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Using qualitative research in systematic reviews: older people's views of hospital discharge
- Authors:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE, FISHER Mike, et al
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2006
- Pagination:
- 68p.
- Place of publication:
- London
Systematic reviews are usually restricted to quantitative studies. This report demonstrates how the review process can be extended to a synthesis of qualitative studies using the example of older people’s views on hospital discharge. There were two kinds of evidence about the potential effectiveness of discharge arrangements – the review by Parker showing that support could be successfully provided to older people discharged from hospital, and international evidence from Sweden, where a similar reform had been implemented. Closer examination of this evidence provided some of the key reasons why this qualitative synthesis of older people’s views of hospital discharge was undertaken.
Hospital discharge of older people with cognitive impairment to care homes
- Author:
- BRITISH GERIATRICS SOCIETY
- Publisher:
- British Geriatrics Society
- Publication year:
- 2006
- Pagination:
- 2p.
The scope of this document is confined to the safe and appropriate discharge of older people with cognitive impairment from hospital to a care home. It is a given, within the context of this document, that discharge to any other care setting has been deemed inappropriate as the result of a comprehensive geriatric assessment (CGA). A separate British Geriatrics Society (BGS) compendium document deals with the wider context of hospital discharge of frail older people.
Reducing emergency hospital stays for older people: Innovation Forum first year report
- Authors:
- WISTOW Gerald, KING Derek
- Publisher:
- Innovation Forum
- Publication year:
- 2006
- Pagination:
- 54p.
- Place of publication:
- London
This report from the Innovation Forum is based on the idea that good housing, a range of facilities for transport, leisure and entertainment, families and friends can all help older people thrive and stay healthy thereby reducing the need for emergency hospital stays. And, if any of this is to come about, it means a firmer strategy than currently exists to ensure there is a sufficiently significant transfer of funding from acute to community settings.
Factors related to hospitalization in elderly manic patients with early and late-onset bipolar disorder
- Authors:
- LEHMANN Susan W., RABINS Peter V.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(11), November 2006, pp.1060-1064.
- Publisher:
- Wiley
The objective was to identify factors contributing to relapse and hospitalization in elderly patients with bipolar disorder. Retrospective chart review surveyed consecutive patients over age 65 admitted to the Johns Hopkins Hospital for a manic episode over a five year period (n = 73). Factors precipitating index admission were compared in patients with early-onset bipolar disorder (<or = age 45, n = 38) and late-onset bipolar disorder (>age 45, n = 35). The distribution of ages of onset of bipolar disorder was most consistent with a bimodal pattern with a cut-point at age 45. Early-onset patients were more likely to have been aggressive and threatening prior to admission (p = 0.014) compared to late-onset patients and were more likely to have been brought to the emergency room on emergency petition for evaluation (p = 0.028). Early-onset patients were also more likely to have been non-adherent with prescribed psychiatric medication (p = 0.032). Relapse and rehospitalization were common among elderly manic patients with early-onset and late-onset bipolar disorder. Strategies which improve medication adherence are needed to help prevent recurring hospitalization.
Screening for depression in older medical inpatients
- Authors:
- CULLUM Sarah, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(5), May 2006, pp.469-476.
- Publisher:
- Wiley
Older people with depression make greater use of healthcare services, but the detection of the disorder is poor. The National Service Framework for Older People recommended screening for depression in acute healthcare settings to improve health outcomes of older people. This study aims to estimate, in a large representative sample of older medical inpatients in a UK hospital setting, the prevalence of depressive symptoms and ICD-10 depressive disorder and to examine the sensitivity and specificity of the 15-item Geriatric Depression Scale (GDS-15) as a screening instrument. A two-phase prevalence study of depressive disorder was carried out in acute wards of a district general hospital. Six hundred and eighteen (61%) of 1,009 eligible older medical inpatients were screened using the GDS-15. A stratified sample of 233 people was further assessed using the Geriatric Mental State, from which ICD-10 diagnoses were determined. The weighted prevalence estimate of ICD-10 depressive disorder was 17.7%. Forty-four percent of participants scored above the normally recommended cut-point of 5 on the GDS-15. However, on the basis of ROC, the optimal cut-point of the GDS-15 for screening for depressive disorder in this hospitalised population is two points higher at 7. This study confirms that depression is common amongst older UK medical inpatients with 1 in 6 suffering from clinical depression. The cut-point for GDS-15 for this population is 7.
