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Can person-centred care for people living with dementia be delivered in the acute care setting?
- Authors:
- ABBOTT Rebecca A., et al
- Journal article citation:
- Age and Ageing, 50(4), 2021, pp.1077-1080.
- Publisher:
- Oxford University Press
The need to improve care for people living with dementia in the hospital setting has long been recognised. Person-centred care has the potential to improve the experience of care for persons living with dementia and their carers, and has been shown to improve the experiences of hospital staff caring for the persons living with dementia, however it remains challenging to deliver in a time- and task-focussed acute care setting. This commentary suggests that to embed person-centred care across the hospital environment, cultural changes are needed at organisational and ward levels. In particular there needs to be: leadership that supports and advocates for workforce capacity to recognise and meet both psychological and physical needs of people living with dementia, promotion of physical environments that support familiarisation and social interactions, an inclusive approach to carers and the development of a culture of sharing knowledge and information across hierarchies and roles. An evidence-based set of pointers for service change are described which highlight institutional and environmental practices and processes that need to be addressed in order for person-centred care to become part of routine care. (Edited publisher abstract)
What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review
- Authors:
- COSCO Theodore D., et al
- Journal article citation:
- Age and Ageing, 50(3), 2021, pp.608-616.
- Publisher:
- Oxford University Press
Background and Aim: The aim of this systematic review was to quantify the association between frailty and COVID-19 in relation to mortality in hospitalised patients. Methods: Medline, Embase, Web of Science and the grey literature were searched for papers from inception to 10 September 2020; the search was re-run in Medline up until the 9 December 2020. Screening, data extraction and quality grading were undertaken by two reviewers. Results were summarised using descriptive statistics, including a meta-analysis of overall mortality; the relationships between frailty and COVID-19 mortality were summarised narratively. Results: A total of 2,286 papers were screened resulting in 26 being included in the review. Most studies were from Europe, half from the UK, and one from Brazil; the median sample size was 242.5, median age 73.1 and 43.5% were female. In total, 22/26 used the Clinical Frailty Scale; reported mortality ranged from 14 to 65%. Most, but not all studies showed an association between increasing frailty and a greater risk of dying. Two studies indicated a sub-additive relationship between frailty, COVID-19 and death, and two studies showed no association. Conclusions: Whilst the majority of studies have shown a positive association between COVID-19-related death and increasing frailty, some studies suggested a more nuanced understanding of frailty and outcomes in COVID-19 is needed. Clinicians should exert caution in placing too much emphasis on the influence of frailty alone when discussing likely prognosis in older people with COVID-19 illness. (Edited publisher abstract)
Screening for depression in older adults on an acute medical ward: the validity of NICE guidance in using two questions
- Authors:
- ESIWE Collins, et al
- Journal article citation:
- Age and Ageing, 44(5), 2015, pp.771-775.
- Publisher:
- Oxford University Press
Background: Depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE). Methods: One hundred and eighteen patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination—Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently, participants completed the two depression screening questions and the 15-item version of the Geriatric Depression Scale (GDS-15). Results: A threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 49% and negative predictive value (NPV) of 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV of 62% and NPV of 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV of 71% and NPV of 94%. Conclusion: The two depression questions perform well as an initial screening process for non-cognitively impaired older people in the acute medical setting. A positive response to either question would indicate that further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false-positive cases. (Publisher abstract)
Learning from Trusted to Care: one year one
- Authors:
- WALES. Welsh Government, NHS WALES
- Publisher:
- Welsh Government
- Publication year:
- 2015
- Pagination:
- 19
- Place of publication:
- Cardiff
Report summarising progress and improvements made in care and practice at the Princess of Wales and Neath Port Talbot Hospitals in Wales since the independent review Trusted to Care found serious concerns about the quality of care and patient safety of frail and older people. The review made 14 recommendations for the health board and four for the Welsh Government. The report finds progress has been made in all 14 recommendation areas made to the health board. Six have been completed either fully or there are clear plans for implementation in place Eight of the recommendations still need work. The report also identifies the progress made against the Welsh Government recommendations. Improvements are identified in the areas of hydration, medication, complaints and professional accountability. (Edited publisher abstract)
Older people's experience of emergency hospital readmission: research report
- Authors:
- LAWRIE Michael, BATTYE Fraser
- Publisher:
- Age UK
- Publication year:
- 2012
- Pagination:
- 41p.
