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Journal article

Falls after discharge from hospital: is there a gap between older peoples’ knowledge about falls prevention strategies and the research evidence?

Authors:
HILL Anne-Marie, et al
Journal article citation:
Gerontologist, 51(5), October 2011, pp.653-662.
Publisher:
Gerontological Society of America

This study explored whether older people were prepared to engage in appropriate falls prevention strategies after discharge from hospital in Swan Districts hospital, Perth, Australia. Three hundred and thirty three older patients about to be discharged from hospital were surveyed about their knowledge regarding falls prevention strategies. Participants were asked to suggest strategies to reduce their falls risk at home after discharge, and their responses were compared with reported research evidence for falls prevention interventions. Strategies were classified into 7 categories: behavioural; support while mobilising; approach to movement; physical environment; visual; medical; and activities or exercise. Although exercise has been identified as an effective falls risk reduction strategy, only about 3% of participants suggested engaging in exercises. Falls prevention was most often conceptualised by participants as requiring one or two strategies for avoiding an accidental event, rather than engaging in sustained multiple risk reduction behaviours. Overall, patients had low levels of knowledge about appropriate falls prevention strategies. The authors concluded that health care workers should design and deliver falls prevention education programmes specifically targeted to older people discharged from hospital.

Journal article Full text available online for free

Taking control after fall induced hip fracture

Authors:
McMILLAN Laura, et al
Journal article citation:
Generations Review, 21(2), April 2011, Online only
Publisher:
British Society of Gerontology

Semi-structured interviews were carried out with 19 older people aged between 67-89 years who had sustained a fall-induced hip fracture, and had been discharged home. Using grounded theory, a core category of ‘taking control’ emerged. The three stages that people moved through in the process of taking control after hip fracture were: ‘going under’, ‘keeping afloat’ and ‘gaining ground’. Nautical metaphors emphasise the precarious and unstable conditions of life after hip fracture, as well as conceptualising the physical and emotional struggles that people faced in ‘balancing’ help and risk. The study stresses the role that healthcare professionals have in facilitating restoration of control and increasing self efficacy.

Journal article Full text available online for free

Can't live at home, can't live in care

Author:
-
Journal article citation:
Community Care, 9.7.09, 2009, pp.26-27.
Publisher:
Reed Business Information

The family of a women of 84 are at a loss at what to do when, despite her strong desire to live at home, it becomes clear she is unable to live independently and inadequate care is provided. Two professionals give their opinions of how to progress the case and the family's point of view is also outlined.

Journal article Full text available online for free

Supporting older people through a hospital stay

Author:
SOCIAL CARE INSTITUTE FOR EXCELLENCE
Journal article citation:
Community Care, 18.9.08, 2008, pp.36-37.
Publisher:
Reed Business Information

Highlights good practice when working with older people admitted to hospital.

Journal article

Delays in discharging elderly psychiatric in-patients

Authors:
HANIF Ifran, RATHOD Bhupendra
Journal article citation:
Psychiatric Bulletin, 32(6), June 2008, pp.211-213.
Publisher:
Royal College of Psychiatrists

The issue of elderly psychiatric patients remaining in hospitals after being declared medically fit is of concern to doctors, hospital managers and politicians alike. This article sets out the findings from a study involving elderly psychiatric patients at a district general hospital, undertaken to establish the actual lengths, reasons for and financial implications of delays in discharge. The study involved 50 in-patients, all of whom had been discharged over the 3-month study period.  More than half of the patients in the sample were subject to some delay in discharge and for patients waiting for Elderly Mentally Infirm (EMI) placements this averaged 50 days. Collectively, nearly 25% of the time spent in hospital was due to delay. The cost to the hospital was estimated at more than £700 000 in 1 year. Patients are being put at extra risk in terms of their health by being delayed in hospital. Issues of institutionalisation, nosocomial infections and falls are of primary concern.

