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Follow-up services for delirium after COVID-19 - where now?
- Authors:
- RAHMAN Shibley, BYATT Kit
- Journal article citation:
- Age and Ageing, 50(3), 2021, pp.601-604.
- Publisher:
- Oxford University Press
Delirium is a common presentation in older inpatients with coronavirus disease 2019 (COVID-19), and a risk factor for cognitive decline at discharge. The glaring gaps in the service provision in delirium care, regardless of aetiology, after a hospital admission pre-existed the pandemic, but the pandemic arguably offers an opportunity now to address them. Whilst a delirium episode in itself is not a long-term condition, the context of it may well be, and therefore patients might benefit from personalised care and support planning. There is no reason to believe that the delirium following COVID-19 is fundamentally different from any other delirium. We propose that the needs of older patients who have experienced delirium including from COVID-19 could be addressed through a new model of post-acute delirium care that combines early supported discharge, including discharge-to-assess, with community-based follow-up to assess for persistent delirium and early new long-term cognitive impairment. Such a drive could be structurally integrated with existing memory clinic services. To succeed, such an ambition has to be flexible, adaptable and person-centred. To understand the impact on resource and service utilisation, techniques of quality improvement should be implemented, and appropriate metrics reflecting both process and outcome will be essential to underpin robust and sustainable business cases to support implementation of delirium care as a long-term solution. (Edited publisher abstract)
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:
- Oxford University Press
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.
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.
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.
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).
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.
Delivery of home care services after discharge: what really happens
- Authors:
- SIMON Ellen Perlman, et al
- Journal article citation:
- Health and Social Work, 20(1), February 1995, pp.5-14.
- Publisher:
- Oxford University Press
Reports on research carried out in New York State, which obtained systematic feedback about postdischarge implementation. A telephone follow-up study was undertaken to determine the extent to which discharge plans for home services were carried out and to identify factors associated with unsuccessful implementation. Findings suggest that follow-up programmes which move beyond the hospital walls are necessary to ensure that patients receive needed services.
Hospital discharge project
- Authors:
- NEILL June, WILLIAMS Jenny
- Journal article citation:
- Social Services Research, 1 1994, 1994, p.65.
- Publisher:
- Social Services Research Group
Briefly looks at elements of the work carried out by the Research Unit at the National Institute for Social Work (NISW), into the process of hospital discharge.
From pillow to post
- Author:
- VICTOR Christina
- Journal article citation:
- Health Service Journal, 13.8.92, 1992, pp.20-22.
- Publisher:
- Emap Healthcare
Describes an inner-city project which identified deficiencies in admission policies, information flow and discharge arrangement; presents an action checklist to improve the procedures involved.
Adequacy of discharge plans for elderly patients
- Authors:
- MORROW-HOWELL N, PROCTOR Enola K, MUI Ada C.
- Journal article citation:
- Social Work Research and Abstracts, 27(1), March 1991, pp.6-12.
- Publisher:
- National Association of Social Workers
Describes a methodology for evaluating the outcome of discharge planning and for identifying patient and family factors and features of the discharge plans which contribute to success.