- Place of publication:
- London
Reducing the occurrence of emergency hospital readmission (an unplanned readmission within 28 days of leaving) for older people is a key issue for the NHS. Over the past decade, rates of emergency hospital readmission have risen, particularly for those over the age of 75. The aim of this study was to investigate older people’s experience of emergency readmission to hospital. The study comprised: qualitative interviews with 18 older people who have experienced an emergency readmission (and in several cases their families); a brief review of key policy documents and research; and 4 semi-structured interviews with senior stakeholders. Interviewees were asked to share their experience, beginning from their first admission to hospital through to the discharge and return home, and then their experience of the readmission to hospital. The findings show that emergency hospital readmission is a complex issue with multiple potential causes which range across an individual’s care pathway. However there are particular challenges to be addressed in the transition between secondary and primary care, and ensuring that a personalised care package is put in place in the community. Implications for Age UK both at the local and national levels are discussed.
“Not just grapes and flowers”: older people's perspectives on the role and importance of hospital visiting
- Authors:
- GREEN Bert, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 13(2), 2012, pp.82-88.
- Publisher:
- Emerald
This paper presents findings from a service user controlled research project which sought to provide commentary by older people on their experiences as visitors to hospital or as patients receiving visitors. Nine focus groups were held with a total of 43 older people at 8 different locations in North Lancashire and South Cumbria. The participants were asked about their recent experience of hospital visiting and its value to them, given their individual circumstances and those prevailing at the hospitals. Full transcripts of digital recordings from the focus groups were analysed to identify particular concerns or vivid experiences. These were classified into the following common themes: getting there and back; on the ward; and the value of visiting. The findings suggest that visitors’ needs are not always being met. Recommendations are made that could improve hospital visiting for older people, and consequently their wellbeing, including: times and rules for visitors; the response they get from staff; the potential of older visitors to help improve the welfare of the older patient; and locating older people's wards.
Nutritional advice in common clinical situations (revised August 2009)
- Author:
- BRITISH GERIATRICS SOCIETY
- Publisher:
- British Geriatrics Society
- Publication year:
- 2009
- Place of publication:
- London
Under-nutrition in older people admitted to hospital is common, and the risk of being malnourished increases during hospitalisation. It is also poorly detected by nursing and medical staff. This good practice guide paper covers nutrition screening, the importance of creating the right environment to support eating and drinking, management of under-nutrition in hospital, ethical and legal considerations, nutrition and stroke, nutrition and dementia, and nutrition in the community and care homes. It includes reference to key resources and guidance about nutritional care in hospital, and makes recommendations covering the advice of dieticians and speech and language therapists, training to enable health professionals to assess and meet nutritional demands, management of dysphagia, policies for review of patients, and development of policies to support nutrition which include auditable standards.
Hungry to be heard survey: older patients’ experience of hospital meals
- Author:
- AGE CONCERN SCOTLAND AND HELP THE AGED SCOTLAND
- Publisher:
- Age Concern Scotland
- Publication year:
- 2009
- Pagination:
- 7p.
- Place of publication:
- Edinburgh
Age Concern Scotland developed the Hungry to be Heard campaign to investigate the experience of older patients and offer recommendations for future action. As part of the campaign, research was carried out across Scotland with over 100 older people who had recently been in hospital. The survey was designed to gain an insight into whether the standards for nutritional care in acute hospitals are being met. A summary of the survey findings are presented.
Eat, drink and be healthy: malnutrition on the wards
- Author:
- TAYLOR Jennifer
- Journal article citation:
- Health Service Journal, 4.6.09, 2009, pp.22-23.
- Publisher:
- Emap Healthcare
The health of many older patients in hospital is being jeopardised through lack of attention at meal times. This article provides some tips on how to ensure older patients eat properly. These include a short case study which outlines a volunteering programme at Darlington Memorial Hospital.
Improving nutrition for older people in hospital by assessing current practice
- Authors:
- MAUD Rebecca, WEBSTER Jonathan
- Journal article citation:
- Nursing Times, 10.2.09, 2009, pp.18-19.
- Publisher:
- Nursing Times
Malnutrition is a major challenge in acute care. This article outlines the development of an audit tool too improve nutritional care for older people on an acute admissions unit. The aim was to examine current practice, identify aspects of good practice and areas for improvement. The audit's outcomes are also reported.