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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.
Continuity of care for older hospital patients: a call for action
- Authors:
- CORNWELL Jocelyn, et al
- Publisher:
- King's Fund
- Publication year:
- 2012
- Pagination:
- 32p.
- Place of publication:
- London
Consistent, reliable high-quality care is what all patients want and health workers aim to provide. However, the reality for most patients, particularly those in acute hospitals, often falls far short of the ideal. In the context of acute care, the risks of fragmentation and breakdown in care co-ordination are high, especially for older patients. This paper focuses on those aged 70 years and older with multiple health problems and explores how continuity of care affects them and the people closest to them. This report outlines the current situation, including the fact that most patients in hospital are older, that the length of time they spend in hospital is directly related to age, that they are frequently moved around inside the hospital and are more likely to be re-admitted after discharge. In addition to reviewing the published evidence both in the UK and beyond, this paper also includes case studies from individual carers and examples of interventions designed to strengthen relationships between patients, carers and professionals.
Not properly authorised: unannounced visits to people receiving treatment under part five of the Adults with Incapacity Act
- Author:
- MENTAL WELFARE COMMISSION FOR SCOTLAND
- Publisher:
- Mental Welfare Commission for Scotland
- Publication year:
- 2012
- Pagination:
- 14p.
- Place of publication:
- Edinburgh
The Adults with Incapacity (Scotland) Act 2000 (The Act) sets out the framework for regulating medical treatment or research for people who may lack capacity to consent. Previous visits to care homes and hospitals found that legal safeguards under the Act for medication and other interventions were not properly observed and therefore people who lacked capacity to consent were not receiving treatment in line with the law. This report details a series of unannounced visits to 90 care homes and hospitals and examined 519 individual care files, an average of about six per visit. Of the 519 files examined in detail, 467 people had a completed Section 47 certificate, around 90% of those who were identified by staff as lacking capacity to consent. The majority of the individuals whose files were examined, around 70%, were identified as having dementia. Around 13% had a learning disability, 7% had a mental illness, and around 5% had an acquired brain injury. A further 5% had alcohol related brain damage. Overall, there were concerns in around 20% of cases.
Screening for elder abuse in hospitalized older adults with dementia
- Authors:
- PISANI Leslie D., WALSH Christine A.
- Journal article citation:
- Journal of Elder Abuse and Neglect, 24(3), 2012, pp.195-215.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Research has shown that individuals with dementia are more likely to be victims of elder abuse. While the opportunity to screen hospitalised older adults with psychiatric issues related to dementia for elder abuse could facilitate prevention, questions remain about the efficacy of screening practices within this population. The purpose of this article is to raise awareness of the need to screen for abuse when inpatients have dementia, provide clinicians with a literature review to support their choice of an appropriate screen for their setting, encourage administrative support for its adoption and successful implementation, and assist in the education of other professionals involved in prevention or treatment of elder abuse. The review findings suggest that, for clinician completion, the Elder Assessment Instrument and the Brief Abuse Screens for the Elderly are recommended. For the older adult, the brief Hwalek-Sengstock Elder Abuse Screening Test is suitable. The Modified Conflict Tactics Scale, which can be used by both the older adult and the nonprofessional caregiver, has many of the recommended characteristics. The article concludes that research is necessary in the application of these screens within hospitals to detect elder abuse within this specialised population.
Dignified care: one year on. The experiences of older people in hospital in Wales
- Author:
- OLDER PEOPLE'S COMMISSIONER FOR WALES
- Publisher:
- Older People's Commissioner for Wales
- Publication year:
- 2012
- Pagination:
- 32p.
- Place of publication:
- Cardiff
A stay in hospital can often be stressful in itself, but to be treated with a lack of dignity and respect causes real distress. In March 2011 the Older People’s Commission for Wales published the findings of its Dignified Care? Review. The report contained 12 recommendations aimed at improving the delivery of hospital care and subsequent patient experience for older people across Wales. One year on, this report sets out the Commissioner’s assessment of the progress made and outline how further review will be undertaken. The report finds there has been an improvement in how seriously the NHS and Welsh Government are taking the issue of dignity in care, and that there is real action underway. Some Health Boards report more progress than others, with all reporting that work has begun across the 12 recommendations. However, it is not yet possible to judge the extent to which a tangible improvement in the hospital experience of patients is being delivered at a ward level. The findings demonstrate that there is still significant unacceptable practice taking place on hospital wards. Chief Executives of Health Boards must ensure that within the next 18 months they move to full compliance with the agreed action plans.
