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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.
Emergency bed use: what the numbers tell us
- Authors:
- POTELIAKHOFF Emmil, THOMPSON James
- Publisher:
- King's Fund
- Publication year:
- 2011
- Pagination:
- 6p.
- Place of publication:
- London
This briefing paper looks at emergency hospital admissions and identifies the groups of patients with the greatest scope for reductions in bed use. It examines why we need to understand more about bed use for emergency admissions and what progress has been made in reducing bed use for emergency admissions, and how reducing bed use for emergency admissions can lead to improved quality of care and patient experience. It highlights the importance of reducing lengths of stay for some patients admitted as emergencies, especially older people, and the changes this will mean for hospital care. The briefing is particularly useful for providers and commissioners.
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.
A discharge protocol: can it make a difference?
- Authors:
- SHIPPEN Jeanette, YOUNG Julie, WOODS Tony
- Journal article citation:
- Journal of Dementia Care, 19(6), November 2011, pp.26-29.
- Publisher:
- Hawker
This article outlines a practice development initiative undertaken by the staff on Druridge Ward, a 24 patient unit for people with dementia who present with complex challenging behaviour, part of the Northumberland Tyne and Wear NHS foundation trust. The discharge protocol aims to ensure that all patients discharged from a ward to a care home are discharged in a safe and timely manner that meets the needs of themselves and their families. The staff were committed to developing a discharge protocol capable of achieving the best possible outcomes for patients. During the planning stage, the staff sought the views of various care home managers as to the level of support that was required to best support an individual’s discharge into a care home, alongside the views of family carers. The article presents how the process was evaluated, and describes the benefits of the discharge protocol that has been created.
Social work and transitions of care: observations from an intervention for older adults
- Authors:
- FABBRE Vanessa D., et al
- Journal article citation:
- Journal of Gerontological Social Work, 54(6), August 2011, pp.615-626.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Healthcare is often provided in a variety of different settings, making the transition between these, for example from hospital to home, challenging for many older adults. This article describes the third component of a multistage project in the US which developed and tested a telephone-based social work intervention for older adults (aged over 65 years) discharged from an acute care setting to home. This paper focuses on the third stage, a qualitative study looking at practice perspectives of the transition process. Interviews with three clinical social workers who managed 356 cases and their clinical notes were analysed to identify the salient themes; three were revealed. First despite some challenges and problems after discharge being potentially avoidable there were surprises that could not have been anticipated. Second, the social workers approached the cases with a broad and interconnected view of the health-care client system. Thirdly, relationship building between patients, care givers and providers, of both healthcare and other supportive services, was a key component of effective care transition. The authors suggest that the broad view taken by social workers, their training and their continuing relationship with their clients (often putting them in the right place at the right time) makes them suitable for developing and delivering models of care transition.
Buffer management to solve bed-blocking in the Netherlands 2000–2010. Cooperation from an integrated care chain perspective as a key success factor for managing patient flows
- Authors:
- MUR-VEEMAN Ingrid, GOVERS Mark
- Journal article citation:
- International Journal of Integrated Care, 11(3), 2011, Online only
- Publisher:
- International Foundation for Integrated Care
In The Netherlands, attempts were made to tackle the problem of bed-blocking in hospitals by using an Intermediate Care Department (ICD) as a buffer for bed-blockers. However, research has shown that ICDs do not sufficiently solve the bed-blocking problem and that bed-blocking is often caused by a lack of buffer management. This paper explains the theory of Buffer management (BM), a tool that endeavours to balance patient flow in the hospital to nursing home chain of care. It then draws on the results of recent explorative research which indicated that the absence of BM is not the result of providers’ thinking that BM is unnecessary, unethical or impossible because of unpredictable patient flows. Instead, BM is hampered by a lack of cooperation between care providers.
How family carers view hospital discharge planning for the older person with a dementia
- Authors:
- BAUER Michael, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 10(3), August 2011, pp.317-323.
- Publisher:
- Sage
In the context of research showing that discharge planning processes vary between hospitals and that some patients with dementia are discharged without adequate aftercare plans, this research looked at carers' experiences of the hospital discharge planning process for a family member with a dementia. A study funded by Alzheimer's Australia Research explored the question of whether caregivers who take responsibility for caring for a family member with dementia receive, as part of the hospital discharge planning process, the physical and psychosocial support they need to continue their caring role. This paper reports on one aspect of the study: family carers' perceptions of hospital discharge planning and preparation. 25 principal family carers of people with dementia were recruited in Victoria, Australia. The qualitative research involved semi-structured interviews about their experience of the preparation for and execution of hospital discharge, within 6 weeks of the patient's discharge from hospital. The article presents results of the analysis of the interviews, with examples. Analysis of the data indicated that the needs of family carers were not always addressed in the hospital discharge process and that discharge planning and execution needs improvement. Common concerns relating to discharge planning and preparation for older people with dementia and their family included: perceptions that discharge planning was ad hoc with no plan, lack of provision of information that family carers identified as important to their role, poor communication and information sharing between healthcare professionals and the family, and care provided to patients not meeting family members' expectations.
Unplanned admissions of older people: exploring the issues
- Authors:
- HENDERSON Catherine, et al
- Publisher:
- National Institute for Health Research. Service Delivery and Organisation Programme
- Publication year:
- 2011
- Pagination:
- 255
- Place of publication:
- Southampton
National strategies, local initiatives, cross-agency agreements, various targets and financial incentives have all been deployed in an effort to reverse the growth in emergency bed days (EBDs). Within this rapidly changing context, there was another effort underway: the Improving the Future for Older People (IFOP) programme of the Innovation Forum. A group of nine English councils created their own network in 2003, with the primary aim of reducing use of emergency bed days. Specifically, they agreed to work in partnership with health and third sector organisations to achieve the ‘headline target’ of a 20% reduction in EBDs for people aged 75 and over, over a three-year period from 2004 to 2007. This research used a multi-method approach, working with all nine councils and local PCTs . This report describes site characteristics (e.g. demographics and supply of hospital beds); their performance on relevant indicators (e.g. delayed discharge); and governance structures. The report also considers: local initiatives to reduce unplanned hospital stays; the role of non-NHS agencies; reducing emergency bed days; and patients’ carers’ and professionals’ experiences of different governance models. Patient journeys were also examined, which offered examples of “good practice” but also demonstrated ways in which practice fell short of expectations. No simple association was found between the model of governance adopted and outcomes achieved within the study site examined. (Edited publisher abstract)
Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review
- Authors:
- PREYDE Michèle, BRASSARD Kristie
- Journal article citation:
- Journal of Evidence-Based Social Work, 8(5), October 2011, pp.445-468.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Many elderly patients experience adversity post-discharge from acute care settings. Hospital readmission is common; however, it is only one aspect of adverse outcomes of importance to social work discharge planners, with other health outcomes including mortality, admission to an institution, or a clinically significant decline in physical or psychosocial functioning. The early recognition of risk factors might ensure a successful transition from the hospital to the home. The purpose of this systematic review was to identify factors associated with adverse outcomes in older patients discharged from hospital to home. A second purpose was to identify and assess discharge assessment tools that could identify these risk factors. Following a comprehensive search, 43 articles that identified risk factors were selected for analysis. The risk factors were characterised in 5 domains: demographic factors; patient characteristics; medical and biological factors; social factors; and discharge factors. The most frequently reported risks were depression, poor cognition, comorbidities, length of hospital stay, prior hospital admission, functional status, patient age, multiple medications, and lack of social support. Four discharge assessment tools for use with the general population of elderly patients were identified.