‐centered care for older people with dementia in the acute hospital

2017 ◽  
Vol 4 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Felicia Hui En Tay ◽  
Claire L. Thompson ◽  
Chih Ming Nieh ◽  
Chih Chiang Nieh ◽  
Hui Mien Koh ◽  
...  
Keyword(s):  
Older People ◽  
Acute Hospital ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care ◽  
Care For Older People
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