The use of the Mental Capacity Act among hospital patients: findings from a case study of one Acute Hospital Trust in England
- Authors:
- PHAIR Lynne, MANTHORPE Jill
- Journal article citation:
- Journal of Adult Protection, 14(6), 2012, pp.259-270.
- Publisher:
- Emerald
This paper presents findings from a review of hospital policies and practices in one NHS Trust in England. The focus of the review was hospital staff policy and practice in safeguarding the rights of vulnerable patients. A sample of 42 staff members was surveyed to investigate their knowledge of the Mental Capacity Act 2005 in 2010. Analysis revealed limited confidence and knowledge about the Mental Capacity Act 2005 and uncertainties about its relevance to clinical practice. In relation to safeguarding, there was limited realisation of the potential of the Act to uphold the rights of patients lacking capacity and staff responsibilities. MCA training had not made a great impression; hospital policies were inconsistent and lacked coherence. The authors concluded that the findings of this case study may be applicable to other hospitals and to other providers of health and social care services. The relevance of the MCA could be highlighted and used on several induction and training programmes. The study identifies features of policy and practice that could be investigated in other organisations.
Homing in on improved care in the community
- Author:
- IMISON Candace
- Journal article citation:
- Health Service Journal, 20.9.12, 2012, pp.28-29.
- Publisher:
- Emap Healthcare
People over the age of 65 continue to experience high rates of emergency bed admissions. Often the admission is avoidable or the length of stay in hospital longer than necessary. Recent research from the King's Fund found a fourfold variation in emergency bed use by people over the age of 65. The article reports on the reasons for this variation and the lessons that can be learnt from Torbay, who now uses less emergency beds per head of the population (for people over 65) than anywhere else in England.
Hospital admissions from nursing homes: a qualitative study of GP decision making
- Authors:
- MCDERMOTT Clare, et al
- Journal article citation:
- British Journal of General Practice, 62(601), August 2012, pp.413-414.
- Publisher:
- Royal College of General Practitioners
Decisions regarding the hospitalisation of nursing home residents may present a difficult dilemma for GPs. There are pressures to admit very frail patients with illness even though such frailty may limit the possible health gains. This study investigated GPs views on factors influencing decisions on admitting frail nursing home residents to hospital. Interviews were held with 21 GPs from two counties in the South of England. Findings indicated that while clinical assessment, perceived benefits and risks of admission, and patients' and relatives' preferences were key factors in determining admissions, other important factors influencing decision making include medico-legal concerns, communications, capability of nursing homes and GP workload. These factors were also perceived by GPs as influencing the feasibility of keeping patients in the nursing home when this was clinically appropriate. Key areas suggested by GPs to improve practice were improving communication, training and support for nursing staff, and peer support for GPs.
Older people and emergency bed use: exploring variation
- Authors:
- IMISON Candace, THOMPSON James, POTELIAKHOFF Emmi
- Publisher:
- Kings Fund
- Publication year:
- 2012
- Pagination:
- 24p.
- Place of publication:
- London
This paper explores factors that might be driving the significant variation in use of hospital beds by patients over 65 admitted as an emergency in order to determine what can be learned from those areas with the highest and lowest rates of bed use. The analysis is based on existing Hospital Episode Statistics (HES) data and local population-based data. It considers the contribution made by patient-based factors, hospital factors, the availability of community services and resources, and broader system relationships (such as how care systems and staff work together and relate to each other) in driving the observed variation in length of stay and rate of admission. The findings indicate that there is a significant opportunity to reduce the overall rate of use of emergency hospital beds by people over 65 while at the same time not threatening and potentially improving the quality of patient care. Primary Care Trusts with the highest bed use tended to have excessive lengths of stay for patients for whom hospital was a transition between home and supported living. Areas with lower rates of bed use tended to have well-developed, integrated services for older people. These areas also delivered a good patient experience and had lower readmission rates.