One of our own kind: carer liaison at work
- Authors:
- SCHOFIELD Joanne, MELLOR Jack Buckley
- Journal article citation:
- Journal of Dementia Care, 14(5), September 2006, pp.12-13.
- Publisher:
- Hawker
The authors explain the value of having a carer available to offer support to other carers with relatives on a continuing care ward. The article focuses on the practice at a NHS psychiatric continuing care ward in Warrington in the north west of England. It includes the views and experiences one carer who has the role of patient and carer liaison officer in the ward.
National audit of the organisation of services for falls and bone health for older people
- Authors:
- HUSK Janet, POTTER Jonathan, LOWE Derek
- Publisher:
- Royal College of Physicians
- Publication year:
- 2006
- Pagination:
- 42p.
- Place of publication:
- London
The aim was to carry out an ‘organisation’ audit of the integrated services (community and hospital-based) for falls and bone health for older people to: assess whether the National Service Framework for Older People milestone requiring integrated services by April 2005 has been met; compare the organisational development between trusts; and to provide a baseline for repeat audit following an intervention programme.
Challenging behaviour in the elderly - monitoring violent incidents
- Authors:
- ALMVIK Roger, RASMUSSEN Kirsten, WOODS Phil
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(4), April 2006, pp.368-374.
- Publisher:
- Wiley
This study aimed to explore the frequency and nature of violent incidents in psychogeriatric wards and nursing homes in terms of type and severity of incidents, what provoked the incidents, and what kind of measure was needed to stop the aggression. Aggressive behaviour of the study group was monitored using the Staff Observation Aggression Scale-Revised (SOAS-R) in two Norwegian nursing homes and two geriatric psychiatric wards for a period of three months. Severity of incidents were monitored with the built-in severity scoring system in SOAS-R. During the study period 32 out of the 82 patients were reported to be violent. The majority of the incidents were generated by a minority of the patients. Physical injury to the staff as a consequence of the aggression was extremely rare. Situations where the client was denied something were the most provocative ones and a substantial number of incidents occurred at bath/shower times. Talking to the patient was the most frequent measure used to stop the aggression, but more intrusive measures were also used. A substantial proportion of the incidents were associated with personal care tasks, suggesting a crucial role for communication difficulties and a focus for staff training. The authors suggest that personal care situations should be added to the variable list in future research.
Psychoanalytical informed research in an NHS continuing care unit for older people: exploring and developing staff's work with complex loss and grief
- Authors:
- HOLMAN Cheryl, MEYER Julienne, DAVENHILL Rachael
- Journal article citation:
- Journal of Social Work Practice, 20(3), November 2006, pp.315-328.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
There are studies about the emotional and social aspects of loss and grief in continuing care environments such as care homes and hospital wards, but researchers have tended to focus on either the cultural aspect of the organisation or the emotional response of individuals. This splitting in the body of knowledge misses the opportunity to examine the link between the personal and the broader public domain. This paper concerns the methodology and initial findings from a psychoanalytically informed research study. It was aimed deliberately at exploring the juncture between the psychological and social domains that care staff have to negotiate in order to provide care related to loss and grief in an NHS continuing care ward in London. The method draws heavily on the Tavistock approach to learning about emotions but also adopts participant observation methods rooted in the ethnographic tradition. The study identifies the emotional demand of caring for people experiencing loss and grief in a continuing care unit and the development of a reflective group that supported practice developments in meeting these tasks. The paper will argue that research that develops an understanding of social practices underpinned by psychoanalytic perspectives can inform development in areas where staff are expected to cope with high levels of anxiety and stress.
Effective partnership working: a case study of hospital discharge
- Author:
- HENWOOD Melanie
- Journal article citation:
- Health and Social Care in the Community, 14(5), September 2006, pp.400-407.
- Publisher:
- Wiley
This paper examines partnership working between health and social care by exploring the specific issues which this case study of hospital discharge provides. The analysis highlights the importance of understanding the dynamics of partnership working on the ground. It also underlines the need for a new relationship between central government and local agencies when old-style models of command and control are no longer fit for purpose. A new approach is required that addresses the complex and multiple relationships which characterise the new partnership agenda.