Journal article

Evidence that supports the value of social work in hospitals

Authors:
AUERBACH Charles, MASON Susan E., LAPORTE Heidi H.
Journal article citation:
Social Work in Health Care, 44(4), 2007, pp.17-32.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

In the US context, there can be a divergence of views on the value of hospital social workers. On the one hand, they are seen as essential to ensuring speedy discharge with appropriate social care support while, on the other, hospital administrators may see them as an unnecessary luxury in face of pressure to contain costs. This paper reports on a study of 64,722 patients admitted to a medical-surgical unit between 2002 and 2004, of whom 10,156 (15.7%) received social work services. Sixty per cent of this sub-group were aged 70 or over, compared to a mean age for the sample of 56.2 years, and their mean length of stay was 11.4 days, compared to 4.3 days for non-social work patients. This difference is statistically significant and the authors attribute it to the fact that social workers dealt with older and more difficult to place patients. The data for the study were derived from the hospital’s patient discharge tracking system, and the authors argue that such a tracking system can help provide objective evidence of the value of social work services in acute care hospitals. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street,  Binghamton, NY 13904-1580).

Book

Directory of services for older people 2007/08

Author:
TRUELOVE Angharad
Publisher:
Keyways
Publication year:
2007
Pagination:
300p.
Place of publication:
Chichester

Published in co-operation with the Guardian, this new directory provides a comprehensive directory of contact details of services for older people, helping you to make a referral, transfer or discharge. This reference book will put you directly in touch with specialists, clinics and key teams in PCTs, County Councils and hospitals across the UK.

Journal article

Part of the problem or part of the solution? The role of care homes in tackling delayed hospital discharges

Authors:
GLASBY Jon, HENWOOD Melanie
Journal article citation:
British Journal of Social Work, 37(2), February 2007, pp.299-312.
Publisher:
Oxford University Press

As part of current UK policies to reduce the number of delayed hospital discharges, a number of commentators have identified an alleged crisis in the care home market as one of key contributing factors. With local authorities under pressure to cut costs, it is argued, the number of care homes is reducing, and delays in hospital can often result. Behind this diagnosis is a series of assumptions about the role and nature of care home provision, the appropriateness of this form of service for many older people, and the need for more care homes to reduce the number of hospital delays. In order to explore and critique these assumptions, this paper reviews the role of care homes in tackling delayed discharges, and argues the need for fewer and different care home placements rather than more of this type of provision.

Journal article Full text available online for free

Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

Authors:
CROTTY Maria, et al
Journal article citation:
British Medical Journal, 12.11.05, 2005, pp.1110-1113.
Publisher:
British Medical Association

This Australian study aimed to assess the effectiveness of moving patients who are waiting in hospital for a long term care bed to an off-site transitional care facility. The participants were 320 elderly patients  in acute hospital beds (212 randomised to intervention, 108 to control). The intervention used was a transitional care facility where all patients received a single assessment from a specialist elder care team and appropriate ongoing therapy. The main outcome measures used included the length of stay in hospital, rates of readmission, deaths, and patient's functional level (modified Barthel index), quality of life (assessment of quality of life), and care needs (residential care scale) at four months. From admission, those in the intervention group stayed a median of 32.5 days in hospital. In the control group the median length of stay was 43.5 days. Patients in the intervention group took a median of 21 days longer to be admitted to permanent care than those in the control group. In both groups few patients went home (14 (7%) in the intervention group v 9 (9%) in the control group). There were no significant differences in death rates (28% v 27%) or rates of transfer back to hospital (28% v 25%). The authors conclude that for frail elderly patients who are awaiting a residential care bed transfer out of hospital to an off-site transitional care unit with focus on aged care "unblocks beds" without adverse effects.

Journal article

Integrating health care services for older people

Author:
ROSBOTHAM-WILLIAMS Anne
Journal article citation:
Nursing Times, 6.8.02, 2002, pp.40-41.
Publisher:
Nursing Times

Reports on a project to increase the number of patients reached by inpatient and community services for older people in Liverpool. Patients were assessed in the local acute hospital assuming that they would benefit from intermediate care. The number of transfers to intermediate care trebled as a result of this change of focus.

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