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Older patients have the most to gain from orthopaedic enhanced recovery programmes
- Authors:
- STARKS Ian, et al
- Journal article citation:
- Age and Ageing, 43(5), 2014, pp.642-648.
- Publisher:
- Oxford University Press
Background: Between August 2007 and May 2009, 2128 consecutive patients underwent either primary hip or knee joint replacement surgery at our institute on an enhanced recovery pathway. The authors aimed to investigate the potential benefits of this pathway in patients over the age of 85 years. Methods: Data extracted from Hospital Episode Statistics were analysed. This data are prospectively collected and independently collated. Results: In all patients median length of stay was reduced when compared with both our own data before the introduction of the pathway (6 to 4 days) and national averages over the same time period for both hip and knee replacements (5 to 4 days). Difference in length of stay was most pronounced in the group of patients aged 85 years and over (9 to 5 days for total hip replacement and 8 to 5 days for total knee replacement). Nearly all patients were discharged directly home (97.4%). Readmission rates were over 45% lower in patients aged 85 and over when compared with national averages (5.2 vs. 9.4%). Conclusions: This is the first series in the literature to assess the role of enhanced recovery pathways in the very elderly. This study not only shows that successful fast track rehabilitation can be achieved in the very elderly population undergoing elective joint replacement surgery, but that it is this cohort of vulnerable patients who have the most to gain from such multidisciplinary recovery programmes. (Edited publisher abstract)
Understanding motor neurone disease
- Author:
- GENT Carol
- Journal article citation:
- Nursing and Residential Care, 14(12), December 2012, pp.646-649.
- Publisher:
- MA Healthcare Ltd.
- Place of publication:
- London
Motor neurone disease (MND) is a progressive, life-limiting neurological condition. It generally affects adults over the age of 40 with the majority of cases developing in the 50-70 year old group. Care providers need to have a level of understanding and awareness of MND. The purpose of this article is to provide an overview of MND and the management of symptoms associated with the disease. It outlines how a multidisciplinary team can help staff to care for these patients. The symptoms discussed include: limb weakness or stiffness; bulbar symptoms resulting in problems with speech and swallowing (and the need for nutrition management); breathing difficulties; and cognitive impairment. Care home staff must be able to recognise changes in disease progression and raise their concerns to the appropriate health professional to ensure timely interventions.
Improving teamwork, trust and safety: an ethnographic study of an interprofessional initiative
- Authors:
- JONES Aled, JONES Delyth
- Journal article citation:
- Journal of Interprofessional Care, 25(3), May 2011, pp.175-181.
- Publisher:
- Taylor and Francis
This study addressed a lack of in-depth qualitative research that could explain the day-to-day realities of interprofessional team working in healthcare. It investigated the perceptions of staff in an interprofessional team based on a medical rehabilitation ward for older people, following the introduction of a service improvement programme designed to promote better team working. Nurses, doctors, physiotherapists, social workers and occupational therapists all participated. Results indicated that interprofessional team working improved over a 12-month period. Four themes emerged from the data: the emergence of collegial trust within the team; the importance of team meetings and participative safety; the role of shared objectives in conflict management; and the value of autonomy within the team. Reductions in staff sickness and absence levels and major patient safety incidents were also detected.
Caring for older people in the community
- Editors:
- HUDSON Angela, MOORE Lesley, (eds.)
- Publisher:
- Wiley-Blackwell
- Publication year:
- 2009
- Pagination:
- 245p.
- Place of publication:
- Chichester
This book is a compilation from 9 academics and practitioners, including the two editors. The first section (Chapters 1-3) discusses the past and current influences on physical, psychological and social ‘nursing’ practices and ethical tensions, when working with older people. Topics covered in the second section (chapters 4-6) with regard to contemporary challenges with older people who may have learning disabilities and dementia as well as experiencing ageing are, health education, sexual health, substance misuse, and the role of assistive technology. Examples of lived scenarios from service users and reflections from professionals are included. Current issues of kinship care for older people, ethics, palliative care and end of life decision making, complementary therapies, vulnerability, citizenship, informed consent, advocacy, empowerment, personalisation and a person centre approach are also mentioned. The third section from the joint editors, is on future challenges and covers: community hospitals, bringing diagnostic technology and chemotherapy interventions closer to cancer patients, the national panel for information and communications technology, ‘whole system demonstrators’, moving towards seamless care, and partnership with older people projects.
Mind your step! A falls prevention programme designed to reduce falls in those over 75 years
- Author:
- CONN Lorna
- Journal article citation:
- Quality in Ageing, 8(1), March 2007, pp.10-22.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
In this study, a multi-disciplinary, falls prevention initiative was developed with older people who had recently fallen. The initiative started with a common assessment but was followed by a variable, individualised programme of different interventions. The older people involved were assessed pre- and post-intervention, using a questionnaire checklist, on several different dimensions associated with falling. Outcomes were assessed in terms of reduction in risk and incidence of falls, both of which were found to be statistically significant in several of the identified dimensions post-intervention. Consequently, it could be estimated that approximately 44 falls were prevented through this nine-month initiative. This study would support the integration of this falls prevention initiative in to routine community care practice though the existing over-75 health check and the development of a specialised falls team. Enhanced participation of user, carer, voluntary and community partners is recommended as this would allow older people themselves to play an active role in improving their own well-being and that of others.
