Design of housing that improves the quality of life of the high-needs elderly in New Zealand

<p>The ageing population is growing rapidly in New Zealand, and those with high-care needs are increasing at an even higher rate. Government policy calls for ageing-in-place,staying in their own home as long as possible, without entering residential care. Subsequently, there is a growing need for housing that accommodates the impairments and care requirements that typically correspond with ageing. Recently a reduced quality of life (QoL) was reported in one of the independent living options specifically designed for the elderly with care needs in New Zealand. Without change to housing that offers support and care for the elderly, the reduced QoLof residents is likely to remain a problem. A review of extensive literature onQoL and the role of architecture identifies a number of gaps in existing knowledge about housing design that facilitates the QoL of those elderly with high needs. These gaps include that, while the role of architecture is already established with regard to facilitating independence and control, there have been only limited insights into housing design that facilitates a wider range of aspects of QoL such as facilitating personal identity, important activities, relationships and maintaining high quality of care.Given the absence of design frameworks that are useful for designing housing that improves the QoL of the high-needs elderly in New Zealand,this research develops a holistic framework for housing design that improves the QoLfor this cohort. Two phases of survey are conducted in three types of senior housing complexes: retirement villages, and both public and private rental housing for the elderly. First, data on the current situations regarding these housing types, focusing on the models of care and physical environments as well as residents’ care requirements, are obtained through two types of questionnaires. This preliminary survey is followed by a qualitative, ethnographical investigation for the QoL of residents that relate to physical environments. Through semi-structured interviews and full-day observation of 30 elderly people who receive assistance in daily life and their caregivers, as well as documentation of physical environments, data are gathered on their perceptions and spatial use. Numerous themes for QoL emerge and are categorised into six main headings: Control in daily activities, Meaningful leisure activities, Meaningful relationships, Maintenance of possessions, Comfort and Quality of care. A number of design requirements are then identified and discussed with reference to existing knowledge, which leads to the development of a design framework. Housing that improves QoL needs to accommodate a variety of needs that reflect diverse individual preferences, circumstances and types of impairments. There is a need for reorganisation of space to accommodate caregivers, valuable relationships and personal possessions. The careful design of micro space greatly improves residents’ control. The design of a complex is also influential on QoL, particularly for facilitating activities as well as maintaining both privacy and connection. Finally, the potential to implement the framework is examined through designing example models of housing units and complexes. The design framework developed through this research has great potential to improve a wide range of aspects of QoL for the high-needs elderly in New Zealand, thereby helping them maintain satisfying and independent living longer.</p>

Design of housing that improves the quality of life of the high-needs elderly in New Zealand

<p>The ageing population is growing rapidly in New Zealand, and those with high-care needs are increasing at an even higher rate. Government policy calls for ageing-in-place,staying in their own home as long as possible, without entering residential care. Subsequently, there is a growing need for housing that accommodates the impairments and care requirements that typically correspond with ageing. Recently a reduced quality of life (QoL) was reported in one of the independent living options specifically designed for the elderly with care needs in New Zealand. Without change to housing that offers support and care for the elderly, the reduced QoLof residents is likely to remain a problem. A review of extensive literature onQoL and the role of architecture identifies a number of gaps in existing knowledge about housing design that facilitates the QoL of those elderly with high needs. These gaps include that, while the role of architecture is already established with regard to facilitating independence and control, there have been only limited insights into housing design that facilitates a wider range of aspects of QoL such as facilitating personal identity, important activities, relationships and maintaining high quality of care.Given the absence of design frameworks that are useful for designing housing that improves the QoL of the high-needs elderly in New Zealand,this research develops a holistic framework for housing design that improves the QoLfor this cohort. Two phases of survey are conducted in three types of senior housing complexes: retirement villages, and both public and private rental housing for the elderly. First, data on the current situations regarding these housing types, focusing on the models of care and physical environments as well as residents’ care requirements, are obtained through two types of questionnaires. This preliminary survey is followed by a qualitative, ethnographical investigation for the QoL of residents that relate to physical environments. Through semi-structured interviews and full-day observation of 30 elderly people who receive assistance in daily life and their caregivers, as well as documentation of physical environments, data are gathered on their perceptions and spatial use. Numerous themes for QoL emerge and are categorised into six main headings: Control in daily activities, Meaningful leisure activities, Meaningful relationships, Maintenance of possessions, Comfort and Quality of care. A number of design requirements are then identified and discussed with reference to existing knowledge, which leads to the development of a design framework. Housing that improves QoL needs to accommodate a variety of needs that reflect diverse individual preferences, circumstances and types of impairments. There is a need for reorganisation of space to accommodate caregivers, valuable relationships and personal possessions. The careful design of micro space greatly improves residents’ control. The design of a complex is also influential on QoL, particularly for facilitating activities as well as maintaining both privacy and connection. Finally, the potential to implement the framework is examined through designing example models of housing units and complexes. The design framework developed through this research has great potential to improve a wide range of aspects of QoL for the high-needs elderly in New Zealand, thereby helping them maintain satisfying and independent living longer.</p>

