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Does dementia predict adverse hospitalization outcomes? A prospective study in aged inpatients
- Author:
- ZEKRY Dina
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(3), March 2009, pp.283-291.
- Publisher:
- Wiley
This study assesses the relative value of dementia for predicting hospitalization outcomes, taking into account comorbidity, functional and nutritional status in 435 inpatients (age 85.3 ± 6.7; 207 cognitively normal, 48 with mild cognitive impairment and 180 demented) from the acute and rehabilitation geriatric hospital of Geneva. Hospitalization outcomes (death in hospital, length of stay, institutionalisation and formal home care needs) were predicted using logistic regression models with sociodemographic characteristics, cognitive status, comorbid Charlson index-CCI, functional and nutritional status as independent variables. Moderate and severe dementia and poor physical function strongly predicted longer hospital stay, institutionalization and greater home care needs in univariate analyses. CCI was the best single predictor, with a four-fold difference in mortality rates between the highest and lowest scores. In multivariate analysis, the best predictor of institutionalisation was dementia, whereas the best predictor of death in hospital or longer hospital stay was higher comorbidity score, regardless of cognitive status. Functional status was the best predictor of greater home care needs. Dementia in very old medically ill inpatients was predictive only of discharge to a nursing home. Higher levels of comorbidity and poor functional status were more predictive than dementia for the other three hospitalization outcomes. Thus, comorbid medical conditions, functional and nutritional status should be considered, together with cognitive assessment, when predicting hospitalization outcome.
Beyond the medical model the Eden Alternative(r) in practice: a Swiss experience
- Author:
- MONKHOUSE Christa
- Journal article citation:
- Journal of Social Work in Long-Term Care, 2(3/4), 2003, pp.339-353.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
The medical or institutional model of care has been the standard in most of the 1300 nursing homes in Switzerland. Consequently, staffing problems, increasing costs, and poor reputation have become the norm. This case study describes two 60-resident homes in Zollikon, Switzerland, which implemented the Eden Alternative(r), beginning in 2000. Based on this model, they are committed to the eradication of resident loneliness, helplessness, and boredom. Their tools are companionship, spontaneity, and the opportunity to give care to each other, staff, children, animals, and plants. The change from a medical model was precipitated by a care and financial crisis. Since then, three steps have been taken. The first, the crisis intervention step, was followed by the implementation of total quality management resulting in significant improvements in clinical outcomes and financial stability. Ultimately, the Eden Alternative was successfully introduced. It was perceived as "the missing link" and appears, at this early stage, to meet the real needs of residents and staff. The change process is described and outcomes are presented and discussed. (Copies of this article are available from: Haworth Document Delivery Centre Haworth Press Inc., 10 Alice Street Binghamton, NY 13904-1580)