Practical psychiatry of old age
- Authors:
- WATTIS John P., CURRAN Stephen
- Publisher:
- Radcliffe
- Publication year:
- 2006
- Pagination:
- 276p.
- Place of publication:
- Oxford
- Edition:
- 4th
Now greatly expanded and completely updated, the "Fourth Edition" is a clinical primer for those in training, or as a day to day reference for healthcare professionals working with older people. The book describes in detail the main psychiatric conditions encountered in old age and their management with many useful brief case histories to illustrate the practical realities of working in this area. In addition, it offers a comprehensive approach to the assessment and management of psychiatric disorders in old age and provides an introduction to the development and management of services. It supports a truly multi-disciplinary approach in line with modern developments, including the new government guidelines on older people's mental health services.
Perceptions of the role of the community psychiatric nurse
- Author:
- BARLOW Ken
- Journal article citation:
- Nursing Times, 28.02.06, 2006, pp.34-38.
- Publisher:
- Nursing Times
This small-scale study explores the self-perceived differences between the contributions of community psychiatric nurses (CPNs) and other members of a multidisciplinary community mental health team for older people. Four CPNs and five other professionals completed questionnaires in order to collect qualitative responses. The questionnaires were analysed on a thematic basis. The results found that CPNs' skills seemed to be recognised and valued by their multidisciplinary colleagues. However, the CPNs were not always the same as those identified by their colleagues. There did not appear to be any consensus among the CPNs yet their colleagues seemed to feel the CPN role was reasonably clear. The study suggests the CPN role involves taking a relationship-based, person-centred approach in which adaptability and flexibility are key characteristics. The results are largely consistent with other findings and demonstrate the need to nurture contributions made by CPNs as autonomous practitioners in multidisciplinary settings providing care for older people with dementia.
Single referrals for inpatient and community rehabilitation
- Author:
- STANDRING Lesley
- Journal article citation:
- Nursing Times, 01.11.05, 2005, pp.34-36.
- Publisher:
- Nursing Times
This article reports on the introduction of a single system for inpatient and community rehabilitation at West Suffolk Hosptial NHS Trust. A multidisciplinary team skilled in assessment decides which model of rehabilitation would meet individual needs. Referral destinations include acute rehabilitation, community hospital rehabilitation, intermediate care, nursing home, and home.
Exploring an integrated palliative care model for older people: an integrative review
- Authors:
- RACO Marina, BURDETT Teresa, HEASLIP Vanessa
- Journal article citation:
- Journal of Integrated Care, 27(2), 2019, pp.111-122.
- Publisher:
- Emerald
Purpose: Due to an international ageing population, global health organisations have recognised the challenges arising from fragmented interaction between health and social sectors in the end of life care. The purpose of this paper is to explore the existing literature on integrative palliative care services for older people. Design/methodology/approach: An integrative review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Papers included in the review focused upon integrated care within palliative care systems (January 2007–2017). A certain number of papers were excluded when the review focused on individuals younger than 65, not written in English and not being focused on integrated palliative care. Findings: Nine studies fitted the inclusion criteria and three themes were identified: person-centred care, co-ordination of care, and education and training. The review identifies that integrated palliative care requires co-ordinated techniques that focus upon the quality of life, individual needs and awareness of vulnerability rather than fixation on inevitable mortality. Research limitations/implications: The emerging presence of the need for integrated palliative care requires further research in order to develop coherent models of integrated palliative care which can be incorporated into practice. Originality/value: This review identified themes relevant to the emerging issues in the global health sector of end of life care. The literature suggests that the optimised use of an integrated care approach to a palliative model of care is required and in need of further investigation. (Edited publisher abstract)
CMHTs for older people: team managers’ views surveyed
- Authors:
- ABENDSTERN Michele, et al
- Journal article citation:
- Journal of Integrated Care, 22(5/6), 2014, pp.209-219.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to identify features of community mental health teams (CMHTs) for older people valued by their managers, and those they would most like to change. Design/methodology/approach: Content analysis was used to analyse “free text” responses to open questions from a national survey about CMHTs’ organisational structures and processes. Responses were sorted into statements which were categorised into content areas and higher level dimensions. Findings: Free text information was provided by 376 teams (an 88 per cent response rate). Eight higher level dimensions were identified. One related specifically to integration with social care services, whilst several more included material about other aspects of intra-team integration (e.g. documentation and location). The largest proportion of statements related to staffing and teamwork. Statements about inter-personal and inter-professional issues were largely positive, whilst statements about resources, bureaucracy and integration with social care services typically detailed desired changes. Practical implications: Four key issues emerged comprising a high level of support from managers to develop integrated practices; a need to define the focus of CMHTs for older people and to be fully resourced; and the importance of a nurturing and supportive team environment. Originality/value: The methodology provides a bridge between qualitative and quantitative research, exploring the volume of statements on particular topics and their meaning. (Publisher abstract)