A Randomised Evaluation of Low-Dose Cytarabine Arabinoside Plus Lenalidomide Versus Single-Agent Low-Dose Cytarabine Arabinoside in Older Patients with Acute Myeloid Leukaemia: Results from the LI-1 Trial

Background: Many patients with Acute Myeloid Leukemia (AML) diagnosed after 60 years of age are not considered suitable for intensive remission induction chemotherapy, either due to co-morbidities or frailty associated with advanced age. Despite treatment with either a hypomethylating agent or low-dose cytarabine arabinoside (LDAC), survival is usually poor, with 1-year survival after LDAC of 24-37% in NCRI AML16 and historical arms of LI-1. Combination therapy with additional agents represents an attractive option, and has the potential to improve patient outcomes without substantially increasing toxicity. Lenalidomide (Revlimid TM) is an immunomodulatory drug, used to treat myeloma, and some cases of myelodysplastic syndrome, and has potent antineoplastic, anti-angiogenic, anti-inflammatory and pro-erythropoietic properties. Early-phase trials of lenalidomide in AML have demonstrated clinical activity with acceptable toxicity. Aim: To assess the efficacy and tolerability of LDAC+lenalidomide versus LDAC alone in patients aged 60+ unsuitable for intensive therapy. The aim was to double 2-year survival from 11% to 22% (HR 0.69). Methods: LI-1 was an international multicentre, multi-arm, randomised phase II trial developed to study the efficacy and tolerability of novel non-intensive therapies in AML using a "pick a winner" design. LDAC was given at 20mg BD SC on days 1-10 of each course. Lenalidomide was administered orally once daily in a flat 10mg dose for 21 days, where day 1 is day 1 of LDAC with courses occurring at 5-week intervals for courses 1-4. Patients considered to be benefitting after 4 courses, i.e. in remission or stable disease, could continue to receive treatment until disease progression, either with LDAC+lenalidomide at 6-week intervals, or lenalidomide only at 4-week intervals if patient had experienced significant toxicity. Toxicities were recorded using CTCAEv3. Primary objectives included overall survival (OS), complete remission (CR + CRi) achievement, reasons for failure, duration of response (CR/CRi), relapse rates and deaths in first CR. Secondary objectives included toxicity, supportive care requirements, and Quality of Life assessments (measured using EORTC QLQ-30, EQ5D and HADS tools). Results: Between Jan-17 and Jun-19, 202 patients from Denmark (8%), New Zealand (16%) and the UK (76%) were randomised. Median age was 78 years (range 62-89). Overall, 58% were male; 76% de novo AML, 20% secondary AML, and 4% high risk MDS; 1% favourable, 66% intermediate, 19% adverse and 14% unknown cytogenetics; WHO performance status 0 for 15%, 1 for 58%, 2 for 22% and 3 for 5%. Median of 2 courses (range 0-24; mean 3.28) was delivered in LDAC arm and 1 course in LDAC+lenalidomide arm (range 0-25; mean 3.48). Overall response (CR/CRi) was achieved in 40/202 patients (20%), (LDAC+lenalidomide 25%, LDAC 14%, OR 0.45 (0.22, 0.93), P=0.031). 30-day mortality was not significantly increased (19% in both arms); and 2-year OS showed no significant difference (14% vs 11.5%, HR 0.94 (0.69, 1.29, P=0.719). Median OS was 3.5 vs 4.6 months; HR 0.96 (0.71, 1.30), P=0.80. 1-year OS for patients that didn't enter CR/CRi was 6.8% for LDAC+lenalidomide vs 16.9% for LDAC (P=0.028). Cause of death for the majority of patients was resistant/recurrent disease: 45(53%) vs 47(58%). Most adverse events (AEs) were grade 1/2 in both arms. During cycle 1, there were 78 vs 51 grade 3/4 AEs in the LDAC+lenalidomide and LDAC arms, respectively (P=0.02). This included 5 thrombotic events in the LDAC+lenalidomide arm (4 grade 3 and 1 grade 4) and none in the LDAC arm. In course 1, supportive care requirements were higher in terms of both days of antibiotics (7 vs 3; p=0.001) and hospitalisation days (11 vs 6.5; p=0.005) for the LDAC+lenalidomide arm. There was no difference in transfusion requirements. Conclusions: Despite improving the CR/CRi rate, the combination of lenalidomide+LDAC did not improve OS, relapse-free survival or time in remission in elderly patients with AML. The addition of lenalidomide to LDAC resulted in increased toxicity, including episodes of thrombosis, as well as increased supportive care requirements. Alternative strategies to improve survival for elderly patients with AML remain a significant clinical need. Acknowledgements: We are grateful to Blood Cancer UK for funding the trial and Celgene for providing drug and additional support for this IIS. Fig 1: OS All patients Figure 1 Figure 1. Disclosures Copland: Astellas: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Incyte: Honoraria, Research Funding, Speakers Bureau; Jazz: Honoraria, Speakers Bureau; Cyclacel Ltd: Research Funding. Russell: Pfizer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Speakers Bureau; Astellas: Membership on an entity's Board of Directors or advisory committees; Jazz: Research Funding, Speakers Bureau. OffLabel Disclosure: Off label use of lenalidomide in combination with low dose cytarabine will be discussed in the setting of elderly unfit AML.

