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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)
Patients' and carers' experiences of UK memory services
- Authors:
- HAILEY Emma, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(6), 2016, pp.676-680.
- Publisher:
- Wiley
Objective: The objective of this study is to test the validity of an accreditation programme for memory services in the UK by investigating whether different levels of accreditation status (excellent compared with accredited) are reflected in patients' and carers' reported satisfaction. Method: A comparison of survey data from patient and carer feedback questionnaires collected from services as part of the accreditation process. Results: Five hundred and eighty-three patient questionnaires and 663 carer questionnaires were returned from 41 services. Patients and carers who attended memory services which were later ‘accredited as excellent’, were more likely than those who had visited ‘accredited’ services to have: been given written information about a variety of topics; been asked for feedback about using the memory service; and had found it easier to get to their appointments. Carers attending services accredited as excellent were more likely to have been offered an assessment of their needs. Conclusion: Patients and carers had very good experiences of memory services overall whether they had standard or excellent accreditation. However, ‘excellent’ services were consistently better on a number of factors. This provides further support that the accreditation process is an important indicator of the quality of memory services (Publisher abstract)
Older adult recovery: “What are we working towards?”
- Authors:
- RANKIN Samantha, PETTY Stephanie
- Journal article citation:
- Mental Health Review Journal, 21(1), 2016, pp.1-10.
- Publisher:
- Emerald
Purpose: The perspectives of frontline clinical staff working with individuals in later life within an inpatient mental health setting, of their role in recovery, have not yet been explored. The purpose of this paper is to understand what recovery means within an inpatient mental health setting for older adults. The authors address clear implications for clinical practice. Design/methodology/approach: Semi-structured interviews were conducted with 11 multidisciplinary participants across two specialist older adult recovery units at an independent hospital in the UK. Thematic analysis was applied to the transcripts. Findings: Three main themes were identified: participants identified their normative task as the promotion of 'moving on' (clinical recovery) and their existential task as personal recovery. The context in which recovery happens was highlighted as the third theme. These represented competing workplace goals of clinical and personal recovery. This highlights the need to give permission to personal recovery as the process that enables mental health recovery in older adults. Originality/value: Staff working in an inpatient mental health service for older adults discussed the meaning of recovery and their role in enabling recovery. This has implications for sustainable clinical practice in this setting. Recovery-orientated practice in this setting is required but the detail is not yet understood. (Publisher abstract)
Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disorders
- Authors:
- JONES Danielle, et al
- Journal article citation:
- Aging and Mental Health, 20(5), 2016, pp.500-509.
- Publisher:
- Taylor and Francis
Objectives: In the UK dementia is under-diagnosed, there is limited access to specialist memory clinics, and many of the patients referred to such clinics are ultimately found to have functional (non-progressive) memory disorders (FMD), rather than a neurodegenerative disorder. Government initiatives on ‘timely diagnosis’ aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve the screening and diagnostic process by analysing communication between clinicians and patients during initial specialist clinic visits. Establishing differential conversational profiles could help the timely differential diagnosis of memory complaints. Method: This study is based on video- and audio recordings of 25 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used to explore recurrent communicative practices associated with each diagnostic group. Results: Two discrete conversational profiles began to emerge, to help differentiate between patients with dementia and functional memory complaints, based on (1) whether the patient is able to answer questions about personal information; (2) whether they can display working memory in interaction; (3) whether they are able to respond to compound questions; (4) the time taken to respond to questions; and (5) the level of detail they offer when providing an account of their memory failure experiences. Conclusion: The distinctive conversational profiles observed in patients with functional memory complaints on the one hand and neurodegenerative memory conditions on the other suggest that conversational profiling can support the differential diagnosis of functional and neurodegenerative memory disorders. (Publisher abstract)
Let's all get home safely: a commentary on NICE and SCIE guidelines (NG27) transition between inpatient hospital settings and community or care home settings
- Authors:
- WINFIELD Anna, BURNS Eileen
- Journal article citation:
- Age and Ageing, 45(6), 2016, pp.757-760.
- Publisher:
- Oxford University Press
Safe and appropriate transition between inpatient settings and the community is one of the major challenges facing the modern NHS. The National Institute for Health and Care Excellence in conjunction with the Social Care Institute for Excellence published guidance on this challenging area in December 2015. This commentary provides context, summary and discussion of the key areas covered. The guidance particularly emphasises the importance of a person-centred approach in which patients are individuals and equal partners in the multidisciplinary team who should be treated with dignity and respect. Additionally, communication and information sharing is crucial both on admission and when taking a proactive approach to discharge, including the role of the discharge coordinator in liaising with community teams and arranging follow-up post-discharge. Self-care and the significance of carers are also highlighted as valuable in facilitating safe discharge and reducing readmissions. It is clear that in older people with complex needs, safe appropriate transition between hospital and community settings has a positive impact on patients and their carers. Given the financial and capacity pressures facing the NHS, strategies to reduce readmissions and prevent delays in discharge are increasingly important. These guidelines are therefore both timely and advocated to improve care for older people. (Publisher abstract)
COMMUNI-CARE: assessment tool for reactions and behaviours of patients with dementia in a multisensory stimulation environment
- Authors:
- LOPEZ Jose Javier Blanco, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 15(4), 2016, p.526–538.
