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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.
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.
Separation of younger from older patients in hospital: statement for the period 1 April 2002 to 31 March 20 prepared pursuant to section 12(2) of the Chronically Sick and Disabled Persons (Northern Ireland) Act 1978
- Author:
- GREAT BRITAIN. Acts, Bills
- Publisher:
- Stationery Office
- Publication year:
- 2005
- Pagination:
- 3p.
- Place of publication:
- Belfast
Annual Statement prepared pursuant to Section 12(2) of the Chronically Sick and Disabled Persons (NI) Act 1978
From hospital to the community: a report examining discharge procedures from hospital and community provision for elderly people
- Author:
- BAGLEY G
- Publisher:
- Birmingham. Social Services Department/North Birmingham Health Authority
- Publication year:
- 1987
- Pagination:
- 36p., tables.
- Place of publication:
- Birmingham
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In-hospital death according to dementia diagnosis in acutely ill elderly patients: the REPOSI study
- Authors:
- MARENGONI A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(9), September 2011, pp.930-936.
- Publisher:
- Wiley
The Registro Politerapie SIMI (REPOSI) study in Italy aimed to describe the prevalence of co-occurring multiple diseases and treatments in hospitalised elderly patients, to correlate clinical characteristics of the patients with type and number of diseases and treatments, and to evaluate the main clinical outcomes. The project described in this article used information from the 38 hospitals in different regions of Italy participating in the REPOSI study during 2008. Logistic regression models were used to evaluate the association of dementia with in-hospital death in the 1,221 patients included in the analyses. 117 participants were diagnosed as being affected by dementia, and patients with dementia were more likely to be women, older, to have cerebrovascular diseases, pneumonia and a higher number of adverse clinical events during hospitalisation. The percentage of patients affected by dementia who died during hospitalisation was higher than that of patients without dementia. The researchers concluded that acutely ill elderly patients affected by dementia are more likely to die shortly after hospital admission and that having dementia and adverse clinical events during hospital stays increases the risk of death.
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.
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.
The onset and alleviation of learned helplessness in older hospitalised people
- Author:
- FAULKNER M.
- Journal article citation:
- Aging and Mental Health, 5(4), November 2001, pp.379-386.
- Publisher:
- Taylor and Francis
This study was to investigate the relevance of learned helplessness (LH) and learned mastery (LM) theories in the respective development of dependence and independence in older hospitalised people. In stage I, meal-related responses of patient participants were automatically completed by a researcher during two consecutive mealtime events (LH induction). LH effects were then assessed by evaluating participant performance during a controllable meal-task and a non-meal-related psychomotor task. In stage II, "helpless" participants were then given an expectation of future control over the mealtime event followed by two further meals during which the researcher provided no active assistance (LM induction). Participants exposed to the LH inducing strategy demonstrated LH effects within both the meal and psychomotor tasks. These effects were alleviated through exposing participants to the LM inducing intervention. Concludes that exposing older hospitalised people to uncontrollable or disempowering circumstances may potentially lead them to develop a LH induced dependence. This may be alleviated by increasing patient's expectation of control leading to the development of LM.
Guardianship patient characteristics and outcomes in geriatric social work practice: Australian context
- Authors:
- JACKMAN Matthew, et al
- Journal article citation:
- Social Work in Health Care, 60(8-9), 2021, pp.614-630.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study explored the patient characteristics and outcomes in relation to guardianship in a large-scale sub-acute Australian hospital. Fifteen patients who appointed a guardian at The Kingston Center, Monash Health, participated through exploratory data collection and analysis utilizing a de-identifiable template. The findings revealed both diverse and complex patient characteristics, and ethical dilemmas in patient outcomes for social workers. Patient outcomes post-guardianship appointment and discharge highlighted a negative impact from long length of stay and the iatrogenic impact on patient wellbeing in hospital. The study reflected a disparity between patients’ discharge goals and their outcomes indicating significant ethical dilemmas and complexities for social workers in ensuring rights to autonomy and responsibility for safety are balanced. (Edited publisher abstract)
The utility of the clock drawing test in detection of delirium in elderly hospitalised patients
- Authors:
- ADAMIS Dimitrios, et al
- Journal article citation:
- Aging and Mental Health, 20(9), 2016, pp.981-986.
- Publisher:
- Taylor and Francis
Objectives: Delirium is common neuropsychiatric condition among elderly inpatients. The clock drawing test (CDT) has been used widely as bedside screening tool in assessing cognitive impairment in elderly people. Previous studies which evaluate its usefulness in delirium reported conflicting results. The objective of this study was to evaluate the utility of CDT to detect delirium in elderly medical patients. Method: Prospective, observational, longitudinal study. All acute medical admissions 70 years of age and above were approached within 72 hours of admission for recruitment. Patients eligible for inclusion were assessed four times, twice weekly during admission. Assessment included Confusion Assessment Method (CAM), Delirium Rating Scale (DRS-98R), Montreal Cognitive Assessment (MoCA), Acute Physiology and Chronic Health Evaluation II (APACHE) II, and CDT. Data was analysed using a linear mixed effect model. Results: Three hundred and twenty-three assessments with the CDT were performed on 200 subjects (50% male, mean age 81.13; standard deviation: 6.45). The overall rate of delirium (CAM+) during hospitalisation was 23%. There was a significant negative correlation between the CDT and DRS-R98 scores (Pearson correlation r = −0.618, p < 0.001), CDT and CAM (Spearman's rho = −0.402, p < 0.001) and CDT and total MoCA score (Pearson's r = 0.767, p < 0.001). However, when the data were analysed longitudinally controlling for all the factors, we found that cognitive function and age were significant factors associated with CDT scores (p < .0001): neither the presence nor the severity of delirium had an additional significant effect on the CDT. Conclusion: CDT score reflects cognitive impairment, independently of the presence or severity of delirium. The CDT is not a suitable test for delirium in hospitalised elderly patients. (Publisher abstract)