Engagement of hospital pharmacists and technicians to optimize staffing schedules

Challenges exist in developing work schedules for hospital pharmacy staff due to the need to meet around the clock patient care requirements. Work–life integration and reduced burnout are increasingly important considerations in staff schedules. However, information regarding methods to systematically improve scheduling satisfaction is currently lacking. Hospital pharmacist scheduling surveys were reviewed for solutions in a retreat setting to address growing concerns at our institution. All hospital pharmacists and technicians were surveyed to understand opportunities to improve their schedules. Subsequently, pharmacists participated in a retreat to identify opportunities to share work, prioritize for scheduling improvements, and develop a staffing restructure proposal. Out of 172 pharmacists, 84% completed surveys, whereas 55% of 196 technicians responded. The highest ranked scheduling improvement was a more consistent schedule for both pharmacists and technicians. Several solutions identified during the pharmacist retreat were incorporated into a proposal including decreased weekend staffing frequency (every 3rd to a mix of every 3rd and every 4th), improved scheduling consistency and reduced evenings. Negotiation was among the methods used to identify scheduling solutions. Engagement of frontline staff to lead staffing restructure is expected to ensure success of scheduling changes. Future directions include measuring pharmacist burnout and staff satisfaction before and after change implementation. If successful, the retreat and technician-developed proposal can be used for implementing technician schedule improvements.

COVID-19 Pandemisi ile Mücadele: COVID-19 Olgusu ve Hemşirelik Yönetimi

Millions of people lost their lives due to the Coronavirus (SARS-Cov-2) epidemic that started in China and spread rapidly all over the world. One of the most important problems in combating the disease was the loss of time in early diagnosis of infections and the ineffectiveness of the quarantine screen due to the incubation period of the disease, which can last up to fourteen days. This process poses a high risk to healthcare professionals and especially nurses, who are the first to come into contact with infected people. Currently, there is no definitive treatment for Covid-19. The only proven form of management is isolation and supportive care. Therefore, nurses, who are involved in every level of patient care, have an important role in combating this epidemic. Being a new emerging disease condition for the whole world, there has been created a huge gap regarding how the nursing care of patients with Covid-19 in hospitals will be. The aim of this article is to implement nursing interventions according to Gordon's Functional Health Patterns Model of a patient diagnosed with Covid-19, to highlight the important points that should be taken into consideration during their care, and to guide the nurses working in the field. Data were collected by face-to-face interviewing with the patient, and care was planned, applied and evaluated according to the model. The model of Functional Health Patterns can be used as an easy and convenient model for determining health care requirements and implementing nursing interventions for patient with a positive diagnosis of Covid-19.

Critical Care Requirements Under Uncontrolled Transmission of SARS-CoV-2

Objectives. To estimate the critical care bed capacity that would be required to admit all critical COVID-19 cases in a setting of unchecked SARS-CoV-2 transmission, both with and without elderly-specific protection measures. Methods. Using electronic health records of all 2432 COVID-19 patients hospitalized in a large hospital in Madrid, Spain, between February 28 and April 23, 2020, we estimated the number of critical care beds needed to admit all critical care patients. To mimic a hypothetical intervention that halves SARS-CoV-2 infections among the elderly, we randomly excluded 50% of patients aged 65 years and older. Results. Critical care requirements peaked at 49 beds per 100 000 on April 1—2 weeks after the start of a national lockdown. After randomly excluding 50% of elderly patients, the estimated peak was 39 beds per 100 000. Conclusions. Under unchecked SARS-CoV-2 transmission, peak critical care requirements in Madrid were at least fivefold higher than prepandemic capacity. Under a hypothetical intervention that halves infections among the elderly, critical care peak requirements would have exceeded the prepandemic capacity of most high-income countries. Public Health Implications. Pandemic control strategies that rely exclusively on protecting the elderly are likely to overwhelm health care systems. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e4. https://doi.org/10.2105/AJPH.2020.306151 )

RubiN – continuous care in regional networks: a study protocol for a prospective controlled trial

