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A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’
- Authors:
- CONROY Simon Paul, et al
- Journal article citation:
- Age and Ageing, 40(4), July 2011, pp.436-443.
- Publisher:
- Oxford University Press
A systematic review on models of care for elderly people following admission to acute medical units, or emergency departments, and early discharge. Five, highly varied, randomised controlled trials were included in the systematic review. There was no firm evidence that either of the forms of comprehensive geriatric assessment (CGA) examined, whether nurse-led or geriatrician-led, has any effect on the outcomes reported – including mortality and readmission. Although there is no clear evidence of benefit with CGA in this population, due to the small number of trials identified, further well-designed research is justified.
Fall assessment in older people
- Authors:
- CLOSE Jacqueline C. T., LORD Stephen R.
- Journal article citation:
- British Medical Journal, 17.9.11, 2011, pp.579-582.
- Publisher:
- British Medical Association
Draws on the authors own knowledge, evidence from recent Cochrane reviews and national and international guidelines to summarise the latest knowledge on falls assessment in older people. Coverage includes the best ways to assess and screen for the risk of falling in the community, in hospitals, and in nursing and residential care. Validated tests and tools are listed and case scenarios provided. Challenges such as the multifactoral nature of falls prevention and the need for further research on falls prevention initiatives are also discussed.
Assessing and helping carers of older people
- Authors:
- CAMERON I. D., et al
- Journal article citation:
- British Medical Journal, 24.9.11, 2011, pp.630-633.
- Publisher:
- British Medical Association
Drawing on recent guidelines and research this clinical review presents recent knowledge and practice on assessing and helping older carers. The review has sections on: how carers should be identified; how a carer assessment should be undertaken; useful interventions to support carers; and the major challenges facing clinicians regarding assessment. Short case scenarios are used to illustrate the issues.
Cognitive assessment of older people
- Authors:
- YOUNG John, MEAGHER David, MACLULLICH Alasdair
- Journal article citation:
- British Medical Journal, 10.9.11, 2011, pp.527-531.
- Publisher:
- British Medical Association
This clinical review article focuses on cognitive assessment of older people (those aged over about 65 years) in the context of possible dementia, delirium, and depression. The article highlights the need for accurate assessments to include three components; observation of the patient, accounts from the carer, and the results of assessment instruments. It also describes some brief cognitive tests. The authors draw on their own experience; the guidelines on dementia, delirium, and depression published by the National Institute for Health and Clinical Excellence (NICE); and a systematic review of cognitive assessment instruments.
Functional assessment in older people
- Authors:
- QUINN T. J., et al
- Journal article citation:
- British Medical Journal, 3.9.11, 2011, pp.469-473.
- Publisher:
- British Medical Association
This clinical review looks at the functional assessment of older people by generalist clinicians. The review discusses how physical function is best assessed; the different aspects of a clinical screening assessment, adapted from the PULSES assessment tool); useful standardised assessment tools; and the challenges of functional assessment. It is based on the author's clinical and research experience and informed by a search of published literature.
How to get leaner, but not meaner
- Authors:
- MUNDY Sue, LEWIS Eirian
- Journal article citation:
- Health Service Journal, 21.4.11, 2011, pp.20-22.
- Publisher:
- Emap Healthcare
Gateshead adult services have applied 'lean' principles to their core assessment process, from the point of referral to a case being closed. The article looks at the five step process used and how the initiative has improved services whilst reducing costs.
The transition from cognitive impairment to dementia: older people's experiences
- Authors:
- MANTHORPE Jill, et al
- Publisher:
- National Institute for Health Research
- Publication year:
- 2011
- Pagination:
- 119p.
- Place of publication:
- London
The aim of this study was to understand the experiences, expectations and service needs of the person who is becoming the person with dementia, from the perspectives of the older person and their supporter or carer. Separate interviews were carried out with 27 people with memory problems as well as 26 key supporters and carers, regarding their perceptions of expectations, experiences and perceptions of the process of assessment and diagnosis. The interviews were transcribed and analysed to generate themes and codes. Few of the participants experienced the system of memory assessment as patient-centred. Instead, they felt that they were kept waiting for long periods of time without knowing what was going on, and sometimes experienced tests and assessments as distressing in settings that could be alarming. Five transitions in the experience of the participants were identified: ‘internalising dialogue’; ‘confirming positions’; ‘seeking expert advice’; ‘being tested’; and ‘seeking understanding’. The findings suggest that transition is not a linear process. Professionals would be better able to provide tailored support to individuals and their carers at this uncertain time if they are informed of the ‘journey’ from the insights of those who have undertaken it. Recommendations are providing relating to: national issues; issues for commissioners and practitioners; and research questions.
Involving specialist clinicians in policies for integrated care
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Journal of Integrated Care, 19(6), 2011, pp.14-22.
- Publisher:
- Emerald
Drawing on a survey examining the impact of the Single Assessment Process for Older People, a policy aimed at integrating assessments, this article discusses issues concerning the involvement of clinicians in integrated approaches to assessment. Cross-sectional surveys of specialist clinicians (geriatricians and old age psychiatrists) were undertaken in 2004 and 2005 as part of a study examining the initial impact of the single assessment process. This article presents a review of the data, exploring the involvement of specialist clinicians in assessment practice. It reports that clinician involvement was limited, with changes to assessment predominantly related to paperwork, and little involvement of older people. The authors suggest that clinicians have previously not been engaged in policies around integrated assessments, that factors that can help engagement include development of a shared vision and appropriate systems to promote information sharing, and that there are lessons to learn in terms of the factors that may help or hinder the achievement of integrated practice.
Substance misuse among care home residents
- Author:
- RAO Tony
- Journal article citation:
- Nursing and Residential Care, 13(12), December 2011, pp.594-595.
- Publisher:
- MA Healthcare Ltd.
- Place of publication:
- London
Substance misuse can affect residents in care homes, with alcohol and prescription medications likely to be especially problematic. This article looks at the problem, how it can affect residents and what care homes can do to assess people and manage the issue. Alcohol related brain injury, such as Korsakoff's syndrome, is also briefly discussed.
Giving courts the information necessary to implement limited guardianships: are we there yet?
- Author:
- GIBSON Laura
- Journal article citation:
- Journal of Gerontological Social Work, 54(8), November 2011, pp.803-818.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Guardianship is a legal mechanism used to appoint substitute decision makers to assist vulnerable individuals who are unable to take care of their personal or financial needs. If a person has the capacity to function in some areas, a limited guardianship can be used to preserve rights in areas of strength. The aim of this study was to learn how interdisciplinary assessment teams in Kentucky contribute to the guardianship process for older adults and what kinds of information they are providing to the courts. A retrospective analysis of written court records and audiotapes of court testimony for adult guardianship cases was conducted. A total of 240 clinical assessments were reviewed for 80 court petitions. Guardianship assessments and court testimony were reviewed to explore the comprehensiveness of reports to the court, the consideration of less restrictive alternatives, and the use of limited guardianships. Ninety-seven percent of petitions were granted; 82% of these were full guardianships and 18% were limited. The findings indicate that more detailed information about functional abilities, as well as consideration of less restrictive alternatives, needs to be presented to the courts. Recommendations are given for ways in which social workers can improve the information given to the courts and advocate for elders in this situation.