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The assessment of pain in older people: national guidelines
- Authors:
- ROYAL COLLEGE OF PHYSICIANS, BRITISH GERIATRICS SOCIETY, BRITISH PAIN SOCIETY
- Publisher:
- Royal College of Physicians
- Publication year:
- 2007
- Pagination:
- 13p.
- Place of publication:
- London
Pain is a subjective, personal experience, and its assessment is particularly challenging in the presence of severe cognitive impairment, communication difficulties or language and cultural barriers. As a result it is often under-recognised and under-treated in older people. These guidelines form part of a series intended to inform those aspects of physicians’ clinical practice which may be outside their own specialist area and are designed to help them make rapid, informed decisions. The advice is based on synthesis of the best available evidence and expert consensus gathered from practising clinicians and service users. The guidelines set out the key components of assessing pain in older people, together with a variety of practical scales that may be used with different groups, including those with cognitive or communication impairment. The purpose is to provide professionals with a set of practical skills to assess pain as the first step towards its effective management. The guidance is relevant to all healthcare and social care staff and can be applied in a wide variety of settings, including the older person’s own home, in care homes, and in hospital.
Using clinical signs of neglect to identify elder neglect cases
- Authors:
- FRIEDMAN Lee S., et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 29(4), 2017, pp.270-287.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual’s residence to identify and assist neglected individuals is in a medical setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack of comprehensive guidelines on which clinical signs to use in screening tools for neglect among patients treated in hospitals. Using the DELPHI method, a group of experts developed and tested a scale to be used as a pre-screener that conceptually could be integrated into electronic health record systems so that it could identify potential neglect cases in an automated manner. By applying the scale as a pre-screener for neglect, the tool would reduce the pool of at-risk patients who would benefit from in-depth screening for elder neglect by 95%. (Publisher abstract)
The prevention, diagnosis and management of delirium in older people: national guidelines
- Authors:
- BRITISH GERIATRICS SOCIETY, ROYAL COLLEGE OF PHYSICIANS
- Publisher:
- Royal College of Physicians
- Publication year:
- 2006
- Pagination:
- 18p.
- Place of publication:
- London
Delirium (acute confusional state) is a common condition in the elderly, affecting up to 30% of all older patients admitted to hospital. The hospital environment often precipitates or exacerbates episodes of delirium. Patients who develop delirium have high mortality, institutionalisation and complication rates and have longer lengths of stay than non-delirious patients. Delirium is often not recognised by clinicians and is often poorly managed. Recent evidence, however, demonstrates that improved understanding of delirium among health professionals and improved attention to the environment around at-risk patients can both prevent the onset of delirium and curtail episodes that do arise. The aim of these guidelines is to provide healthcare professionals with a practical approach to the identification, prevention and management of delirium. While developed primarily with a view to hospital care, the principles within the guidelines are also highly relevant to intermediate and community care settings. The appropriate management of older people at risk of delirium or who develop delirium will greatly enhance the quality of life for individuals and will be cost effective for the NHS in terms of resources required for the management of delirium and patients' length of stay.
Dementia: costing report: implementing the NICE SCIE guidance in England
- Author:
- NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
- Publisher:
- National Institute for Health and Clinical Excellence
- Publication year:
- 2006
- Pagination:
- 41p.
- Place of publication:
- London
This costing report looks at the resource impact of implementing the NICE-SCIE guideline ‘Dementia: supporting people with dementia and their carers in health and social care’ in England. Due to the complexity of this guideline, this report focuses on the recommendations that are considered to have a significant impact on resources and will therefore require the additional resources to implement or that will generate savings. The recommendations that are included in the cost template are the increases in psychological therapy offered to carers of people with dementia, structural imaging requirements, and a reduction in the use of electroencephalograms (EEGs). Other recommendations, such as those relating to the coordination and integration of health and social care, were also considered, but the cost implications were not included in this report due to varying baseline practice across organisations. The report calculates the cost of fully implementing this guideline to be £40.63 million. However, it states that it is reasonable to expect that additional costs will be incurred over and above those identified by the assessment.
Dementia: audit criteria
- Author:
- NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
- Publisher:
- National Institute for Health and Clinical Excellence
- Publication year:
- 2006
- Pagination:
- 17p.
- Place of publication:
- London
This document advices on audit criteria to assist NHS acute and primary care trusts and social care providers to determine whether the service is implementing, and is in compliance with, the NICE-SCIE guideline ‘Dementia: supporting people with dementia and their carers in health and social care’. It advises that the audit should ideally cover a sample of 100 people presenting with dementia, or suspected dementia, over a period of 12 months. The audit criteria require data to be collected from a range of sources, including policy documents, patient health records and health and social care plans. The audit should be repeated periodically in order to allow organisations to monitor progress towards full compliance.
Fit for frailty: consensus best practice guidance for the care of older people living with frailty in community and outpatient settings
- Author:
- TURNER Gillian
- Publisher:
- British Geriatrics Society
- Publication year:
- 2014
- Pagination:
- 27
- Place of publication:
- London
The first of a two-part guidance on the recognition and management of older patients with frailty in community and outpatient settings. This guide has been produced in association with the Royal College of General Practitioners (RCGP) and Age UK and aims to be an invaluable tool for social workers, ambulance crews, carers, GPs, nurses and others working with older people in the community. The guidance will help them to recognise the condition of frailty and to increase understanding of the strategies available for managing it. In the guidelines, the British Geriatrics Society (BGS) calls for all those working with older people to be aware of, and assess for frailty. It dispels the myth that all older people are frail and that frailty is an inevitable part of age. It also highlights the fact that frailty is not static. Like other long term conditions it can fluctuate in severity. (Edited publisher abstract)
How can we help older people not fall again?: implementing the Older People's NSF Falls Standard; support for commissioning good services
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2003
- Pagination:
- 72p.
- Place of publication:
- London
The negative impact of falls and related injuries on older people and health and social care systems is clear. The NSF for Older People Standard 6 aims to prevent falls and reduce their impacts. This document provides guidance, primarily for commissioners, on how to implement that standard and achieve benefits for older people and health and social care systems. ree key elements of good practice in commissioning services to address falls and their impacts were identified: cost benefit analyses that make the case for investment; strategic commissioning is in itself a valuable tool in developing and sustaining effective services; interventions are most beneficial when targeted on those at risk, based on agreed assessment processes, and integrated in a falls strategy developed with the full range of local services.