- Publisher:
- Sage
Background: The ‘Snoezelen’ is an approach based on stimulation and sensory stimulation proposals, giving priority to the notion of caretaking. The aim of this paper is to present the creation and validation of the COMMUNI-CARE scale. This is a new tool that allows for an evaluation of the psycho-emotional well-being that the patient with dementia shows in a ‘Snoezelen’ multisensory stimulation environment. Methods: In total 429 evaluations in 143 multisensory stimulation interventions were made using the COMMUNI-CARE scale, in 16 patients between 53 and 85 years of age, diagnosed with moderate to severe dementia. The goal was to evaluate the psycho-emotional well-being the patients present. Results: The tool’s internal consistency showed a Crombach alpha of 0.90. The concurrent validity between the COMMUNI-CARE scale and the Clinical Global Impression (CGI) was of r = −0.961. The Kappa index used to determine the reliability between evaluators was of K = 0.87. Conclusions: The COMMUNI-CARE scale fulfills the basic principles of classic psychometrics of construct, and criterion validity and reliability. It does so while showing a clear idea, through its five subscales (anxiety, communication, pleasure, adaptation to the surroundings and affection), of the degree of well-being that the patient with dementia shows during such interventions. This scale embodies, through psychometrics, a very subjective human experience with a tool unavailable to date. (Edited publisher abstract)
Perceived value of support for older adults coping with multi-morbidity: patient, informal care-giver and family physician perspectives
- Authors:
- NAGANATHAN Gayathri, et al
- Journal article citation:
- Ageing and Society, 36(9), 2016, pp.1891-1914.
- Publisher:
- Cambridge University Press
This study investigated the perceived value of informal and formal supports for older adults with multi-morbidity from the perspectives of patients, care-givers and family physicians. Semi-structured interviews were conducted with 27 patients, their informal care-givers and their family physicians in an urban academic family health team in Ontario. Analysis was conducted using a General Inductive Approach to facilitate identification of main themes and build a framework of perceived value of supports. Participant views converged on supports that facilitate patient independence and ease care-giver burden. However, important differences in participant perceptions arose regarding these priorities. Physicians and care-givers valued supports that facilitate health and safety while patients prioritised supports that enable self-efficacy and independence. While formal supports which eased care-giver burden were viewed positively by all members of the triad, many patients also rejected formal supports, citing that informal support from their care-giver was available. Such conflicts between patient, care-giver and physician-perceived value of supports may have important implications for consumer and care-giver willingness to accept formal supports when supports are available. These findings contribute to the broader literature on community-based care by incorporating the perspectives of patients, informal care-givers and family physicians to understand better the barriers and facilitators of uptake of supportive services that contribute to successful ageing at home. (Publisher abstract)
Measuring the impact of Helping in Hospitals: final evaluation report
- Authors:
- BABUDU Peter, TREVITHICK Elliot, SPATH Rahel
- Publishers:
- NESTA, The Social Innovation Partnership
- Publication year:
- 2016
- Pagination:
- 56
- Place of publication:
- London
An evaluation of the Helping in Hospitals project to examine the effectiveness of hospital volunteering in improving patient experience and well-being. The project included a variety of hospital impact volunteering roles such as mealtime assistants or dementia buddies aimed at directly improving patient experience and well-being. Evaluation data were collected from nine hospitals, focusing on wards with a large proportion of older and frail patients, many with dementia. Outcomes measured included mood, anxiety, nutrition and hydration, reduced readmissions, length of stay, transfers of care and decreased number of falls. Not all of the sites collected all of the outcomes data. Key results from the nine hospital trusts’ evaluations found that volunteering shows promise as a way to improve patient experience, mood, anxiety levels, nutrition and hydration, while releasing nurse time to care. However, none of the hospitals found any effects on re-admissions, length of stay, delayed transfer of care and number of falls. (Edited publisher abstract)
"You don't know what you are saying ‘Yes’ and what you are saying ‘no’ to”: hospital experiences of older people from minority ethnic communities
- Authors:
- ELLINS Jo, GLASBY Jon
- Journal article citation:
- Ageing and Society, 36(1), 2016, pp.42-63.
- Publisher:
- Cambridge University Press
This paper reports findings from a larger study exploring older people's experiences of care transitions, focusing on the findings from one case study area which explored the hospital and discharge experiences of older people from minority ethnic communities. A participatory approach was adopted, with older people from the local area collaborating in the design, delivery and analysis of the research as ‘co-researchers’. Twenty-four in-depth narrative interviews were carried out with people who had experienced a recent hospital stay as a patient or a family member providing care and support. The findings show that many aspects of the hospital experience, including the desire for personalised and humanistic approaches to care, are important to older people irrespective of ethnic background. However, older people from minority ethnic communities can also face language and cultural barriers which negatively affect the quality and experience of care. People who had limited English proficiency struggled to understand, communicate and participate in their care. Where professional services were not available or requested, interpreting was provided informally by other patients, family members, hospital staff in clinical and domestic roles, or not at all. The paper concludes that targeted strategies are required to ensure appropriate and effective hospital services for a multicultural population. (Edited publisher abstract)