Background The health care situation of geriatric patients is often multifaceted, complex and often overlaps with social living conditions. Due to the lack of cross-sectoral and interprofessional health care geriatric patients often, receive insufficient care. Only a holistic view enables a comprehensive evaluation of the complex health risks, but also the potential to preserve the health of geriatric patients. The implementation of cross-sectoral, multi-professional case management could reduce the gaps in care, improve the autonomy of the geriatric patients in their own homes, and allow them to retain it as long as possible. The “RubiN” project examines the effects of multi-professional, cross-sectoral and assessment-based case management on the quality of the care of geriatric patients. The results of the study aim to show whether geriatric patients receive better care using case management than patients who receive standard health care. In addition, data on the effects of case management on practices of general practitioners (GP), the satisfaction with the care concept amongst the case managers, patients and relatives will be collected. Furthermore, a health economic analysis will be carried out. Methods The project is designed as a prospective controlled study and compares geriatric patients from practice networks in different regions in Germany. Inclusion criteria are: Age ≥ 70 years and care requirements from two different care complexes (identified with the screening instrument ‘Angelina’-questionnaire). The intervention is the use of a geriatric case management, where health care is organised based on patient-specific care requirements. Five practice networks of physicians will implement the intervention (n = 3200 patients) and three practice networks will serve as the control group (n = 1200 patients). The primary endpoint is the ability to manage activities of daily living, measured using the Barthel Index. The patients in the intervention group receive geriatric case management and the patients in the control networks receive standard care (“care as usual”). The analysis of the primary data, which is pseudonymised, occurs according to the intention-to-treat principle. For this purpose, the endpoints will be analysed using a group comparison after 12 months. For the health economic analysis, secondary data from the statutory health insurance providers will be included in the analysis, in addition to the primary data. Data for the analysis of the effects the concept has on the GP practices as well as on the satisfaction of the project participants will be collected with questionnaires and interviews with experts. Discussion The implementation of cross-sectoral and interdisciplinary geriatric case management has been a topic of discussion for years, whereby positive effects have already been-shown. This planned study will be the first evaluation of the effect of case management for geriatric patients with a very large sample. In addition, the effects of case management on the GP practices and also on the relatives of the geriatric patients will be shown. It is intended that the study results pave the way for a widespread implementation of this concept. Trial registration German Clinical Trials Register, ID: DRKS00016642. Registered on 29 October 2019 - Retrospectively registered.

Using Google Trends to Determine Current, Past, and Future Trends in the Reptile Pet Trade

Reptiles are one of the most popular exotic pets in the world, with over a third of all described species currently being traded. However, the most commonly available reptiles are typically non-threatened, captive-bred, and/or domestically obtained, which means they are also largely unregulated and unmonitored, resulting in a large portion of the reptile pet trade remaining unknown. In this study, the past, current, and future trends of the most popular reptiles in the pet trade were examined. Google Trends was used to determine the global popularity of the most popular pets from 2004 to 2020 and compared to the results from an online survey sent to individuals involved in the reptile trade. The most popular pets from the previous five years were also compared globally across regions and countries. The results determined that the most popular reptile species during the last decade is by far bearded dragons, followed by ball pythons and leopard geckos. Although the survey results were similar when asked what the top reptiles were, most respondents named ball pythons as the most popular reptile. However, when asked what reptiles had lost the most popularity during the previous decade, the survey respondents named green iguanas, Burmese pythons, chameleons, red-eared sliders, and green anoles, concurring with what was found with Google Trends. The reptiles thought to be more popular in the upcoming decade by the survey participants were blue-tongued skinks, tegus, uromastyx, crested geckos, and ball pythons—most of which did indeed show an increase in popularity during the last decade, as indicated with Google Trends. The results from Google Trends demonstrated that ball pythons and crested geckos have increased their popularity more than any other reptile in the last two decades. Reptile popularity also differed between countries, with bearded dragons the most popular reptile in Australia, Western Europe, the U.S., and Canada. Leopard geckos were the most popular reptile in Italy and Turkey, and ball pythons were the reptile of choice in Mexico, Indonesia, and India. The general finding of this study is that the reptiles declining in popularity were mostly wild-caught or restricted due to regulations, while current and future species were captive-bred and available in many varieties or morphs. The most popular species were also docile, medium-sized, and easy to handle, with relatively simple care requirements. This study demonstrates that Google Trends can be a useful tool for determining relative popularity among reptiles, or any other pet group, with results closely mirroring those obtained through direct surveying of people involved in the pet trade. However, unlike surveys, this analysis is quick, quantifiable, and can show what is popular and in-demand not only at the global level but at much finer scales. Thus, Google Trends can be a valuable tool in many research applications, especially in topics that may otherwise be difficult to monitor and quantify.